Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges.

PubMed

Eze, Kenneth C; Salami, Taofeek A; Kpolugbo, James U

2014-05-01

To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission.

Use of plain radiography in the diagnosis, surgical management, and postoperative treatment of obstructive urolithiasis in 25 goats and 2 sheep.

PubMed

Kinsley, Marc A; Semevolos, Stacy; Parker, Jill E; Duesterdieck-Zellmer, Katja; Huber, Michael

2013-08-01

To describe use of plain radiography for diagnosis, surgical management, and postoperative treatment of obstructive urolithiasis in small ruminants. Retrospective case series. Small ruminants (n = 27; 25 goats, 2 sheep). Medical records (January 2002-November 2011) and radiographs for all small ruminants diagnosed with obstructive urolithiasis and having plain abdominal radiographs were reviewed. Signalment, surgical procedures, radiographic findings, ultrasonographic findings, position of calculi, and how plain radiography influenced surgical management and postoperative treatment were recorded. Radiopaque urinary calculi were detected in 23 (85%) plain radiographic studies. Location of uroliths determined by plain radiography included: cystic only (n = 5), distal to the sigmoid flexure and cystic (5), subischial (5), distal to the sigmoid flexure only (3), sigmoid flexure (3), and subischial and cystic (2). In 8 of these animals, postoperative radiographs revealed residual calculi in the urethra and were essential for their targeted removal by urethrotomy in 7 animals. In regions where radiopaque calculi (calcium carbonate, calcium oxalate, silica) are commonly encountered in small ruminants, plain radiographs are recommended to determine the appropriate surgical approach(es) and to confirm resolution of the obstruction. © Copyright 2013 by The American College of Veterinary Surgeons.

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings.

PubMed

Muzzafar, Sofia; Swischuk, Leonard E; Jadhav, Siddharth P

2012-03-01

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias.

Plasma osmotic changes during major abdominal surgery.

PubMed

Malone, R A; McLeavey, C A; Arens, J F

1977-12-01

Fluid balance across the capillary membrane is maintained normally by a balance of hydrostatic and colloid osmotic pressures (COP). In 12 patients having major intra-abdominal procedures, the COP was followed during the operative and immediate postoperative periods. The patients' intraoperative fluid management consisted of replacing shed blood with blood and following Shires' concept of crystalloid replacement. Significant decreases in COP to approximately two thirds of the initial value occurred in patients having intra-abdominal procedures versus only a 10 percent decrease in those having peripheral procedures (greater than .001). As a result of this decrease in COP, the balance between hydrostatic and colloid osmotic pressures is lost and risk of pulmonary intersitial edema is increased.

Replacement of the Thoracoabdominal Aorta after Endovascular Abdominal Aneurysm Repair for Ruptured Infected Aneurysm: A Case Report

PubMed Central

Kondo, Nobuo; Tamura, Kentaro; Sakaguchi, Taichi; Chikazawa, Genta; Yoshitaka, Hidenori

2017-01-01

A 73-year-old man underwent emergency endovascular abdominal aneurysm repair (EVAR) for a ruptured infected abdominal aortic aneurysm. Two years after EVAR, he was admitted with a spiking fever and left lower back pain. Computed tomography scan revealed not only recurrent graft infection with psoas abscess but also infection around the orifice of the superior mesenteric artery. Because conservative medical therapy with antibiotics could not control the infection, we performed complete removal of the infected stent graft, debridement of psoas abscess, and in situ replacement of the thoracoabdominal aorta using rifampicin-soaked prosthetic grafts, followed by the omental flap. He was discharged with no complications. PMID:29034025

Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report.

PubMed

Takeuchi, Nobuhiro; Nomura, Yusuke

2014-01-09

Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization. An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria. We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.

Hashish Body Packing: A Case Report

PubMed Central

Soriano-Perez, Manuel Jesus; Serrano-Carrillo, Jose Luis; Marin-Montin, Inmaculada; Cruz-Caballero, Alfonso

2009-01-01

A 42-year-old African male was brought by the police to the emergency department under suspicion of drug smuggling by body-packing. Plain abdominal radiograph showed multiple foreign bodies within the gastrointestinal tract. Contrast-enhanced abdominal CT confirmed the findings, and the patient admitted to have swallowed “balls” of hashish. Body-packing is a recognized method of smuggling drugs across international borders. Body packers may present to the emergency department because of drug toxicity, intestinal obstruction, or more commonly, requested by law-enforcement officers for medical confirmation or exclusion of suspected body packing. PMID:19724651

Abdominal emergencies in pediatrics.

PubMed

Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

2016-05-01

Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Central body fat changes in men affected by post-surgical hypogonadotropic hypogonadism undergoing testosterone replacement therapy are modulated by androgen receptor CAG polymorphism.

PubMed

Tirabassi, G; delli Muti, N; Buldreghini, E; Lenzi, A; Balercia, G

2014-08-01

Little is known about the effect of androgen receptor (AR) gene CAG repeat polymorphism in conditioning body composition changes after testosterone replacement therapy (TRT). In this study, we aimed to clarify this aspect by focussing our attention on male post-surgical hypogonadotropic hypogonadism, a condition often associated with partial or total hypopituitarism. Fourteen men affected by post-surgical hypogonadotropic hypogonadism and undergoing several replacement hormone therapies were evaluated before and after TRT. Dual-energy X-ray absorptiometry (DEXA)-derived body composition measurements, pituitary-dependent hormones and AR gene CAG repeat polymorphism were considered. While testosterone and insulin-like growth factor-1 (IGF-1) levels increased after TRT, cortisol concentration decreased. No anthropometric or body composition parameters varied significantly, except for abdominal fat decrease. The number of CAG triplets was positively and significantly correlated with this abdominal fat decrease, while the opposite occurred between the latter and Δ-testosterone. No correlation of IGF-1 or cortisol variation (Δ-) with Δ-abdominal fat was found. At multiple linear regression, after correction for Δ-testosterone, the positive association between CAG triplet number and abdominal fat change was confirmed. In male post-surgical hypogonadotropic hypogonadism, shorter length of AR CAG repeat tract is independently associated with a more marked decrease of abdominal fat after TRT. Copyright © 2014 Elsevier B.V. All rights reserved.

Etidronate

MedlinePlus

... the skeleton) in people who have had total hip replacement surgery (surgery to replace the hip joint with an artificial joint) or in people ... 8 ounces [180 to 240 mL]) of plain water while you are sitting or standing. Sit or ...

[Endoprosthetic replacement with lifting of abdominal wall in treatment of umbilical and postoperative ventral hernias].

PubMed

Sukhovatykh, B S; Valuyskaya, N M; Gerasimchuk, E V

2015-01-01

The results of complex clinical and ultrasonic investigation of abdominal wall and following surgical treatment in 60 women with umbilical and postoperative large ventral hernias combined with abdomen ptosis were analyzed. Patients were divided into 2 groups with 30 people per group. Endoprosthetic replacement of abdominal wall defect using standard polypropylene prosthesis was applied in the 1st group, endoprosthetic replacement with musculoaponeurotic tissues lifting in hypogastric area using original super lightweight polypropylenepolyvinylidenefluoride prosthesis--in the 2nd group. Polypropylene endoprosthesisconsist of main flap 15×15 cm with roundish edges and additional flap 5×40 cm in the form of wide stripe placed at the lower edge of main flap transversely to its direction. It was revealed increased physical health component in 1.8 times, psychic--in 2.5 times in the 2nd group. Thus number of excellent results increased on 33.3% and amount of satisfactory outcomes reduced on 30%.

Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases.

PubMed

Smerud, M J; Johnson, C D; Stephens, D H

1990-01-01

We retrospectively reviewed abdominal CT and plain film findings in 23 proved cases of mesenteric infarction to compare the value of the two techniques. Criteria considered specific for infarction on CT were identified in nine (39%) of 23 patients and comprised pneumatosis in seven patients (30%), mesenteric or portal venous gas in three patients (13%), and focally thick-walled bowel in two patients (9%). Criteria considered specific for bowel infarction on plain films were identified in seven (30%) of 23 patients and comprised focally edematous bowel in six patients (26%) and pneumatosis intestinalis in one patient (4%). Only one patient had specific changes on both CT and plain films, but 15 (65%) of the 23 showed specific changes on at least one study. The results indicate that plain films remain an important tool in patients suspected of mesenteric infarction and can provide information that is complementary to CT. Also, as both studies were nonspecific in eight (35%) of our patients, negative or nonspecific findings should not deter further diagnostic or interventional procedures in patients in whom the clinical suspicion of bowel infarction is high.

Fetus-in-Fetu: An Unusual Cause for Abdominal Mass in Infancy

PubMed Central

Grosfeld, Jay L.; Stepita, Donald S.; Nance, Walter E.; Palmer, Catherine G.

1974-01-01

Fetus-in-fetu is an unusual cause of retroperitoneal abdominal mass in infants, which most likely arises from inclusion of a monozygotic, diamniotic twin. This entity is distinguished from teratoma by its embryological origin, its unusual location in the retroperitoneal space, its invariable benignity, and by the presence of vertebral organization with limb buds and well-developed organ systems. Diagnosis is made radiographically by the finding of a diminutive vertebral column on a plain abdominal film. The treatment of choice is total excision with special attention being given to the fetus' blood supply which may be directly from the host's superior mesenteric vessels. A well-documented example of this unusual entity that occurred in a six-week old infant male is presented. ImagesFig. 1.Fig. 2.Fig. 3. PMID:4471720

Compound double ileoileal and ileocecocolic intussusception caused by lipoma of the ileum in an adult patient: A case report

PubMed Central

2011-01-01

Introduction The initial diagnosis of intussusception in adults very often can be missed and cause delayed treatment and possible serious complications. We report the case of an adult patient with complicated double ileoileal and ileocecocolic intussusception. Case presentation A 46-year-old Caucasian man was transferred from the gastroenterology service to the abdominal surgery service with severe abdominal pain, nausea, and vomiting. An abdominal ultrasound, barium enema, and abdominal computed tomography scan revealed an intraluminal obstruction of his ascending colon. Plain abdominal X-rays showed diffuse air-fluid levels in his small intestine. A double ileoileal and ileocecocolic intussusception was found during an emergent laparotomy. A right hemicolectomy, including resection of a long segment of his ileum, was performed. The postoperative period was complicated by acute renal failure, shock liver, and pulmonary thromboembolism. Our patient was discharged from the hospital after 30 days. An anatomical pathology examination revealed a lipoma of his ileum. Conclusions Intussusception in adults requires early surgical resection regardless of the nature of the initial cause. Delayed treatment can cause very serious complications. PMID:21910876

Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

PubMed Central

Eze, Kenneth C.; Salami, Taofeek A.; Kpolugbo, James U.

2014-01-01

Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission. PMID:25013248

The Tolerability and Efficacy of Oral Isotonic Solution versus Plain Water in Dengue Patients: A Randomized Clinical Trial.

PubMed

Nainggolan, Leonard; Bardosono, Saptawati; Ibrahim Ilyas, Ermita I

2018-01-01

Plasma leakage plays an important role in dengue infection, and this condition can lead to hemoconcentration, hypovolemia, and shock. Fluid replacement is the main treatment for dengue. There is a lack of evidence to support certain oral fluid therapy as a treatment for dengue patients. The objective of this study is to evaluate tolerability and efficacy of oral isotonic solution (OIS) compared to plain water as a fluid replacement in dengue patients. A randomized, clinical trial with single-blinded groups was conducted to compare tolerability and efficacy of OIS and plain water in dengue patients. We evaluated gastrointestinal disturbances (nausea, vomiting, and bloating), body temperature, mean arterial pressure (MAP), fluid balance, hematocrit, Na + , and K + levels. Data were analyzed with SPSS 20.0, and figures were made with GraphPad Prism version 5.01. Twenty four subjects were included and divided equally into two groups. Our results showed that there are no significant differences but indicate several noteworthy trends. The intervention group (OIS) experienced less nausea, less vomiting, had positive fluid balance and higher MAP, and became afebrile faster compared to the control group (plain water). Although not statistically significant, this study shows the trend that OIS is well-tolerated and effective for dengue patients compared to plain water.

Modeling Responses of Dryland Spring Triticale, Proso Millet and Foxtail Millet to Initial Soil Water in the High Plains

USDA-ARS?s Scientific Manuscript database

Dryland farming strategies in the High Plains must make efficient use of limited and variable precipitation and stored water in the soil profile for stable and sustainable farm productivity. Current research efforts focus on replacing summer fallow in the region with more profitable and environmenta...

Giant T-shaped duplication of the transverse colon. A case report.

PubMed

Trotovsek, Blaz; Hribernik, Marija; Gvardijancic, Diana; Jelenc, Franc

2006-01-01

A case of long diverticular colonic duplication producing acute abdominal pain in a 6-year-old girl is presented. Physical examination showed no signs of acute abdomen at the initial presentation. After a pain-free interval, there was a sudden onset of severe abdominal pain and a large tumor in the lower abdomen was observed. A plain x-ray showed an enormously dilated colonic pouch filled with gas. Excision of the T-shaped duplication and small part of the transverse colon was successful. Because of extensive fibrotic changes in the colon near the opening of duplication, a resection margin of at least 2 cm is recommended.

Evolutionary Interactions Between Visual and Chemical Signals: Chemosignals Compensate for the Loss of a Visual Signal in Male Sceloporus Lizards.

PubMed

Pruett, Jake A; Zúñiga-Vega, J Jaime; Campos, Stephanie M; Soini, Helena A; Novotny, Milos V; Vital-García, Cuauhcihuatl; Martins, Emília P; Hews, Diana K

2016-11-01

Animals rely on multimodal signals to obtain information from conspecifics through alternative sensory systems, and the evolutionary loss of a signal in one modality may lead to compensation through increased use of signals in an alternative modality. We investigated associations between chemical signaling and evolutionary loss of abdominal color patches in males of four species (two plain-bellied and two colorful-bellied) of Sceloporus lizards. We conducted field trials to compare behavioral responses of male lizards to swabs with femoral gland (FG) secretions from conspecific males and control swabs (clean paper). We also analyzed the volatile organic compound (VOC) composition of male FG secretions by stir bar extraction and gas chromatography-mass spectrometry (GC-MS) to test the hypothesis that loss of the visual signal is associated with elaboration of the chemical signal. Males of plain-bellied, but not colorful-bellied species exhibited different rates of visual displays when exposed to swabs of conspecific FG secretions relative to control swabs. The VOC composition of male Sceloporus FG secretions was similar across all four species, and no clear association between relative abundances of VOCs and evolutionary loss of abdominal color patches was observed. The emerging pattern is that behavioral responses to conspecific chemical signals are species- and context-specific in male Sceloporus, and compensatory changes in receivers, but not signalers may be involved in mediating increased responsiveness to chemical signals in males of plain-bellied species.

Penetration of the duodenum by an ingested needle with migration to the pancreas: report of a case.

PubMed

Toyonaga, T; Shinohara, M; Miyatake, E; Ouchida, K; Shirota, T; Ogawa, T; Yoshida, J; Sumitomo, K; Matsuo, K; Akao, M

2001-01-01

A case of a penetration of the duodenum by a needle with migration to the pancreas in a 50-year-old man is reported herein. The patient was referred to us with a chief complaint of diarrhea. An abdominal plain roentgenogram showed a needle in the upper abdominal area. An abdominal computed tomography scan and contrast X-ray revealed the foreign body to be located outside of the duodenum and in the head of the pancreas. An emergency operation was therefore performed on the first day and the needle in the head of the pancreas was thus extirpated safely. A perforation of the gastrointestinal tract by an ingested foreign body is difficult to accurately and quickly diagnose when no peritonitis or abscess formation is observed. Therefore, the use of contrast X-ray is considered to be useful in the diagnosis of such a perforation.

Perforated peptic ulcer in an infant.

PubMed

Feng, C Y; Hsu, W M; Chen, Y

2001-02-01

We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with Helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management.

Plain-water intake and risk of type 2 diabetes in young and middle-aged women1234

PubMed Central

Pan, An; Malik, Vasanti S; Schulze, Matthias B; Manson, JoAnn E; Willett, Walter C

2012-01-01

Background: The replacement of caloric beverages such as sugar-sweetened beverages (SSBs) and fruit juices with noncaloric beverages such as plain water has been recommended for diabetes prevention. Objective: We evaluated the relation of plain-water intake and the substitution of plain water for SSBs and fruit juices with incident type 2 diabetes (T2D) in US women. Design: We prospectively followed 82,902 women in the Nurses’ Health Study II who were free of diabetes, cardiovascular disease, or cancer at baseline. Diet, including various beverages, was assessed by using validated food-frequency questionnaires and updated every 4 y. Incident T2D was confirmed by using a validated supplementary questionnaire. We used a 4-y lagged analysis to minimize reverse causation (ie, increased water consumption that was due to early stage of diabetes). Results: During 1,115,427 person-years of follow-up, we documented 2718 incident T2D cases. Plain-water intake was not associated with T2D risk in the multivariable-adjusted model that included age, BMI, diet, and lifestyle factors; RRs (95% CIs) across categories (<1, 1, 2–3, 4–5, and ≥6 cups/d) were 1.00, 0.93 (0.82, 1.05), 0.93 (0.83, 1.05), 1.09 (0.96, 1.24), and 1.06 (0.91, 1.23), respectively (P-trend = 0.15). We estimated that the replacement of 1 serving SSBs and fruit juices/d by 1 cup plain water/d was associated with 7% (3%, 11%) and 8% (2%, 13%) lower risk of T2D, respectively. Conclusions: Plain-water intake, per se, was not significantly associated with risk of T2D. However, substitution of plain water for SSBs or fruit juices was estimated to be associated with modestly lower risk of T2D. PMID:22552035

Relationships Between Bird Communities and Forest Age, Structure, Species Composition and Fragmentation in the West Gulf Coastal Plain

Treesearch

Richard N. Conner; James G. Dickson

1997-01-01

Bird communities of the West Gulf Coastal Plain are strongly influenced by the stage of forest succession, species composition of understory and overstory vegetation, and forest structure. Alteration of plant communities through forest management and natural disturbances typically does not eliminate birds as a fauna1 group from the area affected, but will replace some...

Method to identify wells that yield water that will be replaced by Colorado River water in Arizona, California, Nevada, and Utah

USGS Publications Warehouse

Wilson, Richard P.; Owen-Joyce, Sandra J.

1994-01-01

Accounting for the use of Colorado River water is required by the U.S. Supreme Court decree, 1964, Arizona v. California. Water pumped from wells on the flood plain and from certain wells on alluvial slopes outside the flood plain is presumed to be river water and is accounted for as Colorado River water. A method was developed to identify wells outside the f1ood plain of the lower Colorado River that yield water that will be replaced by water from the river. The method provides a uniform criterion of identification for all users pumping water from wells. Wells that have a static water-level elevation equal to or below the accounting surface are presumed to yield water that will be replaced by water from the river. Wells that have a static water-level elevation above the accounting surface are presumed to yield water that will be replaced by water from precipitation and inflow from tributary valleys. The method is based on the concept of a river aquifer and an accounting surface within the river aquifer. The river aquifer consists of permeable, partly saturated sediments and sedimentary rocks that are hydraulically connected to the Colorado River so that water can move between the river and the aquifer in response to withdrawal of water from the aquifer or differences in water-level elevations between the river and the aquifer. The accounting surface represents the elevation and slope of the unconfined static water table in the river aquifer outside the flood plain and reservoirs that would exist if the river were the only source of water to the river aquifer. Maps at a scale of 1:100,000 show the extent and elevation of the accounting surface from the area surrounding Lake Mead to Laguna Dam near Yuma, Arizona.

[Gas-containing gallstones: value of the "Mercedes-Benz" sign at CT examination].

PubMed

Delabrousse, E; Bartholomot, B; Narboux, Y; Barrali, E; Chirouze, C; Kastler, B

2000-11-01

Gas-containing gallstones are well-known in vitro. The typical triradiate arrangement of fissures filled with gas, first described on abdominal plain films, was named by Meyers the "Mercedes-Benz" sign. This sign is absent of the recent literature. We report a case where gas was the only CT sign suggesting the presence of gallstones in the gallbladder.

On-call x-rays made easy AN Au-Yong On-call x-rays made easy , Amy Au-Yong and Nigel Broderick Churchill Livingstone Elsevier £21.99 304pp 9780702034459 0702034452 [Formula: see text].

PubMed

2011-02-10

DesigneD for clinicians involved in the management of acutely ill patients, this book enables them to recognise quickly the appearance of life-threatening conditions. It also concentrates on the interpretation of plain chest and abdominal images.

Dual antiplatelet treatment in patients candidates for abdominal surgery.

PubMed

Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

2013-01-01

With the increasing diffusion of percutaneous interventions (PCI), surgeons are often faced with the problem of operating on patients under dual antiplatelet treatment. Replacing dual antiplatelet regiment with low molecular weight heparin may expose to the abrupt thrombosis of coronary stent and massive myocardial infarction. The purpose of this study was to test the hypothesis that abdominal operations can be safely performed under dual antiplatelet treatment. Eleven patients underwent 5 colectomies, 3 nefrectomies, 2 gastrectomies and 1 hysterectomy under aspirin and plavix without any significant perioperative hemorrhage. These preliminary results show that abdominal operations can be safely performed under dual antiplatelet regimen. Abdominal surgery, Dual antiplatelet treatment.

Integrating pasture-based livestock production with annual crop production on the Great Plains to reduce loss of grassland wildlife

USDA-ARS?s Scientific Manuscript database

Tallgrass prairie has been replaced by corn and soybeans and mixed-grass prairie is being replaced by various annual crops. Annual crop fields support vegetarian diets but not much wildlife. Alternatively, integrating pastured livestock farming with annual crops can provide wildlife habitat. For ...

Bilateral ureteric stones: an unusual cause of acute kidney injury.

PubMed

Sumner, Daniel; Rehnberg, Lucas; Kler, Aaron

2016-03-30

A 49-year-old man presented to the accident and emergency department, with a short history of vague abdominal pain, abdominal distension and two episodes of frank haematuria. A plain chest film showed dilated loops of large bowel and blood results on admission showed an acute kidney injury (stage 3). A diagnosis of bowel obstruction was made initially but a CT scan of the abdomen showed bilateral obstructing calculi. After initial resuscitation, the patient had bilateral ultrasound-guided nephrostomies and haemofiltration. He later underwent bilateral antegrade ureteric stenting. A decision will later be made on whether or not he is fit enough to undergo ureteroscopy and laser stone fragmentation. 2016 BMJ Publishing Group Ltd.

Coconut Water

MedlinePlus

... before exercise to prevent dehydration. Coconut water might work better than drinking plain water, but results are still preliminary. Exercise performance. Some athletes use coconut water to replace fluids ...

Effects of tornado damage, prescribed fire, and salvage logging on natural oak (Quercus spp.) regeneration in a xeric southern USA Coastal Plain oak/pine forest

Treesearch

Jeffery B. Cannon; J. Stephen Brewer

2013-01-01

Due in large part to fire exclusion, many oak-dominated (Quercus spp.) forests, woodlands, and savannas throughout eastern North America are being replaced by less diverse forest ecosystems. In the interior coastal plain of the southern United States, these forests are dominated in the mid- and understory by mesophytic species such as Acer...

Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy

PubMed Central

Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud

2014-01-01

A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered. PMID:25143313

Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy.

PubMed

Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud

2014-08-20

A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered. 2014 BMJ Publishing Group Ltd.

Chronic calcific pancreatitis presenting with stunting and diabetes mellitus.

PubMed

Amadife, M U; Muogbo, D C

2008-09-01

We report the case ofa 16 year old boy who presented with 8 months history of weight loss, 3 months history of polydypsia, polyuria and polyphagia. The child had poor growth since age of 5 years, during which time he developed recurrent abdominal pain for 4 years. A diagnosis of chronic calcific pancreatitis complicated by stunting and diabetes mellitus was made on the basis of weight/height ratio less than 5th NCHS percentile for his age, fasting blood sugar of 233mg/dl, and presence of calcifications over the pancreatic area on a plain abdominal X-ray. This case is reported due to the rarity of this condition in children. It is also the first to be seen in our hospital. It will serve to alert the Paediatrician to such clinical condition in children with chronic abdominal pain. In this case, symptoms of diabetes mellitus were the reasons for seeking medical attention and it also shows how chronic pancreatits led to insulin dependent diabetes mellitus.

Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring.

PubMed

Hemmink, Gerrit J M; Weusten, Bas L A M; Bredenoord, Albert J; Timmer, Robin; Smout, André J P M

2009-10-01

Patients with aerophagia suffer from the presence of an excessive volume of intestinal gas, which is thought to result from excessive air ingestion. However, this has not been shown thus far. The aim of this study was therefore to assess swallowing and air swallowing frequencies in patients with suspected aerophagia. Ambulatory 24-hour pH-impedance monitoring was performed in patients in whom excessive amounts of intestinal gas were visualized on plain abdominal radiograms. All patients had symptoms of bloating, abdominal distention, flatulence, or excessive belching. Reflux parameters and the number of swallows and air swallows were assessed. The most common symptoms were bloating, abdominal distention, and constipation. Only 3 patients reported excessive belching and 1 patient reported flatulence as their predominant symptom. During the 24-hour measurement, patients showed high incidences of air swallows (521 +/- 63) and gastric belches (126 +/- 37). Patients had normal swallowing frequency (741 +/- 71). This study presents objective parameters that confirm the existence of excessive air swallowing or aerophagia using esophageal impedance monitoring.

Volvulus of the ascending colon in a non-rotated midgut: Plain film and MDCT findings.

PubMed

Camera, Luigi; Calabrese, Milena; Mainenti, Pier Paolo; Masone, Stefania; Vecchio, Walter Del; Persico, Giovanni; Salvatore, Marco

2012-10-28

Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile, intra-peritoneal, colonic segments. Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments. We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain. Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac. The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography (CT). CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon. At surgery, a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed. However, a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and overlooked in the pre-operative CT. Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.

Rupture of an Abdominal Aortic Aneurysm in a Young Man with Marfan Syndrome.

PubMed

Pedersen, Maria Weinkouff; Huynh, Khiem Dinh; Baandrup, Ulrik Thorngren; Nielsen, Dorte Guldbrand; Andersen, Niels Holmark

2018-04-01

Abdominal aortic aneurysms (AAAs) are very rare in Marfan syndrome. We present a case with a young nonsmoking and normotensive male with Marfan syndrome, who developed an infrarenal AAA that presented with rupture to the retroperitoneal cavity causing life-threatening bleeding shock. The patient had acute aortic surgery and survived. Five months before this incident, the patient had uneventful elective aortic root replacement (ad modum David) due to an enlarged aortic root. At that time, his abdominal aorta was assessed with a routine ultrasound scan that showed a normal-sized abdominal aorta. This documents that the aneurysm had evolved very rapidly despite young age and absence of risk factors. Copyright © 2018 Elsevier Inc. All rights reserved.

Pediatric colonic volvulus: A single-institution experience and review.

PubMed

Tannouri, Sami; Hendi, Aditi; Gilje, Elizabeth; Grissom, Leslie; Katz, Douglas

2017-06-01

Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis. This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015). In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases. Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition. Prognosis Study: Level IV. Study of a Diagnostic Test: Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationships between metabolic profile, hypertension and uric acid with cardiometabolic risk in adolescents with abdominal obesity: impact of geodemographic factors on the prevalence of abdominal obesity.

PubMed

Bouhenni, Hamida; Daoudi, Hadjer; Djemai, Haidar; Noirez, Philippe; Rouabah, Abdelkader; Vitiello, Damien; Rouabah, Leila

2017-11-23

Background Association of hyperuricemia, dyslipidemia and high blood pressure (BP) among adolescents with high waist-to-height ratio (WHtR) remains not fully addressed and could represent a new way to diagnose adolescents early with cardiometabolic risk. Objective We aimed to determine abdominal obesity (AO) prevalence and investigate relations between AO, uric acid (UA), lipid profiles, BP and geographical patterns in adolescents. Subjects 577 and 204 Algerian students aged between 10 and 19 years were included in our epidemiological and biochemical studies, respectively. Methods Height, weight, waist circumference (Wc) and hip circumferences, body mass index (BMI) and BP were measured. Fasting blood sampling was performed to measure glycemia, lipid profile, uricemia, insulinemia and leptinemia. The WHtR ≥0.50 was applied for the diagnosis of AO and geodemographics was evaluated. Results The prevalence of AO was 12.13% among all students, 19.17% and 16.39% among students living in urban and plain areas, respectively. The risk of AO may be reduced in rural and mountainous areas. Lipid parameters, UA, insulin and leptin serum concentrations were significantly increased in adolescents with WHtR ≥0.50 compared to those with WHtR <0.50. Cardiometabolic risk was increased with WHtR ≥0.50 and BMI >26. Means of BMI, Wc, BP, and lipid parameters were significantly increased in the fourth quartiles compared to the first quartile of UA. Conclusion Urban areas and plains represent factors contributing to AO and WHtR ≥0.50 may be used as a cut-off point to define risks of high BP, lipid abnormalities and UA serum level in Algerian adolescents.

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report

PubMed Central

2013-01-01

Introduction Peptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the diagnosis of a perforated ulcer is straightforward in typical cases, its clinical onset may be subtle because of comorbidities and/or concurrent therapies. Case presentation We report the case of a 53-year-old Caucasian man with a history of chronic myeloid leukemia on maintenance therapy (100mg/day) with imatinib who was found to have a subphrenic abscess resulting from a perforated duodenal ulcer that had been clinically overlooked. Our patient was febrile (38.5°C) with abdominal tenderness and hypoactive bowel sounds. On the abdominal plain X-ray films, a right subphrenic abscess could be seen. On contrast-enhanced multi-detector computed tomography, a huge air-fluid collection extending from the subphrenic to the subhepatic anterior space was observed. After oral administration of 500cm3 of 3 percent diluted diatrizoate meglumine, an extraluminal leakage of the water-soluble iodinated contrast media could then be appreciated as a result of a perforated duodenal ulcer. During surgery, the abscess was drained and extensive adhesiolysis had to be performed to expose the duodenal bulb where the ulcer was first identified by methylene blue administration and then sutured. Conclusions While subphrenic abscesses are well known complications of perforated gastric or duodenal ulcers, they have nowadays become rare thanks to advances in both diagnostic and therapeutic strategies for peptic ulcer disease. However, when peptic ulcer disease is not clinically suspected, the contribution of imaging may be substantial. PMID:24215711

Failure criterion of glass fabric reinforced plastic laminates

NASA Technical Reports Server (NTRS)

Haga, O.; Hayashi, N.; Kasuya, K.

1986-01-01

Failure criteria are derived for several modes of failure (in unaxial tensile or compressive loading, or biaxial combined tensile-compressive loading) in the case of closely woven plain fabric, coarsely-woven plain fabric, or roving glass cloth reinforcements. The shear strength in the interaction formula is replaced by an equation dealing with tensile or compressive strength in the direction making a 45 degree angle with one of the anisotropic axes, for the uniaxial failure criteria. The interaction formula is useful as the failure criterion in combined tension-compression biaxial failure for the case of closely woven plain fabric laminates, but poor agreement is obtained in the case of coarsely woven fabric laminates.

Foetus in foetu: CT findings in two cases.

PubMed

Chadha, M; Aggarwal, B K

2002-01-01

Foetus in foetu is a rare abdominal mass presenting in early childhood, which shows classic radiologic appearances that make a preoperative diagnosis certain. We present two such cases in which the diagnosis was initially established on computed tomography, which showed mature skeletal structures including vertebrae and long bones in addition to fat. The diagnosis was corroborated by plain radiography and magnetic resonance imaging in one case and confirmed operatively and histopathologically in both cases.

Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?

PubMed

Hajalioghli, Parisa; Nemati, Masoud; Dinparast Saleh, Leila; Fouladi, Daniel F

2016-07-01

The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.

[Rational therapy of patients with essential hypertension and abdominal obesity with concomitant subclinical hypothyroidism].

PubMed

Pligovka, V M

2014-11-01

It was determined the characteristics of lipid status of patients with essential hypertension, abdominal obesity with concomitant subclinical hypothyroidism--mostly increased levels of total and LDL cholesterol. In assessing the effectiveness of statin therapy in combination with levothyroxine replacement therapy compared with statin monotherapy, combination therapy showed the best result in terms of achievement of target levels of both total cholesterol and LDL. The obtained results allow us to recommend the use of combination therapy for patients with hypertension, abdominal obesity with concomitant subclinical hypothyroidism in order to achieve the target values of LDL and thus to reduce the cardiovascular risk of these patients.

Gastrointestinal injuries from blunt abdominal trauma in children.

PubMed

Ameh, E A; Nmadu, P T

2004-04-01

To determine the pattern, presentation and outcome of gastrointestinal injuries from blunt abdominal trauma in children. A retrospective study. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Twenty one children managed for gastrointestinal injuries from blunt trauma from 1984-2002. The pattern, presentation, management and outcome of gastrointestinal injuries from blunt trauma. In the 19 year period, 1984-2002, 92 children were treated for blunt abdominal trauma, 21(23%) of who had injuries to the gastrointestinal tract. Three presenting after 24 hours had evidence of peritonitis. In six children with isolated gastrointestinal tract (GIT) injury who presented within two hours, abdominal signs were vague at initial evaluation but became marked over a few hours at repeated examination. In eight with associated intraabdominal injuries, abdominal signs were marked at initial examination and five presented with shock. Free peritoneal air was present on plain abdominal and chest radiograph in three of ten patients, dilated bowel loops in six and fluid levels in one. Diagnostic peritoneal lavage or paracentesis was positive in four patients with isolated GIT injuries and eight with associated intraabdominal injuries. There were 24 injuries in the 21 patients consisting of 15 perforations, five contusions, two seromuscular tears, and two gangrene from mesenteric injury. The small intestine was involved in 11 patients, colon six, stomach five, duodenum one and rectum one. Seven (35%) patients had associated extraabdominal injuries. Treatment consisted of simple closure of perforations, over sewing of contusions, resection and anastomosis for gangrene and repair with protective stoma for the rectal injury. One patient each developed prolonged ileus, urinary tract infection and chest infection, respectively postoperatively. Mortality was 28%, all of who had associated intraabdominal or extraabdominal injuries. Gastrointestinal injury from blunt abdominal trauma in children, though uncommon, carries a high mortality, usually from associated intraabdominal or extraabdominal injuries.

Outlet strut fracture and leaflet escape of Bjork-Shiley convexo-concave valve.

PubMed

Uchino, Gaku; Yoshida, Hideo; Sakoda, Naoya; Hattori, Shigeru; Kawabata, Takuya; Saiki, Munehiro; Fujita, Yasufumi; Yunoki, Keiji; Hisamochi, Kunikazu; Mine, Yoshinari

2017-06-01

Prosthetic valve fracture is a serious complication and may arise in patient post-valve replacement. We experienced an outlet strut fracture and leaflet escape of a Bjork-Shiley convexo-concave valve. We performed an emergency redo mitral valve replacement and successfully retrieved the fractured strut and escaped leaflet from superficial femoral artery and the abdominal aorta. The patient showed an uneventful postoperative recovery.

Dura covered with fibrin glue reduces adhesions in abdominal wall defects.

PubMed

Schier, F; Srour, N; Waldschmidt, J

1991-12-01

Dura can greatly facilitate the closure of abdominal wall defects. However, a main disadvantage of its use are the adhesions which develop between omentum, bowel and dura and may lead to bowel obstructions. In this study various groups of rats had either the anterior wall replaced by untreated dura or by dura covered with fibrin glue prior to implantation. Adhesions were found in 75% of sham operated rats, 100% after untreated dura implantation and 50% after the implantation of fibrin glue treated dura.

Plain Water and Sugar-Sweetened Beverage Consumption in Relation to Energy and Nutrient Intake at Full-Service Restaurants

PubMed Central

An, Ruopeng

2016-01-01

Background: Drinking plain water, such as tap or bottled water, provides hydration and satiety without adding calories. We examined plain water and sugar-sweetened beverage (SSB) consumption in relation to energy and nutrient intake at full-service restaurants. Methods: Data came from the 2005–2012 National Health and Nutrition Examination Survey, comprising a nationally-representative sample of 2900 adults who reported full-service restaurant consumption in 24-h dietary recalls. Linear regressions were performed to examine the differences in daily energy and nutrient intake at full-service restaurants by plain water and SSB consumption status, adjusting for individual characteristics and sampling design. Results: Over 18% of U.S. adults had full-service restaurant consumption on any given day. Among full-service restaurant consumers, 16.7% consumed SSBs, 2.6% consumed plain water but no SSBs, and the remaining 80.7% consumed neither beverage at the restaurant. Compared to onsite SSB consumption, plain water but no SSB consumption was associated with reduced daily total energy intake at full-service restaurants by 443.4 kcal, added sugar intake by 58.2 g, saturated fat intake by 4.4 g, and sodium intake by 616.8 mg, respectively. Conclusion: Replacing SSBs with plain water consumption could be an effective strategy to balance energy/nutrient intake and prevent overconsumption at full-service restaurant setting. PMID:27153083

Plain Water and Sugar-Sweetened Beverage Consumption in Relation to Energy and Nutrient Intake at Full-Service Restaurants.

PubMed

An, Ruopeng

2016-05-04

Drinking plain water, such as tap or bottled water, provides hydration and satiety without adding calories. We examined plain water and sugar-sweetened beverage (SSB) consumption in relation to energy and nutrient intake at full-service restaurants. Data came from the 2005-2012 National Health and Nutrition Examination Survey, comprising a nationally-representative sample of 2900 adults who reported full-service restaurant consumption in 24-h dietary recalls. Linear regressions were performed to examine the differences in daily energy and nutrient intake at full-service restaurants by plain water and SSB consumption status, adjusting for individual characteristics and sampling design. Over 18% of U.S. adults had full-service restaurant consumption on any given day. Among full-service restaurant consumers, 16.7% consumed SSBs, 2.6% consumed plain water but no SSBs, and the remaining 80.7% consumed neither beverage at the restaurant. Compared to onsite SSB consumption, plain water but no SSB consumption was associated with reduced daily total energy intake at full-service restaurants by 443.4 kcal, added sugar intake by 58.2 g, saturated fat intake by 4.4 g, and sodium intake by 616.8 mg, respectively. Replacing SSBs with plain water consumption could be an effective strategy to balance energy/nutrient intake and prevent overconsumption at full-service restaurant setting.

First long-term evidence supporting endovascular repair of abdominal aortic aneurysms.

PubMed

Indes, Jeffrey E; Muhs, Bart E; Dardik, Alan

2013-04-01

The traditional method of treating abdominal aortic aneurysms with open surgical repair has been steadily replaced by endovascular repair, thought to be a more minimally invasive approach. It is not known, however, whether the endovascular approach is truly less invasive for operative physiology; in addition, this approach has a different spectrum of complications. As such, it is uncertain whether elective endovascular repair of nonruptured aortic aneurysms reduces long-term morbidity and mortality compared with traditional open approaches. In this article, the authors evaluate a recent publication investigating long-term outcomes of a prospective randomized multicenter trial evaluating patients with asymptomatic abdominal aortic aneurysms treated with either endovascular or open repair, and discuss the results in the context of current evidence.

Excess fat in the abdomen but not general obesity is associated with poorer metabolic and cardiovascular health in premenopausal and postmenopausal Asian women.

PubMed

Goh, Victor Hng Hang; Hart, William George

2018-01-01

To examine the associations of various metabolites and hormones and hormone replacement therapy (HRT) with obesity. This is a cross-sectional study of 1326 Singaporean women. A DXA-derived percent body fat (PBF) of ≥35% and percent abdominal fat (PAbdF) of >21.8% were used, respectively, to define women with general (GOb) and abdominal (AbdOb) obesity. Higher levels of insulin and glucose, lower levels of HDL, higher levels of TC/HDL and HOMA values, and different levels of some hormones were noted only in the women with abdominal, and not general obesity. The incidence of general and abdominal obesity was higher in postmenopausal women with or without HRT, except that those who were on conjugated estradiol-only HRT had no increase in the incidence of general obesity compared with premenopausal women. Abdominal obesity is associated with insulin resistance and with higher risks of metabolic syndrome and cardiovascular diseases, whereas general obesity is not. Abdominal obesity may predispose to a higher risk of diabetes. The onset of the menopause tends to increase the incidence of general and abdominal obesity, except that postmenopausal women on conjugated estradiol HRT appear to be relatively protected from general obesity. Copyright © 2017 Elsevier B.V. All rights reserved.

Gastrointestinal manifestations of Fabry disease: clinical response to enzyme replacement therapy.

PubMed

Banikazemi, Maryam; Ullman, Thomas; Desnick, Robert J

2005-08-01

Gastrointestinal symptoms are often an early and prominent manifestation of Fabry disease, an X-linked inborn error of metabolism caused by the deficient activity of the lysosomal enzyme, alpha-galactosidase A. This enzyme deficiency results in the progressive accumulation of globotriaosylceramide and other glycosphingolipids in tissue lysosomes throughout the body. In classically affected patients, glycosphingolipid accumulation in the vascular endothelium eventually culminates in life-threatening renal, cardiac, and cerebrovascular disease. In addition, over 50% of patients experience post-prandial abdominal pain and diarrhea that interferes with the ability to work and quality of life. Here, we describe four males aged 17-40 years with classic Fabry disease and severe gastrointestinal symptoms who participated in clinical trials of enzyme replacement therapy with agalsidase beta (Fabrazyme, 1 mg/kg every 2 weeks). Before therapy, the three adult patients experienced post-prandial abdominal pain, bloating, and severe diarrhea with 7-10 bowel movements per day every day and the 17-year-old had weekly episodes of diarrhea with six bowel movements per day. Other symptoms included vomiting, food intolerance, and poor weight gain. All patients took medications for these symptoms (diphenoxylate-atropine [Lomotil], ranitidine hydrochloride [Zantac], or sulfasalazine). After 6-7 months of agalsidase beta therapy, all patients reported "no or only occasional" abdominal pain or diarrhea, had discontinued their gastrointestinal medications, and had gained 3-8 kg. These marked improvements in gastrointestinal symptoms have persisted for over 3 years of treatment. In such patients, enzyme replacement at 1 mg/kg effects an early and significant clinical improvement in the gastrointestinal manifestations of Fabry disease.

[Usefullness of transesophageal echocardiography in early detection of coronary spasm].

PubMed

Sagara, M; Haraguchi, M; Hamu, Y; Isowaki, S; Yoshimura, N

1996-04-01

Intraoperative transesophageal echocardiography (TEE) was performed on a 62-year-old man who underwent abdominal aortic replacement for abdominal aortic aneurysm under general anesthesia combined with epidural anesthesia. Coronary artery spasm occurred after unexpected massive hemorrhage, and TEE showed hypokinesis in the posterior-inferior left ventricular wall. The changes in TEE preceded the ST elevation in the ECG. Bolus infusion of isosorbide dinitrate and continuous infusion of nitroglycerin alleviated these changes. TEE enabled us to detect and evaluate coronary spasm before the appearance of ST changes in ECG.

Diagnostic examination of the child with urolithiasis or nephrocalcinosis.

PubMed

Hoppe, Bernd; Kemper, Markus J

2010-03-01

Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis.

Small bowel obstruction following perforation of the uterus at induced abortion.

PubMed

Nkor, S K; Igberase, G O; Osime, O C; Faleyimu, B L; Babalola, R

2009-01-01

Unsafe abortion is an important contributor to maternal morbidity and mortality. To present a case of small bowel obstruction following perforation of the uterus at induced abortion. A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12- week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma. Nigerian female population requires continuous health education on widespread and effective use of contraception. Physicians need training and retraining on abortion techniques and management of abortion complications.

Gorham disease of the lumbar spine with an abdominal aortic aneurysm: a case report.

PubMed

Kakuta, Yohei; Iizuka, Haku; Kobayashi, Ryoichi; Iizuka, Yoichi; Takahashi, Toru; Mohara, Jun; Takagishi, Kenji

2014-01-01

Reports of Gorham disease of the lumbar spine complicated by abdominal aortic aneurysms are rare. We herein report the case of a patient with Gorham disease of the lumber spine involving an abdominal aortic aneurysm (AAA). Case report. A 49-year-old man had a 1-month history of right leg pain and severe low back pain. Plain lumbar radiography revealed an osteolytic lesion in the L4 vertebral body. Computed tomography images demonstrated the presence of an extensive osteolytic lesion in the L4 vertebral body and an AAA in front of the L4 vertebral body. The patient underwent mass resection, spinal reconstruction, and blood vessel prosthesis implantation. During surgery, it was found that the wall of the aorta had completely disappeared and was shielded by the tumor mass; therefore, we speculated that the mass in the lumbar spine had directly invaded the aorta. The patient was able to walk without right leg or low back pain 1 year after undergoing surgery. No recurrence was demonstrated in the magnetic resonance images taken 1 year and 10 months after surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

PubMed Central

TORBA, M.; GJATA, A.; BUCI, S.; TROCI, A.; SUBASHI, K.

2013-01-01

Summary: Background Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully. PMID:23660164

Combining groundwater quality analysis and a numerical flow simulation for spatially establishing utilization strategies for groundwater and surface water in the Pingtung Plain

NASA Astrophysics Data System (ADS)

Jang, Cheng-Shin; Chen, Ching-Fang; Liang, Ching-Ping; Chen, Jui-Sheng

2016-02-01

Overexploitation of groundwater is a common problem in the Pingtung Plain area of Taiwan, resulting in substantial drawdown of groundwater levels as well as the occurrence of severe seawater intrusion and land subsidence. Measures need to be taken to preserve these valuable groundwater resources. This study seeks to spatially determine the most suitable locations for the use of surface water on this plain instead of extracting groundwater for drinking, irrigation, and aquaculture purposes based on information obtained by combining groundwater quality analysis and a numerical flow simulation assuming the planning of manmade lakes and reservoirs to the increase of water supply. The multivariate indicator kriging method is first used to estimate occurrence probabilities, and to rank townships as suitable or unsuitable for groundwater utilization according to water quality standards for drinking, irrigation, and aquaculture. A numerical model of groundwater flow (MODFLOW) is adopted to quantify the recovery of groundwater levels in townships after model calibration when groundwater for drinking and agricultural demands has been replaced by surface water. Finally, townships with poor groundwater quality and significant increases in groundwater levels in the Pingtung Plain are prioritized for the groundwater conservation planning based on the combined assessment of groundwater quality and quantity. The results of this study indicate that the integration of groundwater quality analysis and the numerical flow simulation is capable of establishing sound strategies for joint groundwater and surface water use. Six southeastern townships are found to be suitable locations for replacing groundwater with surface water from manmade lakes or reservoirs to meet drinking, irrigation, and aquaculture demands.

Remodeling of the abdominal epithelial monolayer during the larva-pupa-adult transformation of Manduca.

PubMed

Nardi, James B; Bee, Charles Mark; Wallace, Catherine Lee

2018-06-01

During metamorphosis of insect epithelial monolayers, cells die, divide, and rearrange. In Drosophila undifferentiated diploid cells destined to form the adult cuticle of each abdominal segment segregate early in development from the surrounding polyploid larval epithelial cells of that segment as eight groups of diploid histoblast cells. The larval polyploid cells are programmed to die and be replaced by divisions and rearrangements of histoblast cells. By contrast, abdominal epithelial cells of Manduca larvae form a monolayer of cells representing different ploidy levels with no definitive segregation of diploid cells destined to form adult structures. These epithelial cells of mixed ploidy levels produce a thick smooth larval cuticle with sparsely distributed sensory bristles. Adult descendants of this larval monolayer produce a thinner cuticle with densely packed scale cells. The transition between these differentiated states of Manduca involves divisions of cells, changes in ploidy levels, and sorting of certain polyploid cells into circular rosette patches to minimize contacts of these polyploid cells with surrounding cells of equal or smaller size. Cells within the rosettes and some surrounding cells are destined to die and be replaced by remaining epithelial cells of uniform size and ploidy at pupa-adult apolysis. Copyright © 2018 Elsevier Inc. All rights reserved.

Mechanical properties of concrete containing a high volume of tire-rubber particles.

PubMed

Khaloo, Ali R; Dehestani, M; Rahmatabadi, P

2008-12-01

Due to the increasingly serious environmental problems presented by waste tires, the feasibility of using elastic and flexible tire-rubber particles as aggregate in concrete is investigated in this study. Tire-rubber particles composed of tire chips, crumb rubber, and a combination of tire chips and crumb rubber, were used to replace mineral aggregates in concrete. These particles were used to replace 12.5%, 25%, 37.5%, and 50% of the total mineral aggregate's volume in concrete. Cylindrical shape concrete specimens 15 cm in diameter and 30 cm in height were fabricated and cured. The fresh rubberized concrete exhibited lower unit weight and acceptable workability compared to plain concrete. The results of a uniaxial compressive strain control test conducted on hardened concrete specimens indicate large reductions in the strength and tangential modulus of elasticity. A significant decrease in the brittle behavior of concrete with increasing rubber content is also demonstrated using nonlinearity indices. The maximum toughness index, indicating the post failure strength of concrete, occurs in concretes with 25% rubber content. Unlike plain concrete, the failure state in rubberized concrete occurs gently and uniformly, and does not cause any separation in the specimen. Crack width and its propagation velocity in rubberized concrete are lower than those of plain concrete. Ultrasonic analysis reveals large reductions in the ultrasonic modulus and high sound absorption for tire-rubber concrete.

Method to identify wells that yield water that will be replaced by water from the Colorado River downstream from Laguna Dam in Arizona and California

USGS Publications Warehouse

Owen-Joyce, Sandra J.; Wilson, Richard P.; Carpenter, Michael C.; Fink, James B.

2000-01-01

Accounting for the use of Colorado River water is required by the U.S. Supreme Court decree, 1964, Arizona v. California. Water pumped from wells on the flood plain and from certain wells on alluvial slopes outside the flood plain is presumed to be river water and is accounted for as Colorado River water. The accounting-surface method developed for the area upstream from Laguna Dam was modified for use downstream from Laguna Dam to identify wells outside the flood plain of the lower Colorado River that yield water that will be replaced by water from the river. Use of the same method provides a uniform criterion of identification for all users pumping water from wells by determining if the static water-level elevation in the well is above or below the elevation of the accounting surface. Wells that have a static water-level elevation equal to or below the accounting surface are presumed to yield water that will be replaced by water from the Colorado River. Wells that have a static water-level elevation above the accounting surface are presumed to yield river water stored above river level. The method is based on the concept of a river aquifer and an accounting surface within the river aquifer. The river aquifer consists of permeable sediments and sedimentary rocks that are hydraulically connected to the Colorado River so that water can move between the river and the aquifer in response to withdrawal of water from the aquifer or differences in water-level elevations between the river and the aquifer. The subsurface limit of the river aquifer is the nearly impermeable bedrock of the bottom and sides of the basins that underlie the Yuma area and adjacent valleys. The accounting surface represents the elevation and slope of the unconfined static water table in the river aquifer outside the flood plain of the Colorado River that would exist if the river were the only source of water to the river aquifer. The accounting surface was generated by using water-surface profiles of the Colorado River from Laguna Dam to about the downstream limit of perennial flow at Morelos Dam. The accounting surface extends outward from the edges of the flood plain to the subsurface boundary of the river aquifer. Maps at a scale of 1:100,000 show the extent of the river aquifer and elevation of the accounting surface downstream from Laguna Dam in Arizona and California.

An intrahepatic calculus superimposed over the right renal shadow: a case of mistaken identity.

PubMed

Learney, Robert M; Shrotri, Nitin

2010-08-01

A 36-year-old Caucasian British woman presented with a classic case of right renal colic. Initial plain abdominal radiography and intravenous urography identified an 8 x 5 mm calculus apparently lying within a right lower pole calyx. Following failed extracorporeal lithotripsy and flexible ureterorenoscopy, cross-sectional imaging revealed a misdiagnosis by superposition of an intrahepatic calculus over the right renal shadow. This case serves to support cross-sectional imaging in the diagnosis of renal calculi. Copyright 2010 Elsevier Inc. All rights reserved.

Amylose-potassium oleate inclusion complex in plain set-style yogurt

USDA-ARS?s Scientific Manuscript database

Amylose-potassium oleate inclusion complex (AIC) were used to replace skim milk solids in yogurt. The effect of AIC on yogurt fermentation and small amplitude oscillatory shear flow measurements of storage and loss moduli were studied and compared to full fat samples. Texture, storage modulus, and s...

Intensifying a semi-arid dryland crop rotation by replacing fallow with pea

USDA-ARS?s Scientific Manuscript database

Increasing dryland cropping system intensity in the semi-arid central Great Plains by reducing frequency of fallow can add diversity to cropping systems and decrease erosion potential. However elimination of the periodic fallow phase has been shown to reduce yields of subsequent crops in this region...

Preventing Mitochondrial Diseases: Embryo-Sparing Donor-Independent Options.

PubMed

Adashi, Eli Y; Cohen, I Glenn

2018-05-01

Mutant mitochondrial DNA gives rise to a broad range of incurable inborn maladies. Prevention may now be possible by replacing the mutation-carrying mitochondria of zygotes or oocytes at risk with donated unaffected counterparts. However, mitochondrial replacement therapy is being held back by theological, ethical, and safety concerns over the loss of human zygotes and the involvement of a donor. These concerns make it plain that the identification, validation, and regulatory adjudication of novel embryo-sparing donor-independent technologies remains a pressing imperative. This Opinion highlights three emerging embryo-sparing donor-independent options that stand to markedly allay theological, ethical, and safety concerns raised by mitochondrial replacement therapy. Copyright © 2018 Elsevier Ltd. All rights reserved.

A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient

PubMed Central

Alam, Fahreyar; Planner, Andy; Alexander, Roderick J.

2016-01-01

Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs. PMID:27830103

A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient.

PubMed

Seligman, William H; Alam, Fahreyar; Planner, Andy; Alexander, Roderick J

2016-01-01

Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs.

Assessing Landscape Change and Processes of Recurrence, Replacement, and Recovery in the Southeastern Coastal Plains, USA

NASA Astrophysics Data System (ADS)

Drummond, Mark A.; Stier, Michael P.; Auch, Roger F.; Taylor, Janis L.; Griffith, Glenn E.; Riegle, Jodi L.; Hester, David J.; Soulard, Christopher E.; McBeth, Jamie L.

2015-11-01

The processes of landscape change are complex, exhibiting spatial variability as well as linear, cyclical, and reversible characteristics. To better understand the various processes that cause transformation, a data aggregation, validation, and attribution approach was developed and applied to an analysis of the Southeastern Coastal Plains (SECP). The approach integrates information from available national land-use, natural disturbance, and land-cover data to efficiently assess spatially-specific changes and causes. Between 2001 and 2006, the processes of change affected 7.8 % of the SECP but varied across small-scale ecoregions. Processes were placed into a simple conceptual framework to explicitly identify the type and direction of change based on three general characteristics: replacement, recurrence, and recovery. Replacement processes, whereby a land use or cover is supplanted by a new land use, including urbanization and agricultural expansion, accounted for approximately 15 % of the extent of change. Recurrent processes that contribute to cyclical changes in land cover, including forest harvest/replanting and fire, accounted for 83 %. Most forest cover changes were recurrent, while the extents of recurrent silviculture and forest replacement processes such as urbanization far exceeded forest recovery processes. The total extent of landscape recovery, from prior land use to natural or semi-natural vegetation cover, accounted for less than 3 % of change. In a region of complex change, increases in transitory grassland and shrubland covers were caused by large-scale intensive plantation silviculture and small-scale activities including mining reclamation. Explicit identification of the process types and dynamics presented here may improve the understanding of land-cover change and landscape trajectory.

Assessing landscape change and processes of recurrence, replacement, and recovery in the Southeastern Coastal Plains, USA

USGS Publications Warehouse

Drummond, Mark A.; Stier, Michael P.; Auch, Roger F.; Taylor, Janis L.; Griffith, Glenn E.; Hester, David J.; Riegle, Jodi L.; Soulard, Christopher E.; McBeth, Jamie L.

2015-01-01

The processes of landscape change are complex, exhibiting spatial variability as well as linear, cyclical, and reversible characteristics. To better understand the various processes that cause transformation, a data aggregation, validation, and attribution approach was developed and applied to an analysis of the Southeastern Coastal Plains (SECP). The approach integrates information from available national land-use, natural disturbance, and land-cover data to efficiently assess spatially-specific changes and causes. Between 2001 and 2006, the processes of change affected 7.8 % of the SECP but varied across small-scale ecoregions. Processes were placed into a simple conceptual framework to explicitly identify the type and direction of change based on three general characteristics: replacement, recurrence, and recovery. Replacement processes, whereby a land use or cover is supplanted by a new land use, including urbanization and agricultural expansion, accounted for approximately 15 % of the extent of change. Recurrent processes that contribute to cyclical changes in land cover, including forest harvest/replanting and fire, accounted for 83 %. Most forest cover changes were recurrent, while the extents of recurrent silviculture and forest replacement processes such as urbanization far exceeded forest recovery processes. The total extent of landscape recovery, from prior land use to natural or semi-natural vegetation cover, accounted for less than 3 % of change. In a region of complex change, increases in transitory grassland and shrubland covers were caused by large-scale intensive plantation silviculture and small-scale activities including mining reclamation. Explicit identification of the process types and dynamics presented here may improve the understanding of land-cover change and landscape trajectory.

Assessing Landscape Change and Processes of Recurrence, Replacement, and Recovery in the Southeastern Coastal Plains, USA.

PubMed

Drummond, Mark A; Stier, Michael P; Auch, Roger F; Taylor, Janis L; Griffith, Glenn E; Riegle, Jodi L; Hester, David J; Soulard, Christopher E; McBeth, Jamie L

2015-11-01

The processes of landscape change are complex, exhibiting spatial variability as well as linear, cyclical, and reversible characteristics. To better understand the various processes that cause transformation, a data aggregation, validation, and attribution approach was developed and applied to an analysis of the Southeastern Coastal Plains (SECP). The approach integrates information from available national land-use, natural disturbance, and land-cover data to efficiently assess spatially-specific changes and causes. Between 2001 and 2006, the processes of change affected 7.8% of the SECP but varied across small-scale ecoregions. Processes were placed into a simple conceptual framework to explicitly identify the type and direction of change based on three general characteristics: replacement, recurrence, and recovery. Replacement processes, whereby a land use or cover is supplanted by a new land use, including urbanization and agricultural expansion, accounted for approximately 15% of the extent of change. Recurrent processes that contribute to cyclical changes in land cover, including forest harvest/replanting and fire, accounted for 83%. Most forest cover changes were recurrent, while the extents of recurrent silviculture and forest replacement processes such as urbanization far exceeded forest recovery processes. The total extent of landscape recovery, from prior land use to natural or semi-natural vegetation cover, accounted for less than 3% of change. In a region of complex change, increases in transitory grassland and shrubland covers were caused by large-scale intensive plantation silviculture and small-scale activities including mining reclamation. Explicit identification of the process types and dynamics presented here may improve the understanding of land-cover change and landscape trajectory.

Replacing fallow with forage triticale in dryland crop rotations increases profitability

USDA-ARS?s Scientific Manuscript database

A common dryland rotational cropping system in the semi-arid central Great Plains of the U.S. is wheat (Triticum aestivum L.)-corn (Zea mays L.)-fallow (WCF). However, the 12-month fallow period following corn production has been shown to be relatively inefficient in storing precipitation during the...

The Case of the Noble Savage: The Myth That Governance Can Replace Leadership

ERIC Educational Resources Information Center

Warner, Linda Sue; Grint, Keith

2012-01-01

The presumption of American's noble savage provides the foundation for the creation of one of the world's most recognizable stereotypes--the American Indian. The stereotype, lodged in the minds of most Americans as the Plains Indian warrior, contributed to decades of misunderstanding about leadership in traditional American Indian societies and…

Analysis of surface damage in retrieved carbon fiber-reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements.

PubMed

Wright, T M; Rimnac, C M; Faris, P M; Bansal, M

1988-10-01

The performance of carbon fiber-reinforced ultra-high molecular weight polyethylene was compared with that of plain (non-reinforced) polyethylene on the basis of the damage that was observed on the articulating surfaces of retrieved tibial components of total knee prostheses. Established microscopy techniques for subjectively grading the presence and extent of surface damage and the histological structure of the surrounding tissues were used to evaluate twenty-six carbon fiber-reinforced and twenty plain polyethylene components that had been retrieved after an average of twenty-one months of implantation. All of the tibial components were from the same design of total knee replacement. The two groups of patients from whom the components were retrieved did not differ with regard to weight, the length of time that the component had been implanted, the radiographic position and angular alignment of the component, the original diagnosis, or the reason for removal of the component. The amounts and types of damage that were observed did not differ for the two materials. For both materials, the amount of damage was directly related to the length of time that the component had been implanted. The histological appearance of tissues from the area around the component did not differ for the two materials, except for the presence of fragments of carbon fiber in many of the samples from the areas around carbon fiber-reinforced components.

[Chronic appendicitis due to multiple fecaliths. A case report].

PubMed

Montiel-Jarquín, Álvaro José; Ramírez-Sánchez, Celso; García-Cano, Eugenio; González-Hernández, Nicolás; Rodríguez-Pérez, Fabiola; Alvarado-Ortega, Ivan

2017-12-01

The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported. Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis. The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Generalised and abdominal adiposity are important risk factors for chronic disease in older people: results from a nationally representative survey.

PubMed

Hirani, V

2011-06-01

To look at the trends in prevalence of generalised (body mass index (BMI) ≥ 25 kg/m2) and abdominal obesity (waist circumference (WC) >102 cm, men; > 88 cm, women) among older people from 1993 to 2008, prevalence of chronic disease by overweight/obesity and WC categories in England 2005 and evaluate the association of these measures with chronic diseases. Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). Non-institutionalised men and women aged ≥ 65 years (in HSE 2005, 1512 men and 1747 women). Height, weight, waist circumference, blood pressure measurements were taken according to standardised HSE protocols. Information collected on socio-demographic, health behaviour and doctor diagnosed health conditions. Generalised obesity and abdominal obesity increased among men and women from 1993 to 2008. In 2005, the HSE 2005 focussed on older people. 72% of men and 68% of women aged over 65 were either overweight or obese. Prevalence of raised WC was higher in women (58%) than in men (46%). The prevalence of diabetes and arthritis was higher in people with generalised obesity in both sexes. Men were more likely to have had a joint replacement and had a higher prevalence of stroke if they were overweight only but women were more likely to have had a joint replacement only if they were obese (13%) and had a higher risk of falls with generalised obesity. The pattern was similar for the prevalence of chronic diseases by raised WC. Multivariate analysis showed that generalised and abdominal obesity was independently associated with risk of hypertension, diabetes and arthritis in both men and women. In women only, there was an association between generalised obesity and having a fall in the last year (OR: 1.5), and between abdominal obesity and having a joint replacement (OR: 1.9, p=0.01). Complications of obesity such as diabetes, hypertension and arthritis, are more common in men and women aged over 65 who are overweight or obese, as well as in those with a raised WC. These conditions impact on morbidity, mortality and have cost implications for the health service and are known to improve with weight loss even in old age. Treatment strategies to address these conditions such as weight management and prevention of overweight and obesity are important even in older people. There is a need to ensure that older people are given appropriate advice about keeping physically active and eating sensibly.

Denver, Colorado

NASA Image and Video Library

1994-09-30

STS068-248-092 (30 September-11 October 1994) --- The location of Denver, Colorado - on the western edge of the High Plains, at the junction of the South Platte River and Clear Creek east of the Rocky Mountains - is graphically displayed. Mount Evans and its surroundings are already covered by snow on October 8, 1994. Clear Creek was one of the first areas in the Rockies where gold was discovered by American prospectors in the 19th century, which led to the settlement of Denver. The growth of 20th century Denver, dominantly to the west and south, is apparent. Stapleton Field, close to downtown Denver, is being replaced by the new regional airport well out on the plains.

Spiculated Bladder Calculi: The Culprit for Repeated Catheter Failure

PubMed Central

Wek, C.; Fox, T. P.; Muir, G. H.

2013-01-01

We report on the case of a frustrated 90-year-old gentleman who was seen in the Accident and Emergency department for the third time in four days with failure of his long-term urethral catheter. He reported that the catheter simply “fell out” with the balloon deflated. On each occasion previously, the catheter had been reinserted in A&E and the patient discharged home. These repeated visits to A&E were understandably a source of much frustration for the patient and his family. On the third presentation, plain abdominal radiography demonstrated a large spiculated bladder calculus. PMID:23984173

A review of crust and upper mantle structure studies of the Snake River Plain-Yellowstone volcanic system: A major lithospheric anomaly in the western U.S.A.

USGS Publications Warehouse

Iyer, H.M.

1984-01-01

The Snake River Plain-Yellowstone volcanic system is one of the largest, basaltic, volcanic field in the world. Here, there is clear evidence for northeasterly progression of rhyolitic volcanism with its present position in Yellowstone. Many theories have been advanced for the origin of the Snake River Plain-Yellowstone system. Yellowstone and Eastern Snake River Plain have been studied intensively using various geophysical techniques. Some sparse geophysical data are available for the Western Snake River Plain as well. Teleseismic data show the presence of a large anomalous body with low P- and S-wave velocities in the crust and upper mantle under the Yellowstone caldera. A similar body in which compressional wave velocity is lower than in the surrounding rock is present under the Eastern Snake River Plain. No data on upper mantle anomalies are available for the Western Snake River Plain. Detailed seismic refraction data for the Eastern Snake River Plain show strong lateral heterogeneities and suggest thinning of the granitic crust from below by mafic intrusion. Available data for the Western Snake River Plain also show similar thinning of the upper crust and its replacement by mafic material. The seismic refraction results in Yellowstone show no evidence of the low-velocity anomalies in the lower crust suggested by teleseismic P-delay data and interpreted as due to extensive partial melting. However, the seismic refraction models indicate lower-than-normal velocities and strong lateral inhomogeneities in the upper crust. Particularly obvious in the refraction data are two regions of very low seismic velocities near the Mallard Eake and Sour Creek resurgent domes in the Yellowstone caldera. The low-velocity body near the Sour Creek resurgent dome is intepreted as partially molten rock. Together with other geophysical and thermal data, the seismic results indicate that a sub-lithospheric thermal anomaly is responsible for the time-progressive volcanism along the Eastern Snake River Plain. However, the exact mechanism responsible for the volcanism and details of magma storage and migration are not yet fully understood. ?? 1984.

75 FR 69583 - Technical Corrections to Customs and Border Protection Regulations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

... amends Sec. 10.121(b) to remove the word ``shall'' in the first, second and last sentences and to replace it with the word ``will'' in order to conform this regulation with the plain English mandate. Lastly, the word ``immediately'' is deleted from the last sentence because the use of this term conflicts with...

Groundwater declines are linked to changes in Great Plains stream fish assemblages

USGS Publications Warehouse

Prekins, Joshuah S.; Gido, Keith B.; Falke, Jeffrey A.; Fausch, Kurt D.; Crockett, Harry; Johnson, Eric R.; Sanderson, John

2017-01-01

Groundwater pumping for agriculture is a major driver causing declines of global freshwater ecosystems, yet the ecological consequences for stream fish assemblages are rarely quantified. We combined retrospective (1950–2010) and prospective (2011–2060) modeling approaches within a multiscale framework to predict change in Great Plains stream fish assemblages associated with groundwater pumping from the United States High Plains Aquifer. We modeled the relationship between the length of stream receiving water from the High Plains Aquifer and the occurrence of fishes characteristic of small and large streams in the western Great Plains at a regional scale and for six subwatersheds nested within the region. Water development at the regional scale was associated with construction of 154 barriers that fragment stream habitats, increased depth to groundwater and loss of 558 km of stream, and transformation of fish assemblage structure from dominance by large-stream to small-stream fishes. Scaling down to subwatersheds revealed consistent transformations in fish assemblage structure among western subwatersheds with increasing depths to groundwater. Although transformations occurred in the absence of barriers, barriers along mainstem rivers isolate depauperate western fish assemblages from relatively intact eastern fish assemblages. Projections to 2060 indicate loss of an additional 286 km of stream across the region, as well as continued replacement of large-stream fishes by small-stream fishes where groundwater pumping has increased depth to groundwater. Our work illustrates the shrinking of streams and homogenization of Great Plains stream fish assemblages related to groundwater pumping, and we predict similar transformations worldwide where local and regional aquifer depletions occur.

Groundwater declines are linked to changes in Great Plains stream fish assemblages.

PubMed

Perkin, Joshuah S; Gido, Keith B; Falke, Jeffrey A; Fausch, Kurt D; Crockett, Harry; Johnson, Eric R; Sanderson, John

2017-07-11

Groundwater pumping for agriculture is a major driver causing declines of global freshwater ecosystems, yet the ecological consequences for stream fish assemblages are rarely quantified. We combined retrospective (1950-2010) and prospective (2011-2060) modeling approaches within a multiscale framework to predict change in Great Plains stream fish assemblages associated with groundwater pumping from the United States High Plains Aquifer. We modeled the relationship between the length of stream receiving water from the High Plains Aquifer and the occurrence of fishes characteristic of small and large streams in the western Great Plains at a regional scale and for six subwatersheds nested within the region. Water development at the regional scale was associated with construction of 154 barriers that fragment stream habitats, increased depth to groundwater and loss of 558 km of stream, and transformation of fish assemblage structure from dominance by large-stream to small-stream fishes. Scaling down to subwatersheds revealed consistent transformations in fish assemblage structure among western subwatersheds with increasing depths to groundwater. Although transformations occurred in the absence of barriers, barriers along mainstem rivers isolate depauperate western fish assemblages from relatively intact eastern fish assemblages. Projections to 2060 indicate loss of an additional 286 km of stream across the region, as well as continued replacement of large-stream fishes by small-stream fishes where groundwater pumping has increased depth to groundwater. Our work illustrates the shrinking of streams and homogenization of Great Plains stream fish assemblages related to groundwater pumping, and we predict similar transformations worldwide where local and regional aquifer depletions occur.

Groundwater declines are linked to changes in Great Plains stream fish assemblages

PubMed Central

Perkin, Joshuah S.; Gido, Keith B.; Falke, Jeffrey A.; Fausch, Kurt D.; Crockett, Harry; Johnson, Eric R.; Sanderson, John

2017-01-01

Groundwater pumping for agriculture is a major driver causing declines of global freshwater ecosystems, yet the ecological consequences for stream fish assemblages are rarely quantified. We combined retrospective (1950–2010) and prospective (2011–2060) modeling approaches within a multiscale framework to predict change in Great Plains stream fish assemblages associated with groundwater pumping from the United States High Plains Aquifer. We modeled the relationship between the length of stream receiving water from the High Plains Aquifer and the occurrence of fishes characteristic of small and large streams in the western Great Plains at a regional scale and for six subwatersheds nested within the region. Water development at the regional scale was associated with construction of 154 barriers that fragment stream habitats, increased depth to groundwater and loss of 558 km of stream, and transformation of fish assemblage structure from dominance by large-stream to small-stream fishes. Scaling down to subwatersheds revealed consistent transformations in fish assemblage structure among western subwatersheds with increasing depths to groundwater. Although transformations occurred in the absence of barriers, barriers along mainstem rivers isolate depauperate western fish assemblages from relatively intact eastern fish assemblages. Projections to 2060 indicate loss of an additional 286 km of stream across the region, as well as continued replacement of large-stream fishes by small-stream fishes where groundwater pumping has increased depth to groundwater. Our work illustrates the shrinking of streams and homogenization of Great Plains stream fish assemblages related to groundwater pumping, and we predict similar transformations worldwide where local and regional aquifer depletions occur. PMID:28652354

Spatial variability analysis of combining the water quality and groundwater flow model to plan groundwater and surface water management in the Pingtung plain

NASA Astrophysics Data System (ADS)

Chen, Ching-Fang; Chen, Jui-Sheng; Jang, Cheng-Shin

2014-05-01

As a result of rapid economic growth in the Pingtung Plain, the use of groundwater resources has changed dramatically. The groundwater is quite rich in the Pingtung plain and the most important water sources. During the several decades, a substantial amount of groundwater has been pumped for the drinking, irrigation and aquaculture water supplies. However, because the sustainable use concept of groundwater resources is lack, excessive pumping of groundwater causes the occurrence of serious land subsidence and sea water intrusion. Thus, the management and conservation of groundwater resources in the Pingtung plain are considerably critical. This study aims to assess the conjunct use effect of groundwater and surface water in the Pingtung plain on recharge by reducing the amount of groundwater extraction. The groundwater quality variability and groundwater flow models are combined to spatially analyze potential zones of groundwater used for multi-purpose in the Pingtung Plain. First, multivariate indicator kriging (MVIK) is used to analyze spatial variability of groundwater quality based on drinking, aquaculture and irrigation water quality standards, and probabilistically delineate suitable zones in the study area. Then, the groundwater flow model, Processing MODFLOW (PMWIN), is adopted to simulate groundwater flow. The groundwater flow model must be conducted by the calibration and verification processes, and the regional groundwater recovery is discussed when specified water rights are replaced by surface water in the Pingtung plain. Finally, the most suitable zones of reducing groundwater use are determined for multi-purpose according to combining groundwater quality and quantity. The study results can establish a sound and low-impact management plan of groundwater resources utilization for the multi-purpose groundwater use, and prevent decreasing ground water tables, and the occurrence of land subsidence and sea water intrusion in the Pingtung plain.

Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature.

PubMed

He, Jin Peng; Feng, Jie Xiong

2017-10-01

The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. The patient had an uneventful recovery. It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

Duodenum Exclusion Alone Is Sufficient to Improve Glucose Metabolism in STZ-Induced Diabetes Rats.

PubMed

Wu, Weihang; Lin, Li; Lin, Zhixiong; Yang, Weijin; Cai, Zhicong; Hong, Jie; Qiu, Jiandong; Lin, Chen; Lin, Nan; Wang, Yu

2018-05-22

Several studies have found that metabolic surgery can significantly improve glucose homeostasis; however, the intrinsic mechanisms remain unclear. Accumulating evidence suggests that duodenal bypass plays a crucial role in the treatment of type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the effect of duodenal reflux on glucose metabolism in T2DM. A high-fat diet and low-dose streptozotocin (STZ) administration were used to induce T2DM in male rats, which were assigned to three experimental groups: sham operation (SO; n = 10), new duodenal-jejunal bypass (NDJB; n = 10), and new duodenal-jejunal bypass with a tube (NDJBT; n = 10). Weight, food intake, oral glucose tolerance test (OGTT) results, glucagon-like peptide 1 (GLP-1) levels, and histopathology were assessed before or after surgery. Plain abdominal radiography was performed 1 week after the operation. Plain abdominal radiography indicated the occurrence of contrast agent reflux into the duodenum. The body weight and food intake in all three groups did not significantly differ before and after surgery. The NDJB and particularly the NDJBT groups exhibited better glucose tolerance, lower fasting blood glucose (FBG) levels, lower area under the curves for OGTT (AUC OGTT ) values, and higher GLP-1 levels, as compared with the sham group postoperatively. The villus height and crypt depth were both shorter in the biliopancreatic limb after NDJBT, as compared with those after SO and NDJB. Thus, exclusion of the duodenum alone and tube placement can effectively prevent duodenal reflux and improve glucose homeostasis, which further suggests that the duodenum plays an important role in T2DM.

Walking on thin ice! Identifying methamphetamine "drug mules" on digital plain radiography.

PubMed

Abdul Rashid, S N; Mohamad Saini, S B; Abdul Hamid, S; Muhammad, S J; Mahmud, R; Thali, M J; Flach, P M

2014-04-01

The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in "drug mules" by plain abdominal digital radiography (DR). The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all "drug mules" and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces. There were 16 true-positive "drug mules" identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n = 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n = 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%. The interrater agreement within Group 1 was 0.72 and within Group 2 averaged to 0.79, indicating a fair to very good agreement. DR is a valuable screening tool in cases of MA body packers with huge internal payloads being associated with a high diagnostic insecurity. Diagnostic insecurity on plain films may be overcome by low-dose CT as a cross-sectional imaging modality and addressed by improved radiological education in reporting drug carriers on imaging. Diagnostic signs (double-condom and halo signs) on digital plain radiography are specific in MA "drug mules", although DR is associated with high diagnostic insecurity and underreports the total internal payload.

Abdominal obesity in older women: potential role for disrupted fatty acid reesterification in insulin resistance.

PubMed

Yeckel, Catherine W; Dziura, James; DiPietro, Loretta

2008-04-01

Excess abdominal adiposity is a primary factor for insulin resistance in older age. Our objectives were to examine the role of abdominal obesity on adipose tissue, hepatic, and peripheral insulin resistance in aging, and to examine impaired free fatty acid metabolism as a mechanism in these relations. This was a cross-sectional study. The study was performed at a General Clinical Research Center. Healthy, inactive older (>60 yr) women (n = 25) who were not on hormone replacement therapy or glucose-lowering medication were included in the study. Women with abdominal circumference values above the median (>97.5 cm) were considered abdominally obese. Whole-body peripheral glucose utilization, adipose tissue lipolysis, and hepatic glucose production were measured using in vivo techniques according to a priori hypotheses. In the simple analysis, glucose utilization at the 40 mU insulin dose (6.3 +/- 2.8 vs. 9.1 +/- 3.4; P < 0.05), the index of the insulin resistance of basal hepatic glucose production (23.6 +/- 13.0 vs. 15.1 +/- 6.0; P < 0.05), and insulin-stimulated suppression of lipolysis (35 vs. 54%; P < 0.05) were significantly different between women with and without abdominal obesity, respectively. Using the glycerol appearance rate to free fatty acid ratio as an index of fatty acid reesterification revealed markedly blunted reesterification in the women with abdominal adiposity under all conditions: basal (0.95 +/- 0.29 vs. 1.35 +/- 0.47; P < 0.02); low- (2.58 +/- 2.76 vs. 6.95 +/- 5.56; P < 0.02); and high-dose (4.46 +/- 3.70 vs. 12.22 +/- 7.13; P < 0.01) hyperinsulinemia. Importantly, fatty acid reesterification was significantly (P < 0.01) associated with abdominal circumference and hepatic and peripheral insulin resistance, regardless of total body fat. These findings support the premise of dysregulated fatty acid reesterification with abdominal obesity as a pathophysiological link to perturbed glucose metabolism across multiple tissues in aging.

The history of widespread decrease in oak dominance exemplified in a grassland--forest landscape

Treesearch

Brice B. Hanberry; Daniel C. Dey; Hong S. He

2014-01-01

Regionally-distinctive open oak forest ecosystems have been replaced either by intensive agriculture and grazing fields or by denser forests throughout eastern North America and Europe. To quantify changes in tree communities and density in the Missouri Plains, a grassland-forest landscape, we used historical surveys from1815 to 1864 and current surveys from 2004 to...

Fire regimes for pine-grassland communities in the southeastern United States

Treesearch

Thomas A. Waldrop; David L. White; Steven M. Jones

1992-01-01

Abstract - Four combinations of season and frequency of burning were applied in Coastal Plain loblolly pine stands over a 43-year period. Overstory species composition and growth were unaffected by treatment. Above-ground portions of small hardwoods Qess than 12.5 cm d.b.h.1 were hilled and replaced by numerous sprouts under periodic summer, periodic winter, and annual...

Evidence-based management of neonatal vomiting in the emergency department.

PubMed

Ratnayake, Kristin; Kim, Tommy Y

2014-11-01

Vomiting accounts for up to 36% of neonatal visits to the emergency department. The causes of vomiting can range from benign to life-threatening. Evidence to guide the diagnosis and management of neonatal vomiting in the emergency department is limited. History and physical examination are extremely important in these cases, especially in identifying red flags such as bilious or projectile emesis. A thorough review is presented, discussing various imaging modalities, including plain abdominal radiography, upper gastrointestinal studies, ultrasonography, and contrast enema. A systematic approach in the emergency department, as outlined in this review, is required to identify the serious causes of vomiting in the neonate.

[Bladder stones in children in Gabon. Three case reports].

PubMed

Koko, J; M'Ba-Meyo, J; Reymond-Yeni, A; Llano-White, C; Gahouma, D

1996-01-01

Bladder stones are uncommon in children in Gabon. The authors report the case of 3 boys admitted to the Paediatric Hospital of Owendo for voiding disorders. All patients came from the South of the country, but these stones cannot be described as endemic in view of the small number of cases. The authors recall the main aetiologies, the suggestive symptoms and the simple and inexpensive complementary investigations (plain abdominal x-ray and ultrasonography) allowing the definitive diagnosis. Conventional surgical treatment gives good results, but in the case of small stones, endourological treatment can be more economical in terms of the duration of hospital stay and postoperative morbidity.

Morcellation of undiagnosed uterine sarcoma: A critical review.

PubMed

Bogani, Giorgio; Chiappa, Valentina; Ditto, Antonino; Martinelli, Fabio; Donfrancesco, Cristina; Indini, Alice; Lorusso, Domenica; Raspagliesi, Francesco

2016-02-01

In the recent decades, laparoscopy has replaced open abdominal procedures in the setting of gynecologic surgery. Extraction of large specimens (e.g., large uteri or myomas) following operative laparoscopy is technically challenging. Technological attempts allow the removal of large and solid pelvic masses via small abdominal incisions (using instruments called morcellators), thus reducing unnecessary laparotomies and improving short-term patients' outcomes. However, morcellation of undiagnosed uterine malignancies may lead to worse survival outcomes. Therefore, the Food and Drug Administration (FDA) warns about the use of power morcellators, thus causing ongoing concerns on the applicability of minimally invasive approaches for myomectomy and the removal of large uteri. In the present review, we sought to assess pro and cons regarding minimally invasive morcellation. This review will discuss the effects of morcellation of undiagnosed uterine malignancies, focusing on possible techniques for preoperative detection of uterine sarcoma and for avoiding intra-abdominal dissemination of potentially malignant tissues. Further efforts are necessary in order to identify tools to make a more accurate and reliable preoperative diagnosis of uterine masses. However, on the light of the current evidence, intra-abdominal morcellation should be banned from clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Sizes of abdominal organs in adults with severe short stature due to severe, untreated, congenital GH deficiency caused by a homozygous mutation in the GHRH receptor gene

PubMed Central

Oliveira, Carla R. P.; Salvatori, Roberto; Nóbrega, Luciana M. A.; Carvalho, Erick O. M.; Menezes, Menilson; Farias, Catarine T.; Britto, Allan V. O.; Pereira, Rossana M. C.; Aguiar-Oliveira, Manuel H.

2008-01-01

Summary Objective To assess the sizes of intra-abdominal organs of adult subjects with untreated severe congenital isolated GH deficiency (IGHD) due to lack of functional GHRH receptor (GHRH-R), and to verify whether there is proportionality between size of organ and adult stature and body surface area (BSA). Subjects and methods By using ultrasound, we studied the sizes (absolute and corrected by height, weight and BSA) of the intra-abdominal organs of 18 adult subjects with IGHD (eight females, IGHD group) who have never received GH replacement therapy. They were all homozygous for the same null mutation (IVS1 + 1G → A) in the GHRH receptor gene (GHRH-R). They were compared with normal controls from the same region. Results After correction for BSA, subjects lacking a functional GHRH-R have normal prostate and ovaries size, small spleen and uterus, and large liver, pancreas and kidney. Conclusions Size of individual abdominal organs is influenced in different ways by severe and congenital lack of GH due to a GHRH-R mutation. PMID:18034778

Potential impacts on Colorado Rocky Mountain weather due to land use changes on the adjacent Great Plains

USGS Publications Warehouse

Chase, T.N.; Pielke, R.A.; Kittel, T.G.F.; Baron, Jill S.; Stohlgren, T.J.

1999-01-01

Evidence from both meteorological stations and vegetational successional studies suggests that summer temperatures are decreasing in the mountain-plain system in northeast Colorado, particularly since the early 1980s. These trends are coincident with large changes in regional land cover. Trends in global, Northern Hemisphere and continental surface temperatures over the same period are insignificant. These observations suggest that changes in the climate of this mountain-plain system may be, in some part, a result of localized forcing mechanisms. In this study the effects of land use change on the northern Colorado plains, where large regions of grasslands have been transformed into both dry and irrigated agricultural lands, on regional weather is examined in an effort to understand this local deviation from larger-scale trends. We find with high-resolution numerical simulations of a 3-day summer period using a regional atmospheric-land surface model that replacing grasslands with irrigated and dry farmland can have impacts on regional weather and therefore climate which are not limited to regions of direct forcing. Higher elevations remote from regions of land use change are affected as well. Specifically, cases with altered landcover had cooler, moister boundary layers, and diminished low-level upslope winds over portions of the plains. At higher elevations, temperatures also were lower as was low-level convergence. Precipitation and cloud cover were substantially affected in mountain regions. We advance the hypothesis that observed land use changes may have already had a role in explaining part of the observed climate record in the northern Colorado mountain-plain system. Copyright 1999 by the American Geophysical Union.

Clinical and prognostic role of ammonia in advanced decompensated heart failure. The cardio-abdominal syndrome?

PubMed

Frea, Simone; Bovolo, Virginia; Pidello, Stefano; Canavosio, Federico G; Botta, Michela; Bergerone, Serena; Gaita, Fiorenzo

2015-09-15

Advanced heart failure is associated with end-organ damage. Recent literature suggested an intriguing crosstalk between failing heart, abdomen and kidneys. Venous ammonia, as a by-product of the gut, could be a marker of abdominal injury in heart failure patients. The aim of the study was to investigate the clinical and prognostic role of ammonia in patients with advanced decompensated heart failure (ADHF). 90 patients admitted with ADHF were prospectively studied. The prognostic role of ammonia at admission was evaluated. Primary end-points were: a composite of cardiac death, urgent heart transplantation and mechanical circulatory support at 3 months and need for renal replacement therapies (RRT). In the study cohort (age 59.0 ± 12.0 years, FE 21.6 ± 9.0%, INTERMACS profile 3.7 ± 0.9, creatinine 1.71 ± 0.95 mg/dl) 27 patients (30%) underwent the cardiac composite endpoint, while 9 patients (10%) needed RRT. At ROC curve analysis ammonia ≥ 130 μg/dl (abdominal damage) showed the best diagnostic accuracy. At multivariate analysis abdominal damage predicted the cardiac composite endpoint. Abdominal damage further increased risk among patient with cold profile at admission (HR 2.7, 95% CI 1.1-7.0, p = 0.046). At multivariate analysis abdominal damage also predicted need for RRT (OR 10.8, 95% CI 1.5-75.8, p = 0.017). The combined use of estimated right atrial pressure and ammonia showed the highest diagnostic accuracy and a very high specificity in prediction of need for RRT. In a selected population admitted for ADHF ammonia, as a marker of abdominal derangement, predicted adverse cardiac events and need for RRT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Chance fracture missed by convencional CT: Presentation of a clinical course].

PubMed

Pérez Suárez, Esther; Carceller, Fernando; García Salido, Alberto; Serrano, Ana; Casado, Juan

2011-02-01

Bending-disruption fractures of the vertebral body are called Chance fracture. In some cases these fractures may not be noticeable with a CT scan. A 9 years-old boy suffered a frontal collision while traveling in the back seat of a car. The child was secured by the safetybelt, without a child car seat or elevator adapted to his height. He had abdominal skin lesions in the physical exploration compatible with a belt mark. Conventional thoraco- abdominal CT scan did not show any vertebral fracture. As the clinical suspicion persisted, lateral plain radiography of the lumbar column was performed showing a Chance fracture in L2, confirmed by MRI. Chance fracture is typically seen in children under 12 years less than 135 cm height and with injuries associated with the belt after a traffic accident. This type of fractures may go unnoticed in a conventional CT scan so clinical suspicion must lead us to further work-up. The MRI is the gold standard for the diagnosis. This case remarks the importance of the use of homologated elevated seat devices in older children.

Excessive belching and aerophagia: two different disorders.

PubMed

Bredenoord, Albert J

2010-05-01

Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders.

Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency

PubMed Central

He, Jin Peng; Feng, Jie Xiong

2017-01-01

Abstract Rationale: The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. Patient concerns: An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. Diagnoses: He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. Interventions: Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. Outcomes: The patient had an uneventful recovery. Lessons: It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment. PMID:29019885

Variation in readmission expenditures after high-risk surgery

PubMed Central

Jacobs, Bruce L.; He, Chang; Li, Benjamin Y.; Helfand, Alex; Krishnan, Naveen; Borza, Tudor; Ghaferi, Amir A.; Hollenbeck, Brent K.; Helm, Jonathan E.; Lavieri, Mariel S.; Skolarus, Ted A.

2017-01-01

Background The Hospital Readmissions Reduction Program reduces payments to hospitals with excess readmissions for three common medical conditions and recently extended its readmission program to surgical patients. We sought to investigate readmission intensity as measured by readmission cost for high-risk surgeries and examine predictors of higher readmission costs. Materials and Methods We used the Healthcare Cost and Utilization Project's State Inpatient Database to perform a retrospective cohort study of patients undergoing major chest (aortic valve replacement, coronary artery bypass grafting, lung resection) and major abdominal (abdominal aortic aneurysm repair [open approach], cystectomy, esophagectomy, pancreatectomy) surgery in 2009 and 2010. We fit a multivariable logistic regression model with generalized estimation equations to examine patient and index admission factors associated with readmission costs. Results The 30-day readmission rate was 16% for major chest and 22% for major abdominal surgery (p<0.001). Discharge to a skilled nursing facility was associated with higher readmission costs for both chest (OR 1.99; 95% CI 1.60-2.48) and abdominal surgeries (OR 1.86; 95% CI 1.24-2.78). Comorbidities, length of stay, and receipt of blood or imaging was associated with higher readmission costs for chest surgery patients. Readmission >3 weeks after discharge was associated with lower costs among abdominal surgery patients. Conclusions Readmissions after high-risk surgery are common, affecting about one in six patients. Predictors of higher readmission costs differ among major chest and abdominal surgeries. Better identifying patients susceptible to higher readmission costs may inform future interventions to either reduce the intensity of these readmissions or eliminate them altogether. PMID:28601334

Angiosperm n-alkane distribution patterns and the geologic record of C4 grassland evolution

NASA Astrophysics Data System (ADS)

Henderson, A.; Graham, H. V.; Patzkowsky, M.; Fox, D. L.; Freeman, K. H.

2012-12-01

n-Alkane average chain-length (ACL) patterns vary regionally with community composition and climate. To clarify the influence of phylogenetic and community patterns, we compiled and analyzed a global database of published n-alkane abundance for n-C27 to C35 homologs in modern plant specimens (n=205). ACL for waxes in C4 non-woody plants are longer than for woody plants, suggesting ACL can serve as an indicator of the three-dimensional structure of local vegetation. Further, these findings suggest compound-specific isotopic data for longer alkane homologs (C31, C33, C35) will proportionately represent non-woody vegetation and isotope measurements of C29 are more representative of woody vegetation. Thus, the combination of ACL and carbon isotope compositions should allow us to disentangle C3 woody, C3 non-woody, and C4 non-woody signals in terrestrial paleorecords. Application of this approach to the geologic record of Miocene C4 grassland expansion in the US Great Plains and the Siwaliks in Pakistan illustrate two very different transition scenarios. Alkane-specific isotopic data indicate C4 grasslands appeared 2.5 Ma in the Great Plains and 6.5 Ma in the Siwaliks, and ACL analysis indicates that this transition involved the replacement of woody vegetation in the US and the replacement of C3 grasses in Pakistan. Our analysis illustrates that, consistent with differences in the timing of C4 grassland, the drivers of change were likely not the same in these regions. Oxygen isotope records suggest that the more recent transition in the Great Plains was associated with climate cooling and possibly changes in disturbance regimes and that the transition in the Siwaliks was likely associated with warming and drying.

Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature

PubMed Central

Rashid-Farokhi, Farin; Afshar, Hale

2017-01-01

Patient: Female, 32 Final Diagnosis: Sirolimus induced congestion of kidney and overlying abdominal wall Symptoms: Abdominal pain • abdominal swelling • dyspnea Medication: — Clinical Procedure: Improvement of symptoms with drug withdrawal Specialty: Nephrology Objective: Adverse events of drug therapy Background: Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. Case Report: A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. Conclusions: A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system. PMID:29269724

Survey of IUD replacing status in Sichuan, PR China.

PubMed

Xiaoqin, Chen; Li, Xie; Xiaoping, Pan; Chuanrong, Zhang; Shiyuan, Luo

2003-05-01

To investigate the status of copper-bearing intrauterine device (IUD) replacing inert IUD in Sichuan Province, cluster random sampling method was adopted for the survey. Questionnaires were completed and IUD were inspected through ultrasound among 12,804 subjects of 15 counties, who were inserted an IUD from 1994 to 1998. The insertion rate of copper-bearing IUD was 42.1%, in a gradually increasing trend; it was lower in mountain areas than in plain and hilly areas and increased after induced abortion and previous IUD failure. Some factors, such as lower pregnancy rate, lower expulsion rate and easy removal, etc., contributed to copper-bearing IUD use. On the other hand, other factors like longer contraception period, lower side effects and lower cost contributed to inert IUD use. The results show that the adoption of copper-bearing IUD is increasing, but those factors influencing copper-bearing IUD replacement should not be neglected.

Tuberculosis of hip: A current concept review

PubMed Central

Saraf, Shyam Kumar; Tuli, Surendra Mohan

2015-01-01

Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases. PMID:25593352

Tuberculosis of hip: A current concept review.

PubMed

Saraf, Shyam Kumar; Tuli, Surendra Mohan

2015-01-01

Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases.

Imaging of drug smuggling by body packing.

PubMed

Sica, Giacomo; Guida, Franco; Bocchini, Giorgio; Iaselli, Francesco; Iadevito, Isabella; Scaglione, Mariano

2015-02-01

Body packing, pushing, and stuffing are hazardous practices with complex medicolegal and social implications. A radiologist plays both a social and a medicolegal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location so as to prevent any package remains in the body packer. Radiologists must also be able to recognize the complications associated with these risky practices. Imaging assessment of body packing is performed essentially through plain abdominal X-ray and computed tomography scans. Ultrasound and magnetic resonance imaging, although with some advantages, actually have a limited use. Copyright © 2014 Elsevier Inc. All rights reserved.

[Panhypopituitarism in one identical twin: the effect of hormone replacement].

PubMed

Del Canho, Harrij; van Alfen-van der Velden, Janiëlle; del Canho, Riwka; Otten, Barto

2011-01-01

Panhypopituitarism in childhood is rare. It is even rarer if the disorder appears in a boy with an identical but healthy twin brother. In such a patient it is useful to study the consequences of the hormone disorder and the effect of hormone replacement. A 6-year-old boy saw a paediatrician because of short stature. He was much shorter than his identical twin brother and he had more abdominal fat mass and a smaller penis. Laboratory tests identified hypothyroidism of central origin, in combination with hypocortisolism and growth hormone deficiency. Hormonal replacement resulted in an improvement in growth rate. At the age of 15 years, testosterone therapy was introduced because puberty had not occurred and his growth rate was low. Finally the patient grew a few centimetres taller than his twin brother. In the first year of life, panhypopituitarism has no negative consequences for growth. After this point, growth is clearly delayed. With sufficient replacement growth can completely catch up.

[Case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by transversus abdominis plane block, rectus sheath block, and continuous wound infusion with ropivacaine].

PubMed

Hotta, Arisa; Yagi, Yuuki; Hakata, Saaya; Tsumura, Yae; Shimizu, Motoko; Kukida, Ayako; Nakamoto, Ai; Yoshikawa, Noriko; Oohira, Naoko; Tatekawa, Shigeki

2013-12-01

Ultrasound-guided peripheral nerve blocks in the abdominal wall, such as transversus abdominis plane block (TAP block) and rectus sheath block, are now widely used. We report a case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by abdominal wall block and continuous infusion. A 61-year-old man diagnosed with Leriche's syndrome underwent Y-graft replacement for an abdominal aortic aneurysm. Preoperative enhanced and 3-dimensional CTs showed many collateral arterial systems, especially in the right abdominal wall. It was suggested that the right internal iliac artery had been completely occluded, and the left one showed severe stenosis. After the induction of general anesthesia, we recognized collateral arteries through an ultrasound view as on preoperative CTs. We lowered the pulse repetition frequency more than usual in order not to injure them. We injected 0.1875% ropivacaine 60 ml as TAP block, and 20 ml as rectus sheath block. When the wound was closed, a catheter was passed through an 18-gauge Tuohy needle placed above the fascia along the supraumbilical site. After the operation, 0.2% ropivacaine was continuously delivered at a rate of 6 ml hr-1 through the catheter. We could provide the patient with effective analgesia after surgery.

An abdominal active can defibrillator may facilitate a successful generator change when a lead failure is present.

PubMed

Solomon, A J; Moubarak, J B; Drood, J M; Tracy, C M; Karasik, P E

1999-10-01

Defibrillator generator changes are frequently performed on patients with an implantable cardioverter defibrillator in an abdominal pocket. These patients usually have epicardial patches or older endocardial lead systems. At the time of a defibrillator generator change defibrillation may be unsuccessful as a result of lead failure. We tested the hypothesis that an active can defibrillator implanted in the abdominal pocket could replace a non-functioning endocardial lead or epicardial patch. An abdominal defibrillator generator change was performed in 10 patients, (mean age = 67 +/- 13 years, nine men). Initially, a defibrillation threshold (DFT) was obtained using a passive defibrillator and the chronic endocardial or epicardial lead system. DFTs were then performed using an active can emulator and one chronic lead to simulate endocardial or epicardial lead failure. We tested 30 lead configurations (nine endocardial and 21 epicardial). Although a DFT of 7.3 +/- 4.2 joules was obtained with the intact chronic lead system, the active can emulator and one endocardial or epicardial lead still yielded an acceptable DFT of 19.9 +/- 6.1 joules. In addition, a successful implant (DFT < or = 24 joules) could have been accomplished in 28 of 30 (93%) lead configurations. An active can defibrillator in an abdominal pocket may allow for a successful generator change in patients with defibrillator lead malfunction. This would be simpler than abandoning the abdominal implant and moving to a new pectoral device and lead or tunnelling a new endocardial electrode. However, loss of defibrillation capability with a particular complex lead may be a warning of impending loss of other functions (eg. sensing and/or pacing).

[Bouveret's syndrome: A rare presentation of gallstone ileus].

PubMed

Franco-Avilés, Luis; Arce-Guridi, Héctor Tonalli; Mercado, Ulises

2016-01-01

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a gallstone which passes into the duodenal bulb through a cholecystoduodenal fistula. We reported the case of a 46-year-old woman who presented intermittent epigastric pain, nausea, vomiting, and weight loss of 2-months duration. The patient admitted alcohol and methamphetamine abuse. She had not fever, dehydration or jaundice. Amylase, electrolytes, enzymes, and creatinine level were within normal limits. Seven months previously she was seen in the emergency department for acute cholecystitis. In that occasion, an abdominal ultrasound was reported with cholelithiasis without dilatation of the intra/extra-hepatic bile duct. Abdominal plain radiographs showed no relevant findings. A laparoscopic surgery was performed. During the procedure a sub-hepatic plastron with firm adhesions was found. The gallbladder was found attached to the duodenal bulb and an impacted calculus in the duodenum. The procedure was converted to surgery. Surgeon decided to perform a Bilroth 1 as the best choice. Seven days later, she was discharged. The clinical manifestations of the Bouveret's syndrome are nonspecific. Preoperative diagnosis is a challenge for clinicians because of the rarity of this condition. Treatment must be individualized.

An Interesting Cause of Mechanical Small Bowel Obstruction.

PubMed

Anantha Sathyanarayana, Sandeep; Deutsch, Gary B; Friedman, Barak

2015-12-01

Foreign body ingestion is a known cause of abdominal pain in pediatric population occurring between 6 months and 3 years of age (Wyllie Curr Opin Pediatr 18:563, 2006, Uyemura Am Fam Physician 72:287, 2005, Banerjee Indian J Pediatr 72:173, 2005). Most of the ingested foreign bodies pass spontaneously with 10-20 % requiring endoscopic retrieval, and <1 % of cases require a surgical intervention (Wyllie Curr Opin Pediatr 18:563, 2006, Uyemura Am Fam Physician 72:287, 2005, Shivakumar Indian J Pediatr 71:689, 2004). Presence of intestinal obstruction necessitates surgical intervention to extract the ingested foreign body. Initial abdominal plain radiograph should be obtained when foreign body ingestion is suspected, which differentiates a radiopaque from radiolucent foreign bodies. A computed tomography with 3D reconstruction (3D-CT) is recommended with radiolucent foreign bodies (Uyemura Am Fam Physician 72:287, 2005, Kazam Am J Emerg Med 23:897, 2005). After 24 h of expectant management, failure of spontaneous passage requires further intervention. Timely intervention to relieve the obstruction is pivotal to prevent undue complications. We present an interesting case of a boy who ingested a radiolucent foreign body diagnosed on 3D-CT, successfully treated with surgical extraction.

Walking on thin ice! Identifying methamphetamine “drug mules” on digital plain radiography

PubMed Central

Abdul Rashid, S N; Mohamad Saini, S B; Abdul Hamid, S; Muhammad, S J; Mahmud, R; Thali, M J

2014-01-01

Objective: The purpose of this study was to retrospectively evaluate the sensitivity, specificity and accuracy of identifying methamphetamine (MA) internal payloads in “drug mules” by plain abdominal digital radiography (DR). Methods: The study consisted of 35 individuals suspected of internal MA drug containers. A total of 59 supine digital radiographs were collected. An overall calculation regarding the diagnostic accuracy for all “drug mules” and a specific evaluation concerning the radiological appearance of drug packs as well as the rate of clearance and complications in correlation with the reader's experience were performed. The gold standard was the presence of secured drug packs in the faeces. Results: There were 16 true-positive “drug mules” identified. DR of all drug carriers for Group 1 (forensic imaging experienced readers, n = 2) exhibited a sensitivity of 100%, a mean specificity of 76.3%, positive predictive value (PPV) of 78.5%, negative predictive value (NPV) of 100% and a mean accuracy 87.2%. Group 2 (inexperienced readers, n = 3) showed a lower sensitivity (93.7%), a mean specificity of 86%, a PPV of 86.5%, an NPV of 94.1% and a mean accuracy of 89.5%. The interrater agreement within Group 1 was 0.72 and within Group 2 averaged to 0.79, indicating a fair to very good agreement. Conclusion: DR is a valuable screening tool in cases of MA body packers with huge internal payloads being associated with a high diagnostic insecurity. Diagnostic insecurity on plain films may be overcome by low-dose CT as a cross-sectional imaging modality and addressed by improved radiological education in reporting drug carriers on imaging. Advances in knowledge: Diagnostic signs (double-condom and halo signs) on digital plain radiography are specific in MA “drug mules”, although DR is associated with high diagnostic insecurity and underreports the total internal payload. PMID:24472728

Delicious ice cream, why does salt thaw ice?

NASA Astrophysics Data System (ADS)

Bagnoli, Franco

2016-03-01

Plain Awful is an imaginary valley on the Andes populated by a highly-imitative, cubical people for which the most criminal offence is to exhibit round objects. The duck family (Scrooge, Donald and nephews) are teaming against Scrooge's worst enemy, Flintheart Glomgold, trying to buy the famous Plain Awful square eggs. Inadvertently, Scrooge violates the taboo, showing his Number One Dime, and is imprisoned in the stone quarries. He can be released only after the presentation of an ice cream soda to the President of Plain Awful. Donald and his nephews fly with Flintheart to deliver it, but Scrooge's enemy, of course, betrays the previous agreement after getting the ice cream, forcing the ducks into making an emergence replacement on the spot. Using dried milk, sugar and chocolate from their ration packs, plus some snow and salt for cooling they are able make the ice cream, and after dressing it with the carbonated water from a fire extinguisher they finally manage to produce the desired dessert. This comic may serve as an introduction to the "mysterious" phenomenon that added salt melts the ice and, even more surprising, does it by lowering the temperature of the mixture.

Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease--a prospective comparison with conventional magnetic resonance follow-through.

PubMed

Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke B; Rezanavaz-Gheshlagh, Bijan; Munkholm, Pia; Thomsen, Henrik S

2015-05-01

To compare prospectively the diagnostic accuracy of magnetic resonance imaging (MRI) without use of contrast medium orally or intravenously (plain MRI) with magnetic resonance follow-through (MRFT) in patients with inflammatory bowel disease (IBD). Plain MRI was carried out in addition to MRFT, to which the patients were referred. All patients underwent both examinations on the same day. For the evaluation, the bowel was divided into nine segments. Two radiologists, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging (DWI), and other inflammatory changes in each bowel segments. Further, hyperenhancement of the bowel was also evaluated in MRFT. A total of 100 patients (40 males and 60 females; median age: 38.5; range: 19-90) were enrolled; 44 with Crohn's disease (CD), 25 with ulcerative colitis (UC), 24 with IBD unclassified (IBD-U), and 7 had other diagnosis. Sensitivity, specificity, and accuracy in CD ranged 50-86%, 93-94%, and 91-92% for wall thickening and 49-82%, 85-93%, and 84-89% for DWI, respectively. Sensitivity, specificity, and accuracy in UC range 0-40%, 87-100%, and 80-100% for wall thickening and 0-52%, 83-94% and 76-92% for DWI, respectively. The κ values for bowel wall thickening, DWI, and mural hyperenhancement were detected with fair agreement (κ = 0.26-0.39) at both MRI examinations, whereas only bowel wall thickening in MRFT were detected with moderate agreement (κ = 0.47) Conclusion. Plain MRI cannot currently replace MRFT in the workup of patients with IBD. Further research on plain MRI is needed to improve the protocol.

An ecological comparison of the two arid-zone kangaroos of Australia, and their anomalous prosperity since the introduction of ruminant stock to their environment.

PubMed

Newsome, A E

1975-12-01

This paper discusses the interactions between the large and medium-sized marsupials, the introduced ruminant domestic stock, and the environment in the arid zone of Australia. The grazing of sheep and cattle has produced suitable subclimax pastures which today favor two sympatric kangaroos but not the smaller bandicoots and wallabies. Tall grass tussocks used as shelter by the latter have been grazed down by the ruminants, and replaced by "marsupial lawns" or xeric spinifex, depending on locality, thereby improving the food supplies for the plains kangaroo and the hill kangaroo, respectively. It is argued, however, that even these smaller marsupials benefited originally from the new grazing regime. Patchy grazing of the grasslands probably created edge effects and other early seral changes which improved the food supplies while leaving adequate shelter. Continued grazing by increasingly large numbers of sheep and cattle ultimately and critically removed the shelter and, therefore, eliminated the bandicoots and wallabies. There is evidence that the plains kangaroo, though generally abundant at the present time, is vulnerable to competitive displacement by sheep, cattle, rabbits, and, in one region, by the hill kangaroo when it invades the plains. The plains kangaroo with its diet of green herbage is most threatened during droughts because the other herbivores have finer-grained diets. Like the bandicoots and wallabies the plains kangaroo in at least two localities appears to have first increased in numbers and then decreased. Sheep and cattle numbers have generally done the same. It is postulated, therefore, that there may not be two opposing response curves for the large and medium-sized marsupials to the ruminant invasion of the inland plains, but, in the long run, only one: an initial numerical increase and then decline. Only the time-scale is different, taking 50 years or more for the plains kangaroo, but perhaps half that time or less for the bandicoots and wallabies. The hill kangaroo may be the ultimate winner because it requires the least nitrogen, and the spinifex it eats during drought has spread as part of the subclimax created by ruminants.

Quality Indicators for Quality of Care During Hospitalization for Vulnerable Elder Persons

DTIC Science & Technology

2004-08-01

hip fracture as well as all abdominal, pelvic or lower extremity surgeries above the shin, except laparoscopic surgeries, and patients with prior...24 63. Williams MA, Campbell EB, Raynor WJ, Mlynarczyk SM, Ward SE. Reducing acute confusional states in elderly patients with hip fractures ...studies of patients receiving total hip replacements) but inferior to the acceptable regimens above. Pulmonary embolism, the sequelae of deep vein

Vegetation, substrate and hydrology in floating marshes in the Mississippi river delta plain wetlands, USA

USGS Publications Warehouse

Sasser, C.E.; Gosselink, J.G.; Swenson, E.M.; Swarzenski, C.M.; Leibowitz, N.C.

1996-01-01

In the 1940s extensive floating marshes (locally called 'flotant') were reported and mapped in coastal wetlands of the Mississippi River Delta Plain. These floating marshes included large areas of Panicum hemitomon-dominated freshwater marshes, and Spartina patens/Scirpus olneyi brackish marshes. Today these marshes appear to be quite different in extent and type. We describe five floating habitats and one non-floating, quaking habitat based on differences in buoyancy dynamics (timing and degree of floating), substrate characteristics, and dominant vegetation. All floating marshes have low bulk density, organic substrates. Nearly all are fresh marshes. Panicum hemitomon floating marshes presently occur within the general regions that were reported in the 1940's by O'Neil, but are reduced in extent. Some of the former Panicum hemitomon marshes have been replaced by seasonally or variably floating marshes dominated, or co-dominated by Sagittaria lancifolia or Eleocharis baldwinii. ?? 1996 Kluwer Academic Publishers.

Reflux condensation of pure vapors with and without a noncondensable gas inside plain and enhanced tubes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abdelmessih, A.N.; Rabas, T.J.; Panchal, C.B.

1997-06-01

Estimates of the surface-area and vapor-release reductions are obtained when commercially available enhanced tubes (spirally ribbed) replace plain tubes in a reflux unit condensing pure organic vapors with different concentrations of a noncondensable gas. This investigation was undertaken because there are no existing data and/or prediction methods that are applicable for these shell-and-tube condensers commonly used in the process industries. To obtain these estimates, existing design methods published in the open literature were used. The major findings are that (1) surface-area reductions can almost approach the single-phase heat transfer enhancement level, and (2) vapor-release reductions can approach a factor ofmore » four. The important implication is that enhanced tubes appear to be very cost effective for addressing the recovery of volatile organic vapors (VOCs), and for a vast number of different reflux-condenser applications.« less

Magmatic history of Red Sea rifting: perspective from the central Saudi Arabian coastal plain.

USGS Publications Warehouse

Pallister, J.S.

1987-01-01

An early stage of magmatism related to Red Sea rifting is recorded by a Tertiary dyke complex and comagmatic volcanic rocks exposed on the central Saudi Arabian coastal plain. Field relations and new K/Ar dates indicate episodic magmatism from approx 30 m.y. to the present day and rift-related magmatism as early as 50 m.y. Localized volcanism and sheeted dyke injection ceased at approx 20 m.y. and were replaced by the intrusion of thick gabbro dykes, marking the onset of sea-floor spreading in the central Red Sea. Differences in the depths and dynamics of mantle-melt extraction and transport may account for the transition from mixed alkaline-subalkaline bimodal magmatism of the pre-20 m.y. rift basin to exclusively subalkaline (tholeiitic) magmatism of the Red Sea spreading axis and the alkali basalt volcanism inland.-L.C.H.

Subtraction of subcutaneous fat to improve the prediction of visceral adiposity: exploring a new anthropometric track in overweight and obese youth.

PubMed

Samouda, H; De Beaufort, C; Stranges, S; Van Nieuwenhuyse, J-P; Dooms, G; Keunen, O; Leite, S; Vaillant, M; Lair, M-L; Dadoun, F

2017-08-01

The efficiency of traditional anthropometric measurements such as body mass index (BMI) or waist circumference (Waist C) used to replace biomedical imaging for assessing visceral adipose tissue (VAT) is still highly controversial in youth. We evaluated the most accurate model predicting VAT in overweight/obese youth, using various anthropometric measurements and their correlation with different body fat compartments, especially by testing, for the first time in youth, the hypothesis that subtracting the anthropometric measurement the most highly correlated with subcutaneous abdominal adipose tissue (SAAT) and less correlated possible with VAT from an anthropometric abdominal measurement highly correlated with visceral and total abdominal adipose tissue (TAAT), predicts VAT with higher accuracy. VAT and SAAT data resulted from magnetic resonance imaging (MRI) analysis performed on 181 boys and girls (7-17 y) from Diabetes & Endocrinology Care Paediatrics Clinic in Luxembourg. Height, weight, abdominal diameters, waist, hip, and thigh circumferences were measured with a view to developing the anthropometric VAT predictive algorithms. In girls, subtracting proximal thigh circumference (Proximal Thigh C), the most closely correlated anthropometric measurement with SAAT, from Waist C, the most closely correlated anthropometric measurement with VAT was instrumental in improving VAT prediction, in comparison with the most accurate single VAT anthropometric surrogate. [Formula: see text] Residual analysis showed a negligible estimation error (5 cm 2 ). In boys, Waist C was the best VAT predictor. Subtraction of abdominal subcutaneous fat is important to predict VAT in overweight/obese girls. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Abdominal war wounds--experiences from Red Cross field hospitals.

PubMed

Leppäniemi, Ari K

2005-01-01

The traditional approach to abdominal war wounds consists of triage, eche-loned care, and mandatory laparotomy for penetrating abdominal injuries, and it remains valid in modern conventional wars with well-organized evacuation and surgical services. Expectant management of abdominal casualties can be considered under difficult circumstances with a high influx of patients exhausting the available resources. This can occur in regional conflicts associated with mass movements of people and with collapsed infrastructure. While always combined with adequate fluid resuscitation, antibiotic treatment, and other supportive care, the expectant approach in patients with penetrating abdominal injuries could be indicated for asymptomatic patients with multiple fragment wounds or for patients presenting several days post-injury in good condition. The focus of surgical resources and competence should be on the majority of patients with intestinal perforation only, who need surgery to save life--but not necessarily on an urgent basis--and who have a good chance of survival. The limited availability of blood products to correct blood loss and coagulation factor deficiencies, and the lack of sophisticated monitoring of hemodynamic variables that call into question the value of a damage-control approach for the most severely injured. Even if the bleeding could be temporarily controlled, the subsequent need for adequate resuscitation before returning the patient to the operating room could be difficult to achieve and would result in incompletely resuscitated patients being reoperated while acidotic, coagulopathic, and even hypothermic. Perhaps, in mass casualty situations these patients should be recognized during triage or at least early during operation, and aggressive surgery should be replaced with adequate expectant management with sedation and analgesics.

Abdominal wall desmoid tumors: A case report

PubMed Central

MA, JIN-HUI; MA, ZHEN-HAI; DONG, XUE-FENG; YIN, HANG; ZHAO, YONG-FU

2013-01-01

Desmoid tumors (DTs) are rare lesions that do not possess any metastatic potential. However, they have a strong tendency to invade locally and recur. They constitute 3% of all soft tissue tumors and 0.03% of all neoplasms. Abdominal DTs occur sporadically or are associated with certain familial syndromes, such as familial adenomatous polyposis (FAP). The single form of this neoplasm most frequently occurs in females of reproductive age and during pregnancy. A female patient with a DT of the abdominal wall who had no relevant family history was admitted to hospital. The patient, who presented with a painless mass in the left anterolateral abdomen, had no history of trauma, surgery or childbearing. According to the medical history, physical examination and CT report, the patient was diagnosed with DT. Radical resection of the affected abdominal wall musculature was performed, and the defect was replaced with a polypropylene mesh. The histological diagnosis was of DT. The patient remains in good health and complete remission without any other treatment following surgery. DTs exhibit aggressive growth and have a high rate of recurrence. Surgery is the optimal treatment, and subsequent radiotherapy may decrease the local recurrence rate. Further research into their aetiology is required combined with multicentre clinical trials of new treatments in order to improve management of this disease. This case report provides general knowledge of DT, and may be used as a guidance for diagnosis and treatment. PMID:23833679

Perforated Duodenal Ulcer: Has Anything Changed?

PubMed

Koskensalo, Selja; Leppäniemi, Ari

2010-04-01

To assess the current management and outcome of perforated duodenal peptic ulcer managed with open repair, a focused analysis was conducted, excluding gastric, traumatic and iatrogenic perforations. A retrospective study of a 6-year period identified 61 patients. Mean age was 59 (range 19-87) years and 33 (54%) were male. Medical history included nonsteroidal anti-inflammatory drugs in 46%, smoking in 30%, atherosclerosis in 26% and excessive alcohol use in 23%. Generalized abdominal tenderness was recorded in 64% of the cases. The mean (SD) C-reactive protein value was 100 (141) g/l and white blood cell count was 12.8 (7.9) E9/l. Plain abdominal X-ray was positive for air in 87% (41/47) and CT scan in 86% (18/21). Four patients (7%) were operated without radiological imaging. There were 31 patients (51%) with a delay of 24 h or more from the start of symptoms to surgery. The mean (SD) delay from admission to surgery was 9 (3) (range 3-12) h. The treatment consisted of open suture repair in 92%, peritoneal lavage in 92%, external drainage in 80% and nasogastric decompression in 92%. The overall hospital mortality and morbidity rates were 11 and 21%, respectively. The duodenal suture leak rate was 7% and intra-abdominal abscess rate was 2%. The majority of patients with perforated duodenal ulcer can be diagnosed with conventional clinical and radiological methods, and treated according to established surgical principles. The mortality and duodenal morbidity rates have remained unchanged for the last decade. Shortening preoperative delay could improve the prognosis.

Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion.

PubMed

Gremillion, Christine L; Savage, Mason; Cohen, Eli B

2018-05-01

Colonic torsion is a life-threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed. Fourteen dogs met inclusion criteria. Of these, nine dogs had colonic torsion confirmed at surgery, with five dogs having surgical confirmation of colonic congestion or mesenteric torsion. Radiographic findings included segmental distention of the colon (14/14), focal narrowing of the colon (11/14), displacement of cecum (11/14), displacement of descending colon (14/14), and mild to no small intestinal distention (14/14). In cases where barium enema was performed, focal narrowing of the colon and longitudinal striations that course in a helical pattern were identified, termed the "torsion sign." Vomiting was the most common clinical sign observed (12/14), followed by abdominal pain in a small majority of cases (8/14). Severe abdominal pain and hypovolemic shock were uncommon in the patients reported (3/14). Colonic torsion should be considered as a differential diagnosis for dogs with radiographic segmental colonic distention with displacement of the descending colon and cecum. Barium enema is recommended for more definitive diagnosis. © 2018 American College of Veterinary Radiology.

Dietary Isoflavone-Dependent and Estradiol Replacement Effects on Body Weight in the Ovariectomized (OVX) Rat.

PubMed

Russell, Ashley L; Grimes, Jamie Moran; Cruthirds, Danette F; Westerfield, Joanna; Wooten, Lawren; Keil, Margaret; Weiser, Michael J; Landauer, Michael R; Handa, Robert J; Wu, T John; Larco, Darwin O

2017-06-01

17β-Estradiol is known to regulate energy metabolism and body weight. Ovariectomy results in body weight gain while estradiol administration results in a reversal of weight gain. Isoflavones, found in rodent chow, can mimic estrogenic effects making it crucial to understand the role of these compounds on metabolic regulation. The goal of this study is to examine the effect of dietary isoflavones on body weight regulation in the ovariectomized rat. This study will examine how dietary isoflavones can interact with estradiol treatment to affect body weight. Consistent with previous findings, animals fed an isoflavone-rich diet had decreased body weight (p<0.05), abdominal fat (p<0.05), and serum leptin levels (p<0.05) compared to animals fed an isoflavone-free diet. Estradiol replacement resulted in decreased body weight (p<0.05), abdominal fat (p<0.05), and serum leptin (p<0.05). Current literature suggests the involvement of cytokines in the inflammatory response of body weight gain. We screened a host of cytokines and chemokines that may be altered by dietary isoflavones or estradiol replacement. Serum cytokine analysis revealed significant (p<0.05) diet-dependent increases in inflammatory cytokines (keratinocyte-derived chemokine). The isoflavone-free diet in OVX rats resulted in the regulation of the following cytokines and chemokines: interleukin-10, interleukin-18, serum regulated on activation, normal T cell expressed and secreted, and monocyte chemoattractant protein-1 (p<0.05). Overall, these results reveal that estradiol treatment can have differential effects on energy metabolism and body weight regulation depending on the presence of isoflavones in rodent chow. © Georg Thieme Verlag KG Stuttgart · New York.

Potential population-level nutritional impact of replacing whole and reduced-fat milk with low-fat and skim milk among US children aged 2-19 years.

PubMed

Rehm, Colin D; Drewnowski, Adam; Monsivais, Pablo

2015-01-01

Dietary guidance emphasizes plain low-fat and skim milk over whole, reduced-fat, and flavored milk (milk eligible for replacement [MER]). The objective of this study was to evaluate the population-level impact of such a change on energy, macronutrient and nutrient intakes, and diet cost. Cross-sectional modeling study. Data from the 2001-2002 and 2003-2004 National Health and Nutrition Examination Survey. A total of 8,112 children aged 2-19 years. Energy, macronutrient, and micronutrient intake before and after replacement of MER with low-fat or skim milk. Survey-weighted linear regression models. Milk eligible for replacement accounted for 46% of dairy servings. Among MER consumers, replacement with skim or low-fat milk would lead to a projected reduction in energy of 113 (95% confidence interval [CI], 107-119) and 77 (95% CI, 73-82) kcal/d and percent energy from saturated fat by an absolute value of 2.5% of total energy (95% CI, 2.4-2.6) and 1.4% (95% CI, 1.3-1.5), respectively. Replacement of MER does not change diet costs or calcium and potassium intake. Substitution of MER has the potential to reduce energy and total and saturated fat intake with no impact on diet costs or micronutrient density. The feasibility of such replacement has not been examined and there may be negative consequences if replacement is done with non-nutrient-rich beverages. Copyright © 2015. Published by Elsevier Inc.

General Reevaluation Report and Environmental Impact Statement for the Blanchard River, Ottawa, Ohio Flood Protection Project

DTIC Science & Technology

1987-04-01

Black locust Black willow Honey locust Mulberry Slippery elm Box elder Cottonwood Multiflora rose Green ash Hackberry The U.S. Fish and Wildlife Service...flows in the Blanchard River at Ottawa. The Perry Street bridge was removed in 1951 and replaced by a new bridge at Elm Street that is less restrictive...flood plain. The present tree growth commonly consists of a second growth of spe- cies of elm , maple, and oak. All of the Blanchard River basin lies

Trauma Imaging: A Literature Review.

PubMed

Vela, Jason Heath; Wertz, Christopher Ira; Onstott, Kimberly L; Wertz, Joss R

2017-01-01

To inform radiologic technologists about which imaging modalities and examinations are best suited for evaluating specific anatomical structures in patients who have sustained a traumatic injury. Two scholarly research databases were searched to identify articles focused on trauma imaging of the head, cervical spine, thorax, abdomen, and pelvis. Articles focused on trauma diagnosis were excluded. Thirty-two articles were selected for analysis. Physical examination and plain-film radiographs typically are used to assess nasal bone fracures. Computed tomography (CT) can be used to assess zygomaticomaxillary complex, mandibular, and temporal bone fractures. Traumatic brain injuries are difficult to assess, and broad classifications are used. Depending on the severity of cervical spine trauma, plain-film radiographs or CT imaging is adequate, with magnetic resonance imaging used as a means for further evaluation. Trauma to the thorax typically is assessed with radiography and CT, and CT is recommended for assesment of abdominal and pelvic trauma. The literature was consistent regarding which examinations to perform to best evaluate suspected injuries to the chest, abdomen, and pelvis. The need for, and correct use of, imaging in evaluating trauma to the head and cervical spine is more controversial. Despite the need for additional research, emergency department care providers should be familiar with the structures most commonly injured during trauma and the role of medical imaging for diagnosis.

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension.

PubMed

Regli, Adrian; De Keulenaer, Bart; De Laet, Inneke; Roberts, Derek; Dabrowski, Wojciech; Malbrain, Manu L N G

2015-01-01

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population.Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test.Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

Prior Radiotherapy Does Not Affect Abdominal Wall Reconstruction Outcomes: Evidence from Propensity Score Analysis.

PubMed

Giordano, Salvatore; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-03-01

Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. The purpose of this study was to determine whether prior abdominal wall radiotherapy is associated with a higher incidence of complications following AWR for a hernia or oncologic resection defect. We performed a retrospective study of consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We compared outcomes between patients who underwent prior XRT that directly involved the abdominal wall and those who did not receive XRT. Propensity score match-paired and multivariate analyses were performed. A total of 511 patients (130 [25.4 %] with prior XRT; 381 [74.6 %] without prior XRT) underwent AWR with ADM for repair of a complex hernia or oncologic resection defect. Mean follow-up was 31.4 months, mean XRT dose was 48.9 Gy, and mean time between XRT and reconstruction was 19.2 months. XRT AWR patients underwent more flap reconstructions (14.6 vs. 5.0 %, P < 0.001) but fewer component separations (61.5 vs. 71.4 %; P = 0.036) than non-XRT AWR patients. The two groups had similar rates of hernia recurrence (8.5 vs. 9.4 %; P = 0.737) and surgical site occurrence (25.4 vs. 23.4 %; P = 0.640). In the propensity score-matched subgroups, there were no differences in hernia recurrence, surgical site occurrence, and wound healing complication rates. Prior XRT does not adversely affect outcomes in AWR. However, surgeons should be aware of the higher likelihood of needing a soft tissue flap reconstruction for soft tissue replacement when performing AWR after XRT.

Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature.

PubMed

Rashid-Farokhi, Farin; Afshar, Haleh

2017-12-22

BACKGROUND Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. CASE REPORT A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. CONCLUSIONS A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system.

A serious but rare complication of laparoscopic adjustable gastric banding: bowel obstruction due to caecal volvulus.

PubMed

Agahi, Afshin; Harle, Robin

2009-08-01

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for the treatment of morbid obesity. LAGB complications have declined since its development in the early 1990s. However, LAGB complications are still occurring and can sometimes be serious and life threatening. These complications are related either to the band or to the access port, such as band slippage or tubing disconnection, retrospectively. We report a rare case of bowel obstruction due to caecal volvulus caused by connecting tube used in LAP-BAND system in a bariatric operation, which obstructed a caecal loop, in a female who had undergone LAGB 2 years previously. Diagnosis of bowel obstruction was established with plain abdominal radiograph appearances. Follow-up abdominal computed tomography findings confirmed the diagnosis of caecal obstruction and revealed the underlying cause for this obstruction. Surgery was performed, and intraoperative examination demonstrated that connecting tube of the LAP-BAND system was a main causative factor. We can hypothesize that bowel obstruction secondary to LAGB operation may become frequently diagnosed as more LAGB operations performed worldwide. The emergence of many problems, such as this, can be minimized with enhancement in the development of better surgical materials, proper operative technique, and close postoperative management and follow-up.

Congenital Vitelline Band Causing Intestinal Obstruction in an Adult with a Double Inferior Vena Cava

PubMed Central

Pussepitiya, Kumari; Samarasinghe, Bandula; Wickramasinghe, Nuwan

2016-01-01

Introduction. Vitelline artery remnants are rare causes of intra-abdominal bands leading to bowel obstruction. These bands may be associated with Meckel's diverticulum. Double inferior vena cava (IVC) is a rare presentation and is usually identified incidentally. Case Presentation. A sixty-year-old male presented with progressive vomiting for five days and he was clinically diagnosed with intestinal obstruction. Plain X-ray abdomen showed evidence of small bowel obstruction. CT scan of the abdomen revealed dilated small bowel loops with a small outpouching in the distal ileum with a band like structure attached to it. In the CT, left sided patent IVC draining into the left renal vein was identified. Left external iliac vein was in continuity with the left IVC. Left internal iliac vein was draining into the right IVC. Exploratory laparotomy revealed a Meckel's diverticulum with a band identified as the vitelline remnant attached to its apex and inserting at the anterior abdominal wall near the umbilicus. Discussion. Meckel's diverticulum with vitelline bands, although rare, should be borne in mind in adult patients with intestinal obstruction. Identification of this anomaly can be difficult in imaging studies. Presence of double IVC should be mentioned in the imaging findings to prevent possible catastrophic complications during surgery. PMID:27843667

[A case of obstruction due to right-sided colon cancer in which good quality of life was achieved after colonic stenting].

PubMed

Nakao, Shigetomi; Hori, Takeshi; Miura, Kotaro; Tendo, Masashige; Nakata, Bunzo; Ishikawa, Tetsuro; Hirakawa, Kosei

2013-11-01

We report a case of a 60-year-old woman with abdominal distension who was treated with self-expandable metal stent (SEMS) placement in the proximal transverse colon. She was found to have severe bowel obstruction due to advanced transverse colon cancer on plain computed tomography (CT) and colonoscopy. We performed colonic stenting safely, and the symptom promptly improved. Defecation and flatus were observed on the same day of stenting, and the patient was able to start drinking and eating on the next day. Enhanced abdominal CT revealed multiple liver metastasis, peritoneal dissemination, ascites, and cystic ovarian tumor. After treatment with 1 course of 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6), the patient was discharged on day 14 after admission. The rapidly enlarging ovarian tumors and primary colonic lesion with SEMS were surgically removed after treatment with mFOLFOX6 for 4 months in an outpatient basis. The patient has been alive with a good quality of life (QOL) and being treated with bevacizumab plus mFOLFOX6/Leucovorin, 5-fluorouracil, and irinotecan( FOLFIRI) for 6 months. SEMS placement could be safe and effective for the treatment of obstruction of the right colon, and could maintain a good QOL in patients.

International collaborative study for the calibration of proposed International Standards for thromboplastin, rabbit, plain, and for thromboplastin, recombinant, human, plain.

PubMed

van den Besselaar, A M H P; Chantarangkul, V; Angeloni, F; Binder, N B; Byrne, M; Dauer, R; Gudmundsdottir, B R; Jespersen, J; Kitchen, S; Legnani, C; Lindahl, T L; Manning, R A; Martinuzzo, M; Panes, O; Pengo, V; Riddell, A; Subramanian, S; Szederjesi, A; Tantanate, C; Herbel, P; Tripodi, A

2018-01-01

Essentials Two candidate International Standards for thromboplastin (coded RBT/16 and rTF/16) are proposed. International Sensitivity Index (ISI) of proposed standards was assessed in a 20-centre study. The mean ISI for RBT/16 was 1.21 with a between-centre coefficient of variation of 4.6%. The mean ISI for rTF/16 was 1.11 with a between-centre coefficient of variation of 5.7%. Background The availability of International Standards for thromboplastin is essential for the calibration of routine reagents and hence the calculation of the International Normalized Ratio (INR). Stocks of the current Fourth International Standards are running low. Candidate replacement materials have been prepared. This article describes the calibration of the proposed Fifth International Standards for thromboplastin, rabbit, plain (coded RBT/16) and for thromboplastin, recombinant, human, plain (coded rTF/16). Methods An international collaborative study was carried out for the assignment of International Sensitivity Indexes (ISIs) to the candidate materials, according to the World Health Organization (WHO) guidelines for thromboplastins and plasma used to control oral anticoagulant therapy with vitamin K antagonists. Results Results were obtained from 20 laboratories. In several cases, deviations from the ISI calibration model were observed, but the average INR deviation attributabled to the model was not greater than 10%. Only valid ISI assessments were used to calculate the mean ISI for each candidate. The mean ISI for RBT/16 was 1.21 (between-laboratory coefficient of variation [CV]: 4.6%), and the mean ISI for rTF/16 was 1.11 (between-laboratory CV: 5.7%). Conclusions The between-laboratory variation of the ISI for candidate material RBT/16 was similar to that of the Fourth International Standard (RBT/05), and the between-laboratory variation of the ISI for candidate material rTF/16 was slightly higher than that of the Fourth International Standard (rTF/09). The candidate materials have been accepted by WHO as the Fifth International Standards for thromboplastin, rabbit plain, and thromboplastin, recombinant, human, plain. © 2017 International Society on Thrombosis and Haemostasis.

Factors affecting fat content in mottled ducks on the Upper Texas Gulf Coast

USGS Publications Warehouse

Kearns, Brian; Haukos, David A.; Walther, Patrick; Conway, Warren C.

2014-01-01

Body condition, or an individual's ability to address metabolic needs, is an important measure of organism health. For waterfowl, body condition, usually some measure of fat, provides a useful proxy for assessing energy budgets during different life history periods and potentially is a measure of response to ecosystem changes. The mottled duck (Anas fulvigula) is relatively poorly studied in respect to these dynamics and presents a unique case because its non-migratory life-history strategy releases it from metabolic costs experienced by many related migratory waterfowl species. Additionally, as a species in decline and of conservation concern in many parts of its range, traditional methods of fat content estimation that involve destructive sampling are less viable. The goal of this study was to produce an equation for estimating fat content in mottled ducks using birds (n = 24) donated at hunter-check stations or collected by law enforcement efforts on the Texas Chenier Plain National Wildlife Refuge Complex from 2005 - 2007. Morphometric measurements were taken, and ether extraction and fat removal was used to estimate percent body fat content and abdominal fat mass, respectively. A hierarchical simple linear regression modeling approach was used to determine external morphometrics that best predicted abdominal fat content. A ratio model based on body mass and a length metric (keel and wing chord length possessed equal model support) provided the best relationship with abdominal fat in sampled individuals. We then applied the regression equation to historical check station data to examine fluctuations in fat content over time; fat content or condition varied relatively little with the exception of years characterized by major disturbances. The mottled duck condition model created here can be used to better monitor population status and health without destructively sampling individuals.

Post-traumatic tricuspid insufficiency: a case report.

PubMed

Tütün, Ufuk; Aksöyek, Ayşen; Parlar, Ali Ihsan; Cobanoğlu, Adnan

2011-11-01

Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

Effects of growth hormone administration for 6 months on bone turnover and bone marrow fat in obese premenopausal women.

PubMed

Bredella, Miriam A; Gerweck, Anu V; Barber, Lauren A; Breggia, Anne; Rosen, Clifford J; Torriani, Martin; Miller, Karen K

2014-05-01

Abdominal adiposity is associated with low BMD and decreased growth hormone (GH) secretion, an important regulator of bone homeostasis. The purpose of our study was to determine the effects of a short course of GH on markers of bone turnover and bone marrow fat in premenopausal women with abdominal adiposity. In a 6-month, randomized, double-blind, placebo-controlled trial we studied 79 abdominally obese premenopausal women (21-45 y) who underwent daily sc injections of GH vs. placebo. Main outcome measures were body composition by DXA and CT, bone marrow fat by proton MR spectroscopy, P1NP, CTX, 25(OH)D, hsCRP, undercarboxylated osteocalcin (ucOC), preadipocyte factor 1 (Pref 1), apolipoprotein B (ApoB), and IGF-1. GH increased IGF-1, P1NP, 25(OH)D, ucOC, bone marrow fat and lean mass, and decreased abdominal fat, hsCRP, and ApoB compared with placebo (p<0.05). There was a trend toward an increase in CTX and Pref-1. Among all participants, a 6-month increase in IGF-1 correlated with 6-month increase in P1NP (p=0.0005), suggesting that subjects with the greatest increases in IGF-1 experienced the greatest increases in bone formation. A six-month decrease in abdominal fat, hsCRP, and ApoB inversely predicted 6-month change in P1NP, and 6-month increase in lean mass and 25(OH)D positively predicted 6-month change in P1NP (p≤0.05), suggesting that subjects with greatest decreases in abdominal fat, inflammation and ApoB, and the greatest increases in lean mass and 25(OH)D experienced the greatest increases in bone formation. A six-month increase in bone marrow fat correlated with 6-month increase in P1NP (trend), suggesting that subjects with the greatest increases in bone formation experienced the greatest increases in bone marrow fat. Forward stepwise regression analysis indicated that increase in lean mass and decrease in abdominal fat were positive predictors of P1NP. When IGF-1 was added to the model, it became the only predictor of P1NP. GH replacement in abdominally obese premenopausal women for 6 months increased bone turnover and bone marrow fat. Reductions in abdominal fat, and inflammation, and increases in IGF-1, lean mass and vitamin D were associated with increased bone formation. The increase in bone marrow fat may reflect changes in energy demand from increased bone turnover. Copyright © 2014 Elsevier Inc. All rights reserved.

Preoperative hydration with 0.9% normal saline to prevent acute kidney injury after major elective open abdominal surgery: A randomised controlled trial.

PubMed

Serrano, Ana B; Candela-Toha, Angel M; Zamora, Javier; Vera, Jorge; Muriel, Alfonso; Del Rey, Jose M; Liaño, Fernando

2016-06-01

Postoperative acute kidney injury (AKI) is the second leading cause of hospital-acquired AKI. Although many preventive strategies have been tested, none of them has been totally effective. We investigated whether preoperative intravenous hydration with 0.9% normal saline could prevent postoperative AKI. Randomised controlled trial. University Ramón y Cajal Hospital, Spain, from June 2006 to February 2011. Total 328 inpatients scheduled for major elective open abdominal surgery. 0.9% normal saline at a dose of 1.5 ml kg h for 12 h before surgery. The primary outcome was the overall postoperative AKI incidence during the first week after surgery defined by risk, injury, failure, loss, end-stage kidney disease (RIFLE) and AKI network (AKIN) creatinine criteria. Secondary endpoints were the need for ICU admission, renal replacement therapy during the study period and adverse events and hospital mortality during hospital admission. There was no difference in the incidence of AKI between groups: 4.7% in the normal saline group versus 5.0% in the control group and 11.4% in the 0.9% normal saline group versus 7.9% in the control group as assessed by the RIFLE and AKIN creatinine criteria, respectively. Absolute risk reductions (95% confidence interval) were -0.3% (-5.3 to 4.7%) for RIFLE and 3.5% (-10.2 to 3.6%) for AKIN. ICU admission after surgery was required in 44.5% of all participants. Only 2 (0.7%) patients required renal replacement therapy during the first week after surgery. The analysis of adverse events did not show statistically significant differences between the groups except for pain. In our population, 8 (2.4%) patients died during their hospital admission. Intravenous hydration with 0.9% normal saline before major open abdominal surgery was not effective in preventing postoperative AKI. No safety concerns were identified during the trial. Clinical trials.gov: NCT00953940 and EUDRA CT: 2005-004755-35.

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery.

PubMed

Myles, Paul S; Bellomo, Rinaldo; Corcoran, Tomas; Forbes, Andrew; Peyton, Philip; Story, David; Christophi, Chris; Leslie, Kate; McGuinness, Shay; Parke, Rachael; Serpell, Jonathan; Chan, Matthew T V; Painter, Thomas; McCluskey, Stuart; Minto, Gary; Wallace, Sophie

2018-05-09

Background Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. Methods In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery. The primary outcome was disability-free survival at 1 year. Key secondary outcomes were acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death. Results During and up to 24 hours after surgery, 1490 patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in 1493 patients in the liberal fluid group (P<0.001). The rate of disability-free survival at 1 year was 81.9% in the restrictive fluid group and 82.3% in the liberal fluid group (hazard ratio for death or disability, 1.05; 95% confidence interval, 0.88 to 1.24; P=0.61). The rate of acute kidney injury was 8.6% in the restrictive fluid group and 5.0% in the liberal fluid group (P<0.001). The rate of septic complications or death was 21.8% in the restrictive fluid group and 19.8% in the liberal fluid group (P=0.19); rates of surgical-site infection (16.5% vs. 13.6%, P=0.02) and renal-replacement therapy (0.9% vs. 0.3%, P=0.048) were higher in the restrictive fluid group, but the between-group difference was not significant after adjustment for multiple testing. Conclusions Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability-free survival than a liberal fluid regimen and was associated with a higher rate of acute kidney injury. (Funded by the Australian National Health and Medical Research Council and others; RELIEF ClinicalTrials.gov number, NCT01424150 .).

Potential Population-Level Nutritional Impact of Replacing Whole and Reduced-Fat Milk With Low-Fat and Skim Milk Among US Children Aged 2–19 Years

PubMed Central

Rehm, Colin D.; Drewnowski, Adam; Monsivais, Pablo

2015-01-01

Objective Dietary guidance emphasizes plain low-fat and skim milk over whole, reduced-fat, and flavored milk (milk eligible for replacement [MER]). The objective of this study was to evaluate the population-level impact of such a change on energy, macronutrient and nutrient intakes, and diet cost. Design Cross-sectional modeling study. Setting Data from the 2001–2002 and 2003–2004 National Health and Nutrition Examination Survey. Participants A total of 8,112 children aged 2–19 years. Main Outcome Measures Energy, macronutrient, and micronutrient intake before and after replacement of MER with low-fat or skim milk. Analysis Survey-weighted linear regression models. Results Milk eligible for replacement accounted for 46% of dairy servings. Among MER consumers, replacement with skim or low-fat milk would lead to a projected reduction in energy of 113 (95% confidence interval [CI], 107–119) and 77 (95% CI, 73–82) kcal/d and percent energy from saturated fat by an absolute value of 2.5% of total energy (95% CI, 2.4–2.6) and 1.4% (95% CI, 1.3–1.5), respectively. Replacement of MER does not change diet costs or calcium and potassium intake. Conclusions Substitution of MER has the potential to reduce energy and total and saturated fat intake with no impact on diet costs or micronutrient density. The feasibility of such replacement has not been examined and there may be negative consequences if replacement is done with non-nutrient–rich beverages. PMID:25528079

Periprosthetic osteolysis after AES total ankle replacement: Conventional radiography versus CT-scan.

PubMed

Viste, Anthony; Al Zahrani, Nader; Brito, Nuno; Lienhart, Christophe; Fessy, Michel Henri; Besse, Jean-Luc

2015-09-01

The aim of this study was to compare conventional X-rays and CT-scan in detecting peri-prosthetic osteolytic lesions, a major concern after total ankle replacement (TAR). We prospectively assessed 50 patients (mean age 56 years), consecutively operated on by the same senior surgeon, between 2003 and 2006 and with a mean follow-up period of 4 years (range, 2-6.2). The component used was AES total ankle replacement. The etiologies for total ankle arthroplasty were: posttraumatic in 50%, osteoarthritis secondary to instability in 36%. Plain radiographs were analyzed by 4 independent observers, using a 10-zone protocol (location) and 5 size categories. At 4-year follow-up, all patients had been CT-scan assessed with the same protocol by 2 independent observers. Plain radiographs showed dramatic progression of severe periprosthetic lyses (>10mm): from 14% to 36% of interface cysts for the tibial component respectively at 2 and 4-year follow-up and from 4% to 30% for the talar implant. The talar component was more accurately assessed by CT-scan (mean frontal and sagittal talar lesion: from 270 mm2 to 288 mm2 for CT-scan versus 133 mm2 to 174 mm2 for X-rays). For tibial cysts, axial views showed larger lesions (313 mm2 than frontal (194 mm2) or sagittal (213.5 mm2) views. At 4-year follow-up, 24% of patients had revision with curetage or arthrodesis, and at 7 years follow-up 38% were revised. These results are similar to recent AES series, justifying withdrawal of this device. CT-scan was more accurate than X-rays for detecting and quantifying periprosthetic osteolysis. We recommend a yearly radiological control and CT-scan in case of lesion on X-rays. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Amylose-potassium oleate inclusion complex in plain set-style yogurt.

PubMed

Singh, Mukti; Byars, Jeffrey A; Kenar, James A

2014-05-01

Health and wellness aspirations of U.S. consumers continue to drive the demand for lower fat from inherently beneficial foods such as yogurt. Removing fat from yogurt negatively affects the gel strength, texture, syneresis, and storage of yogurt. Amylose-potassium oleate inclusion complexes (AIC) were used to replace skim milk solids to improve the quality of nonfat yogurt. The effect of AIC on fermentation of yogurt mix and strength of yogurt gel was studied and compared to full-fat samples. Texture, storage modulus, and syneresis of yogurt were observed over 4 weeks of storage at 4 °C. Yogurt mixes having the skim milk solids partially replaced by AIC fermented at a similar rate as yogurt samples with no milk solids replaced and full-fat milk. Initial viscosity was higher for yogurt mixes with AIC. The presence of 3% AIC strengthened the yogurt gel as indicated by texture and rheology measurements. Yogurt samples with 3% AIC maintained the gel strength during storage and resulted in low syneresis after storage for 4 wk. © 2014 Institute of Food Technologists®

Correlation of quantitative dual-energy computed tomography iodine maps and abdominal computed tomography perfusion measurements: are single-acquisition dual-energy computed tomography iodine maps more than a reduced-dose surrogate of conventional computed tomography perfusion?

PubMed

Stiller, Wolfram; Skornitzke, Stephan; Fritz, Franziska; Klauss, Miriam; Hansen, Jens; Pahn, Gregor; Grenacher, Lars; Kauczor, Hans-Ulrich

2015-10-01

Study objectives were the quantitative evaluation of whether conventional abdominal computed tomography (CT) perfusion measurements mathematically correlate with quantitative single-acquisition dual-energy CT (DECT) iodine concentration maps, the determination of the optimum time of acquisition for achieving maximum correlation, and the estimation of the potential for radiation exposure reduction when replacing conventional CT perfusion by single-acquisition DECT iodine concentration maps. Dual-energy CT perfusion sequences were dynamically acquired over 51 seconds (34 acquisitions every 1.5 seconds) in 24 patients with histologically verified pancreatic carcinoma using dual-source DECT at tube potentials of 80 kVp and 140 kVp. Using software developed in-house, perfusion maps were calculated from 80-kVp image series using the maximum slope model after deformable motion correction. In addition, quantitative iodine maps were calculated for each of the 34 DECT acquisitions per patient. Within a manual segmentation of the pancreas, voxel-by-voxel correlation between the perfusion map and each of the iodine maps was calculated for each patient to determine the optimum time of acquisition topt defined as the acquisition time of the iodine map with the highest correlation coefficient. Subsequently, regions of interest were placed inside the tumor and inside healthy pancreatic tissue, and correlation between mean perfusion values and mean iodine concentrations within these regions of interest at topt was calculated for the patient sample. The mean (SD) topt was 31.7 (5.4) seconds after the start of contrast agent injection. The mean (SD) perfusion values for healthy pancreatic and tumor tissues were 67.8 (26.7) mL per 100 mL/min and 43.7 (32.2) mL per 100 mL/min, respectively. At topt, the mean (SD) iodine concentrations were 2.07 (0.71) mg/mL in healthy pancreatic and 1.69 (0.98) mg/mL in tumor tissue, respectively. Overall, the correlation between perfusion values and iodine concentrations was high (0.77), with correlation of 0.89 in tumor and of 0.56 in healthy pancreatic tissue at topt. Comparing radiation exposure associated with a single DECT acquisition at topt (0.18 mSv) to that of an 80 kVp CT perfusion sequence (2.96 mSv) indicates that an average reduction of Deff by 94% could be achieved by replacing conventional CT perfusion with a single-acquisition DECT iodine concentration map. Quantitative iodine concentration maps obtained with DECT correlate well with conventional abdominal CT perfusion measurements, suggesting that quantitative iodine maps calculated from a single DECT acquisition at an organ-specific and patient-specific optimum time of acquisition might be able to replace conventional abdominal CT perfusion measurements if the time of acquisition is carefully calibrated. This could lead to large reductions of radiation exposure to the patients while offering quantitative perfusion data for diagnosis.

Partly replacing meat protein with soy protein alters insulin resistance and blood lipids in postmenopausal women with abdominal obesity.

PubMed

van Nielen, Monique; Feskens, Edith J M; Rietman, Annemarie; Siebelink, Els; Mensink, Marco

2014-09-01

Increasing protein intake and soy consumption appear to be promising approaches to prevent metabolic syndrome (MetS). However, the effect of soy consumption on insulin resistance, glucose homeostasis, and other characteristics of MetS is not frequently studied in humans. We aimed to investigate the effects of a 4-wk, strictly controlled, weight-maintaining, moderately high-protein diet rich in soy on insulin sensitivity and other cardiometabolic risk factors. We performed a randomized crossover trial of 2 4-wk diet periods in 15 postmenopausal women with abdominal obesity to test diets with 22 energy percent (En%) protein, 27 En% fat, and 50 En% carbohydrate. One diet contained protein of mixed origin (mainly meat, dairy, and bread), and the other diet partly replaced meat with soy meat analogues and soy nuts containing 30 g/d soy protein. For our primary outcome, a frequently sampled intravenous glucose tolerance test (FSIGT) was performed at the end of both periods. Plasma total, LDL, and HDL cholesterol, triglycerides, glucose, insulin, and C-reactive protein were assessed, and blood pressure, arterial stiffness, and intrahepatic lipid content were measured at the start and end of both periods. Compared with the mixed-protein diet, the soy-protein diet resulted in greater insulin sensitivity [FSIGT: insulin sensitivity, 34 ± 29 vs. 22 ± 17 (mU/L)(-1) · min(-1), P = 0.048; disposition index, 4974 ± 2543 vs. 2899 ± 1878, P = 0.038; n = 11]. Total cholesterol was 4% lower after the soy-protein diet than after the mixed-protein diet (4.9 ± 0.7 vs. 5.1 ± 0.6 mmol/L, P = 0.001), and LDL cholesterol was 9% lower (2.9 ± 0.7 vs. 3.2 ± 0.6 mmol/L, P = 0.004; n = 15). Thus, partly replacing meat with soy in a moderately high-protein diet has clear advantages regarding insulin sensitivity and total and LDL cholesterol. Therefore, partly replacing meat products with soy products could be important in preventing MetS. This trial was registered at clinicaltrials.gov as NCT01694056. © 2014 American Society for Nutrition.

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm.

PubMed

Moreno, Daniel H; Cacione, Daniel G; Baptista-Silva, Jose C C

2016-05-13

An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mm Hg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 to 100 mm Hg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function. To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA. The Cochrane Vascular Information Specialist searched the Specialised Register (April 2016) and the Cochrane Register of Studies (CENTRAL (2016, Issue 3)). Clinical trials databases were searched (April 2016) for details of ongoing or unpublished studies. We sought all published and unpublished randomised controlled trial (RCTs) that compared controlled hypotension and normotensive resuscitation strategies for the management of shock in patients with ruptured abdominal aortic aneurysms. Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions. We identified no RCTs that met the inclusion criteria. We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required.

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm.

PubMed

Moreno, Daniel H; Cacione, Daniel G; Baptista-Silva, Jose Cc

2018-06-13

An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mmHg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 mmHg to 100 mmHg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function. This is an update of a review first published in 2016. To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA. The Cochrane Vascular Information Specialist searched the Specialised Register (August 2017), the Cochrane Register of Studies (CENTRAL (2017, Issue 7)) and EMBASE (August 2017). The Cochrane Vascular Information Specialist also searched clinical trials databases (August 2017) for details of ongoing or unpublished studies. We sought all published and unpublished randomised controlled trial (RCTs) that compared controlled hypotension and normotensive resuscitation strategies for the management of shock in patients with ruptured abdominal aortic aneurysms. Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions. We identified no RCTs that met the inclusion criteria. We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required.

Benzimidazole resistance in equine cyathostomins in India.

PubMed

Kumar, Sunil; Garg, Rajat; Kumar, Saroj; Banerjee, P S; Ram, Hira; Prasad, A

2016-03-15

Benzimidazole resistance is a major hindrance to the control of equine cyathostominosis throughout the world. There is a paucity of knowledge on the level of benzimidazole resistance in small strongyles of horses in India. In the present study, allele-specific PCR (AS-PCR) that detects F200Y mutation of the isotype 1 β-tubulin gene and faecal egg count reduction test (FECRT) were used for detecting benzimidazole resistance in equine cyathostomin populations in different agro-climatic zones of Uttar Pradesh, India. Results of the FECRT revealed prevalence of benzimidazole resistance in cyathostomins in an intensively managed equine farm in the mid-western plain (FECR=27.5%, LCI=0) and in working horses (extensively managed) at three locations in central plains of Uttar Pradesh (FECR=75.7-83.6%, LCI=29-57%). Post-treatment larval cultures revealed the presence of exclusively cyathostomin larvae. Genotyping of cyathostomin larvae by AS-PCR revealed that the frequency of homozygous resistant (rr) individuals and the resistant allele frequency was significantly higher (p<0.001) in the intensively managed farm in the mid-western plain and in working horses at two locations in central plains of the state. The resistant allele (r) frequency in cyathostomins was significantly higher (p<0.05) in Vindhyan and Tarai and Bhabar zones of Uttar Pradesh. The prevalence of benzimidazole resistant allele (r) was significantly higher (p<0.05) in cyathostomins of intensively managed horses (allelic frequency-0.35) as compared to extensively managed horses (allelic frequency-0.22). The widespread prevalence of benzimidazole resistant alleles in equine cyathostomins in Uttar Pradesh, India, necessitates immediate replacement of the drugs of benzimidazole group with other unrelated effective anthelmintics for management and control of equine cyathostomins. Copyright © 2016 Elsevier B.V. All rights reserved.

Armored brain: A case report and review of the literature.

PubMed

Petraglia, Anthony L; Moravan, Michael J; Jahromi, Babak S

2011-01-01

Calcified chronic subdural hematomas occur infrequently. When the calcifications are extensive and bilateral, the condition is termed "armored brain". We describe a case of "armored brain" incidentally discovered in an adult presenting with abdominal pain and mild headaches, long after initial placement of a ventriculo-peritoneal (VP) shunt. A 38-year-old woman, treated at infancy with a VP shunt, presented with a 2-month history of abdominal pain associated with nausea and chills. She was neurologically intact on exam. An abdominal computed tomography (CT) scan demonstrated a rim-enhancing loculated fluid collection surrounding the patient's distal VP shunt catheter tip. As a part of her initial work-up, she received a head CT to evaluate the proximal VP shunt, which demonstrated large bilateral chronic subdural hematomas with heavily calcified walls. She was eventually taken to the operating room (OR) for replacement of the distal catheter. It was felt that her acute clinical presentation was unrelated to the bilateral, calcified subdural hematomas and thus the decision was made to manage them conservatively. This rare complication of chronic shunting for hydrocephalus is sometimes referred to as armored brain. Surgery for armored brain is infrequently indicated and beneficial in only small subgroup of patients, with management guided by clinical presentation. Our patient fully recovered after shunt revision alone.

Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type A aortic dissection.

PubMed

Hatzidakis, A; Krokidis, M; Androulakakis, Z; Rossi, M

2015-01-01

We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissection. Hippokratia 2015; 19 (3): 270-273.

Development and freeze-thaw durability of high flyash-content concrete

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sajadi, J.

1987-01-01

Objectives were to investigate the effects on concrete strength, drying shrinkage, freeze-thaw durability, and air-void system parameters of replacing various amounts of portland cement with different types of fly ash and to compare selected characteristics of such fly-ash concretes and fly-ash concretes containing a high-range water-reducing admixture to those of a control mixture. It was concluded that concrete mixtures with 90-day compressive strengths equal to the control could be produced when large amounts of cement were replaced by fly ash. In addition, when the high-range water-reducing admixtures was employed, very large amounts of cement could be replaced by fly ashmore » to yield mixtures whose compressive strengths were equal to or greater than the strengths of the control mix at all ages. The maximum amount of cement that could be replaced for equal-strength mixtures depended upon the nature of the fly ash. Drying shrinkage of plain fly-ash concretes and fly-ash concretes containing the high-range water-reducing admixture were similar to those of the control mix. The optimum fly-ash content in a concrete is comparable in strength and durability to a conventional (control) concrete was influenced by the chemical and physical characteristics of the fly ash.« less

Pneumatosis cystoides intestinalis, four cases of a rare disease.

PubMed

Rennenberg, R J M W; Koek, G H; Van Hootegem, Ph; Stockbrügger, R W

2002-03-01

Pneumatosis cystoides intestinalis (PCI) is a disease in which small gas-filled cysts appear in the intestinal wall. Four cases presented here demonstrate the diversity of the associated diseases. In two of the patients constipation probably played a role; in the third patient decreased colonic motility, elevated intestinal pressure and increased mucosal permeability in the context of enteritis treated with codeine was the underlying problem; in the fourth high protein feeding and bowel ischaemia was diagnosed. Various aetiologies are presented in the literature. There is no specific history and physical or laboratory findings do not help to diagnose PCI. Plain abdominal film, ultrasound, computer tomography, magnetic resonance imaging, barium contrast studies and/or endoscopy may be necessary for diagnosis. Therapy is based on enhancing partial oxygen pressure in the bowel wall. PCI usually runs a benign course.

The origin of high sodium bicarbonate waters in the Atlantic and Gulf Coastal Plains

USGS Publications Warehouse

Foster, M.D.

1950-01-01

Some sodium bicarbonate waters at depth in the Atlantic and Gulf Coastal Plains have the same bicarbonate content as the shallower calcium bicarbonate waters in the same formation and appear to be the result of replacement of calcium by sodium through the action of base-exchange minerals. Others, however, contain several hundred parts per million more of bicarbonate than any of the calcium bicarbonate waters and much more bicarbonate than can be attributed to solution of calcium carbonate through the action of carbon dioxide derived from the air and soil. As the waters in the Potomac group (Cretaceous) are all low in sulphate and as the environmental conditions under which the sediments of the Potomac group were deposited do not indicate that large amounts of sulphate are available for solution, it does not seem probable that carbon dioxide generated by chemical or biochemical breakdown of sulphate is responsible for the high sodium bicarbonate waters in this area. Sulphate as a source of oxygen is not necessary for the generation of carbon dioxide by carbonaceous material. Oxygen is an important constituent of carbonaceous material and carbon dioxide is a characteristic decomposition product of such material-as, for example, peat and lignite. Experimental work showed that distilled water, calcium bicarbonate water, and sodium bicarbonate water, after contact with lignite, calcium carbonate, and permutite (a base-exchange material), had all increased greatly in sodium bicarbonate content and had become similar in chemical character and in mineral content to high sodium bicarbonate waters found in the Coastal Plain. The tests indicated that carbonaceous material can act as a source of carbon dioxide, which, when dissolved in water, enables it to take into solution more calcium carbonate. If base-exchange materials are also present to replace calcium with sodium, a still greater amount of bicarbonate can be held in solution. The presence of carbonaceous material, together with calcium carbonate and base-exchange minerals in a formation is, therefore, sufficient to account for the occurrence in it of high sodium bicarbonate waters. ?? 1950.

Cadaveric aorta implantation for aortic graft infection.

PubMed

Ali, Asad; Bahia, Sandeep S S; Ali, Tahir

2016-01-01

This case report describes a 73-year-old gentleman who underwent explantation of an infected prosthetic aorto-iliac graft and replacement with a cryopreserved thoracic and aorto-iliac allograft. The patient has been followed up a for more than a year after surgery and remains well. After elective tube graft repair of his abdominal aortic aneurysm (AAA) in 2003, he presented to our unit in 2012 in cardiac arrest as a result of a rupture of the distal graft suture line due to infection. After resuscitation he underwent aorto-bifemoral grafting using a cuff of the original aortic graft proximally. Distally the new graft was anastomosed to his common femoral arteries, with gentamicin beads left in situ. Post discharge the patient was kept under close surveillance with serial investigations including nuclear scanning, however it became apparent that his new graft was infected and that he would require aortic graft replacement, an operation with a mortality of at least 50%. The patient underwent the operation and findings confirmed a synthetic graft infection. This tube graft was explanted and a cryopreserved aorta was used to the refashion the abdominal aorta and its bifurcation. The operation required a return to theatre day one post operatively for a bleeding side branch, which was repaired. The patient went on to make a full recovery stepping down from the intensive therapy unit day 6 post operatively and went on to be discharged 32 days after his cryopreserved aorta implantation. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Exocrine pancreatic insufficiency is not a cause of abdominal complaints in patients with Fabry disease.

PubMed

Vujasinovic, Miroslav; Tepes, Bojan; Vujkovac, Bojan; Cokan Vujkovac, Andreja; Tretjak, Martin; Korat, Vesna

2015-12-01

Fabry disease (FD), also called Anderson-Fabry disease, is the second most prevalent lysosomal storage disorder after Gaucher disease. Gastrointestinal (GI) symptoms are very common among male and female individuals, although the age of onset is later among female patients. To our best knowledge, exocrine pancreatic insufficiency (EPI) has not yet been studied in patients with FD as a possible cause of abdominal complaints. The aim of our study was to determine whether exocrine pancreatic function is impaired in patients with FD. We analysed medical records of patients with FD treated in Fabry Center in Slovenj Gradec General Hospital (Slovenian referral centre for FD) by the evaluation of the following features: gender, age, first symptoms before confirmation of FD diagnosis, time interval between first symptoms and diagnosis, therapy and current abdominal complaints. Diagnosis of FD was established by genetic analysis and confirmation of mutation in the α-galactosidase A gene. Faecal elastase-1 (FE-1) measurements were performed using enzyme-linked immunosorbent assay and the commercial kit ScheBo Biotech, Giessen, Germany. There were 28 adult patients (Slovene, Caucasians) with known FD included in the study: 12 male and 16 female; mean age, 45.6 ± 14.3 (range, 19-75) years. Seventeen patients (63%) were on enzyme replacement therapy (ERT). In seven (25.9%) patients, abdominal complaints (diarrhoea, bloating and feeling of satiety) were present before introduction of ERT. In three out of these seven patients, abdominal complaints resolved after ERT, and in four patients, they were still occasionally present. FE-1 was normal in all patients (547.9 ± 104.5 µg/g). Our results show that exocrine pancreatic function is normal in all patients with FD and is most likely not a cause of abdominal complaints in this group of patients. Nevertheless, EPI still could not be completely excluded as an aetiology factor for GI problems in patients with FD because all our patients with GI problems were treated with ERT. Therefore, a potential effect of ERT on EPI cannot be excluded. Further studies are necessary to determine the aetiology, especially in the group of naïve male patients.

Effects of proposed highway embankment modifications on water-surface elevations in the lower Pearl River flood plain near Slidell, Louisiana

USGS Publications Warehouse

Gilbert, J.J.; Schuck-Kolben, R. E.

1987-01-01

Major flooding in the lower Pearl River basin in recent years has caused extensive damage to homes and highways in the area. In 1980 and 1983, Interstate Highway 10 and U.S. Highway 190 were overtopped. In 1983, the Interstate Highway 10 crossing was seriously damaged by the flood. The U.S. Geological Survey, in cooperation with the Louisiana Department of Transportation and Development, Office of Highways, used a two-dimensional finite-element surface-water flow model to evaluate the effects the proposed embankment modifications at Interstate Highway 10 and U.S. Highway 90 on the water-surface elevations in the lower Pearl River flood plain near Slidell, Louisiana. The proposed modifications that were considered for the 1983 flood are: (1) Removal of all highway embankments, the natural condition, (2) extension of the West Pearl River bridge by 1,000 feet at U.S. Highway 90, (3) construction of a new 250-foot bridge opening in the U.S. Highways 190 and 90, west of the intersection of the highways. The proposed highway bridge modifications also incorporated lowering of ground-surface elevations under the new bridges to sea level. The modification that provided the largest reduction in backwater, about 35 percent, was a new bridge in Interstate Highway 10. The modification of the West Pearl River bridge at U.S. Highway 90 and replacement of the bridge in U.S. Highway 190 provide about a 25% reduction in backwater each. For the other modification conditions that required structural modifications, maximum backwater computed on the west side of the flood plain ranges from 0.0 to 0.8 foot and on the east side from 0.0 to 0.6 foot. Results show that although backwater is greater on the west side of the flood plain than on the east side, upstream of highway embankments, backwater decreases more rapidly in the upstream direction on the west side of the flood plain than on the east side. Analysis of the proposed modifications indicates that backwater would still occur on the east and west sides of the flood plain, but values would be less than those computed with highway embankments in place. (Author 's abstract)

Surgeon specialization and operative mortality in United States: retrospective analysis

PubMed Central

Dalton, Maurice; Cutler, David M; Birkmeyer, John D; Chandra, Amitabh

2016-01-01

Objective To measure the association between a surgeon’s degree of specialization in a specific procedure and patient mortality. Design Retrospective analysis of Medicare data. Setting US patients aged 66 or older enrolled in traditional fee for service Medicare. Participants 25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13. Main outcome measure Relative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures). Results For all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure. Conclusion For several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon’s procedure specific volume as well as the degree to which a surgeon specializes in that procedure. PMID:27444190

Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007-2012).

PubMed

Higgs, Veronica A; Rudloff, Elke; Kirby, Rebecca; Linklater, Andrew K J

2015-01-01

To describe the use and outcome following autologous blood transfusion (ABT) in dogs. Retrospective study (January 2007-July 2012). Private veterinary referral center. Twenty-five dogs that underwent ABT secondary to thoracic or abdominal hemorrhage. None. The hospital transaction database was searched using the keyword "autotransfusion" from January 2007 to July 2012. Data collected included signalment, body weight, etiology of hemorrhage, source and method of collection, volumes and method of ABT administration, use of anticoagulant, reported complications, and outcome. Twenty-five dogs were included for a total of 27 ABTs. Causes of hemorrhage included vascular trauma (14/25 dogs, 56%), ruptured tumor (8/25, 32%), and coagulopathy attributed to brodifacoum toxicosis (3/25, 12%). Autologous blood was collected from the abdominal (19/25, 76%), thoracic (5/25, 20%), or abdominal and thoracic cavities (1/25, 4%). Anticoagulant was added to the ABT blood in 13 of 25 (52%) cases. A median ABT volume of 29.3 mL/kg (range 2.9-406.9 mL/kg) was infused through either a 210 μm blood administration filter (21/27, 78%) or an 18 μm hemonate filter (6/27, 22%). Reported complications that may have been associated with ABT included hypocalcemia (4/17, 24%), hemolyzed serum (5/19, 26%), and prolonged coagulation times (4/5, 80%). These complications were considered of minimal clinical significance. Additional blood products were administered in 17 of 25 (68%) dogs. Seventeen (68%) dogs survived to discharge. Cause of death in the remaining cases was euthanasia or cardiac arrest secondary to uncontrollable hemorrhage. ABT is an adjunct to volume replacement in dogs with thoracic or abdominal hemorrhage secondary to vascular trauma, ruptured tumor, or anticoagulant rodenticide toxicosis. ABT may be used as bridge to definitive hemorrhage control, particularly when other blood products are not available or affordable. Complications may include hypocalcemia, prolonged coagulation times, and hemolysis. © Veterinary Emergency and Critical Care Society 2015.

Feasibility Study of a Novel Thoraco-abdominal Aortic Hybrid Device (SPIDER-graft) in a Translational Pig Model.

PubMed

Debus, Eike S; Kölbel, Tilo; Duprée, Anna; Daum, Günter; Sandhu, Harleen K; Manzoni, Daniel; Wipper, Sabine H

2018-02-01

The hybrid SPIDER-graft consists of a proximal descending aortic stent graft and a conventional six branched Dacron graft for open abdominal aortic repair. Technical feasibility with regard to avoiding thoracotomy and extracorporeal circulation (ECC) during thoraco-abdominal aortic hybrid repair and peri-procedural safety of this novel device are unknown. This was a feasibility and safety study in domestic pigs (75-85 kg). The abdominal aorta including iliac bifurcation, left renal artery, and visceral arteries were exposed via retroperitoneal access. The right iliac branch was first temporarily anastomosed end to side to the distal aorta via partial clamping. During inflow reduction and infra-coeliac cross-clamping, the coeliac trunk (CT) was divided and the proximal stent graft portion of the SPIDER-graft was deployed into the descending aorta via the CT ostium. Retrograde visceral and antegrade aorto-iliac blood flow was maintained via the iliac side branch. The visceral, renal, and iliac arteries were sequentially anastomosed, finally replacing the first iliac end to side anastomosis. Technical success, blood flow, periods of ischaemia, and peri-procedural complications were evaluated after intra-operative completion angiography and post-operative computed tomography angiography. Six animals underwent successful thoracic stent graft deployment and distal open reconstruction without peri-operative death. The median thoracic graft implantation time was 4.5 min, and the median ischaemia times before reperfusion were 10 min for the CT, 8 min for the superior mesenteric artery, 13 min for the right renal artery, and 22 min for the left renal artery. Angiography demonstrated appropriate graft implantation and blood flow measurements confirmed sufficient blood flow through all side branches. In this translational pig model, thoraco-abdominal hybrid repair using the novel SPIDER-graft was successful in avoiding thoracotomy and ECC. Technical feasibility and safety appear promising, but need to be reassessed in humans. Copyright © 2017. Published by Elsevier Ltd.

Secured independent tools in peritoneoscopy.

PubMed

Tsin, Daniel A; Davila, Fausto; Dominguez, Guillermo; Manolas, Panagiotis

2010-01-01

Secured independent tools are being introduced to aid in peritoneoscopy. We present a simple technique for anchoring instruments, powered lights, and micro machines through the abdominal wall. We used a laparoscopic trainer, micro alligator clips with one or two 2-0 nylon tails and cables for engines and lights. The above instruments were introduced via a 12-mm or 15-mm port. Clips were placed for traction, retraction and exposure, lights for illumination, and motors for potential work. A laparoscopy port closure or suture passer was introduced percutaneously to grab and extract the tails or cables outside of the simulated abdominal cavity. The engines and lights were powered by a direct electric current (DC) plugged into exteriorized cables. We used 2 to 3 clips for each, and engines performed well. This basic simulation adds independent instruments, lights, and engines. We replaced cannulas with threads or cables in an attempt to limit the number of ports. This technique further opens the door for innovations in wired machines in laparoscopy, single-port laparoscopy, or natural orifice surgery.

Increasing the realism of a laparoscopic box trainer: a simple, inexpensive method.

PubMed

Hull, Louise; Kassab, Eva; Arora, Sonal; Kneebone, Roger

2010-01-01

Simulation-based training in medical education is increasing. Realism is an integral element of creating an engaging, effective training environment. Although physical trainers offer a low-cost alternative to expensive virtual reality (VR) simulators, many lack in realism. The aim of this research was to enhance the realism of a laparoscopic box trainer by using a simple, inexpensive method. Digital images of the abdominal cavity were captured from a VR simulator. The images were printed onto a laminated card that lined the bottom and sides of the box-trainer cavity. The standard black neoprene material that encloses the abdominal cavity was replaced with a skin-colored silicon model. The realism of the modified box trainer was assessed by surgeons, using quantitative and qualitative methodologies. Results suggest that the modified box trainer was more realistic than a standard box trainer alone. Incorporating this technique in the training of laparoscopic skills is an inexpensive means of emulating surgical reality that may enhance the engagement of the learner in simulation.

Primary Endometrial Squamous Cell Carcinoma In Situ: Report of a rare disease.

PubMed

Jetley, Sujata; Jairajpuri, Zeeba S; Hassan, Mohammad J; Madaan, Garima; Jain, Reena

2015-11-01

Squamous cell carcinoma (SCC) of the endometrium, whether primary or secondary to cervical cancer, is a rare entity. Primary endometrial squamous cell carcinoma in situ is even more uncommon; it usually occurs in postmenopausal women and has a strong association with pyometra. We report a 60-year-old multiparous postmenopausal woman who presented to the Hakeem Abdul Hameed Centenary Hospital, New Delhi, India, in May 2014 with a lower abdominal swelling corresponding in size to a pregnancy of 26 gestational weeks and vaginal discharge of one year's duration. A total abdominal hysterectomy with a bilateral salpingooophorectomy was performed, which revealed an enlarged uterus with pyometra. Histopathology showed that the entire endometrial lining had been replaced with malignant squamous cells without invasion of the myometrium. Immunohistochemistry revealed that the tumour cells were positive for p63 with a high Ki-67 labelling index. No adjuvant therapy was required and the patient was disease-free at a seven-month follow-up.

Blunt-tip coaxial introducer: a revisited tool for difficult CT-guided biopsy in the chest and abdomen.

PubMed

de Bazelaire, Cedric; Farges, Cecile; Mathieu, Olivier; Zagdanski, Anne-Marie; Bourrier, Pierre; Frija, Jacques; de Kerviler, Eric

2009-08-01

We describe a coaxial introducer provided with an additional blunt-tip stylet that allows safe access to difficult-to-reach lymph nodes in the chest, abdomen, and pelvis under CT control. Once the thoracic, abdominal, or pelvic wall is crossed by the introducer fitted with the sharp-tip stylet, the blunt-tip stylet replaces the sharp stylet for further progression in the fat toward the target. The soft-tip stylet carries a smaller risk of inadvertent perforation displacing vital structures.

Plastic efficiency of different implants used for repair of soft and bone tissue defects.

PubMed

Iriyanov, Yu M; Chernov, V F; Radchenko, S A; Chernov, A V

2013-08-01

The results of clinical and experimental morphological studies of regenerates forming after replacement of large defects of the abdominal wall and tibia with implants from different materials (polytetrafluoroethylene, reperene, prolene, titanium, and titanium nickelide) are analyzed. Study of the regenerate histology and fibroarchitectonics has shown good prospects of mesh constructions from titanium nickelide for effective surgical repair of these defects. The use of this implant seems to be theoretically well-based and promising, particularly under conditions of suppurative infection and low individual reparative regenerative potential.

Deletion Analysis of the Tumorous-Head (tuh–3) Gene in DROSOPHILA MELANOGASTER

PubMed Central

Kuhn, David T.; Woods, Daniel F.; Andrew, Deborah J.

1981-01-01

In the presence of the naturally occurring maternal-effect alleles tuh-1h or tuh-1g, the tuh-3 mutant gene can cause the tumorous-head trait or the sac-testis trait. The tuh-3 gene functions as a semidominant in the presence of the tuh-1h maternal effect. Eye-antennal structures are replaced by posterior abdominal tergites and genital structures. If tuh-1h is replaced by its naturally occurring allele tuh-1g, tuh-3 functions as a recessive hypomorph and the defect switches from anterior to posterior structures, with a male genital-disc defect appearing with variable penetrance. Function and regulation of tuh-3+ may better be understood in light of the cytological localization of tuh-3 either adjacent to or as part of the bithorax complex. The tuh-3+ gene product appears to be essential for normal development, at least in the posterior end of the embryo. PMID:6804305

Diagnostic utility of attenuation measurement (Hounsfield units) in computed tomography stonogram in predicting the radio-opacity of urinary calculi in plain abdominal radiographs.

PubMed

Chua, Michael E; Gatchalian, Glenn T; Corsino, Michael Vincent; Reyes, Buenaventura B

2012-10-01

(1) To determine the best cut-off level of Hounsfield units (HU) in the CT stonogram that would predict the appearance of a urinary calculi in plain KUB X-ray; (2) to estimate the sensitivity and specificity of the best cut-off HU; and (3) to determine whether stone size and location affect the in vivo predictability. A prospective cross-sectional study of patients aged 18-85 diagnosed with urolithiases on CT stonogram with concurrent plain KUB radiograph was conducted. Appearance of stones was recorded, and significant difference between radiolucent and radio-opaque CT attenuation level was determined using ANOVA. Receiver operating characteristics (ROC) curve determined the best HU cut-off value. Stone size and location were used for factor variability analysis. A total of 184 cases were included in this study, and the average urolithiasis size on CT stonogram was 0.84 cm (0.3-4.9 cm). On KUB X-ray, 34.2 % of the urolithiases were radiolucent and 65.8 % were radio-opaque. Mean value of CT Hounsfield unit for radiolucent stones was 358.25 (±156), and that for radio-opaque stones was 816.51 (±274). ROC curve determined the best cut-off value of HU at 498.5, with the sensitivity of 89.3 % and specificity of 87.3 %. For >4 mm stones, the sensitivity was 91.3 % and the specificity was 81.8 %. On the other hand, for =<4 mm stones, the sensitivity was 60 % and the specificity was 89.5 %. Based on the constructed ROC curve, a threshold value of 498.5 HU in CT stonogram was established as cut-off in determining whether a calculus is radio-opaque or radiolucent. The determined overall sensitivity and specificity of the set cut-off HU value are optimal. Stone size but not location affects the sensitivity and specificity.

Homeothermy and primate bipedalism: is water shortage or solar radiation the main threat to baboon (Papio hamadryas) homeothermy?

PubMed

Mitchell, Duncan; Fuller, Andrea; Maloney, Shane K

2009-05-01

Other than the hominin lineage, baboons are the diurnally active primates that have colonized the arid plains of Africa most successfully. While the hominin lineage adopted bipedalism before colonizing the open, dry plains, baboons retained a quadrupedal mode of locomotion. Because bipedalism has been considered to reduce the thermoregulatory stress of inhabiting open dry plains, we investigated how baboons cope with thermal loads and water restriction. Using implanted data loggers, we measured abdominal temperature every 5 min in six unrestrained baboons while they were exposed to simulated desert conditions (15 degrees C at night rising to 35 degrees C during the day, with and without extra radiant heating), or an ambient temperature of 22 degrees C. At 22 degrees C, core temperature averaged 37.9 degrees C and cycled nychthemerally by 1.7 degrees C. Mean, minimum, and maximum daily core temperatures in euhydrated baboons in the simulated desert environments did not differ from the temperatures displayed in the 22 degrees C environment, even when radiant heating was applied. At 22 degrees C, restricting water intake did not affect core temperature. During the desert simulations, maximum core temperature increased significantly on each day of water deprivation, with the highest temperatures (>40 degrees C) on the third day in the simulation that included radiant heat. When drinking water heated to 38 degrees C was returned, core temperature decreased rapidly to a level lower than normal for that time of day. We conclude that baboons with access to water can maintain homeothermy in the face of high air temperatures and radiant heat loads, but that a lack of access to drinking water poses a major threat to baboon homeothermy. We speculate that any competitive thermoregulatory advantage of bipedalism in early hominins was related to coping with water shortage in hot environments, and that their freed hands might have enabled them to transport enough water to avoid dangerous hyperthermia.

Ground-water flow, geochemistry, and effects of agricultural practices on nitrogen transport at study sites in the Piedmont and Coastal Plain physiographic provinces, Patuxent River basin, Maryland

USGS Publications Warehouse

McFarland, Randolph E.

1997-01-01

In an effort to improve water quality in Chesapeake Bay, agricultural practices are being promoted that are intended to reduce contaminant transport to the Bay. The effects of agricultural practices on nitrogen transport were assessed at two 10-acre study sites in the Patuxent River basin, Maryland, during 1986-92. Nitrogen load was larger in ground water than in surface runoff at both sites. At the study site in the Piedmont Province, nitrogen load in ground water decreased from 12 to 6 (lb/acre)/yr (pound per acre per year) as corn under no-till cultivation was replaced by no-till soybeans, continuous alfalfa, and contoured strip crops alternated among corn, alfalfa, and soybeans. At the study site in the Coastal Plain Province, no-till soybeans resulted in a nitrogen load in ground water of 12.55 (lb/acre)/yr, whereas conventional-till soybeans resulted in a nitrogen load in ground water of 11.51 (lb/acre)/yr.

Institution Morphisms

NASA Technical Reports Server (NTRS)

Goguen, Joseph; Rosu, Grigore; Norvig, Peter (Technical Monitor)

2001-01-01

Institutions formalize the intuitive notion of logical system, including both syntax and semantics. A surprising number of different notions of morphisim have been suggested for forming categories with institutions as objects, and a surprising variety of names have been proposed for them. One goal of this paper is to suggest a terminology that is both uniform and informative to replace the current rather chaotic nomenclature. Another goal is to investigate the properties and interrelations of these notions. Following brief expositions of indexed categories, twisted relations, and Kan extensions, we demonstrate and then exploit the duality between institution morphisms in the original sense of Goguen and Burstall, and the 'plain maps' of Meseguer, obtaining simple uniform proofs of completeness and cocompleteness for both resulting categories; because of this duality, we prefer the name 'comorphism' over 'plain map.' We next consider 'theoroidal' morphisms and comorphisims, which generalize signatures to theories, finding that the 'maps' of Meseguer are theoroidal comorphisms, while theoroidal morphisms are a new concept. We then introduce 'forward' and 'semi-natural' morphisms, and appendices discuss institutions for hidden algebra, universal algebra, partial equational logic, and a variant of order sorted algebra supporting partiality.

A warm thermal enclave in the late Pleistocene of the south-eastern United States.

PubMed

Russell, Dale A; Rich, Fredrick J; Schneider, Vincent; Lynch-Stieglitz, Jean

2009-05-01

Physical and biological evidence supports the probable existence of an enclave of relatively warm climate located between the Southern Appalachian Mountains and the Atlantic Ocean in the United States during the Last Glacial Maximum. The region supported a mosaic of forest and prairie habitats inhabited by a "Floridian" ice-age biota. Plant and vertebrate remains suggest an ecological gradient towards Cape Hatteras (35 degreesN) wherein forests tended to replace prairies, and browsing proboscideans tended to replace grazing proboscideans. Beyond 35 degreesN, warm waters of the Gulf Stream were deflected towards the central Atlantic, and a cold-facies biota replaced "Floridian" biota on the Atlantic coastal plain. Because of niche diversity and relatively benign climate, biodiversity may have been greater in the south-eastern thermal enclave than in other unglaciated areas of North America. However, the impact of terminal Pleistocene megafaunal extinctions may also have been shorter and more severe in the enclave than further north. A comparison with biotic changes that occurred in North America approximately 55 million years (ma) ago at the Paleocene-Eocene Thermal Maximum suggests that similar processes of change took place under both ice-house and greenhouse climates.

Use of cryopoor plasma for albumin replacement and continuous antimicrobial infusion for treatment of septic peritonitis in a dog.

PubMed

Ropski, Meaghan K; Guillaumin, Julien; Monnig, Andrea A; Townsend, Katy; McLoughlin, Mary A

2017-05-01

To report the successful management of a dog with septic peritonitis and septic shock secondary to enterectomy dehiscence using novel techniques for identification of intestinal dehiscence and for septic shock treatment. A 5-year-old castrated male Bernese Mountain Dog presented for lethargy 6 days following enterotomy for foreign body obstruction. Septic peritonitis was identified due to dehiscence of the enterotomy site, and resection and anastomosis were performed using a gastrointestinal anastomosis and thoracoabdominal stapling device. Postoperatively the patient experienced severe hypotension, which responded to norepinephrine constant rate infusion (CRI) after failing to improve with fluid therapy or dopamine CRI. Further treatment included antimicrobial CRI and supportive care including careful fluid therapy. Due to low effective circulating volume paired with intersititial fluid overload and large volume abdominal effusion, fluid therapy consisted of a combination of human serum albumin, canine albumin, synthetic colloids, and isotonic crystalloids. Cryopoor plasma (CPP) was used as a source of canine albumin and intravascular volume. On Day 4, food dye was given through a nasogastric tube due to suspicion of dehiscence of the anastomosis site. Dehiscence was confirmed during abdominal exploratory, and a second resection and anastomosis was performed. Abdominal partial closure with vacuum-assisted closure device was performed. Supportive care was continued with CPP CRI and imipenem CRI. Planned relaparotomy to change the vacuum-assisted closure device was performed 48 hours later, with abdominal closure 96 hours after anastomosis. The patient was discharged on Day 15. Recheck 12 months later was normal. This case includes novel techniques such food dye via nasogastric tube to identify anastomosis dehiscence, use of CPP as a source of canine albumin, and antimicrobial CRI in a dog with septic peritonitis. © Veterinary Emergency and Critical Care Society 2017.

Improvement of Fabry Disease-Related Gastrointestinal Symptoms in a Significant Proportion of Female Patients Treated with Agalsidase Beta: Data from the Fabry Registry.

PubMed

Wilcox, William R; Feldt-Rasmussen, Ulla; Martins, Ana Maria; Ortiz, Alberto; Lemay, Roberta M; Jovanovic, Ana; Germain, Dominique P; Varas, Carmen; Nicholls, Katherine; Weidemann, Frank; Hopkin, Robert J

2018-01-01

Fabry disease, an X-linked inherited lysosomal storage disorder, is caused by mutations in the gene encoding α-galactosidase, GLA. In patients with Fabry disease, glycosphingolipids accumulate in various cell types, triggering a range of cellular and tissue responses that result in a wide spectrum of organ involvement. Although variable, gastrointestinal symptoms are among the most common and significant early clinical manifestations; they tend to persist into adulthood if left untreated. To further understand the effects of sustained enzyme replacement therapy (ERT) with agalsidase beta on gastrointestinal symptoms in heterozygotes, a data analysis of female patients enrolled in the Fabry Registry was conducted. To be included, females of any age must have received agalsidase beta (average dose 1.0 mg/kg every 2 weeks) for at least 2.5 years. Measured outcomes were self-reported gastrointestinal symptoms (abdominal pain, diarrhea). Outcomes at baseline and last follow-up, and their change from baseline to last follow-up, were assessed. Relevant data were available for 168 female patients. Mean age at the start of ERT was 43 years and mean treatment duration 5.7 years. Baseline pre-treatment abdominal pain was reported by 45% of females and diarrhea by 39%. At last follow-up, 31% reported abdominal pain (p < 0.01) and 27% diarrhea (p < 0.01). The results of this Fabry Registry analysis suggest that while on sustained treatment with agalsidase beta (1.0 mg/kg every 2 weeks), both abdominal pain and diarrhea improved in many female patients with Fabry disease.

Challenges in the repair of large abdominal wall hernias in Nigeria: review of available options in resource limited environments.

PubMed

Ezeome, E R; Nwajiobi, C E

2010-06-01

To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.

Percutaneous debridement and washout of walled-off abdominal abscess and necrosis using flexible endoscopy: a large single-center experience.

PubMed

Mathers, Bradley; Moyer, Matthew; Mathew, Abraham; Dye, Charles; Levenick, John; Gusani, Niraj; Dougherty-Hamod, Brandy; McGarrity, Thomas

2016-01-01

Direct percutaneous endoscopic necrosectomy has been described as a minimally invasive intervention for the debridement of walled-off pancreatic necrosis (WOPN). In this retrospective cohort study, we aimed to confirm these findings in a US referral center and evaluate the clinical value of this modality in the treatment of pancreatic necrosis as well as other types of intra-abdominal fluid collections and necrosis. Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent computed tomography (CT)-guided drainage catheter placement. Each patient then underwent direct percutaneous endoscopic necrosectomy and washout with repeat debridement performed until complete. Drains were then removed once output fell below 30 mL/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution and sustained resolution at 1-year follow up.  Ten patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. The median time to intervention was 85 days with an average of 2.3 necrosectomies performed. Complete removal of drains was accomplished in 11 patients (92 %). The median time to resolution was 57 days. No serious adverse events occurred; however, one patient developed pancreaticocutaneous fistulas. Ten patients completed 1-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy. This series supports the premise that direct percutaneous endoscopic necrosectomy is a safe and effective intervention for intra-abdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal adverse events. This modality offers several potential advantages over surgical and transgastric approaches including use of improved accessibility, an excellent safety profile, and requirement for only deep or moderate sedation.

A case of gastric hamartomatous inverted polyp resected endoscopically

PubMed Central

Dohi, Moyu; Gen, Yasuyuki; Yoshioka, Mika

2016-01-01

We report the case of a 55-year-old woman with a tumor in the greater curvature of the upper gastric body. The tumor was incidentally found on an upper gastrointestinal X-ray series performed during a routine medical examination. Whereas endoscopy revealed a gastric submucosal tumor (SMT), endoscopic ultrasonography demonstrated a heterogeneous tumor with small, cystic, hypoechoic spots originating from the second layer. The patient was clinically asymptomatic, with no contributory family history or abnormal laboratory data. The results of a physical examination, abdominal computed tomography, and plain chest radiography were all unremarkable. Although the endoscopic tumor type was determined to be SMT, the tumor was successfully resected by endoscopic submucosal dissection (ESD) and subsequently diagnosed as a gastric hamartomatous inverted polyp (GHIP). The findings of the present case highlight the importance of considering GHIP as a diagnosis and indicate the utility of en bloc resection of GHIP with ESD. PMID:27556064

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

PubMed Central

Ikegami, Akiko; Kondo, Takeshi; Tsukamoto, Tomoko; Ohira, Yoshiyuki; Ikusaka, Masatomi

2015-01-01

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome. PMID:25802794

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rossi, Plinio; Arata, Flaminia Marcella; Bonaiuti, Paola

Purpose: To report the risk of fatal atrial migration with the Tempofilter. Methods: Among temporary filters, the high safety profile Tempofilter has been marketed as offering protection for up to 6 weeks. We implanted about 60 Tempofilters to prevent pulmonary embolism. The main indications were temporary thromboembolic risk, recurrent pulmonary embolism, and contraindication to or failure of anticoagulant therapy. Follow-up was performed regularly by plain abdominal film and Doppler ultrasound. Filters were removed about 4 weeks after placement. Results: We encountered three cases (5%) of atrial migration and one case of 5-cm cephalad displacement of the filter. Of the threemore » patients with atrial migration, two died within 3 days of implantation, one from a massive pulmonary embolism and the other with cardiac tamponade. One patient did not show any serious complications. Conclusions: The Tempofilter may actively migrate cranially and become dangerous in the case of migration within the heart.« less

Armored brain: A case report and review of the literature

PubMed Central

Petraglia, Anthony L.; Moravan, Michael J.; Jahromi, Babak S.

2011-01-01

Background: Calcified chronic subdural hematomas occur infrequently. When the calcifications are extensive and bilateral, the condition is termed “armored brain”. We describe a case of “armored brain” incidentally discovered in an adult presenting with abdominal pain and mild headaches, long after initial placement of a ventriculo-peritoneal (VP) shunt. Case Description: A 38-year-old woman, treated at infancy with a VP shunt, presented with a 2-month history of abdominal pain associated with nausea and chills. She was neurologically intact on exam. An abdominal computed tomography (CT) scan demonstrated a rim-enhancing loculated fluid collection surrounding the patient's distal VP shunt catheter tip. As a part of her initial work-up, she received a head CT to evaluate the proximal VP shunt, which demonstrated large bilateral chronic subdural hematomas with heavily calcified walls. She was eventually taken to the operating room (OR) for replacement of the distal catheter. It was felt that her acute clinical presentation was unrelated to the bilateral, calcified subdural hematomas and thus the decision was made to manage them conservatively. Conclusions: This rare complication of chronic shunting for hydrocephalus is sometimes referred to as armored brain. Surgery for armored brain is infrequently indicated and beneficial in only small subgroup of patients, with management guided by clinical presentation. Our patient fully recovered after shunt revision alone. PMID:21918735

Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review.

PubMed

Baptista, Mariana Andrade; Lo, Denise Swei; Hein, Noely; Hirose, Maki; Yoshioka, Cristina Ryoka Miyao; Ragazzi, Selma Lopes Betta; Gilio, Alfredo Elias; Ferronato, Angela Esposito

2014-01-01

Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO), this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT) are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD), although the main etiologic agent of liver abscesses in childhood is S taphylococcus aureus . Differential diagnosis by clinical and epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses.

Aortoiliac aneurysm with congenital right pelvic kidney.

PubMed

Date, Kazuma; Okada, Shuuichi; Ezure, Masahiko; Takihara, Hitomi; Okonogi, Shuuichi; Hasegawa, Yutaka; Sato, Yasushi; Kaneko, Tatsuo

2015-05-01

The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54 mm and a right common iliac aneurysm of 45 mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

PubMed

Tokuda, Yoshiyuki; Oshima, Hideki; Araki, Yoshimori; Narita, Yuji; Mutsuga, Masato; Kato, Katsuhiko; Usui, Akihiko

2013-06-01

To investigate the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting thoracic aortic prosthetic graft infection. Nine patients with clinically suspected thoracic aortic graft infection underwent FDG-PET/CT scanning. In these patients, the diagnoses could not be confirmed using conventional modalities. The patients' clinical courses were retrospectively reviewed. On the basis of surgical, microbiological and clinical follow-up findings, the aortic grafts were considered infected in 4 patients and not infected in 5. All 4 patients with graft infection (root: 2 cases, arch: 1 case and descending: 1 case) eventually underwent in situ re-replacement. Two of the 4 patients also had abdominal grafts; however, only the thoracic grafts were replaced because uptake was low around the abdominal grafts. The maximal standardized uptake value (SUVmax) in the perigraft area was higher in the infected group than in the non-infected group (11.4 ± 4.5 vs 6.9 ± 6.4), although the difference was not statistically significant. According to the receiver operating characteristic analysis, SUVmax >8 appeared to be the cut-off value in distinguishing the two groups (sensitivity: 1.0 and specificity: 0.8). FDG-PET/CT is useful for confirming the presence of graft infection by detecting high uptake around grafts and excluding other causes of inflammation. An SUVmax value greater than 8 around a graft suggests the presence of graft infection. In addition, FDG-PET/CT can be used to clarify the precise extent of infection. This is especially useful if multiple separated prosthetic grafts have been implanted.

Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report.

PubMed

Omata, Jiro; Utsunomiya, Katsuyuki; Kajiwara, Yoshiki; Takahata, Risa; Miyasaka, Nobuo; Sugasawa, Hidekazu; Sakamoto, Naoko; Yamagishi, Yoji; Fukumura, Makiko; Kitagawa, Daiki; Konno, Mitsuhiko; Okusa, Yasushi; Murayama, Michinori

2016-12-01

A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.

The Stranded Stone: Relationship Between Acute Appendicitis and Appendicolith

PubMed Central

Aljefri, Ahmad; Al-Nakshabandi, Nizar

2009-01-01

Background/Aim: To examine the relationship between acute appendicitis and the presence of an appendicolith in abdominal CT scans of patients attending emergency services. Materials and Methods: Abdominal CT scan reports were retrospectively reviewed for 267 patients through the PACS database. A 16-slices MDCT GE Light Speed scanner (Milwaukee WI) was used with a scanning protocol of 5 mm axial collimation and a pitch of 1.0, along with oral contrast material (Gastrografin 3.7% diatrizoate meglumine) and 140 mL of intravenous (IV) nonionic contrast material (Omnipaque). Particular attention was given to the study protocol, patients' age, and gender. Statistical Analysis: We used MS-EXCEL and SPSS version 12.0 to perform chi-square and Fisher's exact tests. Bookends and Papers, components in Mac OS X software, were used for literature reviews and the organization of results. Results: Two hundred and sixty-seven abdominal CT scan reports were examined along side their respective images on a GE Centricity workstation. Thirty-four (12.7%) were labeled as acute appendicitis cases based on the CT findings and the rest were assigned other diagnoses. Twenty-six of the 267 CT scan reports were plain studies and 241 were contrast-enhanced scans. Less than half of the patients (123, 46.1%) were males and 144 (53.9%) were females. Thirteen males (48.1%) and 14 (51.9%) females were found to have an appendicolith. Only 3% in the ≤ 11 years' age group, in contrast to 40% in the 11-20 years' age group, was diagnosed with appendicitis. The incidence in other age groups was as follows: 19% in the 21-30, 14% in the 31-40, 2.5% in the 41-50, 8% each in the 51-60 and 61-70, and none in the ≥71 years' age groups. Conclusions: We conclude that the presence of an appendicolith i) has no particular predilection for gender or age, and ii) is not associated with a diagnosis of appendicitis. PMID:19794272

Factors influencing the restoration of fluid and electrolyte balance after exercise in the heat.

PubMed Central

Maughan, R J; Leiper, J B; Shirreffs, S M

1997-01-01

Maintenance of fluid balance is a major concern for all athletes competing in events held in hot climates. This paper reviews recent work relating to optimisation of fluid replacement after sweat loss induced by exercising in the heat. Data are taken from studies undertaken in our laboratory. Issues investigated were drink composition, volume consumed, effects of consuming food with a drink, effects of alcohol in rehydration effectiveness, voluntary intake of fluid, and considerations for women related to the menstrual cycle. The results are presented as a series of summaries of experiments, followed by a discussion of the implications. The focus of this review is urine output after ingestion of a drink; fluid excreted in urine counteracts rehydration. Also included are data on the restoration of plasma volume losses. Ingestion of large volumes of plain water will inhibit thirst and will also promote a diuretic response. If effective rehydration is to be maintained for some hours after fluid ingestion, drinks should contain moderately high levels of sodium (perhaps as much as 50-60 mmol/l) and possibly also some potassium to replace losses in the sweat. To surmount ongoing obligatory urine losses, the volume consumed should be greater than the volume of sweat lost. Palatability of drinks is important in stimulating intake and ensuring adequate volume replacement. Where opportunities allow, the electrolytes required may be ingested as solid food consumed with a drink. There are no special concerns for women related to changes in hormone levels associated with the menstrual cycle. Ingestion of carbohydrate-electrolyte drinks in the post-exercise period restores exercise capacity more effectively than plain water. The effects on performance of an uncorrected fluid deficit should persuade all athletes to attempt to remain fully hydrated at all times, and the aim should be to start each bout of exercise in a fluid replete state. This will only be achieved if a volume of fluid in excess of the sweat loss is ingested together with sufficient electrolytes. PMID:9298549

Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes.

PubMed

Baharestani, Mona Mylene; Gabriel, Allen

2011-04-01

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases. © 2010 The Authors. © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Hybrid pregnant reference phantom series based on adult female ICRP reference phantom

NASA Astrophysics Data System (ADS)

Rafat-Motavalli, Laleh; Miri-Hakimabad, Hashem; Hoseinian-Azghadi, Elie

2018-03-01

This paper presents boundary representation (BREP) models of pregnant female and her fetus at the end of each trimester. The International Commission on Radiological Protection (ICRP) female reference voxel phantom was used as a base template in development process of the pregnant hybrid phantom series. The differences in shape and location of the displaced maternal organs caused by enlarging uterus were also taken into account. The CT and MR images of fetus specimens and pregnant patients of various ages were used to replace the maternal abdominal pelvic organs of template phantom and insert the fetus inside the gravid uterus. Each fetal model contains 21 different organs and tissues. The skeletal model of the fetus also includes age-dependent cartilaginous and ossified skeletal components. The replaced maternal organ models were converted to NURBS surfaces and then modified to conform to reference values of ICRP Publication 89. The particular feature of current series compared to the previously developed pregnant phantoms is being constructed upon the basis of ICRP reference phantom. The maternal replaced organ models are NURBS surfaces. With this great potential, they might have the feasibility of being converted to high quality polygon mesh phantoms.

Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children.

PubMed

Ameh, E A; Nmadu, P T

2000-01-01

In developed countries, intestinal volvulus in children is most frequently due to malrotation. To review the experience in Nigeria, a retrospective analysis of 28 patients managed over 25 years at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. There were 22 boys and 6 girls with an age range of 4 days to 14 years (median 4 years). There were equal numbers over and less than 5 years of age. Vomiting (89%) and abdominal distension (79%) were the most prominent features. Thirteen children (46%) had fever, associated with bowel gangrene in 5, while 8 (29%) presented with severe dehydration and shock. A plain abdominal radiograph was the only investigation performed, but the features were not specific for volvulus. In 11 children (39%) the volvulus was idiopathic, in 9 (32%) due to adhesions or bands, in 5 (18%) to malrotation, and in 1 each a Meckel's diverticulum, internal herniation, and ventriculoperitoneal shunt. Twenty-three patients had a small-bowel, 4 sigmoid, and 1 caecal volvulus. The bowel resection rate for gangrene was 46% (small bowel 9, sigmoid 3, caecum 1). All patients with malrotation had Ladd's procedure performed. Wound infections occurred in 10 patients (36%), complete wound dehiscence in 1, and recurrence in 1 (idiopathic terminal ileal volvulus). The mortality was 21%, mostly from overwhelming infection (2 neonates, 11-year-old, 3 >/= 5 years). Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are similar, however. This condition carries high morbidity and mortality.

Utility of CT in the diagnosis and management of small-bowel obstruction in children.

PubMed

Wang, Qiuyan; Chavhan, Govind B; Babyn, Paul S; Tomlinson, George; Langer, Jacob C

2012-12-01

CT is often used in the diagnosis and management of small-bowel obstruction in children. To determine sensitivity of CT in delineating presence, site and cause of small-bowel obstruction in children. We retrospectively reviewed the CT scans of 47 children with surgically proven small-bowel obstruction. We noted any findings of obstruction and the site and cause of obstruction. Presence, absence or equivocal findings of bowel obstruction on abdominal radiographs performed prior to CT were also noted. We reviewed patient charts for clinical details and surgical findings, including bowel resection. Statistical analysis was performed using Fisher exact test to determine which CT findings might predict bowel resection. CT correctly diagnosed small-bowel obstruction in 43/47 (91.5%) cases. CT correctly indicated site of obstruction in 37/47 (78.7%) cases and cause of obstruction in 32/47 (68.1%) cases. Small-bowel feces sign was significantly associated with bowel resection at surgery (P = 0.0091). No other CT finding was predictive of bowel resection. Out of 41 children who had abdominal radiographs before CT, 29 (70.7%) showed unequivocal obstruction, six (14.6%) showed equivocal findings and six (14.6%) were unremarkable. CT is highly sensitive in diagnosing small-bowel obstruction in children and is helpful in determining the presence of small-bowel obstruction in many clinically suspected cases with equivocal or normal plain radiographs. CT also helps to determine the site and cause of the obstruction with good sensitivity.

Silk fibroin hydrogel as physical barrier for prevention of post hernia adhesion.

PubMed

Konar, S; Guha, R; Kundu, B; Nandi, S; Ghosh, T K; Kundu, S C; Konar, A; Hazra, S

2017-02-01

Adhesion formation remains a major complication following hernia repair surgery. Physical barriers though effective for adhesion prevention in clinical settings are associated with major disadvantages, therefore, needs further investigation. This study evaluates silk fibroin hydrogel as a physical barrier on polypropylene mesh for the prevention of adhesion following ventral hernia repair. Peritoneal explants were cultured on silk fibroin scaffold to evaluate its support for mesothelial cell growth. Full thickness uniform sized defects were created on the ventral abdominal wall of rabbits, and the defects were covered either with silk hydrogel coated polypropylene mesh or with plain polypropylene mesh as a control. The animals were killed after 1 month, and the adhesion formation was graded; healing response of peritoneum was evaluated by immunohistochemistry with calretinin, collagen staining of peritoneal sections, and expression of PCNA, collagen-I, TNFα, IL6 by real time PCR; and its adverse effect if any was determined. Silk fibroin scaffold showed excellent support for peritoneal cell growth in vitro and the cells expressed calretinin. A remarkable prevention of adhesion formation was observed in the animals implanted with silk hydrogel coated mesh compared to the control group; in these animals peritoneal healing was complete and predominantly by mesothelial cells with minimum fibrotic changes. Expression of inflammatory cytokines decreased compared to control animals, histology of abdominal organs, haematological and blood biochemical parameters remained normal. Therefore, silk hydrogel coating of polypropylene mesh can improve peritoneal healing, minimize adhesion formation, is safe and can augment the outcome of hernia surgery.

Notes on the Reproductive Ecology and Description of the Preimaginal Morphology of Elaphrus sugai Nakane, the Most Endangered Species of Elaphrus Fabricius (Coleoptera: Carabidae) Ground Beetle Worldwide.

PubMed

Sasakawa, Kôji

2016-01-01

Elucidating the basic life-history of endangered species is the first important step in the conservation of such species. This study examined the reproductive ecology and the preimaginal morphology of the endangered ground beetle Elaphrus sugai Nakane (Coleoptera: Carabidae); currently, the Watarase wetland of the central Kanto Plain, Japan is the only confirmed locality of this beetle species. Laboratory rearing of reproductive adults collected in early April revealed that females can lay more than 131 eggs. Eggs were laid in mud, without an egg chamber. Larvae reached adulthood when fed a diet of mealworms, indicating that E. sugai larvae are insect larvae feeders. An earthworm diet, the optimal diet for larvae of a congeneric species (E. punctatus Motschulsky), was lethal to E. sugai larvae. The egg stage was 3-4 days in duration under a 16L8D cycle (22°C). The duration from hatching to adult eclosion was 23-42 days at various temperatures simulating those of the reproductive period. Larval morphology was similar to that of consubgeneric species described previously. The pupa is unusual, in that the setae on the abdominal tergites are long (twice as long as those of the abdominal segment) and have somewhat "coiled" apices. Finally, the current endangered status of E. sugai was compared to that of E. viridis Horn, which has been regarded as the most endangered species of the genus worldwide.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

PubMed

Yazgan, Cisel; Aksu, Nalan M

2016-06-01

To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.

Acute urinary retention in a pre-school girl with constipation

PubMed Central

Traslaviña, Guillermo A. Ariza; Ciampo, Luiz Antonio Del; Ferraz, Ivan Savioli

2015-01-01

Objective: To report a case of a preschool girl who developed acute urinary retention associated with constipation. Case description: A girl aged six years old presented a 24 h history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 h after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. Comments: Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause. PMID:26298658

[Cocaine smuggling in the gastrointestinal tract--the case report with the review of literature].

PubMed

Ciszowski, Krzysztof; Hydzik, Piotr; Waldman, Wojciech; Sein Anand, Jacek

2005-01-01

Body-packing is the way of psychoactive substances smuggling by swallowing of carefully prepared packages with drugs into the gastrointestinal tract or by insertion them into the vagina or the rectum, especially in order to avoid finding them by the custom service. Cocaine, as well as opiates, is the one of the most often smuggled drugs by so called body-packers. In the present study the first case of the body-packer from Malopolska region in Poland, who was observed in the Toxicology Department of the Collegium Medicum UJ, was described. The 29-year-old man swallowed 60 packages containing cocaine with a total net weight of about 500 grams. The plain abdominal radiography revealed multiple shadows of foreign bodies in the gastrointestinal tract, but the results of blood and urine cocaine measurements were negative. During the 37-hours stay in our department the patient was monitored (blood pressure, heart rate, temperature), laxatives and oral fluids were administered. All the packages were evacuated through the natural way and it was followed up by the control abdominal radiography. No symptoms of acute cocaine intoxication or any other complications were observed. According to the case there is also the thorough review of literature presented including the kinds of body-packing, the diagnostic methods used in recognizing of body-packers and the ways of their treatment taking into consideration the conservative management as well as surgical methods.

Obturator hernia: A diagnostic challenge.

PubMed

Kulkarni, Sanjeev R; Punamiya, Aditya R; Naniwadekar, Ramchandra G; Janugade, Hemant B; Chotai, Tejas D; Vimal Singh, T; Natchair, Arafath

2013-01-01

Obturator hernia is an extremely rare type of hernia with relatively high mortality and morbidity. Its early diagnosis is challenging since the signs and symptoms are non specific. Here in we present a case of 70 years old women who presented with complaints of intermittent colicky abdominal pain and vomiting. Plain radiograph of abdomen showed acute dilatation of stomach. Ultrasonography showed small bowel obstruction at the mid ileal level with evidence of coiled loops of ileum in pelvis. On exploration, Right Obstructed Obturator hernia was found. The obstructed Intestine was reduced and resected and the obturator foramen was closed with simple sutures. Postoperative period was uneventful. Obturator hernia is a rare pelvic hernia and poses a diagnostic challenge. Obturator hernia occurs when there is protrusion of intra-abdominal contents through the obturator foramen in the pelvis. The signs and symptoms are non specific and generally the diagnosis is made during exploration for the intestinal obstruction, one of the four cardinal features. Others are pain on the medial aspect of thigh called as Howship Rombergs sign, repeated attacks of Intestinal Obstruction and palpable mass on the medial aspect of thigh. Obturator hernia is a rare but significant cause of intestinal obstruction especially in emaciated elderly woman and a diagnostic challenge for the Doctors. CT scan is valuable to establish preoperative diagnosis. Surgery either open or laproscopic, is the only treatment. The need for the awareness is stressed and CT scan can be helpful. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

[Xanthogranulomatous pyelonephritis in a child with severe malnutrition and recurrent fever].

PubMed

Gramage Tormo, J; Gavilán Martín, C; Atienza Almarcha, T

2015-01-01

Xanthogranulomatous pyelonephritis is a rare inflammatory disease, characterized by replacement of renal parenchyma with granulomatous tissue. Initial clinical presentation includes abdominal pain and constitutional symptoms related to recurrent urinary infections. The microorganisms most commonly involved are Escherichia coli and Proteus mirabilis. Final diagnosis is made by histopathology, and the only curative treatment is total or partial nephrectomy. A recently diagnosed case in our unit is presented, as well as an update on the knowledge of this disease. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Leaflet embolisation from Duromedics valves: a report of two cases.

PubMed

Kumar, N; Balasundaram, S; Rickard, M; al Halees, Z; Duran, C M

1991-12-01

Embolization of parts of mechanical valves has been reported since the inception of prosthetic valve implantation. We report here two cases of embolization of one hemileaflet of a Duromedic bileaflet prosthesis in the mitral position due to a pivot fracture. Both presented with moderately severe mitral regurgitation and pulmonary edema and were successfully managed by replacement of the malfunctioning prostheses. The embolised disc was located in the left common iliac artery by abdominal ultrasound and removed by an inguinal, retroperitoneal approach with low morbidity. Both patients left hospital and are doing well to-date.

Cullen's sign and massive ovarian enlargement secondary to primary hypothyroidism in a patient with a normal FSH receptor

PubMed Central

Sultan, A; Velaga, M R; Fleet, M; Cheetham, T

2006-01-01

Ovarian hyperstimulation is a recognised complication of longstanding hypothyroidism. A 12 year old girl with atrophic thyroiditis who presented with abdominal pain and distension is reported. She was noted to have bruising in the vicinity of the umbilicus (Cullen's sign). She had pronounced ovarian enlargement on ultrasonography and it was hypothesised that this profound phenotype might reflect an abnormal FSH receptor. However sequencing of the FSH receptor was normal. The ovarian enlargement resolved with thyroxine replacement. Physicians and surgeons should consider longstanding hypothyroidism in patients presenting with Cullen's sign. PMID:16714722

Effect of protein source during weight loss on body composition, cardiometabolic risk and physical performance in abdominally obese, older adults: a pilot feeding study.

PubMed

Beavers, K M; Gordon, M M; Easter, L; Beavers, D P; Hairston, K G; Nicklas, B J; Vitolins, M Z

2015-01-01

The purpose of this pilot study was to begin to examine the effect of dietary protein source (soy protein versus non-soy protein) during weight loss on body composition, and cardiometabolic and functional decline risk factors in older, abdominally obese adults. Two-arm, single-blind, randomized, controlled trial. Wake Forest School of Medicine, Winston-Salem NC 27157, USA. 25 older (68.4±5.5 years, 88% female), abdominally obese (BMI: 35.1±4.3 kg/m2; WC: 101.4±13.1 cm) men and women were randomized to participate in the study. A 12-week weight loss intervention, with participants randomized to consume soy protein-based meal replacements (S; n=12) or non-soy protein-based meal replacements (NS; n=12), in addition to prepared meals, and all participants targeted to receive an individualized caloric deficit of 500 kcal/day. Body weight and composition (assessed via DXA and CT), conventional biomarkers of cardiometabolic risk, and physical performance measures were assessed pre- and post-intervention. Additional endpoints of feasibility (accrual, participation, retention, compliance, and safety) are reported. A total of 24 participants (87% female) completed the study (96% retention) and lost an average of 7.8±3.0 kg over the 12-week period, with no difference seen between groups (p=0.83). Although nearly all measures of global and regional body composition were significantly reduced following the 12-week intervention, differences were not observed between groups. Among cardiometabolic risk factors and physical performance measures, only diastolic blood pressure was significantly lower in the NS group compared to the S group (66.7±2.7 mmHg vs 73.5±2.7 mmHg, respectively; p=0.04). Interestingly, in groups combined, despite significant reductions in body weight and lean mass, no significant changes in 400-meter walk time (+5.3±43.4 s), short physical performance battery score (+0.1±1.0), grip strength (-0.3±3.2 kg), or relative knee extensor strength (-0.0±0.0 N/m/cm3 thigh muscle volume) were observed. Data presented here suggest that a 12-week weight loss intervention, which incorporates S and NS meal replacement products, is associated with clinically significant weight loss and improvements in several parameters of cardiometabolic risk and unchanged physical function and strength. RESULTS do not differ by protein source and suggest that soy protein is at least as good as other protein sources for weight loss during low-calorie dietary interventions in older adults.

Effects of Concrete Channels on Stream Biogeochemistry, Maryland Coastal Plain

NASA Astrophysics Data System (ADS)

Prestegaard, K. L.; Gilbert, L.; Phemister, K.

2005-05-01

In the 1950's and 60's, extensive networks of cement-lined channels were built in suburban watersheds near Washington, D.C. to convey storm water to downstream locations. These cement-lined stream channels limit interactions between surface and groundwater and they provide sources of alkalinity in Maryland Coastal Plain watersheds that normally have low alkalinity. This project was designed to 1) compare base flow water chemistry in headwater reaches of urban and non-urban streams, and 2) to evaluate downstream changes in water chemistry in channelized urban streams in comparison with non-urban reference streams. During a drought year, headwater streams in both urban and non-urban sites had significant concentrations of Fe(II) that were discharged from groundwater sources and rapidly oxidized by iron-oxidizing bacteria. During a wet year, the concentrations of Fe(II) were higher in headwater urban streams than in the non-urban streams. This suggests that impervious surfaces in headwater urban watersheds prevent the recharge of oxygen-rich waters during storm events, which maintains iron-rich groundwater discharge to the stream. Downstream changes in water chemistry are prominent in cement-lined urban channels because they are associated with distinctive microbial communities. The headwater zones of channelized streams are dominated by iron-ozidizing bacteria, that are replaced downstream by manganese-oxidizing zones, and replaced further downstream by biofilms dominated by photosynthesizing cyanobacteria. The reaches dominated by cyanobacteria exhibit diurnal changes in pH due to uptake of CO2 for photosynthesis. Diurnal changes range from 7.5 to 8.8 in the summer months to 7.0 to 7.5 in the cooler months, indicating both the impact of photosynthesis and the additional source of alkalinity provided by concrete. The dissolved oxygen, pH, and other characteristics of tributaries dominated by cyanobacteria are similar to the water chemistry characteristics observed in much larger urban river channels further downstream. These downstream redox zonations, microbial habitats, and pH characteristics observed in channelized tributaries are very different from non-urban watersheds in the Maryland Coastal Plain, which have pH values less than 7 and do not have the prominent redox zonations and associated microbial habitats. These downstream changes in redox chemistry and pH in urban stream channels have implications for the transport and retention of heavy metals in urban streams.

Cooling Trends from Agricultural Management Practices that Conserve Soil Carbon Resources in the North American Northern Great Plains: Important First Steps in the Transition toward a BECCS Economy

NASA Astrophysics Data System (ADS)

Stoy, P. C.; Gerken, T.; Bromley, G. T.; Tang Che Ing, A.; Morgan, M.; Wood, D.; Ahmed, S.; Brad, B.; Brookshire, J.; Haggerty, J.; Jarchow, M.; McVay, K.; Miller, P.; Peyton, B.; Rashford, B.; Spangler, L.; Swanson, D.; Taylor, S.; Torrion, J.; Poulter, B.

2016-12-01

The transition toward the Bio-energy with Carbon Capture and Storage (BECCS) economy may have unintended climate drawbacks, but also benefits. Parts of the North American northern Great Plains have experienced a remarkable 6 W m-2 decrease in summertime radiative forcing since the 1970s. Extreme temperature events now occur less frequently, maximum temperatures have decreased by some 2 °C, and precipitation has increased by 10 mm per decade in some areas. This regional trend toward a cooler and wetter summer climate has coincided with changes in agricultural management. Namely, the practice of keeping fields fallow during summer (hereafter `summerfallow') has declined from 15 Mha in the 1970s to 2 Mha at the present in the Canadian Prairie Provinces, and from 16 Mha to 6 Mha in the US, with the largest declines in the Northern Plains. In addition to potential climate impacts, replacing summerfallow with no-till cropping systems results in lesser soil carbon losses - or even gains - and usually confers economic benefits. In other words, replacing summerfallow with no-till cropping may have resulted in a `win-win-win' scenario for climate, soil carbon, and farm-scale economics. The interaction between carbon, climate, and the economy in this region - and the precise domain that has experienced cooling - are still unknown, which limits our ability to forecast the dynamics of the coupled human-climate system during the transition toward a BECCS economy. Here, we use eddy covariance measurements to demonstrate that summerfallow results in carbon losses during the growing season of the same magnitude (ca. 100 g C m-2 per growing season) as carbon uptake by dryland crops. We use surface-atmosphere energy flux measurements to model atmospheric boundary layer and lifted condensation level heights to demonstrate that observed regional changes in near-surface humidity (of up to 7%) are necessary to simulate observed increases in convective precipitation. We analyze climate data to demonstrate that areas with extensive summerfallow decline are not necessarily those that have experienced summer cooling, and we provide a framework for quantifying connections between climate, carbon, and economic drivers in the Upper Missouri River Basin as the transition to the BECCS economy continues.

[Decompensated valvular disease and coarctation. One-stage repair using a median approach with an ascending aorta-abdominal aorta shunt].

PubMed

Baille, Y; Sigwalt, M; Vaillant, A; Sicard Desnuelle, M P; Varnet, B

1981-11-01

The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.

Nontraumatic Retroperitoneal Hematoma After Warfarin Administration: Fatal Case Report and Review of the Literature.

PubMed

Hosseini, Marzieh; Hosseinzadeh, Amin; Raufian, Kasra; Hedjazi, Arya

2015-12-01

Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. The patient had a history of aortic valve replacement surgery and was on warfarin treatment at an international normalized ratio of 2.4. Our patient progressed to cardiorespiratory arrest. The resuscitation was initiated promptly. Despite all resuscitation measures, including transfusion and administration of high doses of catecholamine, the patient died of hypovolemic shock 3 hours after admission. At autopsy, the external surface of the abdominal great vessels (descending aorta and mesenteric vessels) showed scattered petechial hemorrhages without any visible site of perforation. After comprehensive exploration of the abdomen, no evidence of traumatic event was identified and the cause of internal blood loss was noted as warfarin adverse effect.

International consensus conference on open abdomen in trauma.

PubMed

Chiara, Osvaldo; Cimbanassi, Stefania; Biffl, Walter; Leppaniemi, Ari; Henry, Sharon; Scalea, Thomas M; Catena, Fausto; Ansaloni, Luca; Chieregato, Arturo; de Blasio, Elvio; Gambale, Giorgio; Gordini, Giovanni; Nardi, Guiseppe; Paldalino, Pietro; Gossetti, Francesco; Dionigi, Paolo; Noschese, Giuseppe; Tugnoli, Gregorio; Ribaldi, Sergio; Sgardello, Sebastian; Magnone, Stefano; Rausei, Stefano; Mariani, Anna; Mengoli, Francesca; di Saverio, Salomone; Castriconi, Maurizio; Coccolini, Federico; Negreanu, Joseph; Razzi, Salvatore; Coniglio, Carlo; Morelli, Francesco; Buonanno, Maurizio; Lippi, Monica; Trotta, Liliana; Volpi, Annalisa; Fattori, Luca; Zago, Mauro; de Rai, Paolo; Sammartano, Fabrizio; Manfredi, Roberto; Cingolani, Emiliano

2016-01-01

A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure. The literature from 1990 to 2014 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-analyses] protocol. Seventy-six articles were reviewed by a panel of experts to assign grade of recommendations (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] system, and an international consensus conference was held. OA in trauma is indicated at the end of damage-control laparotomy, in the presence of visceral swelling, for a second look in vascular injuries or gross contamination, in the case of abdominal wall loss, and if medical treatment of abdominal compartment syndrome has failed (GoR B, LoE II). Negative-pressure wound therapy is the recommended temporary abdominal closure technique to drain peritoneal fluid, improve nursing, and prevent fascial retraction (GoR B, LoE I). Lack of OA closure within 8 days (GoR C, LoE II), bowel injuries, high-volume replacement, and use of polypropylene mesh over the bowel (GoR C, LoE I) are risk factors for frozen abdomen and fistula formation. Negative-pressure wound therapy allows to isolate the fistula and protect the surrounding tissues from spillage until granulation (GoR C, LoE II). Correction of fistula is performed after 6 months to 12 months. Definitive closure of OA has to be obtained early (GoR C, LoE I) with direct suture, traction devices, component separation with or without mesh. Biologic meshes are an option for wall reinforcement if bacterial contamination is present (GoR C, LoE II). OA and negative-pressure techniques improve the care of trauma patients, but closure must be achieved early to avoid complications.

[Acute renal failure due to obstructive ureteral stone associated with norovirus gastroenteritis in an infant with congenital solitary kidney].

PubMed

Kato, Taiki; Hamano, Atsushi; Kawamura, Hideki

2014-10-01

We report a 35 month-old boy with acute renal failure caused by an obstructive ureteral stone associated with norovirus gastroenteritis. He visited his family physician because of fever, abdominal pain and vomiting. He was diagnosed as acute gastroenteritis. The symptoms relieved once, but abdominal pain and vomiting recurred two days after the visit and the volume of urine decreased. He was diagnosed as norovirus gastoenteritis and acute renal failure which was unresponsive to fluid replacement. Ultrasound study of the abdomen showed a solitary kidney with mild hydronephrosis. He was then admitted to our hospital. He was finally diagnosed as acute postrenal failure due to obstructive ureteral stone with left solitary kidney by abdominal computer tomography (CT). We performed transurethral catheterization immediately. The creatinine and blood urea nitrogen returned to normal level in 2 days. The CT performed on the 28th day post operation showed disappearance of the stone after uric alkalization. Recently, some cases of postrenal failure due to bilateral obstructive ureteral stones, mainly ammonium acid urate stones, associated with viral gastroenteritis were reported. As clinical features, they are common in boys three years or younger after an episode of rotavirus gastroenteritis with high uric acid concentration. By far, the most common cause of acute renal failure in patients with severe gastroenteritis is prerenal failure resulting from hypovolemia. But postrenal cause due to bilateral obstructive stones should be taken in a consideration.

Surgeon specialization and operative mortality in United States: retrospective analysis.

PubMed

Sahni, Nikhil R; Dalton, Maurice; Cutler, David M; Birkmeyer, John D; Chandra, Amitabh

2016-07-21

 To measure the association between a surgeon's degree of specialization in a specific procedure and patient mortality.  Retrospective analysis of Medicare data.  US patients aged 66 or older enrolled in traditional fee for service Medicare.  25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13.  Relative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures).  For all four cardiovascular procedures and two out of four cancer resections, a surgeon's degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure.  For several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon's procedure specific volume as well as the degree to which a surgeon specializes in that procedure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Fish assemblages and habitat relationships in a small northern Great Plains stream

USGS Publications Warehouse

Barfoot, C.A.; White, R.G.

1999-01-01

We examined fish populations and environmental characteristics of pool and riffle habitats of Little Beaver Creek, Montana, a small northern Great Plains stream. We collected 4,980 fishes representing 20 species in eight families. The most abundant and species-rich family was Cyprinidae. Nearly 88% (4,369) of all fishes were collected in pools. Pools also supported greater numbers ofspecies (x = 6.3, SO = 2.6, n = 58) than did riffles ( x = 2.2, SO = 1.9, n = 47). Most species showed distinct patterns of relative abundance along the stream gradient. Community changes were primarily reflected by the downstream addition of species; species replacement was of less importance. A multivariate analysis of fish relative abundance identified two relatively well-defined pool fish assemblages: a downstream assemblage comprised largely of native fluvial cyprinids, and a more diverse midstream-upstream assemblage comprised of fishes from several families. No well-defined assemblages were identified in riffle habitats. Environmental measures of stream size, substrate characteristics, water clarity, and banks ide conditions appeared to be associated with differences in fish assemblage structure. However, correlations between habitat conditions and fish assemblages were weak, possibly because a complex of factors act conculTently to shape assemblages.

Estimating irrigation water use and withdrawal of ground water on the High Plains, U.S.A.

USGS Publications Warehouse

Wray, J.R.

1982-01-01

In four decades following the Dust Bowl days of the 1930's, extensive areas of dry farming and rangeland on the semi-arid U.S. High Plains were transformed into a vast region of irrigated oases, producing meat and grain for much of the world. The agricultural economy has experienced such rapid growth in part because of the availability of ground water and because of development of new irrigation technology to use that water for agriculture. However, more water is being used than is being replaced. To estimate both the volume of water withdrawn and the regional scope of the problem a technique has been developed that combines multispectral data from Earth-orbiting satellite with known pumpage data for the same growing season. The location and extent of irrigated cropland-some with different crops watered at different times-is inventoried using computer-assisted analysis of the data from Landsat. The amount of water used is estimated by multiplying and summing surface area of irrigated agriculture and the average measured pumpage from sampled sites. Published findings to date are cited in the Selected References. All suggest transferability of a promising technology to the study of land transformation processes elsewhere. ?? 1983.

Performance and Characterization of Geopolymer Concrete Reinforced with Short Steel Fiber

NASA Astrophysics Data System (ADS)

Abdullah, M. M. A. B.; Faris, M. A.; Tahir, M. F. M.; Kadir, A. A.; Sandu, A. V.; Mat Isa, N. A. A.; Corbu, O.

2017-06-01

In the recent years, geopolymer concrete are reporting as the greener construction technology compared to conventional concrete that made up of ordinary Portland cement. Geopolymer concrete is an innovative construction material that utilized fly ash as one of waste material in coal combustion industry as a replacement for ordinary Portland cement in concrete. The uses of fly ash could reduce the carbon dioxide emission to the atmosphere, redundant of fly ash waste and costs compared to ordinary Portland cement concrete. However, the plain geopolymer concrete suffers from numerous drawbacks such as brittleness and low durability. Thus, in this study the addition of steel fiber is introduced in plain geopolymer concrete to improve its mechanical properties especially in compressive and flexural strength. Characterization of raw materials also determined by using chemical composition analysis. Short type of steel fiber is added to the mix in weight percent of 1 wt%, 3 wt%, 5 wt% and 7 wt% with fixed molarity of sodium hydroxide of 12M and solid to liquid ratio as 2.0. The addition of steel fiber showed the excellent improvement in the mechanical properties of geopolymer concrete that are determined by various methods available in the literature and compared with each other.

Saltwater Intrusion and its Long-Term Consequences in a Coastal Alluvial Aquifer of Northern Oman

NASA Astrophysics Data System (ADS)

Weyhenmeyer, C. E.; Waber, H. N.

2002-12-01

The alluvial aquifer of the Eastern Batinah coastal plain supplies water for the most densely populated, cultivated and industrialized areas in the Sultanate of Oman. In recent years, overexploitation of these groundwater resources has resulted in a drastic lowering of the groundwater table and consequent seawater intrusion into the coastal aquifer sections. During recent drilling operations near the coast (~3 km) groundwater samples were taken at depths intervals of 2-5 m. The front of the saline intrusion wedge was encountered at a depth of 70-80 mbs as suggested by sudden changes in groundwater chemistry and isotope values. Groundwater near the saline intrusion front is characterized by lower Na/Cl and higher Ca/Mg ratios compared to ion ratios expected from groundwater mixing calculations between fresh- and saltwater. The observed changes in ion ratios suggest that Na is removed from the groundwater and replaced by Ca from cation exchange surfaces in the aquifer (e.g., clay particles), which is an indication that the saline front is still migrating inland. To date, a deterioration of overall groundwater quality can be recognized as far inland as 15 km and Cl and Na concentrations in these areas are well above the general quality standards for drinking water. Estimates of infiltration rates based on isotope ratios (Sr, O, H) suggest that less than 10% of the total groundwater recharge occurs on the coastal plain itself, with the remaining 90% originating in the adjacent Oman Mountains. Groundwater residence times on the coastal plain are in the order of a few hundred to several thousand years as suggested by a number of radioactive isotopes (3H, 85Kr, 39Ar, 14C). Therefore, these groundwater resources essentially have to be considered non-renewable and there is a pressing requirement for the development of sustainable groundwater management strategies. Attempts to artificially increase infiltration on the coastal plain by the construction of large recharge dams has not yet proven successful because infiltration on the alluvial plain is severely inhibited by extensive layers of highly cemented gravel and clay accumulations and by a groundwater table as low as 80 mbs. At present, water conservation and possibly groundwater exploitation in the mountainous areas appear to be the only viable strategies to slow down the rapid decline of available groundwater resources in the Eastern Batinah region

Vanishing testes syndrome-related osteoporosis and high cardio-metabolic risk in an adult male with long term untreated hypergonadotropic hypogonadism.

PubMed

Carsote, Mara; Capatina, Cristina; Valea, Ana; Dumitrascu, Anda

2016-02-01

The male hypogonadism-related bone mass loss is often under diagnosed. Peak bone mass is severely affected if the hypogonadism occurs during puberty and is left untreated. We present an interesting; almost bizarre case of a male with non-functional testes early during childhood and undiagnosed and untreated hypogonadism until his fifth decade of life. Forty six year male is referred for goitre, complaining of back pain. Phenotype suggested intersexuality: gynoid proportions, micropenis, no palpable testes into the scrotum, no facial or truncal hair. His medical history had been unremarkable until the previous year when primary hypothyroidism was diagnosed and levothyroxine replacement was initiated. Later, he was diagnosed with ischemic heart disease, with inaugural unstable angina. On admission, the testosterone was 0.2 ng/mL (normal: 1.7-7.8 ng/mL), FSH markedly increased (56 mUI/mL), with normal adrenal axis, and TSH (under thyroxine replacement). High bone turnover markers, and blood cholesterol, and impaired glucose tolerance were diagnosed. The testes were not present in the scrotum. Abdominal computed tomography suggested bilateral masses of 1.6 cm diameter within the abdominal fat that were removed but no gonadal tissue was confirmed histopathologically. Vanishing testes syndrome was confirmed. The central DXA showed lumbar bone mineral density of 0.905 g/cm2, Z-score of -2.9SD. The spine profile X-Ray revealed multiple thoracic vertebral fractures. Alendronate therapy together with vitamin D and calcium supplements and trans-dermal testosterone were started. Four decades of hypogonadism associate increased cardiac risk, as well as decreased bone mass and high fracture risk.

Replacement value of undecorticated sunflower meal as a supplement for milk production by crossbred cows and buffaloes in the northern plains of India.

PubMed

Sharma, K; Dutta, N; Pattanaik, A K; Hasan, Q Z

2003-04-01

The replacement value of undecorticated sunflower meal (SFM) in the diets of dairy animals was assessed on-station and on-farm. Eighteen primiparous crossbred (Bos taurus x Bos indicus) cows (350.4 +/- 8.84 kg), randomly allocated to three groups, were used in the on-station study. The animals were fed on either a conventional concentrate supplement (control) or on an experimental concentrate, in which SFM replaced 25% (SFM-25) or 50% (SFM-50) of the CP in the control supplement. Green oats (Avena sativa) were supplied ad libitum. A metabolism trial conducted following 60 days of experimental feeding revealed that the intakes of DM, DCP and TDN were similar among the groups. The digestibilities of OM, CP, EE, NDF and ADF were also without significant differences. All the groups were in positive nitrogen balance. Inclusion of SFM at either level had no effect on the intake, excretion or retention of nitrogen. The daily milk yield and its composition did not differ among the dietary treatments. Moreover, the efficiency of utilization of DOM and TDN for FCM production tended to reflect, although non-significantly, increasing levels of SFM inclusion. In the on-farm study, seven multiparous milking buffaloes belonging to six farmers were used to assess the effect of replacing 20% of the CP of the conventional supplement with SFM, in a predominantly crop residue-based diet. The study continued for 4 months and revealed that the average daily feed intake and milk production was similar in the control and SFM-fed groups. It was concluded that SFM can be effectively utilized as a cheaper replacement for costly oil cakes and wheat bran for economic milk production by smallholder farmers.

[Minor strut fracture of the Björk-Shiley mitral valve].

PubMed

Sugita, T; Yasuda, R; Watarida, S; Onoe, M; Tabata, R; Mori, A

1990-06-01

In May, 1982, a 49-year-old man underwent mitral valve replacement (MVR) in our hospital with a 31 mm Björk-Shiley prosthesis for mitral regurgitation. He had been doing well until his episode of palpitation and dyspnea of sudden onset, and was transferred to our ICU with severe cardiogenic shock in Aug, 1986. Chest X-ray film revealed pulmonary edema and breakage of the valve with migration of the disc and the minor strut of the prosthesis. He was operated upon 5 hours after the onset of his complaints. The minor strut was removed from the left upper pulmonary vein and mitral valve re-replacement was done with a 29 mm Björk-Shiley Monostrut valve. The disc which had dislocated into the abdominal aorta was also recovered on the twenty-third post operative day. His postoperative course was uneventful. Immediate diagnosis and subsequent re-operation is absolute indication for rescue from acute cardiac failure due to mechanical failure of any prosthetic valve.

Tetany caused by chronic diarrhea in a child with celiac disease: A case report

PubMed Central

Hurtado-Valenzuela, Jaime Gabriel; Sotelo-Cruz, Norberto; López-Cervantes, Guillermo; de la Barca, Ana María Calderón

2008-01-01

There is no awareness about celiac disease (CD) in Mexico. A 2.9 year old mestizo boy was admitted to a Mexican hospital with muscle cramps and fine tremors. He suffered chronic diarrhea, abdominal distention, hypotrophic limbs, stunting and wasting, and presented hypocalcemia, anemia and high titers of serological markers. Diagnosis of CD was confirmed by a duodenal biopsy. After replacement of calcium and a gluten-free diet, the symptoms resolved within 6 weeks. After 2-months, serum analyses, anthropometric data as well as antibodies titers were normal after 4 years. CD screening tests are needed in chronic diarrhea for any ethnicity patients. PMID:18811963

Bilateral External Iliac Artery Dissection in a Middle-Aged Male Athlete

PubMed Central

Yamanaka, Yasushi; Yoshida, Tetsuya; Nagaoka, Eiki

2017-01-01

We present the case of a bilateral external iliac artery (EIA) dissection in a 44-year-old male athlete. The patient was referred to our department for right lower abdominal pain without claudication during single squatting. His athletic history included participation in approximately five athletic events per year. Contrast-enhanced computed tomography (CT) revealed bilateral EIA dissection and right renal infarction. Following medical treatment for his hypertension and considering his medical history, a bilateral EIA replacement with 8-mm Dacron straight grafts was performed on the 24th day after hospital admission. Postoperative contrast-enhanced CT revealed good bilateral graft patency and perfusion following surgery. PMID:29515713

Bilateral External Iliac Artery Dissection in a Middle-Aged Male Athlete.

PubMed

Yamanaka, Yasushi; Yoshida, Tetsuya; Nagaoka, Eiki

2017-12-25

We present the case of a bilateral external iliac artery (EIA) dissection in a 44-year-old male athlete. The patient was referred to our department for right lower abdominal pain without claudication during single squatting. His athletic history included participation in approximately five athletic events per year. Contrast-enhanced computed tomography (CT) revealed bilateral EIA dissection and right renal infarction. Following medical treatment for his hypertension and considering his medical history, a bilateral EIA replacement with 8-mm Dacron straight grafts was performed on the 24th day after hospital admission. Postoperative contrast-enhanced CT revealed good bilateral graft patency and perfusion following surgery.

Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

PubMed

Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

2016-07-01

We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

[Chronic recurrent volvulus of the colonic splenic flexure associated with the eventration of left diaphragm].

PubMed

Kim, Hee Sun; Yoo, Jeong Seon; Han, Seok Joo; Park, Hyojin

2007-01-01

The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.

Laparoscopic management of a translocated intrauterine device embedded in the gastric serosa.

PubMed

Bozkurt, Murat; Yumru, Ayse Ender; Coskun, Ebru Inci; Ondes, Banu

2011-10-01

Intrauterine devices (IUD) are the most common contraceptive methods all over the world. Besides many advantages, there are also some complications of this method. The most important complication of IUD is uterine perforation. The reported incidence of IUD perforation ranges from 0.2 to 9.6 per thousand insertions. In this article we would like to report a case that has an IUD migrated to the gastric serosa. A 41 years-old Turkish woman presented with abdominal pain. Plain X-ray of the abdomen demonstrated two IUDs, one in the upper quadrant of the abdomen, the other in the pelvic area and determined in the endometrium by TV-USG (transvaginal ultrasonography). Laparascopy was performed and the IUD, lying over the omentum of stomach was removed. This report demonstrates the first case in the literature that has an IUD embedded in the gastric serosa and also a second IUD in uterine cavity. The management was performed laparoscopically. No complication was observed during and after operation.

Clinics in diagnostic imaging (171). Caecal volvulus with underlying intestinal malrotation.

PubMed

Ooi, Su Kai Gideon; Tan, Tien Jin; Ngu, James Chi Yong

2016-11-01

A 46-year-old Chinese woman with a history of cholecystectomy and appendicectomy presented to the emergency department with symptoms of intestinal obstruction. Physical examination revealed central abdominal tenderness but no clinical features of peritonism. Plain radiography of the abdomen revealed a grossly distended large bowel loop with the long axis extending from the right lower abdomen toward the epigastrium, and an intraluminal air-fluid level. These findings were suspicious for an acute caecal volvulus, which was confirmed on subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis. CT demonstrated an abnormal positional relationship between the superior mesenteric vein and artery, indicative of an underlying intestinal malrotation. This case highlights the utility of preoperative imaging in establishing the diagnosis of an uncommon cause of bowel obstruction. It also shows the importance of recognising the characteristic imaging features early, so as to ensure appropriate and expedient management, thus reducing patient morbidity arising from complications. Copyright: © Singapore Medical Association.

Congenital asymptomatic diaphragmatic hernias in adults: a case series.

PubMed

Bianchi, Enrica; Mancini, Paola; De Vito, Stefania; Pompili, Elena; Taurone, Samanta; Guerrisi, Isabella; Guerrisi, Antonino; D'Andrea, Vito; Cantisani, Vito; Artico, Marco

2013-05-13

Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease.

Prognostic value of aortic stiffness and calcification for cardiovascular events and mortality in dialysis patients: outcome of the calcification outcome in renal disease (CORD) study.

PubMed

Verbeke, Francis; Van Biesen, Wim; Honkanen, Eero; Wikström, Björn; Jensen, Per Bruno; Krzesinski, Jean-Marie; Rasmussen, Merete; Vanholder, Raymond; Rensma, Pieter L

2011-01-01

Radiographic calcification and arterial stiffness each individually are predictive of outcome in dialysis patients. However, it is unknown whether combined assessment of these intermediate endpoints also provides additional predictive value. Scoring of abdominal aortic calcification (AAC) using plain lateral abdominal x-ray and measurement of carotid-femoral pulse wave velocity (PWV) were performed in a cohort of 1084 prevalent dialysis patients recruited from 47 European dialysis centers. During a follow-up of 2 years, 234 deaths and 91 nonfatal cardiovascular (CV) events occurred. Compared with the lowest tertile of AAC, the risk of an event was increased by a factor 3.7 in patients with a score of 5 to 15 (middle tertile), and by a factor 8.6 in patients with scores of 16 to 24. Additionally, each 1-m/s increase in PWV was associated with a 15% higher risk. At higher AAC (scores ≥ 5), the effect of PWV was attenuated because of a negative PWV × AAC interaction (hazard ratio [HR]: 0.895 and 0.865 for middle and upper AAC tertiles). After accounting for age, diabetes, and serum albumin, AAC and PWV remained independent predictors of outcome. AAC and central arterial stiffness are independent predictors of mortality and nonfatal CV events in dialysis patients. The risk associated with an increased PWV is less pronounced at higher levels of calcification. Assessment of AAC and PWV is feasible in a clinical setting and both may be used for an accurate CV risk estimation in this heterogeneous population.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

PubMed Central

Aksu, Nalan M

2016-01-01

Objective: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. PMID:26959613

Simple patch closure for perforated peptic ulcer in children followed by helicobacter pylori eradication.

PubMed

Yildiz, Turan; Ilce, Huri Tilla; Ceran, Canan; Ilce, Zekeriya

2014-05-01

Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6-170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3-94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.

The depositional setting of the Late Quaternary sedimentary fill in southern Bannu basin, Northwest Himalayan fold and thrust belt, Pakistan.

PubMed

Farid, Asam; Khalid, Perveiz; Jadoon, Khan Zaib; Jouini, Mohammed Soufiane

2014-10-01

Geostatistical variogram and inversion techniques combined with modern visualization tools have made it possible to re-model one-dimensional electrical resistivity data into two-dimensional (2D) models of the near subsurface. The resultant models are capable of extending the original interpretation of the data to depict alluvium layers as individual lithological units within the 2D space. By tuning the variogram parameters used in this approach, it is then possible to visualize individual lithofacies and geomorphological features for these lithologic units. The study re-examines an electrical resistivity dataset collected as part of a groundwater study in an area of the Bannu basin in Pakistan. Additional lithological logs from boreholes throughout the area have been combined with the existing resistivity data for calibration. Tectonic activity during the Himalayan orogeny uplifted and generated significant faulting in the rocks resulting in the formation of a depression which subsequently has been filled with clay-silt and dirty sand facies typical of lacustrine and flood plain environments. Streams arising from adjacent mountains have reworked these facies which have been eroded and replaced by gravel-sand facies along channels. It is concluded that the sediments have been deposited as prograding fan shaped bodies, flood plain, and lacustrine deposits. Clay-silt facies mark the locations of paleo depressions or lake environments, which have changed position over time due to local tectonic activity and sedimentation. The Lakki plain alluvial system has thus formed as a result of local tectonic activity with fluvial erosion and deposition characterized by coarse sediments with high electrical resistivities near the mountain ranges and fine sediments with medium to low electrical resistivities towards the basin center.

Mitigating Groundwater Depletion in North China Plain with Cropping System that Alternate Deep and Shallow Rooted Crops

PubMed Central

Yang, Xiao-Lin; Chen, Yuan-Quan; Steenhuis, Tammo S.; Pacenka, Steven; Gao, Wang-Sheng; Ma, Li; Zhang, Min; Sui, Peng

2017-01-01

In the North China Plain, groundwater tables have been dropping at unsustainable rates of 1 m per year due to irrigation of a double cropping system of winter wheat and summer maize. To reverse the trend, we examined whether alternative crop rotations could save water. Moisture contents were measured weekly at 20 cm intervals in the top 180 cm of soil as part of a 12-year field experiment with four crop rotations: sweet potato→ cotton→ sweet potato→ winter wheat-summer maize (SpCSpWS, 4-year cycle); peanuts → winter wheat-summer maize (PWS, 2-year cycle); ryegrass–cotton→ peanuts→ winter wheat-summer maize (RCPWS, 3-year cycle); and winter wheat-summer maize (WS, each year). We found that, compared to WS, the SpCSpWS annual evapotranspiration was 28% lower, PWS was 19% lower and RCPWS was 14% lower. The yield per unit of water evaporated improved for wheat within any alternative rotation compared to WS, increasing up to 19%. Average soil moisture contents at the sowing date of wheat in the SpCSpWS, PWS, and RCPWS rotations were 7, 4, and 10% higher than WS, respectively. The advantage of alternative rotations was that a deep rooted crop of winter wheat reaching down to 180 cm followed shallow rooted crops (sweet potato and peanut drawing soil moisture from 0 to 120 cm). They benefited from the sequencing and vertical complementarity of soil moisture extraction. Thus, replacing the traditional crop rotation with cropping system that involves rotating with annual shallow rooted crops is promising for reducing groundwater depletion in the North China Plain. PMID:28642779

Impact of replacing regular chocolate milk with the reduced-sugar option on milk consumption in elementary schools in Saskatoon, Canada.

PubMed

Henry, Carol; Whiting, Susan J; Finch, Sarah L; Zello, Gordon A; Vatanparast, Hassan

2016-05-01

Excess sugar consumption in children has led to the removal of chocolate milk from some schools. Lower-sugar formulations, if accepted, would provide the benefits of milk consumption. In a cross-over trial, milk consumption was measured in 8 schools over 6 weeks in 2 phases: phase 1 provided standard 1% chocolate milk and plain 2% milk choices for the first 3 weeks, and phase 2 provided reduced-sugar 1% chocolate milk and plain 2% milk for the next 3 weeks. Milk selection and milk wasted were measured by sex and grade (1-8). Children chose chocolate milk more often than white milk in both phases (phase 1, 8.93% ± 0.75% vs. 0.87% ± 0.11% (p < 0.001), and phase 2, 5.76% ± 0.29% vs. 0.78% ± 0.14% (p < 0.001), respectively). Fewer children chose reduced-sugar chocolate milk in phase 2 (p < 0.001). A greater percentage of younger students (grades 1-4) than older students (grades 5-8) purchased milk in both phases (phase 1, 11.10% ± 0.81% vs. 8.36% ± 0.74%, p = 0.020, and phase 2, 8.47% ± 0.43% vs. 4.62% ± 0.40%, p < 0.001, respectively); older children drank more milk at lunch. Schoolchildren preferred chocolate milk over plain milk even when a reduced-sugar formula was offered; however, switching to reduced-sugar chocolate milk led to a decrease in the number of students choosing milk. Longer-duration studies are required to determine if students would purchase reduced-sugar chocolate milk at the same rate as they would purchase regular chocolate milk.

Effects of abscisic acid and xanthoxin on elongation and gravitropism in primary roots of Zea mays

NASA Technical Reports Server (NTRS)

Lee, J. S.; Hasenstein, K. H.; Mulkey, T. J.; Yang, R. L.; Evans, M. L.

1990-01-01

We examined the involvement of abscisic acid (ABA) and xanthoxin (Xan) in maize root gravitropism by (1) testing the ability of ABA to allow positive gravitropism in dark-grown seedlings of the maize cultivar LG11, a cultivar known to require light for positive gravitropism of the primary root, (2) comparing curvature in roots in which half of the cap had been excised and replaced with agar containing either ABA or indole-3-acetic acid (IAA), (3) measuring gravitropism in roots of seedlings submerged in oxygenated solutions of ABA or IAA and (4) testing the effect of Xan on root elongation. Using a variety of methods of applying ABA to the root, we found that ABA did not cause horizontally-oriented primary roots of dark-grown seedlings to become positively gravitropic. Replacing half of the root cap of vertically oriented roots with an agar block containing ABA had little or no effect on curvature relative to that of controls in which the half cap was replaced by a plain agar block. Replacement of the removed half cap with IAA either canceled or reversed the curvature displayed by controls. When light-grown seedlings were submerged in ABA they responded strongly to gravistimulation while those in IAA did not. Xan (up to 0.1 mM) did not affect root elongation. The results indicate that ABA is not a likely mediator of root gravitropism and that the putative ABA precursor, Xan, lacks the appropriate growth-inhibiting properties to serve as a mediator of root gravitropism.

Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012.

PubMed

Zakine, Gilbert; Baruch, Jean; Dardour, Jean-Claude; Flageul, Gérard

2015-03-01

Perforation of one or several intraperitoneal organs during a liposuction procedure is an exceptional but underestimated complication. Knowledge of this complication is essential because of frequent delay in diagnosis and possible dramatic consequences. Nineteen cases were evaluated by experts and are presented in a retrospective analysis. Sixteen women and three men, aged 24 to 72 years, were operated on in France between July of 2001 and January of 2012. Abdominal liposuction (200 to 2400 ml) was performed in combination or not with an abdominoplasty. Uncommon pain and an intestinal obstruction were present in all of the patients. The peritonitis was never frank, replaced frequently by infraclinic peritonitis with septic and/or hypovolemic shock. Diagnosis, performed by abdominal scan between days 1 and 7, revealed intraperitoneal gas or liquid. Perforation, unique or multiple, because of the intraperitoneal passage of the cannula, often in the umbilical region and promoted by the presence of a hernia, involved the following organs: ileum (14 cases), jejunum (two cases), spleen (two cases), transverse colon (one case), cecum (one case), and sigmoid (one case). Death occurred in three cases, between days 2 and 11. Eleven patients had temporary ileostomy or colostomy. Associated complications were abdominal wall cellulitis, necrotizing fasciitis, thrombophlebitis, lung collection, and late subobstructive syndrome. Visceral perforation during liposuction, a severe and sometimes fatal complication with late and difficult diagnosis, is not often reported. Careful technique, particularly if an umbilical approach is used, should avoid this dramatic complication. Therapeutic, IV.

Intra-peritoneal chronic loculation in peritoneal dialysis patients - a new medical management approach.

PubMed

Mitoiu, Dan; David, Cristiana; Peride, Ileana; Niculae, Andrei; Mureşan, Alin; Ciocâlteu, Alexandru; Geavlete, Bogdan Florin; Checheriţă, Ionel Alexandru

2014-01-01

Peritoneal dialysis (PD) limitation as renal replacement therapy is mostly due to peritonitis and complications. Formation and persistence of intra-abdominal loculations is often under-diagnosed. Encapsulated peritoneal sclerosis (EPS) is a life-threatening complication, but malnutrition, recurrent peritonitis and early membrane failure are insidious enemies that need to be emphasized. It is important to highlight the persistence of intra-abdominal fluid collection after clinical resolution of peritonitis in PD patients and to indicate a new medical management approach for an early diagnosis. During five years, we selected PD peritonitis cases followed by a six months interval free of infections. Ninety-seven subjects were followed at six months and one year after the first peritonitis. Tomography had been performed to patients presenting a positive inflammatory state without a specific infectious cause. Subjects presenting documented localized fluid collection (31 cases) were divided into: drug-treated group and those undergoing laparoscopy by a new surgery technique (seven patients); a comparison regarding the clinical state and biohumoral parameters was assessed in both groups. The prevalence of intra-abdominal loculation following an apparent resolved peritonitis was high (31.9%). The cases undergoing laparoscopy presented a better evolution - improved clinical status (p=0.001), higher hemoglobin values (p=0.06), significant lower doses of erythropoietin requirement (p=0.03), improved dialysis adequacy (p=0.005) and inflammatory state. In cases with confirmed fluid encapsulated loculation, an active attitude (screening imaging protocol and laparoscopic exploration) appears to be mandatory, decreasing the risk of EPS, a serious complication which pathology and treatment are incompletely understood.

Effect of exercise on patient specific abdominal aortic aneurysm flow topology and mixing

PubMed Central

Arzani, Amirhossein; Les, Andrea S.; Dalman, Ronald L.; Shadden, Shawn C.

2014-01-01

SUMMARY Computational fluid dynamics modeling was used to investigate changes in blood transport topology between rest and exercise conditions in five patient-specific abdominal aortic aneurysm models. Magnetic resonance imaging was used to provide the vascular anatomy and necessary boundary conditions for simulating blood velocity and pressure fields inside each model. Finite-time Lyapunov exponent fields, and associated Lagrangian coherent structures, were computed from blood velocity data, and used to compare features of the transport topology between rest and exercise both mechanistically and qualitatively. A mix-norm and mix-variance measure based on fresh blood distribution throughout the aneurysm over time were implemented to quantitatively compare mixing between rest and exercise. Exercise conditions resulted in higher and more uniform mixing, and reduced the overall residence time in all aneurysms. Separated regions of recirculating flow were commonly observed in rest, and these regions were either reduced or removed by attached and unidirectional flow during exercise, or replaced with regional chaotic and transiently turbulent mixing, or persisted and even extended during exercise. The main factor that dictated the change in flow topology from rest to exercise was the behavior of the jet of blood penetrating into the aneurysm during systole. PMID:24493404

Hyponatremia in a Teenager: A Rare Diagnosis.

PubMed

Correia, Filipa; Fernandes, Alexandre; Mota, Teresa C; Garcia, Milagros; Castro-Correia, Cíntia; Fontoura, Manuel; Ribeiro, Augusto

2015-12-01

Hyponatremia is a common electrolyte alteration which has the potential for significant morbidity and mortality. Endocrine disorders, such as primary hypothyroidism and adrenal insufficiency are uncommon causes of hyponatremia. We present the case of a teenager with symptomatic hyponatremia caused by a rare disorder. A 17-year-old boy was admitted to the emergency department with abdominal pain, nausea and vomiting, asthenia, and weight loss. He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. The laboratory findings showed severe hyponatremia, hyperkalemia, and renal dysfunction. The patient started inotropic support and antibiotics. Plasma cortisol and corticotropin levels allowed the diagnosis of primary adrenal insufficiency. He began replacement therapy with hydrocortisone and fludrocortisone, with gradual symptom resolution. An abdominal computed tomography scan showed adrenal hypoplasia. Findings for antiadrenal and antithyroid antibodies were positive, allowing the diagnosis of autoimmune polyglandular syndrome type II. Adrenal insufficiency is a rare disease, especially in children, and its clinical manifestations are due to glucocorticoid and mineralocorticoid deficiency. In most of the cases, symptoms are nonspecific, requiring a high index of clinical suspicion. If the diagnosis and treatment are delayed, acute adrenal insufficiency carries a high morbidity and mortality.

Simulating the 2012 High Plains Drought Using Three Single Column Models (SCM)

NASA Astrophysics Data System (ADS)

Medina, I. D.; Baker, I. T.; Denning, S.; Dazlich, D. A.

2015-12-01

The impact of changes in the frequency and severity of drought on fresh water sustainability is a great concern for many regions of the world. One such location is the High Plains, where the local economy is primarily driven by fresh water withdrawals from the Ogallala Aquifer, which accounts for approximately 30% of total irrigation withdrawals from all U.S. aquifers combined. Modeling studies that focus on the feedback mechanisms that control the climate and eco-hydrology during times of drought are limited, and have used conventional General Circulation Models (GCMs) with grid length scales ranging from one hundred to several hundred kilometers. Additionally, these models utilize crude statistical parameterizations of cloud processes for estimating sub-grid fluxes of heat and moisture and have a poor representation of land surface heterogeneity. For this research, we focus on the 2012 High Plains drought and perform numerical simulations using three single column model (SCM) versions of BUGS5 (Colorado State University (CSU) GCM coupled to the Simple Biosphere Model (SiB3)). In the first version of BUGS5, the model is used in its standard bulk setting (single atmospheric column coupled to a single instance of SiB3), secondly, the Super-Parameterized Community Atmospheric Model (SP-CAM), a cloud resolving model (CRM) (CRM consists of 32 atmospheric columns), replaces the single CSU GCM atmospheric parameterization and is coupled to a single instance of SiB3, and for the third version of BUGS5, an instance of SiB3 is coupled to each CRM column of the SP-CAM (32 CRM columns coupled to 32 instances of SiB3). To assess the physical realism of the land-atmosphere feedbacks simulated by all three versions of BUGS5, differences in simulated energy and moisture fluxes are computed between the 2011 and 2012 period and are compared to those calculated using observational data from the AmeriFlux Tower Network for the same period at the ARM Site in Lamont, OK. This research will provide a better understanding of model deficiencies in reproducing and predicting droughts in the future, which is essential to the economic, ecologic and social well being of the High Plains.

Geothermal Conceptual Model in Earthquake Swarm Area: Constrains from Physical Properties of Supercritical Fluids and Dissipative Theory

NASA Astrophysics Data System (ADS)

Wang, S. C.; Lee, C. S.

2016-12-01

In recent five years, geothermal energy became one of the most prosperous renewable energy in the world, but produces only 0.5% of the global electricity. Why this great potential of green energy cannot replace the fuel and nuclear energy? The necessity of complicated exploration procedures and precious experts in geothermal field is similar to that of the oil and gas industry. The Yilan Plain (NE Taiwan) is one of the hot area for geothermal development and research in the second phase of National Energy Program (NEP-II). The geological and geophysical studies of the area indicate that the Yilan Plain is an extension of the Okinawa Trough back arc rifting which provide the geothermal resource. Based on the new constrains from properties of supercritical fluids and dissipative structure theory, the geophysical evidence give confident clues on how the geothermal system evolved at depth. The geothermal conceptual model in NEP-II indicates that the volcanic intrusion under the complicate fault system is possibly beneath the Yilan Plain. However, the bottom temperature of first deep drilling and geochemical evidence in NEP-II imply no volcanic intrusion. In contrast, our results show that seismic activities in geothermal field observed self-organization, and are consistent with the brittle-ductile / brittle-plastic transition, which indicates that supercritical fluids triggered earthquake swarms. The geothermal gradient and geochemical anomalies in Yilan Plain indicate an open system far from equilibrium. Mantle and crust exchange energy and materials through supercritical fluids to generate a dissipative structure in geothermal fields and promote water-rock interactions and fractures. Our initial studies have suggested a dissipative structure of geothermal system that could be identified by geochemical and geophysical data. The key factor is the tectonic setting that triggered supercritical fluids upwelling from deep (possibly from the mantle or the upper crust). Our next step is to collect mobile elements and magnetotelluric data to exam our initial model. Dissipative structure theory is one of the essential tools for understanding non-linear dynamic system. We will apply this method to other developed geothermal fields, and estimate the geothermal potential compared to the actual production.

Camelina Seed Yield and Fatty Acids as Influenced by Genotype and Environment

DOE PAGES

Obour, Augustine K.; Obeng, Eric; Mohammed, Yesuf A.; ...

2017-05-05

Camelina (Camelina sativa L. Crantz) is an alternative oilseed crop with potential for fallow replacement in dryland cereal-based crop production systems in the semiarid Great Plains. The interaction between genotype and environment was investigated on camelina seed yield, oil content, and fatty acid composition across two locations in the U.S. Great Plains. Treatments were three spring camelina genotypes (cultivars Blaine Creek, Pronghorn, and Shoshone), three growing seasons (2013, 2014, and 2015) and two locations (at Hays, KS, and Moccasin, MT). Our results showed camelina grown at Hays yielded 54% less than that at Moccasin. Blaine Creek yielded 17 and 42%more » more than Pronghorn and Shoshone at Hays but yields were not different among genotypes at Moccasin. Oil content ranged from 262 g kg -1 at Hays to 359 g kg -1 at Moccasin. The proportion of polyunsaturated fatty acids (PUFAs) ranged from 51% at Hays to 55% at Moccasin, whereas monounsaturated fatty acid (MUFA) and saturated fatty acid (SFA) contents were greater at Hays. The linolenic acid content ranged from 26% when Pronghorn was planted at Hays to 35% when planted at Moccasin. In general, the variations in seed yield and fatty acid profile corresponded well with growing season precipitation and temperatures at each environment.« less

Breaking sod or breaking even? Flax on the northern Great Plains and Prairies, 1889-1930.

PubMed

MacFayden, Joshua D

2009-01-01

A new thirst for paint and color in cities made extensive flax production profitable in the northern Great Plains and Prairies and contributed to the cultivation of the most fragile grassland ecosystems. The production of flax seed for linseed oil became an early spin-off of the Prairie wheat economy but, unlike wheat, flax vanished from old land after one or two rotations and reappeared in districts with the most new breaking. Officials explained the migrant crop as preparing native grasslands for cultivation or exhausting soil in old land, but farmers brought flax to their new breaking for other reasons. Producers would only put flax on any land when a range of economic and environmental conditions were in place. It was never sown without promise of adequately high prices or in the absence of affordable seed and other inputs. When price allowed, it usually appeared on new breaking because it could be planted later and transported further without upsetting the balance of other activities and without farmers learning many new techniques. Scientists discovered that diseased soil drove flax off old land, not soil exhaustion. Circumventing the disease was possible but costly, and farmers simply replaced flax with the next most lucrative commodity.

Integrating remotely sensed land cover observations and a biogeochemical model for estimating forest ecosystem carbon dynamics

USGS Publications Warehouse

Liu, J.; Liu, S.; Loveland, Thomas R.; Tieszen, L.L.

2008-01-01

Land cover change is one of the key driving forces for ecosystem carbon (C) dynamics. We present an approach for using sequential remotely sensed land cover observations and a biogeochemical model to estimate contemporary and future ecosystem carbon trends. We applied the General Ensemble Biogeochemical Modelling System (GEMS) for the Laurentian Plains and Hills ecoregion in the northeastern United States for the period of 1975-2025. The land cover changes, especially forest stand-replacing events, were detected on 30 randomly located 10-km by 10-km sample blocks, and were assimilated by GEMS for biogeochemical simulations. In GEMS, each unique combination of major controlling variables (including land cover change history) forms a geo-referenced simulation unit. For a forest simulation unit, a Monte Carlo process is used to determine forest type, forest age, forest biomass, and soil C, based on the Forest Inventory and Analysis (FIA) data and the U.S. General Soil Map (STATSGO) data. Ensemble simulations are performed for each simulation unit to incorporate input data uncertainty. Results show that on average forests of the Laurentian Plains and Hills ecoregion have been sequestrating 4.2 Tg C (1 teragram = 1012 gram) per year, including 1.9 Tg C removed from the ecosystem as the consequences of land cover change. ?? 2008 Elsevier B.V.

Camelina Seed Yield and Fatty Acids as Influenced by Genotype and Environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Obour, Augustine K.; Obeng, Eric; Mohammed, Yesuf A.

Camelina (Camelina sativa L. Crantz) is an alternative oilseed crop with potential for fallow replacement in dryland cereal-based crop production systems in the semiarid Great Plains. The interaction between genotype and environment was investigated on camelina seed yield, oil content, and fatty acid composition across two locations in the U.S. Great Plains. Treatments were three spring camelina genotypes (cultivars Blaine Creek, Pronghorn, and Shoshone), three growing seasons (2013, 2014, and 2015) and two locations (at Hays, KS, and Moccasin, MT). Our results showed camelina grown at Hays yielded 54% less than that at Moccasin. Blaine Creek yielded 17 and 42%more » more than Pronghorn and Shoshone at Hays but yields were not different among genotypes at Moccasin. Oil content ranged from 262 g kg -1 at Hays to 359 g kg -1 at Moccasin. The proportion of polyunsaturated fatty acids (PUFAs) ranged from 51% at Hays to 55% at Moccasin, whereas monounsaturated fatty acid (MUFA) and saturated fatty acid (SFA) contents were greater at Hays. The linolenic acid content ranged from 26% when Pronghorn was planted at Hays to 35% when planted at Moccasin. In general, the variations in seed yield and fatty acid profile corresponded well with growing season precipitation and temperatures at each environment.« less

The social construction of violence among Northern Plains tribal members with antisocial personality disorder and alcohol use disorder

PubMed Central

Jervis, Lori L.; Spicer, Paul; Belcourt, Annie; Sarche, Michelle; Novins, Douglas K.; Fickenscher, Alexandra; Beals, Janette

2015-01-01

Whereas recent reports from national studies have presented extremely high rates for many personality disorders in American Indian communities, persistent concerns about the meaning of these symptoms have left many troubled by these reports. American Indians as a group are known to suffer disproportionately from a number of violent experiences, but the dynamics of this violence have received little attention. This paper examines perspectives on violence in the lives of 15 northern plains tribal members who met criteria for antisocial personality disorder and comorbid alcohol use disorder. It explores how study participants constructed and understood their own violent encounters, as well as the motivations they described (characterized here as reputation, leveling, retaliation, catharsis, and self-defense). Violence was gendered in this study, with men generally presenting as perpetrators and women as victims. Men often described themselves as ready participants in a violent world, while women were quite clear that aggression for them was often simply required as they tried to defend themselves from male violence. While this analysis does not replace clinical analyses of violence in antisocial personality disorder, it does reveal an underlying cultural logic that may play a role in shaping the recourse to violence for that minority of individuals for whom it appears to be the obvious choice. PMID:24045407

The social construction of violence among Northern Plains tribal members with antisocial personality disorder and alcohol use disorder.

PubMed

Jervis, Lori L; Spicer, Paul; Belcourt, Annie; Sarche, Michelle; Novins, Douglas K; Fickenscher, Alexandra; Beals, Janette

2014-02-01

Whereas recent reports from national studies have presented extremely high rates for many personality disorders in American Indian communities, persistent concerns about the meaning of these symptoms have left many troubled by these reports. American Indians as a group are known to suffer disproportionately from a number of violent experiences, but the dynamics of this violence have received little attention. This paper examines perspectives on violence in the lives of 15 northern plains tribal members who met criteria for antisocial personality disorder and comorbid alcohol use disorder. It explores how study participants constructed and understood their own violent encounters, as well as the motivations they described (characterized here as reputation, leveling, retaliation, catharsis, and self-defense). Violence was gendered in this study, with men generally presenting as perpetrators and women as victims. Men often described themselves as ready participants in a violent world, while women were quite clear that aggression for them was often simply required as they tried to defend themselves from male violence. While this analysis does not replace clinical analyses of violence in antisocial personality disorder, it does reveal an underlying cultural logic that may play a role in shaping the recourse to violence for that minority of individuals for whom it appears to be the obvious choice.

Circumferential Esophageal Replacement by a Tissue-engineered Substitute Using Mesenchymal Stem Cells

PubMed Central

Catry, Jonathan; Luong-Nguyen, Minh; Arakelian, Lousineh; Poghosyan, Tigran; Bruneval, Patrick; Domet, Thomas; Michaud, Laurent; Sfeir, Rony; Gottrand, Frederic; Larghero, Jerome; Vanneaux, Valerie

2018-01-01

Tissue engineering appears promising as an alternative technique for esophageal replacement. Mesenchymal stem cells (MSCs) could be of interest for esophageal regeneration. Evaluation of the ability of an acellular matrix seeded with autologous MSCs to promote tissue remodeling toward an esophageal phenotype after circumferential replacement of the esophagus in a mini pig model. A 3 cm long circumferential replacement of the abdominal esophagus was performed with an MSC-seeded matrix (MSC group, n = 10) versus a matrix alone (control group, n = 10), which has previously been matured into the great omentum. The graft area was covered with an esophageal removable stent. A comparative histological analysis of the graft area after animals were euthanized sequentially is the primary outcome of the study. Histological findings after maturation, overall animal survival, and postoperative morbidity were also compared between groups. At postoperative day 45 (POD 45), a mature squamous epithelium covering the entire surface of the graft area was observed in all the MSC group specimens but in none of the control group before POD 95. Starting at POD 45, desmin positive cells were seen in the graft area in the MSC group but never in the control group. There were no differences between groups in the incidence of surgical complications and postoperative death. In this model, MSCs accelerate the mature re-epitheliazation and early initiation of muscle cell colonization. Further studies will focus on the use of cell tracking tools in order to analyze the becoming of these cells and the mechanisms involved in this tissue regeneration. PMID:29390879

Obesity and Breast Cancer.

PubMed

Fortner, Renée T; Katzke, Verena; Kühn, Tilman; Kaaks, Rudolf

The relationship between adiposity and breast cancer risk and prognosis is complex, with associations that differ depending on when body size is assessed (e.g., pre- vs. postmenopausal obesity) and when breast cancer is diagnosed (i.e., pre- vs. postmenopausal disease). Further, the impact of obesity on risk differs by tumor hormone receptor status (e.g., estrogen (ER) and progesterone (PR) receptor) and, among postmenopausal women, use of exogenous hormones (i.e., hormone replacement therapy (HRT)). In the context of these complexities, this review focuses on associations between childhood and adolescent adiposity, general adiposity, weight changes (i.e., loss and gain), abdominal adiposity, and breast cancer risk and survival. Finally, we discuss potential mechanisms linking adiposity to breast cancer.

Stenting for Acute Aortic Dissection with Malperfusion as “Bridge Therapy”

PubMed Central

Fujita, Wakako; Taniguchi, Satoshi; Daitoku, Kazuyuki; Fukuda, Ikuo

2010-01-01

The most common treatment of acute type A aortic dissection is immediate surgical repair. However, early surgery for acute dissections with peripheral vascular compromise carries a high mortality rate. Herein, we report a case in which we placed percutaneous endovascular stents in a type A dissection patient before proceeding with proximal aortic repair. Bare-metal stents were placed into the obliterated true channel of the abdominal aorta and the left external iliac artery. Endovascular stenting immediately relieved the lower-left-extremity ischemic symptoms, and the patient underwent hemi-arch replacement 7 days after the procedure. Stent placement for patients who have acute aortic dissection with malperfusion can be used as “bridge therapy.” PMID:21224949

Development, characterization and in vivo evaluation of benzocaine-loaded liposomes.

PubMed

Mura, Paola; Maestrelli, Francesca; González-Rodríguez, Maria Luisa; Michelacci, Ilaria; Ghelardini, Carla; Rabasco, Antonio M

2007-08-01

This study reports the development and in vivo evaluation of a liposomal formulation of the local anaesthetic benzocaine. Multi-lamellar (MLV) and small uni-lamellar (SUV) vesicles entrapping benzocaine were prepared using 50:50 w/w phosphatidylcholine-cholesterol as lipophilic phase and 50:50 v/v ethanol-water as hydrophilic phase. Liposome size, Zeta-potential, encapsulation efficiency and skin penetration properties were determined. Drug permeation from liposomal dispersions, as such or formulated in Carbopol gel, was evaluated through artificial lipophilic membranes and excised abdominal rat skin, whereas in vivo anaesthetic effect was tested on rabbits. Interestingly, addition of the drug into the hydrophilic phase, rather than into the lipophilic one, during liposome preparation enabled an improvement of the MLV's entrapment efficiency from 29.7% to 82.3%. On the other hand, sonication conditions to obtain SUV influenced size and polydispersity index of the vesicles and reduced the entrapment efficiency by about 30%. All liposomal-benzocaine formulations showed sustained release properties and a more intense anaesthetic effect than plain drug. Permeation experiments from drug solutions in gel containing the same amount of ethanol as in the liposomal formulations made it possible to exclude a possible enhancer effect of this solvent, at least when not used in liposomal formulations. MLV with the drug added into the hydrophilic phase gave the most effective formulation, showing a permeability coefficient value 2.5 times higher than that of the plain drug and allowing a significant improvement (P<0.01) not only of intensity but also of duration of anaesthetic effect of benzocaine. These results suggest that a suitably developed liposomal formulation of benzocaine can be of actual value for improving its clinical effectiveness in topical anaesthesia.

Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones.

PubMed

Manzo, B O; Bertacchi, M; Lozada, E; Rasguido, A; Aleman, E; Cabrera, M; Rodríguez, A; Manzo, G; Sánchez, H; Blasco, J

2016-05-01

The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed >100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones >2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring >2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones <2cm; a small percentage of these urologists perform >100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

[Formula diets as baseline therapy for type 2 diabetes].

PubMed

Martin, S; Kempf, K

2014-05-01

Case 1: 59-year-old man with newly diagnosed type 2 diabetes mellitus. Case 2: 69-year-old woman with poorly controlled type 2 diabetes mellitus. Case 1: BMI 36,8 kg/m2. Biochemical evaluation were normal except elevated transaminases. Case 2: BMI 37,0 kg/m2. Abdominal ultrasound showed a fatty liver. THERAPY AND FOLLOW UP: Both patients underwent a 12-week interven tion with a formula diet. In the first week the three principle meals were replaced by the formular diet. The three following weeks the patients received 2 meals of formular diet and a low-carb lunch. In the last 8 weeks only the dinner was replaced by the formular diet. In both patients HbA1c and body weight improved after 3, 6 and 12 months. Using formula diets a fast weight loss and improvement of metabolic control can be achieved. Formula diets can be used as baseline therapy for newly diagnosed type 2 diabetes as well as to regain treatability in case of poorly controlled type 2 diabetes. © Georg Thieme Verlag KG Stuttgart · New York.

Small Bowel Perforations by Metallic Grill Brush Bristles: Clinical Presentations and Opportunity for Prevention.

PubMed

Sordo, Salvador; Holloway, Travis L; Woodard, Russell L; Conway, Bruce E; Liao, Lillian F; Eastridge, Brian J; Myers, John G; Stewart, Ronald M; Dent, Daniel L

2016-05-01

Increasing reports on the incidental ingestion of metallic bristles from barbeque grill cleaning brushes have been reported. We sought to describe the clinical presentation and grilling habits of patients presenting after ingesting metallic bristles in an attempt to identify risk factors. We performed a chart review of six patients with documented enteric injury from metallic bristles. Subjects were contacted and administered a survey focused on the events surrounding the bristle ingestion. We arranged for in-home visits to inspect the grill and grill brush whenever possible. Of the six subjects identified, three (50%) were male, five (83%) were white, and they ranged in age from 18 to 65 years (mean 42.5). All complained of abdominal pain. All bristles were identified by CT scan. Three patients underwent laparoscopic enterorrhaphy, and two underwent laparotomy. The remaining patients did not require intervention. None had replaced their grill brush in at least two years. Surgeon's awareness of this unusual injury is important to identify and manage this problem. Alternative methods to clean the grill should be sought and grill brushes should be replaced at least every two years.

Endovascular repair vs open surgical repair of abdominal aortic aneurysms: comparative utilization trends from 2001 to 2006.

PubMed

Levin, David C; Rao, Vijay M; Parker, Laurence; Frangos, Andrea J; Sunshine, Jonathan H

2009-07-01

Within the past few years, endovascular aneurysm repair (EVAR) has come into use for the treatment of abdominal aortic aneurysms (AAAs). In many cases, EVAR has the potential to replace traditional open surgical repair (OSR), which is more invasive, risky, and expensive. The aim of this study was to determine to what extent EVAR is replacing OSR, whether the frequency of treatment is increasing with the advent of the less invasive approach, and which specialties are performing the procedures. The Medicare Part B data sets for 2001 through 2006 were studied. Procedure volume and utilization rates per 100,000 Medicare beneficiaries were determined for the 7 Current Procedural Terminology, fourth edition, procedure codes that describe EVAR and the 4 codes that describe OSR for AAA. Medicare's physician specialty codes were used to ascertain the specialties of the physician providers. A total of 31,965 OSRs for AAA were performed in Medicare beneficiaries in 2001, dropping to 15,665 by 2006 (-51%). In contrast, EVAR was carried out in 11,028 instances in 2001, increasing to 28,937 by 2006 (+162%). The utilization rate per 100,000 for OSR dropped from 90 to 42 (a rate decrease of 48) during the study period, while the rate for EVAR increased from 31 to 77 (a rate increase of 46). The combined utilization rate per 100,000 of the two types of interventions for AAA (EVAR and OSR) decreased from 121 in 2001 to 119 in 2006. In performing EVAR, procedure volume and market share in 2006 by specialty were 1) 22,003 procedures by surgeons, a 76% share; 2) 3,287 procedures by radiologists, an 11% share; 3) 1,915 procedures by cardiologists, a 7% share; and 4) 1,732 procedures by all other physicians, a 6% share. Treatment for AAA seems to be an example of the responsible use of new technology by physicians. The newer, less invasive, and less risky procedure (EVAR) is replacing the older and more invasive procedure (OSR) to a considerable degree. However, the overall combined utilization rate of both types of AAA treatment has remained stable in the Medicare population. There is thus no evidence to suggest that the introduction of the newer approach has led to the overtreatment of patients. Although radiologists do have a role in EVAR, surgeons strongly predominate.

[Postchemotherapy residual tumour resection in complex metastatic sites of advanced testicular germ cell tumours].

PubMed

Paffenholz, P; Pfister, D; Heidenreich, A

2016-05-01

Postchemotherapy residual tumour resection (PC-RTR) is an integral part of the multimodal therapy for advanced testicular germ cell tumours. Depending on the extent and localisation of the residual mass, PC-RTR may necessitate a multidisciplinary procedure (which should be planned preoperatively), to resolve even complex situations in an oncologically sound manner, with lower treatment-related morbidity The aim of article is to report on the interdisciplinary management of complex residual masses. Of a total of 162 patients who underwent PC-RTR, 24 (17.8 %) patients underwent, in addition to a bilateral postchemotherapy retroperitoneal lymphadenectomy (PC-RPLND), complex adjunctive resections including the abdominal aorta, the inferior vena cava, or the thoracic/lumbar spine, and the neighbouring vessels (n = 15). We performed a retrospective analysis of treatment-associated complications according to the Clavien-Dindo classification and of progression-free, cancer-specific and overall survival. Median patient age was 24.5 (18-52) years. All patients had an intermediate or poor prognosis according to the International Germ Cell Cancer Collaboration Group (IGCCCG). Median tumour diameter at the time of surgery was 18.6 (9.0-35) cm. In 5 patients 1-2 metastatic lumbar vertebral bodies were completely resected, stabilised and replaced by means of a cage. In 6 patients resection of the abdominal aorta/inferior vena cava with vascular prosthesis replacement was required owing to infiltration. In 2 patients the common iliac artery or vein was resected and replaced. In addition, retrocrural lymph nodes had to be resected in 5 patients and 3 patients required adjunctive nephrectomy. In another 4 patients the Whipple procedure was required owing to infiltration into the pancreas and/or duodenum. The median operating time was 7.8 (6-15) h, the median blood loss was around 1,450 (900-3,400) ml, and 2 Clavien-Dindo grade IVa complications occurred. Pathohistology revealed teratoma/vital cancer in 16/24 patients and scarring/necrosis in 8 patients. After a median follow-up of 2.5 years, 1 patient developed recurrent disease and 1 patient died of the disease. Postchemotherapy, a few patients with advanced nonseminomas (NS) need complex residual tumour resection in an interdisciplinary setting, with a good functional and oncological outcome. Even the involvement of vascular vertebral structures does not constitute a contraindication for complete resection.

Utilization of tigernut (Cyperus rotundus, L.) meal in diets for cockerel starters.

PubMed

Bamgbose, A M; Eruvbetine, Daisy; Dada, W

2003-09-01

The effect of feeding graded levels of tigernut meal (TGN) as a replacement for maize in the diets of cockerel starters on carcass characteristics and economics of feed conversion was assessed for 70 days. Tigernut replaced maize at 0%, 33.33%, 66.67% and 100% levels. A total of 120 day-old chicks were randomly allotted to four experimental diets such that each dietary treatment had three replicates of ten birds. Inclusion of TGN at 33.33% in cockerel diets supported better carcass yield in terms of high plucked, eviscerated, drumstick, thigh, neck, wing, heads, shanks, livers, hearts and lung weights without significant differences (P>0.05) in values obtained. However, there were significant difference (P<0.05) in back, breast, abdominal fat, gizzard, spleen, kidney and intestinal weights and lengths. Inclusion of TGN 100% level significantly depressed parameters assessed. The optimum replacement level of maize with TGN was 33.33% as this gave no significant reduction in carcass yield of the birds but a significant reduction in the cost of feed consumed. It required a feed cost of 42.90 ( 0.31 US dollars) to produce one kilogram weight gain on diet 2 (33.33%). Inclusion of TNG in the diets resulted in feed cost savings of 4.88% (D2), 8.17 (D3) and 8.90% (D4) respectively.

Simultaneous antegrade/retrograde upper urinary tract access: Bart's modified lateral position for complex upper tract endourologic pathologic features.

PubMed

Moraitis, Konstantinos; Philippou, Prodromos; El-Husseiny, Tamer; Wazait, Hassan; Masood, Junaid; Buchholz, Noor

2012-02-01

To determine whether the Bart's modified lateral position is safe and effective for achieving simultaneous anterograde and retrograde access in complex upper urinary tract pathologic features. From November 2006 to September 2010, 45 procedures were performed, with the patients in the modified lateral position. The indication for these procedures was the presence of complex unilateral upper urinary tract pathologic features. The patients with muscular and/or skeletal abnormalities were excluded. All procedures were performed using simultaneous anterograde and retrograde access with the patient under general anesthesia. The preoperative investigation protocol included assessment of the stone burden and location using enhanced abdominal computed tomography. The patients were routinely examined 6 weeks after the procedure with a combination of plain abdominal radiography and renal ultrasonography. For patients treated for conditions causing upper urinary tract obstruction (pelviureteral junction obstruction and/or ureteral strictures), a mercaptoacetyltriglycine renography was performed at 4, 12, and 24 months postoperatively. The mean patient age was 51.2 years (range 17-79). Stone clearance was achieved by a single combined procedure in 36 patients (80%). Successful recanalization was achieved in all patients with pelviureteral junction obstruction and ureteral strictures. In 4 patients (8.8%), persistent hematuria was noted, and 2 patients (4.4%) developed postoperative urinary sepsis and were treated conservatively. Modification to the lateral position compares equally with contemporary percutaneous nephrolithotomy series. It provides wide exposure of the flank, allowing the choice of multiple access sites, enhanced control, and a wide angle for handling of the antegrade instruments. Two surgeons can work simultaneously, addressing complex endourologic pathologic features in high-risk patients. Copyright © 2012. Published by Elsevier Inc.

Congenital asymptomatic diaphragmatic hernias in adults: a case series

PubMed Central

2013-01-01

Introduction Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. Case presentations In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Conclusions Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease. PMID:23668793

Sectorial technetium-99m-dimercaptosuccinic acid scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy for calyceal calculi on regional renal function.

PubMed

Al-Tawheed, A; Al-Awadi, K A; Kehinde, E O; Loutfi, I; Abdul-Haleem, H; Al-Mohannadi, S

2003-01-01

To apply a semiquantitative method for analysis of technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA) renal scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy (EPL) in patients with calyceal stones on regional kidney function and to check whether EPL had caused any deleterious effect on the target calyceal renal parenchymal function. Forty patients (mean age 35 years) suffering from calyceal stones documented by abdominal plain radiography, intravenous urogram or abdominal ultrasound were studied. All patients were treated by EPL. (99m)Tc-DMSA scan was performed before and 4 weeks after EPL. Sector analysis involved calculation of the relative function of the target calyx to the function of the ipsilateral kidney and the relative function of the treated kidney to global renal function. The stone sizes were 6-11 mm in diameter and 11 were located in the upper, 13 in the middle and 16 in the lower calyx. After EPL, the overall stone clearance rate was 85% (100% for calculi in the upper and middle calyces, 62% for lower calyces). The sector analysis did not show statistically significant change of the relative regional (calyceal) or whole kidney function between the pre- and post-EPL (99m)Tc-DMSA scans. Using sector analysis, EPL appeared to be a safe modality and its usage was not associated with any untoward effect on calyceal or whole kidney function. Sector analysis of (99m)Tc-DMSA renal scan is a simple semiquantitative method for monitoring regional changes of kidney function after EPL for treatment of calyceal stone. Copyright 2003 S. Karger AG, Basel

Surgical management of acute perforation of peptic ulcers. A single centre experience.

PubMed

Lemaitre, J; El Founas, W; Simoens, Chr; Ngongang, Chr; Smets, D; Mendes da Costa, P

2005-01-01

Acute perforation may occur in gastric and duodenal ulcers. During the past decade, the need for elective operation for peptic ulceration has decreased as medical treatment has improved. However, emergency operations for acute complications such as perforation or bleeding remain constant. Actually, the treatment of choice is simple suture-closure, with or without omentoplasty, and peritoneal lavage or even omentoplasty alone, associated with a high intravenous dose of inhibitors of the proton pump and Helicobacter pylori eradication, if needed. The standard treatment in our team is to perform a peritoneal lavage and drainage and a simple closure of the ulcer with an omentoplasty. A first retrospective analysis was made on data collected from 1996 to 2001 and we completed a prospective study from 2001 to 2003 to compare our results with our old data and with data collected from other teams. The mean age and the mean ASA score were similar in the two groups. For the majority of the patients, the diagnosis was made from symptoms and the presence of free abdominal air. The delay between arrival in the emergency room and the operating room was significantly shorter in the second group, but operating time was longer in this group. Morbidity was more frequent in the first group but mortality remained quite similar. Our results indicate that in a trained team the morbidity has decreased as the delay in surgery decreased and that the rate of diagnosis on plain abdominal film has increased. Laparoscopic suture of a perforated peptic ulcer is as safe as the open procedure but allows the surgeon to search for another cause of free air and offers the possibility, if conversion is needed, to perform a shorter laparotomy.

Trends in diagnosis and surgical management of patients with perforated peptic ulcer.

PubMed

Thorsen, Kenneth; Glomsaker, Tom B; von Meer, Andreas; Søreide, Kjetil; Søreide, Jon Arne

2011-08-01

While the laparoscopic treatment of perforated peptic ulcers (PPU) has been shown to be feasible and safe, its implementation into routine clinical practice has been slow. Only a few studies have evaluated its overall utility. The aim of this study was to investigate changes in surgical management of PPU and associated outcomes. The study was a retrospective, single institution, population-based review of all patients undergoing surgery for PPU between 2003 and 2009. Patient demographics, diagnostic evaluation, management, and outcomes were evaluated. Included were 114 patients with a median age of 67 years (range, 20-100). Women comprised 59% and were older (p < 0.001), had more comorbidities (p = 0.002), and had a higher Boey risk score (p = 0.036) compared to men. Perforation location was gastric/pyloric in 72% and duodenal in 28% of patients. Pneumoperitoneum was diagnosed by plain abdominal x-ray in 30 of 41 patients (75%) and by abdominal computerized tomography (CT) in 76 of 77 patients (98%; p < 0.001).Laparoscopic treatment was initiated in 48 patients (42%) and completed in 36 patients (75% of attempted cases). Laparoscopic treatment rate increased from 7% to 46% during the study period (p = 0.02). Median operation time was shorter in patients treated via laparotomy (70 min) compared to laparoscopy (82 min) and those converted from laparoscopy to laparotomy (105 min; p = 0.017). Postoperative complications occurred in 56 patients (49%). Overall 30-day postoperative mortality was 16%. No statistically significant differences were found in morbidity and mortality between open versus laparoscopic repair. This study demonstrates an increased use of CT as the primary diagnostic tool for PPU and of laparoscopic repair in its surgical treatment. These changes in management are not associated with altered outcomes.

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

PubMed Central

Párniczky, Andrea; Kui, Balázs; Szentesi, Andrea; Balázs, Anita; Szűcs, Ákos; Mosztbacher, Dóra; Czimmer, József; Sarlós, Patrícia; Bajor, Judit; Gódi, Szilárd; Vincze, Áron; Illés, Anita; Szabó, Imre; Pár, Gabriella; Takács, Tamás; Czakó, László; Szepes, Zoltán; Rakonczay, Zoltán; Izbéki, Ferenc; Gervain, Judit; Halász, Adrienn; Novák, János; Crai, Stefan; Hritz, István; Góg, Csaba; Sümegi, János; Golovics, Petra; Varga, Márta; Bod, Barnabás; Hamvas, József; Varga-Müller, Mónika; Papp, Zsuzsanna; Sahin-Tóth, Miklós; Hegyi, Péter

2016-01-01

Objective The aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP) in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP. Design Eighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group. Patients 600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013. Main Results With respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality. Conclusions Analysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP. PMID:27798670

Comparing Hemodynamic Symptoms and the Level of Abdominal Pain in High- Versus Low-Pressure Carbon Dioxide in Patients Undergoing Laparoscopic Cholecystectomy.

PubMed

Mohammadzade, A R; Esmaili, F

2018-02-01

The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstone. To view the surgical site in this type of operations better, carbon dioxide is used with a certain pressure. The current study aimed to compare the hemodynamic symptoms and the level of abdominal pain due to using high- and low-pressure carbon dioxide in patients undergoing LC. The current double-blind randomized clinical trial was conducted on 60 patients with the age range of 20-70 years old undergoing LC. The first and second groups experienced PaCO 2 of 7-10 and 12-14 mmHg, respectively. The hemodynamic symptoms, abdominal pain, shoulder-tip pain, nausea and vomiting after the surgery, and the mean of liver function tests were evaluated. Data were analyzed using T test, Chi-square test, and repeated measures ANOVA by SPSS 16. Information of 60 patients in two groups was analyzed. There was a significant difference between the groups regarding the mean of systolic blood pressure ( P  < 0.05). The mean of heart rate was significantly higher in the high-pressure group during surgery and 1 h after that ( P  < 0.05). The frequency of pain in shoulder-tip and abdomen was higher in the high-pressure group. Frequency of nausea and vomiting 12 h after the surgery between two groups was significant ( P  < 0.05). The mean of alkaline phosphatase was higher in the low-pressure group than the high-pressure group ( P  < 0.05). Considering the good performance and low side effects of low-pressure laparoscopic cholecystectomy compared to those of high-pressure, this method can be replaced by high-pressure in LC.

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome after Abdominal Wall Reconstruction: Quaternary Syndromes?

PubMed

Kirkpatrick, A W; Nickerson, D; Roberts, D J; Rosen, M J; McBeth, P B; Petro, C C; Berrevoet, Frederik; Sugrue, M; Xiao, Jimmy; Ball, C G

2017-06-01

Reconstruction with reconstitution of the container function of the abdominal compartment is increasingly being performed in patients with massive ventral hernia previously deemed inoperable. This situation places patients at great risk of severe intra-abdominal hypertension and abdominal compartment syndrome if organ failure ensues. Intra-abdominal hypertension and especially abdominal compartment syndrome may be devastating systemic complications with systematic and progressive organ failure and death. We thus reviewed the pathophysiology and reported clinical experiences with abnormalities of intra-abdominal pressure in the context of abdominal wall reconstruction. Bibliographic databases (1950-2015), websites, textbooks, and the bibliographies of previously recovered articles for reports or data relating to intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome in relation to ventral, incisional, or abdominal hernia repair or abdominal wall reconstruction. Surgeons should thus consider and carefully measure intra-abdominal pressure and its resultant effects on respiratory parameters and function during abdominal wall reconstruction. The intra-abdominal pressure post-operatively will be a result of the new intra-peritoneal volume and the abdominal wall compliance. Strategies surgeons may utilize to ameliorate intra-abdominal pressure rise after abdominal wall reconstruction including temporizing paralysis of the musculature either temporarily or semi-permanently, pre-operative progressive pneumoperitoneum, permanently removing visceral contents, or surgically releasing the musculature to increase the abdominal container volume. In patients without complicating shock and inflammation, and in whom the abdominal wall anatomy has been so functionally adapted to maximize compliance, intra-abdominal hypertension may be transient and tolerable. Intra-abdominal hypertension/abdominal compartment syndrome in the specific setting of abdominal wall reconstruction without other complication may be considered as a quaternary situation considering the classification nomenclature of the Abdominal Compartment Society. Greater awareness of intra-abdominal pressure in abdominal wall reconstruction is required and ongoing study of these concerns is required.

Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management

PubMed Central

White, Paul F.; Elvir Lazo, Ofelia Loani; Galeas, Lidia; Cao, Xuezhao

2017-01-01

The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. The use of epidural local analgesia for perioperative pain management was not found to be protective against persistent opioid use in a large cohort of opioid-naïve patients undergoing abdominal surgery. In a retrospective study involving over 390,000 outpatients more than 66 years of age who underwent minor ambulatory surgery procedures, patients receiving a prescription opioid analgesic within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery. In a review of 11 million patients undergoing elective surgery from 2002 to 2011, both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain (namely radiofrequency ablation therapy) was recently reported to have no clinical benefit. Therefore, this clinical commentary will review evidence in the peer-reviewed literature supporting the use of electroanalgesia and laser therapies for treating acute pain, cervical (neck) pain, low back pain, persistent post-surgical pain after spine surgery (“failed back syndrome”), major joint replacements, and abdominal surgery as well as other common chronic pain syndromes (for example, myofascial pain, peripheral neuropathic pain, fibromyalgia, degenerative joint disease/osteoarthritis, and migraine headaches). PMID:29333260

Recovery of hazardous semiconductor-industry sludge as a useful resource.

PubMed

Lee, Tzen-Chin; Liu, Feng-Jiin

2009-06-15

Sludge, a solid waste recovered from wastewater of semiconductor-industries composes of agglomerates of nano-particles like SiO(2) and CaF(2). This sludge deflocculates in acidic and alkaline aqueous solutions into nano-particles smaller than 100 nm. Thus, this sludge is potentially hazardous to water resources when improperly dumped. It can cause considerable air-pollution when fed into rotary-kilns as a raw material for cement production. In this study, dried and pulverized sludge was used to replace 5-20 wt.% Portland cement in cement mortar. The compressive strength of the modified mortar was higher than that of plain cement mortar after curing for 3 days and more. In particular, the strength of mortar with 10 wt.% substitution improved by 25-35% after curing for 7-90 days. TCLP studies reveal no detectable release of heavy metals. Preliminary studies showed that nano-particles deflocculated from the sludge, when cured for up to 3 days retain in the modified mortar their nano-size, which become large-sized hydration compounds that contribute to the final mortar strength. Semiconductor sludge can thus be utilized as a useful resource to replace portion of cement in cement mortar, thereby avoiding their potential hazard on the environment.

Identifying wells downstream from Laguna Dam that yield water that will be replaced by water from the Colorado River, Arizona and California

USGS Publications Warehouse

Owen-Joyce, Sandra J.

2000-01-01

This report summarizes a comprehensive study and development of the method documented in Owen-Joyce and others (2000). That report and one for the area upstream from Laguna Dam (Wilson and Owen-Joyce, 1994) document the accounting-surface method to identify wells that yield water that will be replaced by water from the Colorado River. Downstream from Laguna Dam, the Colorado River is the source for nearly all recharge to the river aquifer. The complex surface-water and ground-water system that exists in the area is, in part, the result of more than 100 years of water-resources development. Agriculture is the principal economy and is possible only with irrigation. The construction and operation of canals provides the means to divert and distribute Colorado River water to irrigate agricultural lands on the flood plains and mesas along the Colorado and Gila Rivers, in Imperial and Coachella Valleys, and in the area upstream from Dome along the Gila River. Water is withdrawn from wells for irrigation, dewatering, and domestic use. The area downstream from Laguna Dam borders additional areas of agricultural development in Mexico where Colorado River water also is diverted for irrigation.

Palynological evidence of the replacement of the hygrophilous forest by field vegetation during the last 7,000 years B.P. in the northern coast of Rio de Janeiro, Brazil.

PubMed

Luz, Cynthia F P da; Barth, Ortrud M; Martin, Louis; Silva, Cleverson G; Turcq, Bruno J

2011-09-01

Historians claim that European colonizers of the northern coast of Rio de Janeiro State found vast herbaceous fields when arrived in this region. Hypotheses about the origin of these fields include forest burning by the Goitacás indians and periodical floods by the Paraíba do Sul River and the lagoon system. The palynologycal analysis of two lake cores obtained in the municipality of Campos dos Goytacazes revealed opening episodes of hygrophilous forest and the establishment of field vegetation, recorded at ca. 6,500 and ca. 4,000 (14)C yr BP. The partial replacement of forest by field vegetation in the first episode was probably caused by floods of the lower areas during the development of the Holocene lagoon phase. During the second episode, successions of vegetational patterns occurred due to lowering of the sea level. Drying and enlarging of the coastal plain have allowed its colonization by herbs and heliophyte plants. The palynological analysis does not provide any evidence that sustains the theories of use of fire and agricultural activities by indigenous groups during these periods.

Reuse of waste iron as a partial replacement of sand in concrete.

PubMed

Ismail, Zainab Z; Al-Hashmi, Enas A

2008-11-01

One of the major environmental issues in Iraq is the large quantity of waste iron resulting from the industrial sector which is deposited in domestic waste and in landfills. A series of 109 experiments and 586 tests were carried out in this study to examine the feasibility of reusing this waste iron in concrete. Overall, 130 kg of waste iron were reused to partially replace sand at 10%, 15%, and 20% in a total of 1703 kg concrete mixtures. The tests performed to evaluate waste-iron concrete quality included slump, fresh density, dry density, compressive strength, and flexural strength tests: 115 cubes of concrete were molded for the compressive strength and dry density tests, and 87 prisms were cast for the flexural strength tests. This work applied 3, 7, 14, and 28 days curing ages for the concrete mixes. The results confirm that reuse of solid waste material offers an approach to solving the pollution problems that arise from an accumulation of waste in a production site; in the meantime modified properties are added to the concrete. The results show that the concrete mixes made with waste iron had higher compressive strengths and flexural strengths than the plain concrete mixes.

Effect of exercise on patient specific abdominal aortic aneurysm flow topology and mixing.

PubMed

Arzani, Amirhossein; Les, Andrea S; Dalman, Ronald L; Shadden, Shawn C

2014-02-01

Computational fluid dynamics modeling was used to investigate changes in blood transport topology between rest and exercise conditions in five patient-specific abdominal aortic aneurysm models. MRI was used to provide the vascular anatomy and necessary boundary conditions for simulating blood velocity and pressure fields inside each model. Finite-time Lyapunov exponent fields and associated Lagrangian coherent structures were computed from blood velocity data and were used to compare features of the transport topology between rest and exercise both mechanistically and qualitatively. A mix-norm and mix-variance measure based on fresh blood distribution throughout the aneurysm over time were implemented to quantitatively compare mixing between rest and exercise. Exercise conditions resulted in higher and more uniform mixing and reduced the overall residence time in all aneurysms. Separated regions of recirculating flow were commonly observed in rest, and these regions were either reduced or removed by attached and unidirectional flow during exercise, or replaced with regional chaotic and transiently turbulent mixing, or persisted and even extended during exercise. The main factor that dictated the change in flow topology from rest to exercise was the behavior of the jet of blood penetrating into the aneurysm during systole. Copyright © 2013 John Wiley & Sons, Ltd.

Lamellipodia-based migrations of larval epithelial cells are required for normal closure of the adult epidermis of Drosophila

PubMed Central

Bischoff, Marcus

2012-01-01

Cell migrations are an important feature of animal development. They are, furthermore, essential to wound healing and tumour progression. Despite recent progress, it is still mysterious how cell migration is spatially and temporally regulated during morphogenesis and how cell migration is coordinated with other cellular behaviours to shape tissues and organs. The formation of the abdominal epithelium of Drosophila during metamorphosis provides an attractive system to study morphogenesis. Here, the diploid adult histoblasts replace the polyploid larval epithelial cells (LECs). Using in vivo 4D microscopy, I show that, besides apical constriction and apoptosis, the LECs undergo extensive coordinated migrations. The migrations follow a transition from a stationary (epithelial) to a migratory mode. The migratory behaviour is stimulated by autocrine Dpp signalling. Directed apical lamellipodia-like protrusions propel the cells. Initially, planar cell polarity determines the orientation of LEC migration. While LECs are migrating they also constrict apically, and changes in activity of the small GTPase Rho1 can favour one behaviour over the other. This study shows that the LECs play a more active role in morphogenesis than previously thought, with their migrations contributing to abdominal closure. It furthermore provides insights into how the migratory behaviour of cells is regulated during morphogenesis. PMID:22230614

A comparative study of colour and perfusion between two different post surgical scars. Do the laser Doppler imager and the colorimeter measure the same features of a scar?

PubMed

Mermans, J F; Peeters, W J; Dikmans, R; Serroyen, J; van der Hulst, R R J W; Van den Kerckhove, E

2013-05-01

The purpose of this study was to investigate the influence of different located post surgical scars on both perfusion and redness. The pattern of change and correlation between perfusion and redness of post surgical scars is also examined. In this study, we measured redness and perfusion of the abdominal and breast scar of 24 women undergoing breast reconstruction with Deep Inferior Epigastric Perforator Free Flap surgery with the Minolta Chromameter CR-400/410 and the Moor Instruments laser Doppler imager 12IR, respectively, at different intervals post-operatively. The laser Doppler imager gives significantly higher values for the abdominal compared with the breast scar. There was no consistent correlation found between perfusion and redness at the different test moments for both locations. The scores of both parameters were significantly associated after 9 months follow-up for both locations. Scars closed with higher mechanical force show higher perfusion and prolonged activity; and more redness is associated with more perfusion for both post surgical scars. Nevertheless, there was no consistent correlation found between these parameters making the laser Doppler imager and the Colorimeter still non-replaceable instruments. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Acute GI obstruction.

PubMed

Hucl, Tomas

2013-10-01

Acute gastrointestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The blockage can occur at any level throughout the gastrointestinal tract. The clinical symptoms depend on the level and extent of obstruction. Various benign and malignant processes can produce acute gastrointestinal obstruction, which often represents a medical emergency because of the potential for bowel ischemia leading to perforation and peritonitis. Early recognition and appropriate treatment are thus essential. The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and failure to pass bowel movements. Abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds suggest the diagnosis. The diagnostic process involves imaging including radiography, ultrasonography, contrast fluoroscopy and computer tomography in less certain cases. In patients with uncomplicated obstruction, management is conservative, including fluid resuscitation, electrolyte replacement, intestinal decompression and bowel rest. In many cases, endoscopy may aid in both the diagnostic process and in therapy. Endoscopy can be used for bowel decompression, dilation of strictures or placement of self-expandable metal stents to restore the luminal flow either as a final treatment or to allow for a delay until elective surgical therapy. When gastrointestinal obstruction results in ischemia, perforation or peritonitis, emergency surgery is required. Copyright © 2013. Published by Elsevier Ltd.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

PubMed

Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

2007-10-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

Death by 'ice': fatal methamphetamine intoxication of a body packer case detected by postmortem computed tomography (PMCT) and validated by autopsy.

PubMed

Bin Abdul Rashid, Saiful Nizam; Rahim, Amir Saad Abdul; Thali, Michael J; Flach, Patricia M

2013-03-01

Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA 'body packer' who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication.

Is pre-operative imaging essential prior to ureteric stone surgery?

PubMed

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Myxedema coma and cardiac ischemia in relation to thyroid hormone replacement therapy in a 38-year-old Japanese woman.

PubMed

Taguchi, Takafumi; Iwasaki, Yasumasa; Asaba, Koichi; Takao, Toshihiro; Hashimoto, Kozo

2007-12-01

Although thyroid hormone deficiency, either clinical or subclinical, is an established risk factor for cardiovascular disease, coronary ischemia in a premenopausal woman in her 30s is relatively rare. A 38-year-old woman was referred to our hospital with severe breathlessness and depressed consciousness. Physical examination found facial, abdominal, and pretibial edema; coarse hair, hoarse voice, and dry skin; engorged jugular veins; a distant heart sound; and reduced bilateral entry of air into the chest. Laboratory examinations revealed severe hypothyroidism, hyperlipidemia, and elevated serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125). A computed tomography scan showed massive pleural and pericardial effusions. After 3 months of levothyroxine replacement therapy (initial dose: 12.5 microg/d; maintenance dose: 125 microg/d), all abnormal laboratory values associated with hypothyroidism returned to within normal ranges, with the exception of a transient and paradoxical rise in serum thyroid-stimulating hormone levels. However, 3 weeks after the initiation of therapy, the patient reported intermittent chest pains during the course of therapy, and a coronary artery angiogram revealed diffuse stenosis of all 3 branches. The patient underwent coronary artery bypass grafting, with subsequent improvement in coronary perfusion. Careful cardiovascular evaluation is recommended before the start of thyroid hormone replacement therapy. In addition, care should be taken in the interpretation of serum biomarkers of malignancy (eg, CEA, CA125) in patients with myxedema, as values may be elevated in a hypothyroid state. Long-standing hypothyroidism may be associated with severe coronary atherosclerosis, even in a relatively young, premenopausal woman. The potential adverse cardiovascular effects of thyroid hormone must be considered during replacement therapy, even in relatively young patients.

Rupture after Previous Endovascular Aneurysm Repair due to Type IA Endoleak: Complete Endograft Preservation Is Feasible with Proximal Suturing, Aortic Neck Banding, and Sac Plication.

PubMed

Karkos, Christos D; Mitka, Maria; Pliatsios, Ioannis; Xanthopoulou, Efthalia; Giagtzidis, Ioakeim T; Papadimitriou, Christina T; Papazoglou, Konstantinos O

2018-05-01

Rupture of an abdominal aortic aneurysm (AAA) after previous endovascular repair (EVAR) may require endograft explantation and replacement with a prosthetic surgical graft. Recent reports have suggested that total endograft removal during late surgical conversion in the nonruptured setting may not be necessary and that preserving functional parts of the endograft may improve results. Similar techniques may be used for ruptured cases diminishing the magnitude of an already difficult and complex procedure. We describe the successful treatment of a ruptured AAA after previous EVAR with complete endograft preservation by combining transmural endograft fixation with sutures, proximal aortic neck banding, and sac plication. Copyright © 2018 Elsevier Inc. All rights reserved.

Actinomycosis: a frequently forgotten disease.

PubMed

Boyanova, Lyudmila; Kolarov, Rossen; Mateva, Lyudmila; Markovska, Rumyana; Mitov, Ivan

2015-01-01

Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and 'sulfur granules' are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1-4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.

[Denys-Drash syndrome: a case report].

PubMed

Puczko-Nogal, Barbara; Nogal, Paweł; Bilińska, Wiesława; Kulig, Andrzej; Nowicki, Michał

2003-04-01

Nephrotic syndrome (NS) rarely develops before the age of 1 year. The case is presented of nephrotic syndrome occurring in the form of Denys-Drash syndrome. In a newborn of female sex in birth certificate, dysmorphia was found of the external urogenital organs. The karyotype was 46XY. Massive proteinuria, low total serum protein level, dysproteinaemia, hypercholesterolaemia justified the diagnosis of NS. In renal biopsy performed diffuse mesangial fibrosis was found. The progression of renal insufficiency was very rapid and within few weeks terminal renal failure developed. The parents refused consent to renal replacement treatment. The baby died at the age of 102 days. The autopsy examination confirmed renal changes in the form of diffuse fibrosis; gonads of testicular structure were found in the abdominal cavity.

Disc dislodgment in Björk Shiley mitral valve prosthesis: two successfully operated cases.

PubMed

Dubernet, J; Irarrázaval, M J; Urzúa, J; Maturana, G; Morán, S; Lema, G; Asenjo, F; Fajuri, A

1986-02-01

Two patients with Björk Shiley mitral valve replacement had migration and embolization of the occluding disc. One patient suffered migration of the disc a few hours after surgery and the other had a strut fracture with disc translocation six years after the initial operation. Clinical signs in both cases were pulmonary edema, cardiogenic shock, and absence of prosthetic sounds. Both patients were reoperated on an emergency basis, recovering after a complicated postoperative course. They are on functional Class I, 8 and 1 years later, respectively, with their dislodged discs still in the abdominal aorta. The only hope for survival in these patients is emergency reoperation, once the prosthetic mitral valve dysfunction is confirmed.

The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature.

PubMed

Noussios, George; Dimitriou, Ioannis; Chatzis, Iosif; Katsourakis, Anastasios

2017-04-01

Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.

The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia

PubMed Central

Vleeming, A; Schuenke, M D; Danneels, L; Willard, F H

2014-01-01

The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior displacement of the PLF and increase the compliance of the lateral border. The resulting change in PMC geometry could diminish any effects of increased tension of the CTrA. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA. PMID:25139243

The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia.

PubMed

Vleeming, A; Schuenke, M D; Danneels, L; Willard, F H

2014-10-01

The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior displacement of the PLF and increase the compliance of the lateral border. The resulting change in PMC geometry could diminish any effects of increased tension of the CTrA. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA. © 2014 Anatomical Society.

Application of a multipurpose unequal probability stream survey in the Mid-Atlantic Coastal Plain

USGS Publications Warehouse

Ator, S.W.; Olsen, A.R.; Pitchford, A.M.; Denver, J.M.

2003-01-01

A stratified, spatially balanced sample with unequal probability selection was used to design a multipurpose survey of headwater streams in the Mid-Atlantic Coastal Plain. Objectives for the survey include unbiased estimates of regional stream conditions, and adequate coverage of unusual but significant environmental settings to support empirical modeling of the factors affecting those conditions. The design and field application of the survey are discussed in light of these multiple objectives. A probability (random) sample of 175 first-order nontidal streams was selected for synoptic sampling of water chemistry and benthic and riparian ecology during late winter and spring 2000. Twenty-five streams were selected within each of seven hydrogeologic subregions (strata) that were delineated on the basis of physiography and surficial geology. In each subregion, unequal inclusion probabilities were used to provide an approximately even distribution of streams along a gradient of forested to developed (agricultural or urban) land in the contributing watershed. Alternate streams were also selected. Alternates were included in groups of five in each subregion when field reconnaissance demonstrated that primary streams were inaccessible or otherwise unusable. Despite the rejection and replacement of a considerable number of primary streams during reconnaissance (up to 40 percent in one subregion), the desired land use distribution was maintained within each hydrogeologic subregion without sacrificing the probabilistic design.

The accuracy of ultrasound for measurement of mobile- bearing motion.

PubMed

Aigner, Christian; Radl, Roman; Pechmann, Michael; Rehak, Peter; Stacher, Rudolf; Windhager, Reinhard

2004-04-01

After anterior cruciate ligament-sacrificing total knee replacement, mobile bearings sometimes have paradoxic movement but the implications of such movement on function, wear, and implant survival are not known. To study this potential problem accurate, reliable, and widely available inexpensive tools for in vivo mobile-bearing motion analyses are needed. We developed a method using an 8-MHz ultrasound to analyze mobile-bearing motion and ascertained accuracy, precision, and reliability compared with plain and standard digital radiographs. The anterior rim of the mobile bearing was the target for all methods. The radiographs were taken in a horizontal plane at neutral rotation and incremental external and internal rotations. Five investigators examined four positions of the mobile bearing with all three methods. The accuracy and precision were: ultrasound, 0.7 mm and 0.2 mm; digital radiograph, 0.4 mm and 0.2 mm; and plain radiographs, 0.7 mm and 0.3 mm. The interrater and intrarater reliability ranged between 0.3 to 0.4 mm and 0.1 to 0.2 mm, respectively. The difference between the methods was not significant for neutral rotation but ultrasound was significantly more accurate than any one degree of rotation or higher. Ultrasound of 8 MHz provides an accuracy and reliability that is suitable for evaluation of in vivo meniscal bearing motion. Whether this method or others are sufficiently accurate to detect motion leading to abnormal wear is not known.

Association between Plain Water and Sugar-Sweetened Beverages and Total Energy Intake among Mexican School-Age Children.

PubMed

Shamah-Levy, Teresa; García-Chávez, Claudia Gabriela; Rodríguez-Ramírez, Sonia

2016-12-18

Water consumption promotes a decrease in total diet energy intake, and one explanation for this fact is the replacement of sugar-sweetened beverages (SSBs) by plain water (PW). The objective of this study was to analyze the association between SSB and PW consumption as a part of the total energy intake. Dietary information was obtained by one 24 h recall of 2536 school-age children who participated in the National Nutrition Survey in Mexico. PW and SSB consumption was measured in mL and servings (240 mL), and consumption was stratified into two levels (<2 and ≥2 servings/day). Linear regression models were used to evaluate the association between PW and SSB consumption in relation to total energy intake. Models were adjusted for age, sex, the proportion of energy obtained from non-beverage food, area of residence, and socioeconomic status (based on information regarding housing conditions and ownership of home appliances). PW consumption at the national level was two servings/day, and was not associated with total energy intake. However, the combination of the high consumption of PW and the low consumption of SSB was associated with less total energy intake ( p < 0.05). Promoting higher PW and lower SSB consumption provides a useful public health strategy for reducing total energy intake and preventing overconsumption among Mexican school-age children.

Regional summer cooling from agricultural management practices that conserve soil carbon in the northern North American Great Plains

NASA Astrophysics Data System (ADS)

Stoy, Paul; Bromley, Gabriel; Gerken, Tobias; Tang, Angela; Morgan, Mallory; Wood, David; Ahmed, Selena; Bauer, Brad; Brookshire, Jack; Haggerty, Julia; Jarchow, Meghann; Miller, Perry; Peyton, Brent; Rashford, Ben; Spangler, Lee; Swanson, David; Taylor, Suzi; Poulter, Ben

2017-04-01

Conserving soil carbon resources while transitioning to a C negative economy is imperative for meeting global climate targets, and can also have critical but under-investigated regional effects. Parts of the North American northern Great Plains have experienced a remarkable 6 W m-2 decrease in summertime radiative forcing since the 1970s. Extreme temperature events now occur less frequently, maximum temperatures have decreased by some 2 ˚ C, and precipitation has increased by 10 mm per decade in some areas. This regional trend toward a cooler and wetter summer climate has coincided with changes in agricultural management. Namely, the practice of keeping fields fallow during summer (hereafter 'summerfallow') has declined by some 23 Mha from the 1970s until the present in the Canadian Prairie Provinces and across the U.S., an area of similar size to the United Kingdom. In addition to potential climate impacts, replacing summerfallow with no-till cropping systems results in lesser soil carbon losses - or even gains - and usually confers economic benefits. In other words, replacing summerfallow with no-till cropping may have resulted in a 'win-win-win' scenario for regional climate, soil carbon conservation, and farm-scale economics. The interaction between carbon, climate, and the economy in this region - and the precise domain that has experienced cooling - are still unknown, which limits our ability to forecast coupled carbon, climate, and human dynamics. Here, we use eddy covariance measurements to demonstrate that summerfallow results in carbon losses during the growing season of the same magnitude as carbon uptake by winter and spring wheat, on the order of 100 - 200 g C m-2 per growing season. We use eddy covariance energy flux measurements to model atmospheric boundary layer and lifted condensation level heights to demonstrate that observed regional changes in near-surface humidity (of up to 7%) are necessary to simulate observed increases in convective precipitation, and use a slab atmospheric model to quantify the role of land cover in convective initiation. We analyze climate data to demonstrate that areas with extensive summerfallow decline are not necessarily those that have experienced summer cooling, and provide a framework for quantifying connections between climate, carbon, and human behavior across the northern North American Great Plains using a coupled modeling framework. Ongoing research will quantify how biofuels and other approaches to manage lands for energy create opportunities and conflicts within the food-energy-water nexus in the Upper Missouri River Basin, and investigate sustainable pathways during the transition toward a BECCS (Bio-energy with carbon capture and storage) economy.

Fluvial depositional environment evolving into deltaic setting with marine influences in the buntsandstein of northern vosges (France)

NASA Astrophysics Data System (ADS)

Gall, Jean-Claude

The Buntsandstein in the Northern Vosges (France) originates mainly in an inland braidplain fluvial environment which passes in the upper part of the sequence into deltaic milieu in the coastal plain along the border of the sea, with the continental environment finally being drowned with the transgression of the shallow sea. The fluvial sedimentation is characterized by the presence of two facies throughout the Buntsandstein : channel facies and overbank plain facies. The channel facies comprises sandy and conglomeratic deposits forming within active streams by strong currents, whereas the overbank plain facies is built up of silty-clayey sandstones or silt/clay originating in stagnant water in abandoned watercourses, ponds, pools and puddles. The significance of particularly the floodplain sediments is subjected to considerable changes throughout the Buntsandstein sequence. There are all stages of transition between overbank plain deposits being only preserved in ghost-like facies as reworked clasts due to effective secondary removal of primarily occasionally formed suspension fines, and an abundance of autochthonous floodplain sediments in the depositional record resulting from favourable conditions of primary origin and secondary preservation. Reworked ventifacts within fluvial channel sediments testify to subordinate aeolian influences in the alluvial plain, with reasonable reworking, however, having removed all in situ traces of wind activity. Declining aridity of palaeoclimate towards the top is indicated by the appearance of violet horizon palaeosols in the Zone-Limite-Violette and the Couches intermédiaires being accompanied by Bröckelbank carbonate breccias originating from concentration of reworked fragments of pedogenic carbonate nodules. Biogenic traces are in the lower part of the sequence mainly present as Planolites burrows in the finer-grained sediments. Palaeosalinities as revealed from boron contents indicate progressively increasing supersaturation of stagnant waters with time. The fluvial environment persists up to the lower part of the Grès à Voltzia where the progression of the sea towards the west gives rise to a close intertonguing of fluvial and marine influences in a deltaic setting. Lenticular sandstone bodies are laid down as stream mouth bars at the end of the distributary channels and as river bars in the watercourses during both normal and flood discharge. Silty-clayey sediments settle out in stagnant water in restricted ponds, pools and puddles as well as in extensive veneers of shallow water in the overbank plain between the streams. Carbonate-bearing deposits originate in the coastal littoral mud flat, marsh seam, beach belt and tidal flat. The Grès à Voltzia has the greatest palaeoenvironmental and palaeoecological significance in the Buntsandstein of the Northern Vosges due to the occurrence of a wealth of extraordinarily well-preserved plant and animal fossils (having been recovered by Louis Grauvogel during almost 50 years and since abt. 25 years by Jean-Claude Gall). The rich suite of faunal and floral elements includes aquatic invertebrates, terrestrial animals and continental plants. The aquatic invertebrate fauna lives in fresh lakes and brackish ponds in the overbank plain and in brackish lagoons in the coastal seam as well as in hypersaline and euhaline marginal marine waters. The terrestrial plants colonize both dry and wet substrates, and the continental fauna consists of mainly arthropods, amphibians and reptiles inhabiting the levee zones of standing and flowing waters and strolling across the desiccated flats. The marine euryhaline association of invertebrates is with time replaced by a stenohaline community, and the deltaic plain of the Grès à Voltzia is finally inundated by a pellicular transgression representing the first stage of the Muschelkalk sea setting an end to Buntsandstein continental deposition.

Water Levels In Major Artesian Aquifers Of The New Jersey Coastal Plain, 1988

USGS Publications Warehouse

Rosman, Robert; Lacombe, Pierre J.; Storck, Donald A.

1995-01-01

Water levels in 1,251 wells in the New Jersey Coastal Plain, Philadelphia County, Pennsylvania, and Kent and New Castle Counties, Delaware, were measured from October 1988 to February 1989 and compared with 1,071 water levels measured from September 1983 to May 1984. Water levels in 916 of the wells measured in the 1983 study were remeasured in the 1988 study. Alternate wells were selected to replace wells used in 1983 that were inaccessible at the time of the water-level measurements in 1988 or had been destroyed. New well sites were added in strategic locations to increase coverage where possible. Large cones of depression have formed or expanded in the nine major artesian aquifers that underlie the New Jersey Coastal Plain. Water levels are shown on nine potentiometric-surface maps. Hydrographs for observation wells typically show water-level declines for 1983, through 1989. In the confined Cohansey aquifer, the lowest water level, 20 feet below sea level, was measured in a well located at Cape May City Water Department, Cape May County. Water levels in the Atlantic City 800-foot sand declined as much as 21 feet at Ventnor, Atlantic County, over the 6-year period from the 1983 study to this study for 1988. Water levels in the Piney Point aquifer were as low as 56 feet below sea level at Seaside Park, Ocean County; 45 feet below sea level in southern Cumberland County; and 28 feet below sea level at Margate, Atlantic County. Water levels in the Vincentown aquifer did not change over the 6-year period. The lowest water levels in the Wenonah-Mount Laurel aquifer and the Englishtown aquifer system were 218 feet and 256 feet below sea level, respectively. Large cones of depression in the Potomac- Raritan-Magothy aquifer system are centered in the Camden County area and the Middlesex and Monmouth County area. Water levels declined as much as 46 feet in these areas over the 6-year period.

Artificial neural network in predicting craniocervical junction injury: an alternative approach to trauma patients.

PubMed

Bektaş, Frat; Eken, Cenker; Soyuncu, Secgin; Kilicaslan, Isa; Cete, Yildiray

2008-12-01

The aim of this study is to determine the efficiency of artificial intelligence in detecting craniocervical junction injuries by using an artificial neural network (ANN) that may be applicable in future studies of different traumatic injuries. Major head trauma patients with Glasgow Coma Scale

Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group.

PubMed

Katzman, Wendy B; Miller-Martinez, Dana; Marshall, Lynn M; Lane, Nancy E; Kado, Deborah M

2014-01-16

The prevalence of hyperkyphosis is increased in older men; however, risk factors other than age and vertebral fractures are not well established. We previously reported that poor paraspinal muscle composition contributes to more severe kyphosis in a cohort of both older men and women. To specifically evaluate this association in older men, we conducted a cross-sectional study to evaluate the association of paraspinal muscle composition and degree of thoracic kyphosis in an analytic cohort of 475 randomly selected participants from the Osteoporotic Fractures in Men (MrOS) study with baseline abdominal quantitative computed tomography (QCT) scans and plain thoracic radiographs. Baseline abdominal QCT scans were used to obtain abdominal body composition measurements of paraspinal muscle and adipose tissue distribution. Supine lateral spine radiographs were used to measure Cobb angle of kyphosis. We examined the linear association of muscle volume, fat volume and kyphosis using loess plots. Multivariate linear models were used to investigate the association between muscle and kyphosis using total muscle volume, as well as individual components of the total muscle volume, including adipose and muscle compartments alone, controlling for age, height, vertebral fractures, and total hip bone mineral density (BMD). We examined these associations among those with no prevalent vertebral fracture and those with BMI < 30 kg/m2. Among men in the analytic cohort, means (SD) were 74 (SD = 5.9) years for age, and 37.5 (SD = 11.9) degrees for Cobb angle of kyphosis. Men in the lowest tertile of total paraspinal muscle volume had greater mean Cobb angle than men in the highest tertile, although test of linear trend across tertiles did not reach statistical significance. Neither lower paraspinal skeletal muscle volume (p-trend = 0.08), or IMAT (p-trend = 0.96) was associated with greater kyphosis. Results were similar among those with no prevalent vertebral fractures. However, among men with BMI < 30 kg/m2, those in the lowest tertile of paraspinal muscle volume had greater adjusted mean kyphosis (40.0, 95% CI: 37.8 - 42.1) compared to the highest tertile (36.3, 95% CI: 34.2 - 38.4). These results suggest that differences in body composition may potentially influence kyphosis.

Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the osteoporotic fractures in men (MrOS) research group

PubMed Central

2014-01-01

Background The prevalence of hyperkyphosis is increased in older men; however, risk factors other than age and vertebral fractures are not well established. We previously reported that poor paraspinal muscle composition contributes to more severe kyphosis in a cohort of both older men and women. Methods To specifically evaluate this association in older men, we conducted a cross-sectional study to evaluate the association of paraspinal muscle composition and degree of thoracic kyphosis in an analytic cohort of 475 randomly selected participants from the Osteoporotic Fractures in Men (MrOS) study with baseline abdominal quantitative computed tomography (QCT) scans and plain thoracic radiographs. Baseline abdominal QCT scans were used to obtain abdominal body composition measurements of paraspinal muscle and adipose tissue distribution. Supine lateral spine radiographs were used to measure Cobb angle of kyphosis. We examined the linear association of muscle volume, fat volume and kyphosis using loess plots. Multivariate linear models were used to investigate the association between muscle and kyphosis using total muscle volume, as well as individual components of the total muscle volume, including adipose and muscle compartments alone, controlling for age, height, vertebral fractures, and total hip bone mineral density (BMD). We examined these associations among those with no prevalent vertebral fracture and those with BMI < 30 kg/m2. Results Among men in the analytic cohort, means (SD) were 74 (SD = 5.9) years for age, and 37.5 (SD = 11.9) degrees for Cobb angle of kyphosis. Men in the lowest tertile of total paraspinal muscle volume had greater mean Cobb angle than men in the highest tertile, although test of linear trend across tertiles did not reach statistical significance. Neither lower paraspinal skeletal muscle volume (p-trend = 0.08), or IMAT (p-trend = 0.96) was associated with greater kyphosis. Results were similar among those with no prevalent vertebral fractures. However, among men with BMI < 30 kg/m2, those in the lowest tertile of paraspinal muscle volume had greater adjusted mean kyphosis (40.0, 95% CI: 37.8 – 42.1) compared to the highest tertile (36.3, 95% CI: 34.2 – 38.4). Conclusions These results suggest that differences in body composition may potentially influence kyphosis. PMID:24428860

Electromyographic evaluation of abdominal-muscle function with and without concomitant pelvic-floor-muscle contraction.

PubMed

Tahan, Nahid; Arab, Amir Massoud; Vaseghi, Bita; Khademi, Khosro

2013-05-01

Coactivation of abdominal and pelvic-floor muscles (PFM) is an issue considered by researchers recently. Electromyography (EMG) studies have shown that the abdominal-muscle activity is a normal response to PFM activity, and increase in EMG activity of the PFM concomitant with abdominal-muscle contraction was also reported. The purpose of this study was to compare the changes in EMG activity of the deep abdominal muscles during abdominal-muscle contraction (abdominal hollowing and bracing) with and without concomitant PFM contraction in healthy and low-back-pain (LBP) subjects. A 2 × 2 repeated-measures design. Laboratory. 30 subjects (15 with LBP, 15 without LBP). Peak rectified EMG of abdominal muscles. No difference in EMG of abdominal muscles with and without concomitant PFM contraction in abdominal hollowing (P = .84) and abdominal bracing (P = .53). No difference in EMG signal of abdominal muscles with and without PFM contraction between LBP and healthy subjects in both abdominal hollowing (P = .88) and abdominal bracing (P = .98) maneuvers. Adding PFM contraction had no significant effect on abdominal-muscle contraction in subjects with and without LBP.

Incidence, Patterns, and Factors Predicting Mortality of Abdominal Injuries in Trauma Patients

PubMed Central

Gad, Mohammad A; Saber, Aly; Farrag, Shereif; Shams, Mohamed E; Ellabban, Goda M

2012-01-01

Background: Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. Aim: This study was designed to determine the incidence and patterns of abdominal injuries in trauma patients. Materials and Methods: We classified and identified the incidence and subtype of abdominal injuries and associated trauma, and identified variables related to morbidity and mortality. Results: Abdominal trauma was present in 248 of 300 cases; 172 patients with blunt abdominal trauma and 76 with penetrating. The most frequent type of abdominal trauma was blunt trauma; its most common cause was motor vehicle accident. Among patients with penetrating abdominal trauma, the most common cause was stabbing. Most abdominal trauma patients presented with other injuries, especially patients with blunt abdominal trauma. Mortality was higher among penetrating abdominal trauma patients. Conclusions: Type of abdominal trauma, associated injuries, and Revised Trauma Score are independent risk factors for mortality in abdominal trauma patients. PMID:22454826

Abdominal Adhesions

MedlinePlus

... Clearinghouse What are abdominal adhesions? Abdominal adhesions are bands of fibrous tissue that can form between abdominal ... Esophagus Stomach Large intestine Adhesion Abdominal adhesions are bands of fibrous tissue that can form between abdominal ...

Abdominal Pain

MedlinePlus

... and Recurrent or Functional Abdominal Pain (RAP or FAP) What is abdominal pain? Abdominal pain , or stomachache, ... recurrent abdominal pain (RAP) or functional abdominal pain (FAP)? If your health care provider has ruled out ...

7 CFR 650.25 - Flood-plain management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Flood-plain management. 650.25 Section 650.25... Flood-plain management. Through proper planning, flood plains can be managed to reduce the threat to... encourages sound flood-plain management decisions by land users. (a) Policy—(1) General. NRCS provides...

7 CFR 650.25 - Flood-plain management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Flood-plain management. 650.25 Section 650.25... Flood-plain management. Through proper planning, flood plains can be managed to reduce the threat to... encourages sound flood-plain management decisions by land users. (a) Policy—(1) General. NRCS provides...

Introduction

Treesearch

Ronald E. Sosebee; David B. Wester

2007-01-01

The Southern High Plains of Texas (also known as the Llano Estacado) are in the southernmost subdivision of the High Plains section of the Great Plains Physiographic Province. Most of the Southern Great Plains is comprised of upland sites that were once grasslands dominated mostly by shortgrass plains that supported large herds of native buffalo. However, topographic...

Geologic Mapping of the V-36 Thetis Regio Quadrangle: 2008 Progress Report

NASA Technical Reports Server (NTRS)

Basilevsky, A. T.; Head, James W.

2008-01-01

As a result of mapping, eleven material stratigraphic units and three structural units have been identified and mapped. The material units include (from older to younger): tessera terrain material (tt), material of densely fractured plains (pdf), material of fractured and ridged plains (pfr), material of shield plains (psh), material of plains with wrinkle ridges (pwr), material of smooth plains of intermediate brightness (psi), material of radardark smooth plains (psd), material of lineated plains (pli) material of lobate plains (plo), material of craters having no radar-dark haloes (c1), and material of craters having clear dark haloes (c2). The morphologies and probably the nature of the material units in the study area are generally similar to those observed in other regions of Venus [2]. The youngest units are lobate plains (plo) which here typically look less lobate than in other areas of the planet. Close to them in age are smooth plains which are indeed smooth and represented by two varieties mentioned above. Lineated plains (pli) are densely fractured in a geometrically regular way. Plains with wrinkle ridges, being morphologically similar to those observed in other regions, here occupy unusually small areas. Shield (psh) plains here are also not abundant. Locally they show wrinkle ridging. Fractured and ridged plains (pfr), which form in other regions, the so called ridge belts, are observed as isolated areas of clusters of ridged plains surrounded by other units. Densely fractured plains (pdf) are present in relatively small areas in association with coronae and corona-like features. Tessera terrain (tt) is dissected by structures oriented in two or more directions. Structures are so densely packed that the morphology (and thus nature) of the precursor terrain is not known. Structural units include tessera transitional terrain (ttt), fracture belts (fb) and rifted terrain (rt). Tessera transitional terrain was first identified and mapped by [4] as areas of fractured and ridged plains (pfr) and densely fractured plains (pdf) deformed by transverse faults that made it formally resemble tessera terrain (tt). The obvious difference between units tt and ttt is the recognizable morphology of precursor terrain of unit ttt. Fracture belts are probably ancient rift zones [3]. Rifted terrain (rt), as in other regions of Venus, is so saturated with faults that according to the recommendation of [1, 5] it should be mapped as a structural unit.

44 CFR 10.14 - Flood plains and wetlands.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Flood plains and wetlands. 10... Flood plains and wetlands. For any action taken by FEMA in a flood plain or wetland, the provisions of... Executive Order 11988, Flood Plain Management, and Executive Order 11990, Protection of Wetlands (44 CFR...

Evaluation of the levels of metalloproteinsase-2 in patients with abdominal aneurysm and abdominal hernias.

PubMed

Antoszewska, Magdalena

2013-05-01

Abdominal aortic aneurysms and abdominal hernias become an important health problems of our times. Abdominal aortic aneurysm and its rupture is one of the most dangerous fact in vascular surgery. There are some theories pointing to a multifactoral genesis of these kinds of diseases, all of them assume the attenuation of abdominal fascia and abdominal aortic wall. The density and continuity of these structures depend on collagen and elastic fibers structure. Reducing the strength of the fibers may be due to changes in the extracellular matrix (ECM) by the proteolytic enzymes-matrix metalloproteinases (MMPs) that degrade extracellular matrix proteins. These enzymes play an important role in the development of many disease: malignant tumors (colon, breast, lung, pancreas), cardiovascular disease (myocardial infarction, ischemia-reperfusion injury), connective tissue diseases (Ehler-Danlos Syndrome, Marfan's Syndrome), complications of diabetes (retinopathy, nephropathy). One of the most important is matrix metalloproteinase-2 (MMP-2). The aim of the study was an estimation of the MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia, and in patients with only abdominal aortic aneurysm. The study involved 88 patients aged 42 to 89 years, including 75 men and 13 women. Patients were divided into two groups: patients with abdominal aortic aneurysm and primary abdominal hernia (45 persons, representing 51.1% of all group) and patients with only abdominal aortic aneurysm (43 persons, representing 48,9% of all group). It was a statistically significant increase in MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia compared to patients with only abdominal aortic aneurysm. It was a statistically significant increase in the prevalence of POCHP in patients with only abdominal aortic aneurysm compared to patients with abdominal aortic aneurysm and primary abdominal hernia. Statistically significant higher MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia seems shows that this enzyme plays a role in the pathogenesis of primary abdominal hernias. The observed distribution of MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia may raise the conclusion that this enzyme determines the presence of multi-organ failure of the connective tissue--the patients with only abdominal aortic aneurysm had significantly lower MMP-2 blood levels.

Successful Treatment of Abdominal Cutaneous Entrapment Syndrome Using Ultrasound Guided Injection

PubMed Central

Hong, Myong Joo; Seo, Dong Hyuk

2013-01-01

There are various origins for chronic abdominal pain. About 10-30% of patients with chronic abdominal pain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominal pain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominal pain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy. PMID:23862004

Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head

PubMed Central

Panagopoulos, Andreas; Tatani, Irini; Megas, Panagiotis

2016-01-01

Background: Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure Case Presentation: A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays. Conclusion: Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem. PMID:28217203

Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head.

PubMed

Panagopoulos, Andreas; Tatani, Irini; Megas, Panagiotis

2016-01-01

Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure. A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13 th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays. Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.

Chenier plain genesis explained by feedbacks between waves, mud, and sand

NASA Astrophysics Data System (ADS)

Nardin, William; Fagherazzi, Sergio

2017-04-01

Cheniers are sandy ridges parallel to the coast established by high energy waves. Here we discuss ontogeny of chenier plains through dimensional analysis and numerical results from the morphodynamic model Delft3D-SWAN. Our results show that wave energy and inner-shelf slope play an important role in the formation of chenier plains. In our numerical experiments, waves affect chenier plain development in three ways: by winnowing coarse sediment from the mudflat, by eroding mud and accumulating sand over the beach during extreme wave events. We further show that different sediment characteristics and wave climates can lead to three alternative coastal landscapes: strand plains, mudflats, or the more complex chenier plains. Low inner-shelf slopes are the most favorable for strand plain and chenier plain formation, while high slopes decrease the likelihood of mudflat development and preservation.

Chenier plain development: feedbacks between waves, mud and sand

NASA Astrophysics Data System (ADS)

Nardin, W.; Fagherazzi, S.

2015-12-01

Cheniers are sandy ridges parallel to the coast established by high energy waves. Here we discuss Chenier plains ontogeny through dimensional analysis and numerical results from the morphodynamic model Delft3D-SWAN. Our results show that wave energy and shelf slope play an important role in the formation of Chenier plains. In our numerical experiments waves affect Chenier plain development in three ways: by winnowing sediment from the mudflat, by eroding mud and accumulating sand over the beach during extreme wave events. We further show that different sediment characteristics and wave climates can lead to three alternative coastal landscapes: strand plains, mudflats, or the more complex Chenier plains. Low inner-shelf slopes are the most favorable for strand plain and Chenier plain formation, while high slopes decrease the likelihood of mudflat development and preservation.

Abdominal tap

MedlinePlus

Peritoneal tap; Paracentesis; Ascites - abdominal tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap ... abdominal cavity ( most often cancer of the ovaries ) Cirrhosis of the liver Damaged bowel Heart disease Infection ...

Ocean-Bottom Topography: The Divide between the Sohm and Hatteras Abyssal Plains.

PubMed

Pratt, R M

1965-06-18

A compilation of precision echo soundings has delineated the complex topography between the Sohm and Hatteras abyssal plains off the Atlantic coast of the United States. At present the divide between the two plains is a broad, flat area about 4950 meters deep; however, the configuration of channels and depressions suggests spillage of turbidity currents from the Sohm Plain into the Hatteras Plain and a shifting of the divide toward the northeast. Hudson Canyon terminates in the divide area and has probably fed sediment into both plains.

Omphalocele

MedlinePlus

Birth defect - omphalocele; Abdominal wall defect - infant; Abdominal wall defect - neonate; Abdominal wall defect - newborn ... Omphalocele is considered an abdominal wall defect (a hole in the abdominal wall). The child's intestines usually ...

Echinococcus multilocularis in two lowland gorillas (Gorilla g. gorilla).

PubMed

Rehmann, P; Gröne, A; Lawrenz, A; Pagan, O; Gottstein, B; Bacciarini, L N

2003-07-01

An unusual presentation of alveolar echinococcosis was observed in two lowland gorillas (Gorilla g. gorilla). Clinical signs included progressive abdominal enlargement, apathy and anorexia. Macroscopical changes consisted of severe peritonitis and foci of hepatic necrosis with large cavities replacing most of the normal tissue. Additionally, a few structures resembling hydatid cysts were present. Histologically, some necrotic areas contained fragments of a laminated wall characteristic of echinococcal metacestodes. Only a few areas showed the multiloculated architecture typical of Echinococcus multilocularis. Serum antibodies against E. multilocularis antigen were detected in both animals, and granulomatous and necrotizing hepatitis with severe peritonitis due to E. multilocularis was diagnosed. The pathological changes in alveolar echinococcosis in gorillas appear to resemble more closely those found in human beings than those in other non-human primates.

Hospital strain colonization by Staphylococcus epidermidis.

PubMed

Blum-Menezes, D; Bratfich, O J; Padoveze, M C; Moretti, M L

2009-03-01

The skin and mucous membranes of healthy subjects are colonized by strains of Staphylococcus epidermidis showing a high diversity of genomic DNA polymorphisms. Prolonged hospitalization and the use of invasive procedures promote changes in the microbiota with subsequent colonization by hospital strains. We report here a patient with prolonged hospitalization due to chronic pancreatitis who was treated with multiple antibiotics, invasive procedures and abdominal surgery. We studied the dynamics of skin colonization by S. epidermidis leading to the development of catheter-related infections and compared the genotypic profile of clinical and microbiota strains by pulsed field gel electrophoresis. During hospitalization, the normal S. epidermidis skin microbiota exhibiting a polymorphic genomic DNA profile was replaced with a hospital-acquired biofilm-producer S. epidermidis strain that subsequently caused repetitive catheter-related infections.

Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension.

PubMed

Villoria, Albert; Azpiroz, Fernando; Burri, Emanuel; Cisternas, Daniel; Soldevilla, Alfredo; Malagelada, Juan-R

2011-05-01

The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.

[Selection of type of urinary tract drainage in laparoscopic ureterolithotomy].

PubMed

Kisliakov, D A; Sirota, E S; Shpot', E V; Enikeev, M É

2014-01-01

The article presents the results of 44 laparoscopic ureterolithotomies performed for large stones in upper and middle third of the ureter. Patients' age ranged from 35 to 82 years. The different types of drainage of the urinary tract depending on the characteristics of surgical treatment (retro- or transperitoneal ureterolithotomy) were used. The effectiveness was evaluated according to the results of plain urography, ultrasound, and multi-layer spiral CT. The results showed that the preferred method of urinary tract drainage is a preoperative deployment of ureteral catheter-stent. However, in the case of impossibility of such procedure, preoperative deployment of ureteral catheter with subsequent intraoperative replacing it on catheter-stent is permissible. With retroperitoneal approach, tubeless ureterolithotomy is feasible in the absence of the ipsilateral kidney stones, residual ureteral stones and pronounced changes in the area of finding the stones.

Flutamide-metformin plus an oral contraceptive (OC) for young women with polycystic ovary syndrome: switch from third- to fourth-generation OC reduces body adiposity.

PubMed

Ibáñez, Lourdes; De Zegher, Francis

2004-08-01

Low-dose flutamide-metformin has been developed as a background therapy for non-obese adolescents and young women with hyperinsulinaemic hyperandrogenism, a variant of polycystic ovary syndrome (PCOS). We verified whether the lipolytic efficacy of flutamide-metformin in women with PCOS is enhanced by giving an oral contraceptive (OC) co-therapy that contains drospirenone, instead of gestodene, as progestin. An open-labelled study was carried out in which non-obese women with PCOS (n = 29; age approximately 20 years), who had been on a combination of flutamide (62.5 mg/day), metformin (850 mg/day) and ethinylestradiol-gestodene for 8-15 months, were randomized for replacement of the gestodene OC by a drospirenone OC. Assessments of endocrine-metabolic state and body composition (by dual-energy X-ray absorptiometry) were performed at randomization and after 6 months. The switch to drospirenone OC was accompanied by a reduction of total and abdominal fat (mean -0.8 and -0.5 kg) and by an increment of lean body mass (+0.6 kg; all P < 0.01), so that body adiposity was strikingly reduced without changing body weight. In non-obese women with PCOS, low-dose flutamide-metformin reduces total and abdominal fat excess more effectively if contraceptive co-therapy contains drospirenone, instead of gestodene, as progestin. Copyright 2004 European Society of Human Reproduction and Embryology

[Hereditary phaeochromocytoma in twins].

PubMed

Tóth, Géza; Patócs, Attila; Tóth, Miklós

2016-08-01

Phaeochromocytoma is a tumor of the catecholamine-producing cells of the adrenal gland. Extraadrenal phaeochromocytomas are frequently called paragangliomas. The majority of phaeochromocytomas are sporadic, however, about 25-30% are caused by genetic mutation. These tumor are frequently referred as hereditary phaeochromocytomas/paragangliomas. Their incidence increases continuously which can be attributed to availability of genetic examination and to the discovery of novel genes. The 47-year-old female patient underwent abdominal computed tomography which revealed bilateral adrenal gland enlargement. Abdominal magnetic resonance imaging, the 131-I- metaiodobenzylguanidine scintigraphy, urinary catecholamines and serum chomogranin A measurements confirmed the diagnosis of bilateral phaeochromocytomas. The genetically identical twin sister of the patient was also diagnosed with hormonally active bilateral phaechromocytoma, suggesting the genetic origin of phaeochromocytoma. Mutation screening confirmed a germline mutation of the transmembrane protein 127 tumorsupressor gene in both patients. Both patients underwent cortical-sparing adrenalectomy. The adrenal gland with the larger tumor was totally resected, while in the opposite side only the tumor was resected and a small part of the cortex was saved. After the operation urinary catecholamines and serum chromogranin A returned to normal in both patients. Adrenocortical deficiency was absent in the first patient, but her sister developed adrenal insufficiency requiring glucocorticoid replacement. To the best of the authors' knowledge phaeochromocytoma affecting twins has never been described earlier. Genetic examination performed in siblings confirmed the presence of the mutant gene through four generations. Orv. Hetil., 2016, 157(33), 1326-1330.

CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kelogrigoris, M., E-mail: kelogre.mic@hotmail.com; Sotiropoulou, E.; Stathopoulos, K.

This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkagemore » of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.« less

Cost identification of abdominal aortic aneurysm imaging by using time and motion analyses.

PubMed

Rubin, G D; Armerding, M D; Dake, M D; Napel, S

2000-04-01

To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs). A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health-matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs. The mean total direct cost of intraarterial DSA (+/- SD) was $1,052 +/- 71, and that of CT angiography was $300 +/- 30, which are significantly different (P < 4.1 x 10(-11)). With 95% confidence, intraarterial DSA cost 3.2-3.7 times more than CT angiography for the assessment of AAA. Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.

Assessment of the accuracy of AortaScan for detection of abdominal aortic aneurysm (AAA).

PubMed

Abbas, A; Smith, A; Cecelja, M; Waltham, M

2012-02-01

AortaScan AMI 9700 is a portable 3D ultrasound device that automatically measures the maximum diameter of the abdominal aorta without the need for a trained sonographer. It is designed to rapidly diagnose or exclude an AAA and may have particular use in screening programs. Our objective was to determine its accuracy to detect AAA. Subjects from our AAA screening and surveillance programs were examined. The aorta was scanned using the AortaScan and computed tomography (CT). Ninety-one subjects underwent imaging (44 AAA on conventional ultrasound surveillance and 47 controls). The largest measurement obtained by AortaScan was compared against the CT-aortic measurement. The mean aortic diameter was 2.8 cm. The CT scan confirmed the diagnosis of AAA in 43 subjects. There was one false positive measurement on conventional ultrasound. AortaScan missed the diagnosis of AAA in eight subjects. There were thirteen false positive measurements. The sensitivity, specificity, positive and negative predictive values were 81%, 72%, 72% and 81% respectively. A device to detect AAA without the need for a trained operator would have potential in a community-based screening programme. The AortaScan, however, lacks adequate sensitivity and significant technical improvement is necessary before it could be considered a replacement for trained screening personnel. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Waste tyre rubberized concrete: properties at fresh and hardened state.

PubMed

Aiello, M A; Leuzzi, F

2010-01-01

The main objective of this paper is to investigate the properties of various concrete mixtures at fresh and hardened state, obtained by a partial substitution of coarse and fine aggregate with different volume percentages of waste tyres rubber particles, having the same dimensions of the replaced aggregate. Workability, unit weight, compressive and flexural strength and post-cracking behaviour were evaluated and a comparison of the results for the different rubcrete mixtures were proposed in order to define the better mix proportions in terms of mechanical properties of the rubberized concrete. Results showed in this paper were also compared to data reported in literature. Moreover, a preliminary geometrical, physical and mechanical characterization on scrap tyre rubber shreds was made. The rubberized concrete mixtures showed lower unit weight compared to plain concrete and good workability. The results of compressive and flexural tests indicated a larger reduction of mechanical properties of rubcrete when replacing coarse aggregate rather than fine aggregate. On the other hand, the post-cracking behaviour of rubberized concrete was positively affected by the substitution of coarse aggregate with rubber shreds, showing a good energy absorption and ductility indexes in the range observed for fibrous concrete, as suggested by standard (ASTM C1018-97, 1997). 2010 Elsevier Ltd. All rights reserved.

Downscaling with a nested regional climate model in near-surface fields over the contiguous United States

NASA Astrophysics Data System (ADS)

Wang, Jiali; Kotamarthi, Veerabhadra R.

2014-07-01

The Weather Research and Forecasting (WRF) model is used for dynamic downscaling of 2.5-degree National Centers for Environmental Prediction-U.S. Department of Energy Reanalysis II (NCEP-R2) data for 1980-2010 at 12 km resolution over most of North America. The model's performance for surface air temperature and precipitation is evaluated by comparison with high-resolution observational data sets. The model's ability to add value is investigated by comparison with NCEP-R2 data and a 50 km regional climate simulation. The causes for major model bias are studied through additional sensitivity experiments with various model setup/integration approaches and physics representations. The WRF captures the main features of the spatial patterns and annual cycles of air temperature and precipitation over most of the contiguous United States. However, simulated air temperatures over the south central region and precipitation over the Great Plains and the Southwest have significant biases. Allowing longer spin-up time, reducing the nudging strength, or replacing the WRF Single-Moment six-class microphysics with Morrison microphysics reduces the bias over some subregions. However, replacing the Grell-Devenyi cumulus parameterization with Kain-Fritsch shows no improvement. The 12 km simulation does add value above the NCEP-R2 data and the 50 km simulation over mountainous and coastal zones.

River flood plains: Some observations on their formation

USGS Publications Warehouse

Wolman, M. Gordon; Leopold, Luna Bergere

1957-01-01

On many small rivers and most great rivers, the flood plain consists of channel and overbank deposits. The proportion of the latter is generally very small.Frequency studies indicate that the flood plains of many streams of different sizes flowing in diverse physiographic and climatic regions are subject to flooding about once a year.The uniform frequency of flooding of the flood-plain surface and the small amount of deposition observed in great floods (average 0.07 foot) support the conclusion that overbank deposition contributes only a minor part of the material constituting the flood plain. The relatively high velocities (1 to 4 fps) which can occur in overbank flows and the reduction in sediment concentration which often accompanies large floods may also help account for this. Although lateral migration of channels is important in controlling the elevation of the flood plain, rates of migration are extremely variable and alone cannot account for the uniform relation the flood-plain surface bears to the channel.Detailed studies of flood plains in Maryland and in North Carolina indicate that it is difficult to differentiate between channel and overbank deposits in a stratigraphic section alone.Because deposition on the flood plain does not continue indefinitely, the flood-plain surface can only be transformed into a terrace surface by some tectonic or climatic change which alters the regimen of the river and causes it to entrench itself below its established bed and associated flood plain. A terrace, then, is distinguished from a flood plain by the frequency with which each is overflowed.

Abdominal wall fat pad biopsy

MedlinePlus

Amyloidosis - abdominal wall fat pad biopsy; Abdominal wall biopsy; Biopsy - abdominal wall fat pad ... most common method of taking an abdominal wall fat pad biopsy . The health care provider cleans the ...

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

PubMed Central

Bozeman, Matthew C.; Ross, Charles B.

2012-01-01

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are common complications of ruptured abdominal aortoiliac aneurysms (rAAAs) and other abdominal vascular catastrophes even in the age of endovascular therapy. Morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) are significant. Recognition and management of IAH are key critical care measures which may decrease morbidity and improve survival in these vascular patients. Two strategies have been utilized: expectant management with prompt decompressive laparotomy upon diagnosis of threshold levels of IAH versus prophylactic, delayed abdominal closure based upon clinical parameters at the time of initial repair. Competent management of the abdominal wound with preservation of abdominal domain is also an important component of the care of these patients. In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events. PMID:22454763

Intra-abdominal hypertension and abdominal compartment syndrome in association with ruptured abdominal aortic aneurysm in the endovascular era: vigilance remains critical.

PubMed

Bozeman, Matthew C; Ross, Charles B

2012-01-01

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are common complications of ruptured abdominal aortoiliac aneurysms (rAAAs) and other abdominal vascular catastrophes even in the age of endovascular therapy. Morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) are significant. Recognition and management of IAH are key critical care measures which may decrease morbidity and improve survival in these vascular patients. Two strategies have been utilized: expectant management with prompt decompressive laparotomy upon diagnosis of threshold levels of IAH versus prophylactic, delayed abdominal closure based upon clinical parameters at the time of initial repair. Competent management of the abdominal wound with preservation of abdominal domain is also an important component of the care of these patients. In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events.

Plain Language to Communicate Physical Activity Information: A Website Content Analysis.

PubMed

Paige, Samantha R; Black, David R; Mattson, Marifran; Coster, Daniel C; Stellefson, Michael

2018-04-01

Plain language techniques are health literacy universal precautions intended to enhance health care system navigation and health outcomes. Physical activity (PA) is a popular topic on the Internet, yet it is unknown if information is communicated in plain language. This study examined how plain language techniques are included in PA websites, and if the use of plain language techniques varies according to search procedures (keyword, search engine) and website host source (government, commercial, educational/organizational). Three keywords ("physical activity," "fitness," and "exercise") were independently entered into three search engines (Google, Bing, and Yahoo) to locate a nonprobability sample of websites ( N = 61). Fourteen plain language techniques were coded within each website to examine content formatting, clarity and conciseness, and multimedia use. Approximately half ( M = 6.59; SD = 1.68) of the plain language techniques were included in each website. Keyword physical activity resulted in websites with fewer clear and concise plain language techniques ( p < .05), whereas fitness resulted in websites with more clear and concise techniques ( p < .01). Plain language techniques did not vary by search engine or the website host source. Accessing PA information that is easy to understand and behaviorally oriented may remain a challenge for users. Transdisciplinary collaborations are needed to optimize plain language techniques while communicating online PA information.

Abdominal epilepsy as an unusual cause of abdominal pain: a case report.

PubMed

Yunus, Yilmaz; Sefer, Ustebay; Dondu, Ulker Ustebay; Ismail, Ozanli; Yusuf, Ehi

2016-09-01

Abdominal pain, in etiology sometimes difficult to be defined, is a frequent complaint in childhood. Abdominal epilepsy is a rare cause of abdominal pain. In this article, we report on 5 year old girl patient with abdominal epilepsy. Some investigations (stool investigation, routine blood tests, ultrasonography (USG), electrocardiogram (ECHO) and electrocardiograpy (ECG), holter for 24hr.) were done to understand the origin of these complaints; but no abnormalities were found. Finally an EEG was done during an episode of abdominal pain and it was shown that there were generalized spikes especially precipitated by hyperventilation. The patient did well on valproic acid therapy and EEG was normal 1 month after beginning of the treatment. The cause of chronic recurrent paroxymal abdominal pain is difficult for the clinicians to diagnose in childhood. A lot of disease may lead to paroxysmal gastrointestinal symptoms like familial mediterranean fever and porfiria. Abdominal epilepsy is one of the rare but easily treatable cause of abdominal pain. In conclusion, abdominal epilepsy should be suspected in children with recurrent abdominal pain.

Migration of the Pee Dee River system inferred from ancestral paleochannels underlying the South Carolina Grand Strand and Long Bay inner shelf

USGS Publications Warehouse

Baldwin, W.E.; Morton, R.A.; Putney, T.R.; Katuna, M.P.; Harris, M.S.; Gayes, P.T.; Driscoll, N.W.; Denny, J.F.; Schwab, W.C.

2006-01-01

Several generations of the ancestral Pee Dee River system have been mapped beneath the South Carolina Grand Strand coastline and adjacent Long Bay inner shelf. Deep boreholes onshore and high-resolution seismic-reflection data offshore allow for reconstruction of these paleochannels, which formed during glacial lowstands, when the Pee Dee River system incised subaerially exposed coastal-plain and continental-shelf strata. Paleochannel groups, representing different generations of the system, decrease in age to the southwest, where the modern Pee Dee River merges with several coastal-plain tributaries at Winyah Bay, the southern terminus of Long Bay. Positions of the successive generational groups record a regional, southwestward migration of the river system that may have initiated during the late Pliocene. The migration was primarily driven by barrier-island deposition, resulting from the interaction of fluvial and shoreline processes during eustatic highstands. Structurally driven, subsurface paleotopography associated with the Mid-Carolina Platform High has also indirectly assisted in forcing this migration. These results provide a better understanding of the evolution of the region and help explain the lack of mobile sediment on the Long Bay inner shelf. Migration of the river system caused a profound change in sediment supply during the late Pleistocene. The abundant fluvial source that once fed sand-rich barrier islands was cut off and replaced with a limited source, supplied by erosion and reworking of former coastal deposits exposed at the shore and on the inner shelf.

Characterizing Early Succession Following Wildfires at Different Severities in Boreal Bog and Fen Peatlands

NASA Astrophysics Data System (ADS)

Ernst, E. J.; Bourgeau-Chavez, L. L.; Kane, E. S.; Wagenbrenner, J. W.; Endres, S.

2016-12-01

The Arctic-boreal region is experiencing changes in climate, trending toward warmer summers, resulting in a greater occurrence of wildfires with longer burning periods and higher intensities. Drought-like conditions have dried surface fuels, leading to a higher probability of ignition, even in lowland peatlands. Previous work has been done to characterize post-fire succession rates in Arctic-boreal upland sites, but much less is known of fire effects and early successional dynamics in lowlands. Wildland fires are the number one disturbance in Canada's Northwest Territories (NWT), which characteristically burn at high intensities with large flame fronts, and result in some of the biggest wildfires in the world. Areas surrounding the Great Slave Lake, NWT—including parts of the Taiga Plains, Taiga Shield, and Boreal Plains ecozones—experienced exceptional wildfire activity in 2014 and 2015. We characterized burn severity of the bog and fen peat surface and canopy layers at several burned sites. To determine if the severe ground or crown wildfires were stand-replacing events, we characterized post-fire vegetation in peatlands in 2015 and 2016 based on seedling regeneration. We stratified sites according to estimated water residence times across the three ecozones and made comparisons between data collected at the same sites across years. This work adds much needed context for post-fire succession in boreal peatland ecosystems, as the susceptibility of these systems to burning will continue to increase with a warming climate.

Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor.

PubMed

Yang, Yun-Fa; Wang, Jian-Wei; Huang, Pin; Xu, Zhong-He

2016-08-17

Giant cell tumors (GCTs) located in the distal radius are likely to recur, and the treatment of such recurrent tumors is very difficult. Here, we report our clinical experience in distal radius reconstruction with vascularized proximal fibular autografts after en-bloc excision of the entire distal radius in 17 patients with recurrent GCT (RGCT) of the distal radius. All 17 patients with RGCT in distal radius underwent plain radiography and/or magnetic resonance imaging (MRI) of the distal radius as the initial evaluation after hospitalization. Then the distal radius were replaced by vascularized proximal fibular autografts after en-bloc RGCT resection. We assessed all patients by using clinical examinations, plain radiography of the wrist and chest, and Mayo wrist scores in the follow-ups. After an average follow-up of 4.3 years (range: 1.5-10.0 years), no lung metastasis or local recurrence was detected in any of the 17 patients. In total, 14 patients had excellent or good functional wrist scores, 16 were pain free or had occasional pain, and 15 patients returned to work. The mean range of motion of the wrist was 101° (flexion-extension), and the mean grip strength was 77.2 % of the contralateral normal hand. En-bloc excision of the entire distal radius and distal radius reconstruction with a vascularized proximal fibular autograft can effectively achieve local tumor control and preserve wrist function in patients with RGCT of the distal radius.

Skeletal muscle derived stem cells microintegrated into a biodegradable elastomer for reconstruction of the abdominal wall.

PubMed

Takanari, Keisuke; Hashizume, Ryotaro; Hong, Yi; Amoroso, Nicholas J; Yoshizumi, Tomo; Gharaibeh, Burhan; Yoshida, Osamu; Nonaka, Kazuhiro; Sato, Hideyoshi; Huard, Johnny; Wagner, William R

2017-01-01

A variety of techniques have been applied to generate tissue engineered constructs, where cells are combined with degradable scaffolds followed by a period of in vitro culture or direct implantation. In the current study, a cellularized scaffold was generated by concurrent deposition of electrospun biodegradable elastomer (poly(ester urethane)urea, PEUU) and electrosprayed culture medium + skeletal muscle-derived stem cells (MDSCs) or electrosprayed culture medium alone as a control. MDSCs were obtained from green fluorescent protein (GFP) transgenic rats. The created scaffolds were implanted into allogenic strain-matched rats to replace a full thickness abdominal wall defect. Both control and MDSC-integrated scaffolds showed extensive cellular infiltration at 4 and 8 wk. The number of blood vessels was higher, the area of residual scaffold was lower, number of multinucleated giant cells was lower and area of connective tissue was lower in MDSC-integrated scaffolds (p < 0.05). GFP + cells co-stained positive for VEGF. Bi-axial mechanical properties of the MDSC-microintegrated constructs better approximated the anisotropic behavior of the native abdominal wall. GFP + cells were observed throughout the scaffold at ∼5% of the cell population at 4 and 8 wk. RNA expression at 4 wk showed higher expression of early myogenic marker Pax7, and b-FGF in the MDSC group. Also, higher expression of myogenin and VEGF were seen in the MDSC group at both 4 and 8 wk time points. The paracrine effect of donor cells on host cells likely contributed to the differences found in vivo between the groups. This approach for the rapid creation of highly-cellularized constructs with soft tissue like mechanics offers an attractive methodology to impart cell-derived bioactivity into scaffolds providing mechanical support during the healing process and might find application in a variety of settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

12 CFR 611.1217 - Plain language requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Plain language requirements. 611.1217 Section 611.1217 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ORGANIZATION Termination of System Institution Status § 611.1217 Plain language requirements. (a) Plain language presentation. All...

12 CFR 611.1217 - Plain language requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Plain language requirements. 611.1217 Section 611.1217 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ORGANIZATION Termination of System Institution Status § 611.1217 Plain language requirements. (a) Plain language presentation. All...

49 CFR 229.64 - Plain bearings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Plain bearings. 229.64 Section 229.64 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION....64 Plain bearings. A plain bearing box shall contain visible free oil and may not be cracked to the...

Development of New Lemon-Lime Flavored Beverage for OGTT: Acceptability and Reproducibility.

PubMed

Chotwanvirat, Phawinpon; Thewjitcharoen, Yotsapon; Parksook, Wyn; Krittiyawong, Sirinate; Hutaphat, Kritchana; Nakasatien, Soontaree; Kaocharoen, Sming; Himathongkam, Thep

2016-05-01

The oral glucose tolerance test (OGTT) is essential procedure in both screening and diagnosis of impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and diabetes mellitus (DM), but it is not easy to perform because of intense sweetness of the 75-g glucose test beverage causing abdominal discomfort post-testing. Therefore, the new formula of non-carbonated lemon-lime flavored beverage was developed to increase its palatability and better compliance. To develop a new non-carbonated lemon-lime flavored beverage to replace the standard beverage for OGTT Subsequently, the diagnostic value and acceptability between the new formula and the traditional 75-g OGTT formula were compared in healthy subjects. The new lemon-lime flavored formula was developed to replace the standard beverage for OGTT by adding 1,000 milligram of citric acid and 0.03 gram of lime flavor to 75 gram of anhydrous glucose to a final volume of 300 ml. The study was conducted in 30 healthy subjects who underwent the traditional 75-gram OGTT test and the new formula of OGTT beverage one week later, or vice versa, to access acceptability, indices markers of insulin secretion, and insulin sensitivity. Palatability was determined by rating on a 9-point Hedonic Scale. Thirty healthy subjects (15 females) with the age of 33.2 ± 7.5 years and body mass index of 22.9 ± 3.5 kg/m² were enrolled. No significant difference was found between plasma glucose in 0, 30, 60, 90, and 120 minutes, insulin level (0 and 120 minutes) and four insulin surrogate markers in both traditional 75-gram OGTT and new formula of lemon-lime flavored OGTT beverage. The overall satisfaction score of the new formula OGTT was better when compared with the scores of the traditional OGTT (7.1 ± 1.8 vs. 4.7 ± 2.0). Only one subject complained about abdominal discomfort in both episode of OGTT CONCLUSION: The modified lemon-lime flavored beverage for OGTT demonstrated better acceptance in the subjects without difference in plasma glucose values and OGTT derived parameters responses to OGTT in comparison to the traditional formula.

[Well-differentiated endocrine carcinoma of the small bowel. Case report and literature review].

PubMed

García-Ruiz, Antonio; Barrera-Rodríguez, Francisco Javier; Alvarez-Trasgallo, José Francisco; Márquez-García, Miguel Angel

2007-01-01

Of all cancers, only 0.3% are carcinoid tumors of the small bowel. The diagnostic approach of these patients is difficult because they may appear asymptomatic for a long time and also because of the low specificity of the currently available diagnostic tests. We present a case in which the laparoscopic approach allowed not just the diagnosis but facilitated surgery. A 58-year-old male had 2 months with mid-intestinal subocclusive symptoms (late postprandial abdominal pain relieved by vomiting). No abnormalities were found on physical examinations or with laboratory tests. Barium plain x-rays and CT scan revealed a retention stomach and proximal dilation of the small bowel without demonstrating cause. Laparoscopically, we found a 5-cm jejunal tumor. We performed intestinal resection and anastomosis by mini-laparotomy (7 cm). There were no postoperative complications. Pathology report disclosed a well-differentiated neuroendocrine carcinoma. At 1-year follow-up there are no signs of tumor activity. Laparoscopic surgery contributes to diagnosis and facilitates the management of patients with mid-intestinal subocclusive disease. Due to previous reports, the frequency of small intestine carcinoids may be underestimated. There are carcinoid tumors 2 cm or larger without metastases at the time of diagnosis.

Generalized potentiometric surface, estimated depth to water, and estimated saturated thickness of the High Plains aquifer system, March–June 2009, Laramie County, Wyoming

USGS Publications Warehouse

Bartos, Timothy T.; Hallberg, Laura L.

2011-01-01

The High Plains aquifer system, commonly called the High Plains aquifer in many publications, is a nationally important water resource that underlies a 111-million-acre area (173,000 square miles) in parts of eight States including Wyoming. Through irrigation of crops with groundwater from the High Plains aquifer system, the area that overlies the aquifer system has become one of the major agricultural regions in the world. In addition, the aquifer system also serves as the primary source of drinking water for most residents of the region. The High Plains aquifer system is one of the largest aquifers or aquifer systems in the world. The High Plains aquifer system underlies an area of 8,190 square miles in southeastern Wyoming. Including Laramie County, the High Plains aquifer system is present in parts of five counties in southeastern Wyoming. The High Plains aquifer system underlies 8 percent of Wyoming, and 5 percent of the aquifer system is located within the State. Based on withdrawals for irrigation, public supply, and industrial use in 2000, the High Plains aquifer system is the most utilized source of groundwater in Wyoming. With the exception of the Laramie Mountains in western Laramie County, the High Plains aquifer system is present throughout Laramie County. In Laramie County, the High Plains aquifer system is the predominant groundwater resource for agricultural (irrigation), municipal, industrial, and domestic uses. Withdrawal of groundwater for irrigation (primarily in the eastern part of the county) is the largest use of water from the High Plains aquifer system in Laramie County and southeastern Wyoming. Continued interest in groundwater levels in the High Plains aquifer system in Laramie County prompted a study by the U.S. Geological Survey in cooperation with the Wyoming State Engineer's Office to update the potentiometric-surface map of the aquifer system in Laramie County. Groundwater levels were measured in wells completed in the High Plains aquifer system from March to June 2009. The groundwater levels were used to construct a map of the potentiometric surface of the High Plains aquifer system. In addition, depth to water and estimated saturated-thickness maps of the aquifer system were constructed using the potentiometric-surface map.

Management of intra-abdominal hypertension and abdominal compartment syndrome: a review

PubMed Central

2014-01-01

Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function. PMID:24499574

Acute abdomen in children due to extra-abdominal causes.

PubMed

Tsalkidis, Aggelos; Gardikis, Stefanos; Cassimos, Dimitrios; Kambouri, Katerina; Tsalkidou, Evanthia; Deftereos, Savas; Chatzimichael, Athanasios

2008-06-01

Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain. The notes of all children (1 month-14 years of age) examined for acute abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis District University Hospital in January 2001-December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome. Of a total number of 28 124 children who were brought to the A&E department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5). Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.

Chronic abdominal wall pain--a diagnostic challenge for the surgeon.

PubMed

Lindsetmo, Rolv-Ole; Stulberg, Jonah

2009-07-01

Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain. The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain. CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical test (Carnett's test), >90% of patients with CAWP can be recognized, without risk for missing intra-abdominal pathology. The condition can be confirmed when the injection of local anesthetics in the trigger point(s) relieves the pain. A fasciotomy in the anterior abdominal rectus muscle sheath through the nerve foramina of the affected branch of one of the anterior intercostal nerves heals the pain.

Simulating the 2012 High Plains drought using three single column versions (SCM) of BUGS5

NASA Astrophysics Data System (ADS)

Medina, I. D.; Denning, S.

2013-12-01

The impact of changes in the frequency and severity of drought on fresh water sustainability is a great concern for many regions of the world. One such location is the High Plains, where the local economy is primarily driven by fresh water withdrawals from the Ogallala Aquifer, which accounts for approximately 30% of total irrigation withdrawals from all U.S. aquifers combined. Modeling studies that focus on the feedback mechanisms that control the climate and eco-hydrology during times of drought are limited, and have used conventional General Circulation Models (GCMs) with grid length scales ranging from one hundred to several hundred kilometers. Additionally, these models utilize crude statistical parameterizations of cloud processes for estimating sub-grid fluxes of heat and moisture and have a poor representation of land surface heterogeneity. For this research, we will focus on the 2012 High Plains drought and will perform numerical simulations using three single column versions (SCM) of BUGS5 (Colorado State University (CSU) GCM coupled to the Simple Biosphere Model (SiB3)) at multiple sites overlying the Ogallala Aquifer for the 2011-2012 periods. In the first version of BUGS5, the model will be used in its standard bulk setting (single atmospheric column coupled to a single instance of SiB3), secondly, the Super-Parameterized Community Atmospheric Model (SP-CAM), a cloud resolving model (CRM consists of 64 atmospheric columns), will replace the single CSU GCM atmospheric parameterization and will be coupled to a single instance of SiB3, and for the third version of BUGS5, an instance of SiB3 will be coupled to each CRM column of the SP-CAM (64 CRM columns coupled to 64 instances of SiB3). To assess the physical realism of the land-atmosphere feedbacks simulated at each site by all versions of BUGS5, differences in simulated energy and moisture fluxes will be computed between the 2011 and 2012 period and will be compared to differences calculated using observational data from the AmeriFlux tower network for the same period. These results will give some insight to the land-atmosphere feedbacks GCMs may produce when atmospheric and land surface heterogeneity are included within a single framework. Furthermore, this research will provide a better understanding of model deficiencies in reproducing and predicting droughts in the future, which is essential to the economic, ecologic and social well being of the High Plains.

Don't Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma.

PubMed

Matalon, Shanna A; Askari, Reza; Gates, Jonathan D; Patel, Ketan; Sodickson, Aaron D; Khurana, Bharti

2017-01-01

Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). These injuries are often overlooked clinically because of (a) a lack of findings at physical examination or (b) distraction by more-severe associated injuries. However, these injuries are important to detect because they are highly associated with potentially grave visceral and vascular injuries, such as aortic injury, and because their detection can lead to the diagnosis of these more clinically important grave traumatic injuries. Failure to make a timely diagnosis can result in delayed complications, such as bowel hernia with potential for obstruction or strangulation, or misdiagnosis of an abdominal wall neoplasm. Groin injuries, such as athletic pubalgia, and inferior costochondral injuries should also be considered in patients with abdominal pain after nonpenetrating trauma, because these conditions may manifest with referred abdominal pain and are often included within the field of view at cross-sectional abdominal imaging. Radiologists must recognize and report acute abdominal wall injuries and their associated intra-abdominal pathologic conditions to allow appropriate and timely treatment. © RSNA, 2017.

Pancreatic neuroendocrine tumor with complete replacement of the pancreas by serous cystic neoplasms in a patient with von Hippel-Lindau disease: a case report.

PubMed

Maeda, Shimpei; Motoi, Fuyuhiko; Oana, Shuhei; Ariake, Kyohei; Mizuma, Masamichi; Morikawa, Takanori; Hayashi, Hiroki; Nakagawa, Kei; Kamei, Takashi; Naitoh, Takeshi; Unno, Michiaki

2017-09-25

von Hippel-Lindau disease is a dominantly inherited multi-system syndrome with neoplastic hallmarks. Pancreatic lesions associated with von Hippel-Lindau include serous cystic neoplasms, simple cysts, and neuroendocrine tumors. The combination of pancreatic neuroendocrine tumors and serous cystic neoplasms is relatively rare, and the surgical treatment of these lesions must consider both preservation of pancreatic function and oncological clearance. We report a patient with von Hippel-Lindau disease successfully treated with pancreas-sparing resection of a pancreatic neuroendocrine tumor where the pancreas had been completely replaced by serous cystic neoplasms, in which pancreatic function was preserved. A 39-year-old female with von Hippel-Lindau disease was referred to our institution for treatment of a pancreatic neuroendocrine tumor. Abdominal computed tomography demonstrated a well-enhanced mass, 4 cm in diameter in the tail of the pancreas, and two multilocular tumors with several calcifications, 5 cm in diameter, in the head of the pancreas. There was complete replacement of the pancreas by multiple cystic lesions with diameters ranging from 1 to 3 cm. Magnetic resonance cholangiopancreatography showed innumerable cystic lesions on the whole pancreas and no detectable main pancreatic duct. Endoscopic ultrasound-guided fine-needle aspiration of the mass in the pancreatic tail showed characteristic features of a neuroendocrine tumor. A diagnosis of pancreatic neuroendocrine tumor in the tail of the pancreas and mixed-type serous cystic neoplasms replacing the whole pancreas was made and she underwent distal pancreatectomy while avoiding total pancreatectomy. The stump of the pancreas was sutured as firm as possible using a fish-mouth closure. The patient made a good recovery and was discharged on postoperative day 9. She is currently alive and well with no symptoms of endocrine or exocrine pancreatic insufficiency 8 months after surgery. A pancreas-sparing resection should be considered for patients with pancreatic neuroendocrine tumors and complete cystic replacement of the pancreas to preserve quality of life after surgery.

27 CFR 9.207 - Outer Coastal Plain.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Outer Coastal Plain. (a) Name. The name of the viticultural area described in this section is “Outer...,000 scale. (c) Boundary. The Outer Coastal Plain viticultural area includes all of Cumberland, Cape... Counties in the State of New Jersey. The boundary of the Outer Coastal Plain viticultural area is as...

Staged abdominal re-operation for abdominal trauma.

PubMed

Taviloglu, Korhan

2003-07-01

To review the current developments in staged abdominal re-operation for abdominal trauma. To overview the steps of damage control laparotomy. The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Investigation into Fretting Fatigue Under Cyclic Contact Load and in Conjunction with Plain Fatigue of Titanium Alloy

DTIC Science & Technology

2008-03-01

by plain fatigue and the process kept alternating or finishing all fretting fatigue cycles first followed by plain fatigue...fatigue and the process kept alternating or finishing all fretting fatigue cycles first followed by plain fatigue. 127  6.2.2. Phase Difference...component’s life. Figure 1.2 illustrates the process of combination of fretting fatigue and plain fatigue, by using three parts. The first part of this figure

Contraction of the Ventral Abdomen Potentiates Extracardiac Retrograde Hemolymph Propulsion in the Mosquito Hemocoel

PubMed Central

Andereck, Jonathan W.; King, Jonas G.; Hillyer, Julián F.

2010-01-01

Background Hemolymph circulation in mosquitoes is primarily controlled by the contractile action of a dorsal vessel that runs underneath the dorsal midline and is subdivided into a thoracic aorta and an abdominal heart. Wave-like peristaltic contractions of the heart alternate in propelling hemolymph in anterograde and retrograde directions, where it empties into the hemocoel at the terminal ends of the insect. During our analyses of hemolymph propulsion in Anopheles gambiae, we observed periodic ventral abdominal contractions and hypothesized that they promote extracardiac hemolymph circulation in the abdominal hemocoel. Methodology/Principal Findings We devised methods to simultaneously analyze both heart and abdominal contractions, as well as to measure hemolymph flow in the abdominal hemocoel. Qualitative and quantitative analyses revealed that ventral abdominal contractions occur as series of bursts that propagate in the retrograde direction. Periods of ventral abdominal contraction begin only during periods of anterograde heart contraction and end immediately following a heartbeat directional reversal, suggesting that ventral abdominal contractions function to propel extracardiac hemolymph in the retrograde direction. To test this functional role, fluorescent microspheres were intrathoracically injected and their trajectory tracked throughout the hemocoel. Quantitative measurements of microsphere movement in extracardiac regions of the abdominal cavity showed that during periods of abdominal contractions hemolymph flows in dorsal and retrograde directions at a higher velocity and with greater acceleration than during periods of abdominal rest. Histochemical staining of the abdominal musculature then revealed that ventral abdominal contractions result from the contraction of intrasegmental lateral muscle fibers, intersegmental ventral muscle bands, and the ventral transverse muscles that form the ventral diaphragm. Conclusions/Significance These data show that abdominal contractions potentiate extracardiac retrograde hemolymph propulsion in the abdominal hemocoel during periods of anterograde heart flow. PMID:20886066

Elasticity of the living abdominal wall in laparoscopic surgery.

PubMed

Song, Chengli; Alijani, Afshin; Frank, Tim; Hanna, George; Cuschieri, Alfred

2006-01-01

Laparoscopic surgery requires inflation of the abdominal cavity and this offers a unique opportunity to measure the mechanical properties of the living abdominal wall. We used a motion analysis system to study the abdominal wall motion of 18 patients undergoing laparoscopic surgery, and found that the mean Young's modulus was 27.7+/-4.5 and 21.0+/-3.7 kPa for male and female, respectively. During inflation, the abdominal wall changed from a cylinder to a dome shape. The average expansion in the abdominal wall surface was 20%, and a working space of 1.27 x 10(-3)m(3) was created by expansion, reshaping of the abdominal wall and diaphragmatic movement. For the first time, the elasticity of human abdominal wall was obtained from the patients undergoing laparoscopic surgery, and a 3D simulation model of human abdominal wall has been developed to analyse the motion pattern in laparoscopic surgery. Based on this study, a mechanical abdominal wall lift and a surgical simulator for safe/ergonomic port placements are under development.

Effects of Antiadhesion preparation on free fibrinogen and fibrin degrading products in abdominal exudates of rabbits postoperatively

PubMed Central

Wang, You-Li; Pan, Cheng-En; Yang, Ping-Lin; Tian, Yuan; Pei, Shu-Wen; Dong, Ming

2004-01-01

AIM: To observe effects of ACOL on fibrinogen (FIB), fibrin degrading products (FDP) and changes of FIB and FDP concentration in rabbits with intro-abdominal exudates during 7 d after major abdominal surgery. METHODS: Sixty New Zealand rabbits were randomly divided into 4 groups: ACOL group, the control group, DCT group and the normal group. After being modeled, except the normal group, the other 3 groups were treated with different ways for a week; the intro-abdominal exudates of rabbits in the 4 groups were drawn for FIB and FDP measurement once daily during 7 d after major abdominal surgery. RESULTS: FIB and FDP in the intro-abdominal exudates altered in a regular way and ACOL could change the concentration of FIB and FDP in the intra-abdominal exudates after major abdominal surgery. CONCLUSION: ACOL can prevent intestinal adhesion by reducing the concentration of FIB and raising that of FDP in the intro-abdominal exudates after major abdominal surgery. PMID:15309738

Desert plains classification based on Geomorphometrical parameters (Case study: Aghda, Yazd)

NASA Astrophysics Data System (ADS)

Tazeh, mahdi; Kalantari, Saeideh

2013-04-01

This research focuses on plains. There are several tremendous methods and classification which presented for plain classification. One of The natural resource based classification which is mostly using in Iran, classified plains into three types, Erosional Pediment, Denudation Pediment Aggradational Piedmont. The qualitative and quantitative factors to differentiate them from each other are also used appropriately. In this study effective Geomorphometrical parameters in differentiate landforms were applied for plain. Geomorphometrical parameters are calculable and can be extracted using mathematical equations and the corresponding relations on digital elevation model. Geomorphometrical parameters used in this study included Percent of Slope, Plan Curvature, Profile Curvature, Minimum Curvature, the Maximum Curvature, Cross sectional Curvature, Longitudinal Curvature and Gaussian Curvature. The results indicated that the most important affecting Geomorphometrical parameters for plain and desert classifications includes: Percent of Slope, Minimum Curvature, Profile Curvature, and Longitudinal Curvature. Key Words: Plain, Geomorphometry, Classification, Biophysical, Yazd Khezarabad.

Fabry disease in children: agalsidase-beta enzyme replacement therapy.

PubMed

Borgwardt, L; Feldt-Rasmussen, U; Rasmussen, A K; Ballegaard, M; Meldgaard Lund, A

2013-05-01

Fabry disease is a rare, multiorgan disease. The most serious complications involve the kidney, brain and heart. This study aims to assess the effect of enzyme replacement therapy (ERT) using agalsidase-beta in children with Fabry disease. We carried out a nationwide, descriptive and observational retrospective cohort study of 10 children (9-16 years at baseline), who underwent regular systematic investigations for 1-8 years after initiation of ERT with agalsidase-beta (Fabryzyme®, Genzyme). Ophthalmological, echocardiographic abnormalities and hypohidrosis were found at baseline and during the follow-up period. Serious kidney, heart or brain involvement had not developed at the last follow-up examination. For the majority of the patients improvements were found concerning headache, acroparaesthesias and gastrointestinal pain during the follow-up period. The level of energy and physical activity also increased. Treatment with agalsidase-beta was associated with a reduction of neuropathic and abdominal pain and headache. Although all aspects of the Fabry pain phenotype cannot be treated with ERT, the observed effects were clinically significant in the lives of the majority of Fabry children and together with the absence of serious Fabry manifestations at last follow-up, we argue that early initiation of ERT may be considered. © 2012 John Wiley & Sons A/S.

Hypertriglyceridemia-induced pancreatitis: A case-based review

PubMed Central

Gan, S Ian; Edwards, Alun L; Symonds, Christopher J; Beck, Paul L

2006-01-01

Hypertriglyceridemia is an established cause of pancreatitis. In a case-based approach, we present a review of hypertriglyceridemia and how it can cause pancreatitis. We outline how to investigate and manage such patients. A 35 year old man presented to the emergency department with abdominal pain and biochemical evidence of acute pancreatitis. There was no history of alcohol consumption and biliary imaging was normal. The only relevant past medical history was that of mild hyperlipidemia, treated with diet alone. Physical exam revealed epigastric tenderness, right lateral rectus palsy, lipemia retinalis, bitemporal hemianopsia and a delay in the relaxation phase of his ankle reflexes. Subsequent laboratory investigation revealed marked hypertriglyceridemia and panhypopituarism. An enhanced CT scan of the head revealed a large suprasellar mass impinging on the optic chiasm and hypothalamus. The patient was treated supportively; thyroid replacement and lipid lowering agents were started. He underwent a successful resection of a craniopharyngioma. Post-operatively, the patient did well on hormone replacement therapy. He has had no further attacks of pancreatitis. This case highlights many of the factors involved in the regulation of triglyceride metabolism. We review the common causes of hypertriglyceridemia and the proposed mechanisms resulting in pancreatitis. The incidence and management of hypertriglyceridemia-induced pancreatitis are also discussed. PMID:17131487

Genetic variation in Great Plains Juniperus

Treesearch

David F. Van Haverbeke; Rudy M. King

1990-01-01

Fifth-year analyses of Great Plains Juniperus seed sources indicate eastern redcedar should be collected in east-central Nebraska for use throughout the Great Plains; Rocky Mountain juniper seed should be collected from northwest Nebraska, or central Montana, for planting southward through the Great Plains into west-central Kansas west of the 100th meridian.

44 CFR 60.12 - Flood plain management criteria for State-owned properties in special hazard areas.

Code of Federal Regulations, 2012 CFR

2012-10-01

... MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for State Flood Plain Management Regulations § 60.12 Flood plain management criteria for State-owned properties in... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Flood plain management...

44 CFR 60.12 - Flood plain management criteria for State-owned properties in special hazard areas.

Code of Federal Regulations, 2014 CFR

2014-10-01

... MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for State Flood Plain Management Regulations § 60.12 Flood plain management criteria for State-owned properties in... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Flood plain management...

44 CFR 60.12 - Flood plain management criteria for State-owned properties in special hazard areas.

Code of Federal Regulations, 2013 CFR

2013-10-01

... MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for State Flood Plain Management Regulations § 60.12 Flood plain management criteria for State-owned properties in... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Flood plain management...

44 CFR 60.12 - Flood plain management criteria for State-owned properties in special hazard areas.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for State Flood Plain Management Regulations § 60.12 Flood plain management criteria for State-owned properties in... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Flood plain management...

44 CFR 60.12 - Flood plain management criteria for State-owned properties in special hazard areas.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for State Flood Plain Management Regulations § 60.12 Flood plain management criteria for State-owned properties in... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Flood plain management...

49 CFR 230.102 - Tender plain bearing journal boxes.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Tender plain bearing journal boxes. 230.102... Locomotives and Tenders Running Gear § 230.102 Tender plain bearing journal boxes. Plain bearing journal boxes... expected to damage the bearing; or have a detrimental effect on the lubrication of the journal and bearing...

49 CFR 230.102 - Tender plain bearing journal boxes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Tender plain bearing journal boxes. 230.102... Locomotives and Tenders Running Gear § 230.102 Tender plain bearing journal boxes. Plain bearing journal boxes... expected to damage the bearing; or have a detrimental effect on the lubrication of the journal and bearing...

Detailed Analysis of the Intra-Ejecta Dark Plains of Caloris Basin, Mercury

NASA Technical Reports Server (NTRS)

Buczkowski, Debra L.; Seelos, K. S.

2010-01-01

The Caloris basin on Mercury is floored by light-toned plains and surrounded by an annulus of dark-toned material interpreted to be ejecta blocks and smooth, dark, ridged plains. Strangely, preliminary crater counts indicate that these intra-ejecta dark plains are younger than the light-toned plains within the Caloris basin. This would imply a second, younger plains emplacement event, possibly involving lower albedo material volcanics, which resurfaced the original ejecta deposit. On the other hand, the dark plains may be pre-Caloris light plains covered by a thin layer of dark ejecta. Another alternative to the hypothesis of young, dark volcanism is the possibility that previous crater counts have not thoroughly distinguished between superposed craters (fresh) and partly-buried craters (old) and therefore have not accurately determined the ages of the Caloris units. This abstract outlines the tasks associated with a new mapping project of the Caloris basin, intended to improve our knowledge of the geology and geologic history of the basin, and thus facilitate an understanding of the thermal evolution of this region of Mercury.

Treatment and outcomes of aortic endograft infection.

PubMed

Smeds, Matthew R; Duncan, Audra A; Harlander-Locke, Michael P; Lawrence, Peter F; Lyden, Sean; Fatima, Javariah; Eskandari, Mark K

2016-02-01

This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66%), fever/chills (66%), and aortic fistula (27%). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90%) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83% soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35%) and gram-positive (22%). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35% and mortality of 11%. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70%, 65%, 61%, 56%, and 51% at 1, 2, 3, 4, and 5 years, respectively. Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Evaluation of Polyherbal Formulation and Synthetic Choline Chloride on Choline Deficiency Model in Broilers: Implications on Zootechnical Parameters, Serum Biochemistry and Liver Histopathology.

PubMed

Selvam, Ramasamy; Saravanakumar, Marimuthu; Suresh, Subramniyam; Chandrasekaran, C V; Prashanth, D'Souza

2018-04-12

The study was designed to establish choline deficiency model (CDM) in broilers for evaluating efficacy of polyherbal formulation (PHF) in comparison with synthetic choline chloride (SCC). A total of 2550 one-day-old Cobb 430 broiler chicks were randomly assigned to different groups in three experiments. In experiment 1, G1 and G2 served as normal controls and were fed a basal diet with 100% soybean meal (SBM) as a major protein source supplemented with and without SCC, respectively. In G3, G4, G5 and G6 groups, SBM was replaced at 25%, 50%, 75% and 100% by soy protein isolate (SPI) to induce a graded level of choline deficiency. In experiment 2, PHF (500 and 1000 g/ton) in comparison with SCC (1000 g/ton) were evaluated. In experiment 3, dose response of PHF (200, 400 and 500 g/ton) with SCC (400 g/ton) was determined. Replacement of SBM by SPI produced a linear decrease in body weight gain (BWG) with a poor feed conversion ratio (FCR). 25% SBM replacement by SPI yielded an optimum negative impact on BWG and FCR; hence, it is considered for further studies. In experiment 2, PHF (500 and 1000 g/ton) and SCC (1000 g/ton) showed a similar performance in BWG, FCR and relative liver weight. In experiment 3, PHF produced an optimum efficacy at 400 g/ton and was comparable to SCC in the restoration of serum aspartate aminotransferase activity, abdominal fat, breast muscle lipid content and liver histopathological abnormalities. Replacement of SBM by SPI caused choline deficiency characterised by worsening of BWG, FCR, elevation in liver enzymes and histopathological changes indicating fatty liver. CDM was found valid for evaluating SCC and PHF. It is concluded that PHF has the potential to mimic biological activities of SCC through the restoration of negative effects caused by CDM.

Radar Rainfall Statistics During PECAN

NASA Astrophysics Data System (ADS)

Romatschke, U.; Weckwerth, T.

2017-12-01

The Plains Elevated Convection At Night (PECAN) field campaign, based in Kansas, USA, took place from May to July 2015. It was designed to understand the causes and improve predictions of the central US nocturnal precipitation maximum. Over 100 instruments were utilized to sample the pre-convective and convective conditions within and around unorganized storms and Mesoscale Convective Systems (MCSs). We analyze quantitative precipitation estimates (QPEs) derived from a dense network of NEXRADs which, combined with S-Pol, cover an area extending from the eastern side of the Rocky Mountains over the Central Great Plains. As expected, precipitation maxima occurred during the afternoon and evening over the eastern Rocky Mountains and during the night over the plains. The precipitation over the mountains is almost exclusively associated with smaller scale storms which are triggered by solar heating over the elevated terrain. The mountain triggered storms quickly grow and merge to the size of MCSs and are then advected east over the plains. Storms are also initiated over the plains but at much lower frequency than over the mountains. The diurnal cycle of plain initiation is much less pronounced with a broad peak in the afternoon and evening but also significant convection initiation during the night. The nocturnal precipitation over the plains is primarily associated with the MCSs advected from the mountains which merge with the storms triggered over the plains. Some precipitation over the plains is generated by pristine storms triggered over the plains but their precipitation contribution is mostly secondary compared to the merged systems.

Plain water intake of Korean adults according to life style, anthropometric and dietary characteristic: the Korea National Health and Nutrition Examination Surveys 2008-2010

PubMed Central

Kim, Jihye

2014-01-01

BACKGROUND/OBJECTIVES The objective of the study was to provide useful insights into plain water intake of Korean adults according to life style, anthropometric, and dietary characteristics. SUBJECTS/METHODS The data from the 2008-2010 Korea National Health and Nutrition Examination Survey were used. The subjects were 14,428 aged 20-64 years. Water intake was estimated by asking the question "How much water do you usually consume per day?". Dietary intake was estimated by 24-hour dietary recall. A qualitative food frequency questionnaire including 63 food items was also administered. RESULTS The mean plain water intake for men and women were 6.3 cup/day and 4.6 cup/day, respectively. Plain water intake increased as lean body mass, waist circumference, and body mass index levels increased, except for percentage of body fat. As energy and alcohol intakes increased, plain water intake increased. As total weight of food intake and total volume of food intake increased, plain water intake increased. Plain water intake increased as consumption of vegetables increased. Plain water intake increased as frequencies of green tea, alcoholic drink, and all beverages were increased in men. Plain water intake increased with increased frequencies of green tea, milk, soy milk, and alcoholic drink and decreased frequencies of coffee and soda in women. CONCLUSIONS Our results suggest that persons who had a higher waist circumference or lean body mass and women with higher BMI consumed more plain water. The persons eating high quality diet, or the persons who had more vegetables, green tea, milk, soy milk, or alcoholic drink consumed more plain water. PMID:25324940

Uterine prolapse with associated rupture in a Podengo bitch.

PubMed

Payan-Carreira, R; Albuquerque, C; Abreu, H; Maltez, L

2012-08-01

A case of uterine prolapse coexisting with uterine horn rupture in a 3-year-old Portuguese Podengo bitch, which is an uncommon occurrence, is described. The female was presented with a history of recent parturition, with delivery of four healthy puppies that were normally tended and nursed. The situation developed after an uneventfully pregnancy, and no direct causative factor was identified. The duration of the prolapse was unknown, but considered to be recent because of the swollen reddish appearance of the tubular everted mass. No foetus was found in the uterus or the abdominal cavity. The female was presented in good physical condition, without signs of shock or haemorrhage. During surgical treatment, the uterus was replaced to its normal position followed by ovary-hysterectomy at 12 h from admittance. © 2011 Blackwell Verlag GmbH.

Rectus sheath hematoma: three case reports

PubMed Central

Kapan, Selin; Turhan, Ahmet N; Alis, Halil; Kalayci, Mustafa U; Hatipoglu, Sinan; Yigitbas, Hakan; Aygun, Ersan

2008-01-01

Introduction Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen. Case presentation We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Conclusion Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management. PMID:18221529

More than one way to stretch: A tectonic model for extension along the plume track of the Yellowstone hotspot and adjacent Basin and Range Province

USGS Publications Warehouse

Parsons, T.; Thompson, G.A.; Smith, R.P.

1998-01-01

The eastern Snake River Plain of southern Idaho poses a paradoxical problem because it is nearly aseismic and unfaulted although it appears to be actively extending in a SW-NE direction continuously with the adjacent block-faulted Basin and Range Province. The plain represents the 100-km-wide track of the Yellowstone hotspot during the last ???16-17 m.y., and its crust has been heavily intruded by mafic magma, some of which has erupted to the surface as extensive basalt flows. Outside the plain's distinct topographic boundaries is a transition zone 30-100 km wide that has variable expression of normal faulting and magmatic activity as compared with the surrounding Basin and Range Province. Many models for the evolution of the Snake River Plain have as an integral component the suggestion that the crust of the plain became strong enough through basaltic intrusion to resist extensional deformation. However, both the boundaries of the plain and its transition zone lack any evidence of zones of strike slip or other accommodation that would allow the plain to remain intact while the Basin and Range Province extended around it; instead, the plain is coupled to its surroundings and extending with them. We estimate strain rates for the northern Basin and Range Province from various lines of evidence and show that these strains would far exceed the elastic limit of any rocks coupled to the Basin and Range; thus, if the plain is extending along with its surroundings, as the geologic evidence indicates, it must be doing so by a nearly aseismic process. Evidence of the process is provided by volcanic rift zones, indicators of subsurface dikes, which trend across the plain perpendicular to its axis. We suggest that variable magmatic strain accommodation, by emplacement and inflation of dikes perpendicular to the least principal stress in the elastic crust, allows the crust of the plain to extend nearly aseismically. Dike injection releases accumulated elastic strain but generates only the small earthquakes associated with dike propagation. The rate of dike emplacement required to accommodate the estimated longitudinal strain rate of the plain is roughly a composite width of 10 m every 1000 years for the geologically youngest and most active part of the plain. The locus of most rapid intrusion and strain has migrated toward Yellowstone and is now in the northeastern 100-150 km of the plain. Reduced magmatic input in the transition zone of the plain causes the transitional expression of seismicity and faulting there.

An Experience in the Management of the Open Abdomen in Severely Injured Burn Patients

DTIC Science & Technology

2012-07-01

laparotomy was ACS in 31 patients (82%), abdominal trauma in 6 patients (16%), and a perforated gastric ulcer in 1 patient (3%). The abdominal...and other primary intra-abdominal pathology resulting in an abdominal catastrophe. Decompres- sive laparotomy for the treatment of ACS has been...presence of burns involving abdominal skin. • Treatment characteristics: method of temporary abdominal closure, number of days to closure, and number

The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex

NASA Technical Reports Server (NTRS)

Stuart, J. J.; Brown, S. J.; Beeman, R. W.; Denell, R. E.; Spooner, B. S. (Principal Investigator)

1993-01-01

The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7-9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex.

PubMed

Stuart, J J; Brown, S J; Beeman, R W; Denell, R E

1993-01-01

The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7-9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

[A commonly seen cause of abdominal pain: abdominal cutaneous nerve entrapment syndrome].

PubMed

Solmaz, Ilker; Talay, Mustafa; Tekindur, Şükrü; Kurt, Ercan

2012-01-01

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.

Technical advances for abdominal wall closure after intestinal and multivisceral transplantation.

PubMed

Gerlach, Undine A; Pascher, Andreas

2012-06-01

Abdominal wall closure after intestinal transplantation (ITX) or multivisceral transplantation (MVTX) is challenging because of the loss of abdominal domain and wall elasticity as a result of previous operations and donor-to-recipient weight and height mismatch. We report on abdominal wall closure management in 30 ITX and MVTX recipients. In 60% of patients (n = 18), a primary abdominal closure (PAC) was achieved, in 40% (n = 12) a staged closure (SAC) was necessary. Patients with PAC had undergone less pretransplant operations and required less posttransplant relaparotomies. They were mainly ITX recipients or more abdominal domain because of a longer intestinal remnant. A literature review revealed different strategies to overcome a failed primary closure. They focus on graft reduction or an enlargement of the abdominal domain. The latter includes temporary coverage with prosthetic materials for SAC. Definite abdominal closure is achieved by skin only closure, or by using acellular dermal matrix, rotational flaps, rectus muscle fascia or abdominal wall grafts. Abdominal wall reconstruction after ITX/MVTX is commonly demanded and can be conducted by different strategies. The technique should be easy to use in a timely manner and should prevent abdominal infections, intestinal fistulation, incisional hernias, and wound dehiscence.

Medical evacuation for unrecognized abdominal wall pain: a case series.

PubMed

Msonda, Hapu T; Laczek, Jeffrey T

2015-05-01

Chronic abdominal pain is a frequently encountered complaint in the primary care setting. The abdominal wall is the etiology of this pain in 10 to 30% of all cases of chronic abdominal pain. Abdominal cutaneous nerve entrapment at the lateral border of the rectus abdominis muscle has been attributed as a cause of this pain. In the military health care system, patients with unexplained abdominal pain are often transferred to military treatment facilities via the Military Medical Evacuation (MEDEVAC) system. We present two cases of patients who transferred via MEDEVAC to our facility for evaluation and treatment of chronic abdominal pain. Both patients had previously undergone extensive laboratory evaluation, imaging, and invasive procedures, such as esophagogastroduodenoscopy before transfer. Upon arrival, history and physical examinations suggested an abdominal wall source to their pain, and both patients experienced alleviation of their abdominal wall pain with lidocaine and corticosteroid injection. This case series highlights the need for military physicians to be aware of abdominal wall pain. Early diagnosis of abdominal cutaneous nerve entrapment syndrome by eliciting Carnett's sign will limit symptom chronicity, avoid unnecessary testing, and even prevent medical evacuation. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Simultaneous Recording and Analysis of Uterine and Abdominal Muscle Electromyographic Activity in Nulliparous Women During Labor.

PubMed

Qian, Xueya; Li, Pin; Shi, Shao-Qing; Garfield, Robert E; Liu, Huishu

2017-03-01

To record and characterize electromyography (EMG) from the uterus and abdominal muscles during the nonlabor to first and second stages of labor and to define relationships to contractions. Nulliparous patients without any treatments were used (n = 12 nonlabor stage, 48 during first stage and 33 during second stage). Electromyography of both uterine and abdominal muscles was simultaneously recorded from electrodes placed on patients' abdominal surface using filters to separate uterine and abdominal EMG. Contractions of muscles were also recorded using tocodynamometry. Electromyography was characterized by analysis of various parameters. During the first stage of labor, when abdominal EMG is absent, uterine EMG bursts temporally correspond to contractions. In the second stage, uterine EMG bursts usually occur at same frequency as groups of abdominal bursts and precede abdominal bursts, whereas abdominal EMG bursts correspond to contractions and are accompanied by feelings of "urge to push." Uterine EMG increases progressively from nonlabor to second stage of labor. (1) Uterine EMG activity can be separated from abdominal EMG events by filtering. (2) Uterine EMG gradually evolves from the antepartum stage to the first and second stages of labor. (3) Uterine and abdominal EMG reflect electrical activity of the muscles during labor and are valuable to assess uterine and abdominal muscle events that control labor. (4) During the first stage of labor uterine, EMG is responsible for contractions, and during the second stage, both uterine and abdominal muscle participate in labor.

Treatment by ultrasound-guided local infiltration in adhesion-related abdominal pain and intractable hiccups: A case report.

PubMed

Zhu, Dan; Gu, Zhi-Yong; Lin, Chia-Shiang; Nie, Fa-Chuan; Cui, Jian

2018-04-01

Abdominal pain and hiccups secondary to intra-abdominal adhesion are surgical complications that are often treated by painkillers and secondary surgeries with an unsatisfactory therapeutic effect. This study presents a new treatment method that uses ultrasound-guided local infiltration in peritoneal and abdominal wall adhesions in patients with hiccups and abdominal pain. A 62-year-old patient presented to our hospital with a history of intractable hiccups and abdominal pain for 30 years. Her abdominal examination revealed a scar with an approximate length of 10 cm on the abdominal umbilical plane; pressing the right scar area could simultaneously induce abdominal pain and hiccups. Intraperitoneal computed tomography examination clearly demonstrated that the bowel had no obvious expansion. Ultrasonographic examination found that peritoneal motility below the normal peritoneal adhesion regions was significantly slower than in the normal regions. The diagnosis of chronic postoperative pain syndrome was clear. The symptoms were significantly alleviated by a successful treatment with ultrasound-guided local infiltration in the peritoneal and abdominal wall scar adhesions. After 3 stages of hospitalization and 1 year of follow-up, the patient's abdominal wall pain was relieved by approximately 80% and hiccups were relieved by approximately 70%. The above treatment is a useful option for managing abdominal adhesion and accompanying pain or hiccups resulting from abdominal surgery. This method could ease the psychological and economic burden of patients and improve their quality of life.

Prediction of the Chloride Resistance of Concrete Modified with High Calcium Fly Ash Using Machine Learning

PubMed Central

Marks, Michał; Glinicki, Michał A.; Gibas, Karolina

2015-01-01

The aim of the study was to generate rules for the prediction of the chloride resistance of concrete modified with high calcium fly ash using machine learning methods. The rapid chloride permeability test, according to the Nordtest Method Build 492, was used for determining the chloride ions’ penetration in concrete containing high calcium fly ash (HCFA) for partial replacement of Portland cement. The results of the performed tests were used as the training set to generate rules describing the relation between material composition and the chloride resistance. Multiple methods for rule generation were applied and compared. The rules generated by algorithm J48 from the Weka workbench provided the means for adequate classification of plain concretes and concretes modified with high calcium fly ash as materials of good, acceptable or unacceptable resistance to chloride penetration. PMID:28793740

Strength Development of High-Strength Ductile Concrete Incorporating Metakaolin and PVA Fibers

PubMed Central

Nuruddin, Muhammad Fadhil; Shafiq, Nasir

2014-01-01

The mechanical properties of high-strength ductile concrete (HSDC) have been investigated using Metakaolin (MK) as the cement replacing material and PVA fibers. Total twenty-seven (27) mixes of concrete have been examined with varying content of MK and PVA fibers. It has been found that the coarser type PVA fibers provide strengths competitive to control or higher than control. Concrete with coarser type PVA fibers has also refined microstructure, but the microstructure has been undergone with the increase in aspect ratio of fibers. The microstructure of concrete with MK has also more refined and packing of material is much better with MK. PVA fibers not only give higher stiffness but also showed the deflection hardening response. Toughness Index of HSDC reflects the improvement in flexural toughness over the plain concrete and the maximum toughness indices have been observed with 10% MK and 2% volume fraction of PVA fibers. PMID:24707202

Strength development of high-strength ductile concrete incorporating Metakaolin and PVA fibers.

PubMed

Nuruddin, Muhammad Fadhil; Khan, Sadaqat Ullah; Shafiq, Nasir; Ayub, Tehmina

2014-01-01

The mechanical properties of high-strength ductile concrete (HSDC) have been investigated using Metakaolin (MK) as the cement replacing material and PVA fibers. Total twenty-seven (27) mixes of concrete have been examined with varying content of MK and PVA fibers. It has been found that the coarser type PVA fibers provide strengths competitive to control or higher than control. Concrete with coarser type PVA fibers has also refined microstructure, but the microstructure has been undergone with the increase in aspect ratio of fibers. The microstructure of concrete with MK has also more refined and packing of material is much better with MK. PVA fibers not only give higher stiffness but also showed the deflection hardening response. Toughness Index of HSDC reflects the improvement in flexural toughness over the plain concrete and the maximum toughness indices have been observed with 10% MK and 2% volume fraction of PVA fibers.

From random microstructures to representative volume elements

NASA Astrophysics Data System (ADS)

Zeman, J.; Šejnoha, M.

2007-06-01

A unified treatment of random microstructures proposed in this contribution opens the way to efficient solutions of large-scale real world problems. The paper introduces a notion of statistically equivalent periodic unit cell (SEPUC) that replaces in a computational step the actual complex geometries on an arbitrary scale. A SEPUC is constructed such that its morphology conforms with images of real microstructures. Here, the appreciated two-point probability function and the lineal path function are employed to classify, from the statistical point of view, the geometrical arrangement of various material systems. Examples of statistically equivalent unit cells constructed for a unidirectional fibre tow, a plain weave textile composite and an irregular-coursed masonry wall are given. A specific result promoting the applicability of the SEPUC as a tool for the derivation of homogenized effective properties that are subsequently used in an independent macroscopic analysis is also presented.

Performance of Swashplateless Ultralight Helicopter Rotor with Trailing-edge Flaps for Primary Flight Control

NASA Technical Reports Server (NTRS)

Shen, Jin-Wei; Chopra, Inderjit

2003-01-01

The objective of present study is to evaluate the rotor performance, trailing-edge deflections and actuation requirement of a helicopter rotor with trailing-edge flap system for primary flight control. The swashplateless design is implemented by modifying a two-bladed teetering rotor of an production ultralight helicopter through the use of plain flaps on the blades, and by replacing the pitch link to fixed system control system assembly with a root spring. A comprehensive rotorcraft analysis based on UMARC is carried out to obtain the results for both the swashplateless and a conventional baseline rotor configuration. The predictions show swashplateless configuration achieve superior performance than the conventional rotor attributed from reduction of parasite drag by eliminating swashplate mechanic system. It is indicated that optimal selection of blade pitch index angle, flap location, length, and chord ratio reduces flap deflections and actuation requirements, however, has virtually no effect on rotor performance.

78 FR 49684 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

...-AA00 Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago... the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago... the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago...

41 CFR 102-2.140 - What elements of plain language appear in the FMR?

Code of Federal Regulations, 2010 CFR

2010-07-01

... MANAGEMENT REGULATION SYSTEM Plain Language Regulatory Style § 102-2.140 What elements of plain language... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What elements of plain language appear in the FMR? 102-2.140 Section 102-2.140 Public Contracts and Property Management Federal...

Wrinkle ridges in the floor material of Kasei Valles, Mars: Nature and origin

NASA Technical Reports Server (NTRS)

Watters, Thomas R.; Craddock, Robert A.

1991-01-01

Wrinkle ridges on Mars occur almost exclusively in smooth plains material referred to as ridged plains. One of the largest contiguous units of ridged plains occurs on Lunae Planum on the eastern flank of the Tharsis rise. The eastern, western, and northern margins of the ridged plains of Lunae Planum suffered extensive erosion in early Amazonian channel-forming events. The most dramatic example of erosion in early Amazonian plains is in Kasei Valles. The nature an origin of the wrinkle ridges in the floor material of Kasei Valles are discussed.

The import of abdominal pain in adults with sickle cell disorder.

PubMed

Akinola, N O; Bolarinwa, R A; Faponle, A F

2009-03-01

The aetiology, clinical correlates and outcome of abdominal pain in Nigerian adults with sickle cell disorder (SCD) have not been extensively reported. To determine the prevalence of abdominal vasoocclusive crisis in sickle cell patients with abdominal pain and their clinical correlates if any. Clinical records of adults with SCD (Hb SS and Hb SC) attending the Haematology Outpatients' Clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Southwest Nigerian, over a ten-year period, were reviewed. Demographic, clinical and laboratory data with respect to abdominal pain were retrieved. Data were analysed using appropriate descriptive and inferential statistics. A total of 154 records (128 Hb SS and 26 Hb SC) were available for assessment. The patients mean ages were 22.5 +/- 7.3 years (Hb SS patients) and 24.2 +/- 9.7 years (Hb SC patients) (p > 0.05). The prevalence of abdominal pain was 39.1% and 30.8% in Hb SS and Hb SC respectively (p > 0.05). Pain was commonly in the epigastrium; dull in 35% Hb SS, but peppery/burning in 37.5% Hb SC. All patients with abdominal vaso-occlusive crisis (VOC) had diffuse/generalised dull abdominal pains. A diagnosis of gastritis/peptic ulcer disease was made in 50% of Hb SC patients and 28% of Hb SS patients. Abdominal VOC was diagnosed in 26% Hb SS, but none in Hb SC patients. The size of the liver or spleen and the haematocrit of Hb SS patients did not correlate with the frequency of abdominal pain generally or abdominal VOC specifically. The prevalence rates and patterns of abdominal pain in Hb SS and Hb SC patients appear similar. Abdominal VOC characterised by diffuse/generalised dull abdominal pain occurred in only Hb SS patients and may be a marker of disease severity in these patients.

Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery.

PubMed

Cleva, Roberto de; Assumpção, Marianna Siqueira de; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Fló, Claudia; Lunardi, Adriana C; Jacob Filho, Wilson

2014-07-01

Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.

[Rome III classification of functional gastrointestinal disorders in children with chronic abdominal pain].

PubMed

Plocek, Anna; Wasowska-Królikowska, Krystyna; Toporowska-Kowalska, Ewa

2010-01-01

The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.

The cardio-respiratory effects of intra-abdominal hypertension: Considerations for critical care nursing practice.

PubMed

Christensen, Martin; Craft, Judy

2018-02-01

Intra-abdominal hypertension can be classified as either primary or secondary. Primary intra-abdominal hypertension is often associated through trauma or diseases of the abdominopelvic region such as pancreatitis or abdominal surgery, while secondary intra-abdominal hypertension is the result of extra-abdominal causes such as sepsis or burns. The critically ill patient offers some challenges in monitoring in particular secondary intra-abdominal hypertension because of the effects of fluid resuscitation, the use of inotropes and positive pressure ventilation. Recent work suggests that intensive care unit nurses are often unaware of the secondary effects of intra-abdominal pressure and therefore this is not monitored effectively. Therefore being aware of the cardio-respiratory effects may alert theintensive care nurse nurse to the development of intra-abdominal hypertension. The aim of this paper is to discuss the pathophysiology associated with the cardio-respiratory effects seen with intra-abdominal hypertension in the critically ill. In particular it will discuss how intra-abdominal hypertension can inadvertently be overlooked because of the low flow states that it produces which could be misconstrued as something else. It will also discuss how intra-abdominal hypertension impedes ventilation and respiratory mechanics which can often result in a non-cardiogenic pulmonary oedema. To close, the paper will offer some implications for critical care nursing practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Snake River Plain Volcanic Province: Insights from Project Hotspot

NASA Astrophysics Data System (ADS)

Shervais, J. W.; Potter, K. E.; Hanan, B. B.; Jean, M. M.; Duncan, R. A.; Champion, D. E.; Vetter, S.; Glen, J. M. G.; Christiansen, E. H.; Miggins, D. P.; Nielson, D. L.

2017-12-01

The Snake River Plain (SRP) Volcanic Province is the best modern example of a time-transgressive hotspot track beneath continental crust. The SRP began 17 Ma with massive eruptions of Columbia River basalt and rhyolite. After 12 Ma volcanism progressed towards Yellowstone, with early rhyolite overlain by basalts that may exceed 2 km thick. The early rhyolites are anorogenic with dry phenocryst assemblages and eruption temperatures up to 950C. Tholeiitic basalts have major and trace element compositions similar to ocean island basalts (OIB). Project Hotspot cored three deep holes in the central and western Snake River Plain: Kimama (mostly basalt), Kimberly (mostly rhyolite), and Mountain Home (lake sediments and basaslt). The Kimberly core documents rhyolite ash flows up to 700 m thick, possibly filling a caldera or sag. Chemical stratigraphy in Kimama and other basalt cores document fractional crystallization in relatively shallow magma chambers with episodic magma recharge. Age-depth relations in the Kimama core suggest accumulation rates of roughly 305 m/Ma. Surface and subsurface basalt flows show systematic variations in Sr-Nd-Pb isotopes with distance from Yellowstone interpreted to reflect changes in the proportion of plume source and the underlying heterogeneous cratonic lithosphere, which varies in age, composition, and thickness from west to east. Sr-Nd-Pb isotopes suggest <5% lithospheric input into a system dominated by OIB-like plume-derived basalts. A major flare-up of basaltic volcanism occurred 75-780 ka throughout the entire SRP, from Yellowstone in the east to Boise in the west. The youngest western SRP basalts are transitional alkali basalts that range in age from circa 900 ka to 2 ka, with trace element and isotopic compositions similar to the plume component of Hawaiian basalts. These observations suggest that ancient SCLM was replaced by plume mantle after the North America passed over the hotspot in the western SRP, which triggered renewed basaltic volcanism throughout the system. This young volcanism supports an active geothermal system fueled by a shallow crustal sill complex that underlies most of the SRP today.

Impacts of Irrigation on Land-Atmosphere Coupling Strength Under Different Evapotranspiration Characteristics

NASA Astrophysics Data System (ADS)

Liao, C. Y.; Lo, M. H.

2017-12-01

The Budyko curve displays that the magnitude of evapotranspiration (ET) is limited mainly by the availabilities of energy and water, i.e., under wet conditions, ET is primarily controlled by the available energy, while under dry conditions, ET is primarily controlled by the available water. Land-atmosphere coupling (LAC) strength, which relates to the Budyko curve, is widely discussed because of its contribution towards the improvement in seasonal climate forecasts. For example, the "hot spots" of LAC, where the soil moisture anomalies strongly affect the local precipitation, are found in the transition zones between wet and dry climates. ET of these transition zones is limited by the available water, but at the same time, the surface latent heat flux is large enough to trigger moist convection. Recently, the impacts of irrigation have gained lots of attention, including the change in LAC. Badger and Dirmeyer (2015) analyzed the climate response of Amazon forest replacement by crop with consideration of irrigation in model simulations, discovering negative relationship between added irrigation water and coupling between the soil moisture and the latent heat flux. In addition, Lu et al. (2017) found remarkable decreases of LAC strength with the increase of irrigated cropland percentage in the Great Plains of America. The two studies show that irrigation is possible to affect land-atmosphere coupling strength. However, whether the irrigation process leads to the reduction of coupling strength in other regions of the world remains unclear. This study aims to compare the differences of irrigation impact on land-atmosphere coupling strength between five selected locations undergoing intense irrigation: India, North China Plain, Southwest Europe, Great Plains and Middle East. The spatial divergence of the factor that limits the ET (e.g., either by the available energy or water) will be the focus in this study. Both offline simulation (Community Land Model) and couple simulation (coupled with Community Atmosphere Model) are used to explore the direct change and the subsequent shifts in land-atmosphere interactions. Also, three LAC indices are adopted to quantify the coupling strength between land and atmosphere.

Estimating landscape-scale impacts of agricultural management on soil carbon using measurements and models

NASA Astrophysics Data System (ADS)

Schipanski, M.; Rosenzweig, S. T.; Robertson, A. D.; Sherrod, L. A.; Ghimire, R.; McMaster, G. S.

2017-12-01

Agriculture covers 40% of Earth's ice-free land area and has broad impacts on global biogeochemical cycles. While some agricultural management changes are small in scale or impact, others have the potential to shift biogeochemical cycles at landscape and larger scales if widely adopted. Understanding which management practices have the potential to contribute to climate change adaptation and mitigation while maintaining productivity requires scaling up estimates spatially and temporally. We used on-farm, long-term, and landscape scale datasets to estimate how crop rotations impact soil organic carbon (SOC) accumulation rates under current and future climate scenarios across the semi-arid Central and Southern Great Plains. We used a stratified, landscape-scale soil sampling approach across 96 farm fields to evaluate crop rotation intensity effects on SOC pools and pesticide inputs. Replacing traditional wheat-fallow rotations with more diverse, continuously cropped rotations increased SOC by 17% and 12% in 0-10 cm and 0-20 cm depths, respectively, and reduced herbicide use by 50%. Using USDA Cropland Data Layer, we estimated soil C accumulation and pesticide reduction potentials of shifting to more intensive rotations. We also used a 30-year cropping systems experiment to calibrate and validate the Daycent model to evaluate rotation intensify effects under future climate change scenarios. The model estimated greater SOC accumulation rates under continuously cropped rotations, but SOC stocks peaked and then declined for all cropping systems beyond 2050 under future climate scenarios. Perennial grasslands were the only system estimated to maintain SOC levels in the future. In the Southern High Plains, soil C declined despite increasing input intensity under current weather while modest gains were simulated under future climate for sorghum-based cropping systems. Our findings highlight the potential vulnerability of semi-arid regions to climate change, which will be compounded by declining groundwater levels along the western edge of the High Plains Aquifer that increase reliance on dryland farming systems. Understanding these challenges provides opportunities to develop future transition and adaptation strategies in partnership with producers, policy makers, and rural communities.

Reconstructing the Holocene depositional environments along the northern coast of Sfax (Tunisia): Mineralogical and sedimentological approaches

NASA Astrophysics Data System (ADS)

Lamourou, Ali; Touir, Jamel; Fagel, Nathalie

2017-05-01

A sedimentological and mineralogical study of sedimentary cores allowed reconstructing the evolution of depositional environments along the Northern coast of Sfax (Tunisia). The aim of this research work is to identify the factors controlling the sedimentation from the Holocene to the Present time. Three 30-m sediment cores collected by drilling at 30 m water depth were analyzed for their color, magnetic susceptibility signal, grain size by laser diffraction, organic matter content by loss of ignition, carbonate content by calcimetry and mineralogy by X-ray diffraction on bulk powder and clay <2 μm. They broadly present the same sedimentological and mineralogical features. Microscopical observations of petrographic slides allowed identifying six main sedimentary facies. Bulk mineralogical assemblages comprised clay minerals, quartz, calcite, gypsum and K-feldspars were examined. Considerable change was observed in the carbonate content that mimicked the bioclaste abundance and diluted the detrital minerals (clay minerals, quartz and feldspars). The gypsum mainly occurred in the lower sedimentary columns (SC12 and SC9) and in the upper/middle of core SC6. The clay fraction was made of a mixture of kaolinite, illite, smectite and palygorskite with no clear variation through core depth. Both grain-size parameters and magnetic susceptibility profile showed a sharp transition in the upper 2-5 m of the sedimentological columns. Coarse, sandy to gravely sediments characterized by a low magnetic susceptibility signal were replaced by fine bioclastic-rich clayey sediments. The analysis of vertical succession of depositional facies revealed a fluvial depositional environment (coastal plain) basically marked by fluvial channels and inundation plains at the bottom of all cores. However, core-top sediments recorded a littoral marine environment with sand depositions rich in gastropods, lamellibranches and algæ. Depositional facies, sedimentological and mineralogical parameters were consistent with a transition from a fluviatile depositional environment with some emersion phases marked by the gypsum precipitation, to a marine littoral environment. Such evolution was accompanied with a relative sea-level rise which flooded the fluvial system at the coastal plain during the Holocene, in agreement with sea-level fluctuations in southeast Tunisia during the Holocene.

[Abdomen specific bioelectrical impedance analysis (BIA) methods for evaluation of abdominal fat distribution].

PubMed

Ida, Midori; Hirata, Masakazu; Hosoda, Kiminori; Nakao, Kazuwa

2013-02-01

Two novel bioelectrical impedance analysis (BIA) methods have been developed recently for evaluation of intra-abdominal fat accumulation. Both methods use electrodes that are placed on abdominal wall and allow evaluation of intra-abdominal fat area (IAFA) easily without radiation exposure. Of these, "abdominal BIA" method measures impedance distribution along abdominal anterior-posterior axis, and IAFA by BIA method(BIA-IAFA) is calculated from waist circumference and the voltage occurring at the flank. Dual BIA method measures impedance of trunk and body surface at the abdominal level and calculates BIA-IAFA from transverse and antero-posterior diameters of the abdomen and the impedance of trunk and abdominal surface. BIA-IAFA by these two BIA methods correlated well with IAFA measured by abdominal CT (CT-IAFA) with correlatipn coefficient of 0.88 (n = 91, p < 0.0001) for the former, and 0.861 (n = 469, p < 0.01) for the latter. These new BIA methods are useful for evaluating abdominal adiposity in clinical study and routine clinical practice of metabolic syndrome and obesity.

Retrospective comparison of abdominal ultrasonography and radiography in the investigation of feline abdominal disease

PubMed Central

Won, Wylen Wade; Sharma, Ajay; Wu, Wenbo

2015-01-01

Abdominal radiography and ultrasonography are commonly used as part of the initial diagnostic plan for cats with nonspecific signs of abdominal disease. This retrospective study compared the clinical usefulness of abdominal radiography and ultrasonography in 105 feline patients with signs of abdominal disease. The final diagnosis was determined more commonly with ultrasonography (59%) compared to radiography (25.7%). Ultrasonography was also able to provide additional clinically relevant information in 76% of cases, and changed or refined the diagnosis in 47% of cases. Based on these findings, ultrasonography may be sufficient as an initial diagnostic test for the investigation of feline abdominal disease. PMID:26483582

Topographic Rise in the Northern Smooth Plains of Mercury: Characteristics from Messenger Image and Altimetry Data and Candidate Modes of Origin

NASA Technical Reports Server (NTRS)

Dickson, James L.; Head, James W.; Whitten, Jennifer L.; Fassett, Caleb I.; Neumann, Gregory A.; Smith, David E.; Zuber, Maria T.; Phillips, Roger J.

2012-01-01

MESSENGER observations from orbit around Mercury have revealed that a large contiguous area of smooth plains occupies much of the high northern latitudes and covers an area in excess of approx.6% of the surface of the planet [1] (Fig. 1). Smooth surface morphology, embayment relationships, color data, candidate flow fronts, and a population of partly to wholly buried craters provide evidence for the volcanic origin of these plains and their emplacement in a flood lava mode to depths at least locally in excess of 1 km. The age of these plains is similar to that of plains associated with and postdating the Caloris impact basin, confirming that volcanism was a globally extensive process in the post-heavy bombardment history of Mercury [1]. No specific effusive vent structures, constructional volcanic edifices, or lava distributary features (leveed flow fronts or sinuous rilles) have been identified in the contiguous plains, although vent structures and evidence of high-effusion-rate flood eruptions are seen in adjacent areas [1]. Subsequent to the identification and mapping of the extensive north polar smooth plains, data from the Mercury Laser Altimeter (MLA) on MESSENGER revealed the presence of a broad topographic rise in the northern smooth plains that is 1,000 km across and rises more than 1.5 km above the surrounding smooth plains [2] (Fig. 2). The purpose of this contribution is to characterize the northern plains rise and to outline a range of hypotheses for its origin.

Identification of possible recent water/lava source vents in the Cerberus plains: Stratigraphic andcrater count age constraints

NASA Astrophysics Data System (ADS)

Thomas, Rebecca J.

2013-04-01

In order to investigate sources of lava and water to the Cerberus plains of Mars, geomorphological mapping on High Resolution Imaging Science Experiment (HiRISE) images was carried out to reveal the history of activity of fissures and pits which lie upstream of channels and deposits associated with a wrinkle ridge near Cerberus Fossae. The fissures and pits are superbly exposed and imaged, and flows and channels emanate directly from them, interpreted as clear evidence that these are vents. The mapping establishes stratigraphic relationships between the plains and the channels and deposits originating from the vents, establishing the vent history. For example, to the south of the wrinkle ridge, both incised channels and leveed flows extend onto the southern plain and are clearly the final phase of plains-forming activity. Conversely, to the north, vent-sourced channels only incise the plain close to the ridge—beyond that, they are overlain by large-scale regional flows that appear to have originated from the direction of Athabasca Valles. In the southeast, there is evidence of contemporaneity between vent-sourced activity and large-scale plains-forming flow that was not sourced from the vents, indicating that activity here was part of a broader process of Cerberus plains formation from multiple sources. Crater counts show all the activity to be Late Amazonian, with the latest activity tentatively dating to circa 11 Ma. Thus, this study implies that very recent outflows from these vents contributed to the formation of the Cerberus plains and constrains the timing and local flow direction of plains-forming deposits from other sources.

Characterization of abdominal pain during methylnaltrexone treatment of opioid-induced constipation in advanced illness: a post hoc analysis of two clinical trials.

PubMed

Slatkin, Neal E; Lynn, Richard; Su, Chinyu; Wang, Wenjin; Israel, Robert J

2011-11-01

Methylnaltrexone is a selective peripherally acting mu-opioid receptor antagonist that decreases the constipating effects of opioids without affecting centrally mediated analgesia. In two double-blind, placebo-controlled, Phase III studies of methylnaltrexone for opioid-induced constipation in patients with advanced illness, abdominal pain was the most common adverse event (AE) reported. This analysis sought to further characterize the Medical Dictionary for Regulatory Activities-defined abdominal pain AEs experienced in these studies. A post hoc analysis of verbatim descriptions was used to further assess AEs characterized as abdominal pain in both trials. Descriptive summary statistics were used to assess severity of abdominal pain, effect of abdominal pain on global pain scores, and other characteristics. Logistic regression analysis was used to determine the association of baseline characteristics with abdominal pain. Most verbatim descriptions of abdominal pain referred to "abdominal cramps" or "cramping." Abdominal pain AEs were mostly mild to moderate in severity and did not affect patients' global evaluation of pain. The incidence of abdominal pain AEs in methylnaltrexone-treated patients was greatest after the first dose and decreased with subsequent doses. No association between abdominal pain AEs and most baseline patient characteristics was noted. Abdominal pain AEs in methylnaltrexone-treated patients in clinical trials are usually described as "cramps" or "cramping," are mostly mild to moderate in severity, and decrease in incidence with subsequent dosing. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Hydrology and water budget for a forested atlantic coastal plain watershed, South Carolina

Treesearch

Scott V. Harder; Devendra M Amatya; Callahan Timothy J.; Carl C. Trettin; Hakkila Jon

2007-01-01

Increases in timber demand and urban development in the Atlantic Coastal Plain over the past decade have motivated studies on the hydrology, water quality, and sustainable management of coastal plain watersheds. However, studies on baseline water budgets are limited for the low-lying, forested watersheds of the Atlantic Coastal Plain. The purpose of this study was to...

76 FR 2829 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

... Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... enforce a segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines...

77 FR 20295 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-04

... Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... enforce a segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines...

78 FR 36091 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago...

77 FR 65478 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

...-AA00 Safety Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago... the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago... segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River...

77 FR 60044 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

...-AA00 Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago... the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago... segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River...

76 FR 65609 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-24

... Zone, Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal...

77 FR 35854 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... enforce a segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines...

75 FR 52462 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... enforce a segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines...

75 FR 73966 - Safety Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... Zone, Brandon Road Lock and Dam to Lake Michigan Including Des Plaines River, Chicago Sanitary and Ship...; Brandon Road Lock and Dam to Lake Michigan including Des Plaines River, Chicago Sanitary and Ship Canal... enforce a segment of the Safety Zone; Brandon Road Lock and Dam to Lake Michigan including Des Plaines...

Women's Life Course in Northern Plains Indian Societies: Achieving the Honored Rank of Old Lady.

ERIC Educational Resources Information Center

Kehoe, Alice B.

Among Indian groups of the Northwestern Plains (Blackfoot, Plains Cree, Dakota, Plains Ojibwa), older persons are respected for the spiritual power they have obtained. Differences exist between the several ethnic groups, but in general they assume that attainment of maturity and then old age proves spiritual power and makes the elder a proper…

41 CFR 102-2.140 - What elements of plain language appear in the FMR?

Code of Federal Regulations, 2011 CFR

2011-01-01

... language appear in the FMR? 102-2.140 Section 102-2.140 Public Contracts and Property Management Federal... MANAGEMENT REGULATION SYSTEM Plain Language Regulatory Style § 102-2.140 What elements of plain language appear in the FMR? The FMR is written in a “plain language” regulatory style. This style is easy to read...

Hyrdology and water budget for a forested atlantic coastal plain watershed, South Carolina

Treesearch

Scott V. Harder; Devendra M. Amatya; Timothy J. Callahan; Carl C. Trettin; Jon Hakkila

2007-01-01

Increases in timber demand and urban development in the Atlantic Coastal Plain over the past decade have motivated studies on the hydrology, water quality, and sustainable management of coastal plain watersheds. However, studies on baseline water budgets are limited for the low-lying, forested watersheds of the Atlantic Coastal Plain. The purpose of this study was to...

Tobacco plain packaging: Evidence based policy or public health advocacy?

PubMed

McKeganey, Neil; Russell, Christopher

2015-06-01

In December 2012, Australia became the first country to require all tobacco products be sold solely in standardised or 'plain' packaging, bereft of the manufacturers' trademarked branding and colours, although retaining large graphic and text health warnings. Following the publication of Sir Cyril Chantler's review of the evidence on the effects of plain tobacco packaging, the Ministers of the United Kingdom Parliament voted in March 2015 to implement similar legislation. Support for plain packaging derives from the belief that tobacco products sold in plain packs have reduced appeal and so are more likely to deter young people and non-smokers from starting tobacco use, and more likely to motivate smokers to quit and stay quit. This article considers why support for the plain packaging policy has grown among tobacco control researchers, public health advocates and government ministers, and reviews Australian survey data that speak to the possible introductory effect of plain packaging on smoking prevalence within Australia. The article concludes by emphasising the need for more detailed research to be undertaken before judging the capacity of the plain packaging policy to deliver the multitude of positive effects that have been claimed by its most ardent supporters. Copyright © 2015 Elsevier B.V. All rights reserved.

Abdominal Aortic Aneurysm

MedlinePlus

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life ... familydoctor.org editorial staff Categories: Family Health, Men, Seniors, WomenTags: abdominal aorta, abdominal aortic aneurysm, abdominal pain, ...

Financial Impact of PEVAR Compared With Standard Endovascular Repair in Canadian Hospitals.

PubMed

Roche-Nagle, Graham; Hazel, Maureen; Rajan, Dheeraj K

2018-05-01

The percutaneous endovascular abdominal aortic repair (PEVAR) approach is a minimally invasive technique that has demonstrated clinical benefit over traditional surgical cut down associated with standard endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The objective of our study was to evaluate the budget impact to a Canadian hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach. We examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay, and postoperative complications occurring within 30 days. The use of PEVAR in AAA repair is associated with increased access device costs when compared with the EVAR approach (CAD$1000 vs CAD$400). However, AAA repair completed with the PEVAR approach demonstrates reduced operating time (101 minutes vs 133 minutes), length of stay (2.2 days vs 3.5 days), time in the recovery room (174 minutes vs 193 minutes), and postoperative complications (6% vs 30%), which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of CAD$245,120. A change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals. Copyright © 2017 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

External jugular venous pressure as an alternative to conventional central venous pressure in right lobe donor hepatectomies.

PubMed

Abdullah, Mohamed Hussein; Soliman, Hossam El Deen; Morad, Wessam Saber

2011-12-01

Many centers have adopted central vein cannulation both for central venous pressure monitoring and fluid administration for right hepatectomy in living-liver donors. However, use of central venous catheters is associated with adverse events that are hazardous to patients and expensive to treat. This study sought to examine the use of external jugular venous pressure as an alternative to conventional central venous pressure in right lobe donor hepatectomies Forty ASA grade I adult living liver-donors without a known history of significant cardiac or pulmonary diseases were enrolled in this prospective observational study. Paired measurement of venous pressures (external jugular venous pressure and internal jugular venous pressure) were taken at the following times: after induction of anesthesia, 30 minutes after skin incision, during right lobe mobilization (every 15 minutes), during hepatic transaction (every 15 minutes), after right lobe resection (every 15 minutes), and after abdominal closure. Paired measurements were equal in 47.5%, 53.5%, 61.5%, 46.3%, and 52.5% for after induction, after skin incision, right lobe mobilization, right lobe transection, after resection, and before abdominal closure periods. However, all measurements were within acceptable limits of bias measurements (± 2 mm Hg). Central venous pressure catheter placement can be avoided and replaced by a less-invasive method such as external jugular venous pressure (which gave an acceptable estimate of central venous pressure in all phases of right lobe resection) in living-donor liver transplant and allowed equivalent monitor even during fluid restriction phases.

Classification System for Individualized Treatment of Adult Buried Penis Syndrome.

PubMed

Tausch, Timothy J; Tachibana, Isamu; Siegel, Jordan A; Hoxworth, Ronald; Scott, Jeremy M; Morey, Allen F

2016-09-01

The authors present their experience with reconstructive strategies for men with various manifestations of adult buried penis syndrome, and propose a comprehensive anatomical classification system and treatment algorithm based on pathologic changes in the penile skin and involvement of neighboring abdominal and/or scrotal components. The authors reviewed all patients who underwent reconstruction of adult buried penis syndrome at their referral center between 2007 and 2015. Patients were stratified by location and severity of involved anatomical components. Procedures performed, demographics, comorbidities, and clinical outcomes were reviewed. Fifty-six patients underwent reconstruction of buried penis at the authors' center from 2007 to 2015. All procedures began with a ventral penile release. If the uncovered penile skin was determined to be viable, a phalloplasty was performed by anchoring penoscrotal skin to the proximal shaft, and the ventral shaft skin defect was closed with scrotal flaps. In more complex patients with circumferential nonviable penile skin, the penile skin was completely excised and replaced with a split-thickness skin graft. Complex patients with severe abdominal lipodystrophy required adjacent tissue transfer. For cases of genital lymphedema, the procedure involved complete excision of the lymphedematous tissue, and primary closure with or without a split-thickness skin graft, also often involving the scrotum. The authors' overall success rate was 88 percent (49 of 56), defined as resolution of symptoms without the need for additional procedures. Successful correction of adult buried penis often necessitates an interdisciplinary, multimodal approach. Therapeutic, IV.

Ultrasound guidance system for prostate biopsy

NASA Astrophysics Data System (ADS)

Hummel, Johann; Kerschner, Reinhard; Kaar, Marcus; Birkfellner, Wolfgang; Figl, Michael

2017-03-01

We designed a guidance system for prostate biopsy based on PET/MR images and 3D ultrasound (US). With our proposed method common inter-modal MR-US (or CT-US in case of PET/CTs) registration can be replaced by an intra-modal 3D/3D-US/US registration and an optical tracking system (OTS). On the pre-operative site, a PET/MR calibration allows to link both hybrid modalities with an abdominal 3D-US. On the interventional site, another abdominal 3D US is taken to merge the pre-operative images with the real-time 3D-US via 3D/3D-US/US registration. Finally, the images of a tracked trans-rectal US probe can be displayed with the pre-operative images by overlay. For PET/MR image fusion we applied a point-to-point registration between PET and OTS and MR and OTS, respectively. 3D/3D-US/US registration was evaluated for images taken in supine and lateral patient position. To enable table shifts between PET/MR and US image acquisition a table calibration procedure is presented. We found fiducial registration errors of 0.9 mm and 2.8 mm, respectively, with respect to the MR and PET calibration. A target registration error between MR and 3D US amounted to 1.4 mm. The registration error for the 3D/3D-US/US registration was found to be 3.7 mm. Furthermore, we have shown that ultrasound is applicable in an MR environment.

Electrical and Mechanical Responses in Deep Abdominal Extensor Muscles of Crayfish and Lobster

PubMed Central

Abbott, Bernard C.; Parnas, I.

1965-01-01

Electrical and mechanical studies have been made of the deep abdominal extensor muscles, medial (DEAM) and lateral (DEAL), of crayfish and lobster. The medial muscle responds to direct (intracellular) and indirect stimulation with a transient membrane depolarization which exhibits the properties of a propagated non-decremental action potential but does not overshoot the zero level. The amplitude is about 30 mv in crayfish and 50 mv in lobster. It is followed by a fast all-or-none twitch whose duration at 20°C is 30 to 50 msec. and whose developed tension is 500 gm/cm2 or about half the tetanic value. Membrane potential is K+-dependent and immersion in high K+ induces a brief transient tension rise as in other twitch-type muscles. The action potential and twitch are normal even if all external Na+ is replaced with sucrose but vary with external Ca++, the action potential increasing 8 to 10 mv for a twofold increase in Ca++. The lateral muscle (DEAL) is much slower and responds to intracellular stimulation only with an electrotonic or a local response. Mechanical responses and relaxation speeds are slow with minimal duration of contraction of 0.5 to 2 seconds. Immersion in high K solutions induces large maintained tensions. Sarcomere length in the fast DEAM is uniform and about 2 µ at rest, but in the DEAL speed is less and sarcomere length is greater averaging about 4.5 µ but with a mixed population of fibers. PMID:14324996

Are plain radiographs sufficient to exclude cervical spine injuries in low-risk adults?

PubMed

Hunter, Benton R; Keim, Samuel M; Seupaul, Rawle A; Hern, Gene

2014-02-01

The routine use of clinical decision rules and three-view plain radiography to clear the cervical spine in blunt trauma patients has been recently called into question. In low-risk adult blunt trauma patients, can plain radiographs adequately exclude cervical spine injury when clinical prediction rules cannot? Four observational studies investigating the performance of plain radiographs in detecting cervical spine injury in low-risk adult blunt trauma patients were reviewed. The consistently poor performance of plain radiographs to rule out cervical spine injury in adult blunt trauma victims is concerning. Large, rigorously performed prospective trials focusing on low- or low/moderate-risk patients will be needed to truly define the utility of plain radiographs of the cervical spine in blunt trauma. Copyright © 2014 Elsevier Inc. All rights reserved.

Minimizing donor-site morbidity following bilateral pedicled TRAM breast reconstruction with the double mesh fold over technique.

PubMed

Bharti, Gaurav; Groves, Leslie; Sanger, Claire; Thompson, James; David, Lisa; Marks, Malcolm

2013-05-01

Transverse rectus abdominus muscle flaps (TRAM) can result in significant abdominal wall donor-site morbidity. We present our experience with bilateral pedicle TRAM breast reconstruction using a double-layered polypropylene mesh fold over technique to repair the rectus fascia. A retrospective study was performed that included patients with bilateral pedicle TRAM breast reconstruction and abdominal reconstruction using a double-layered polypropylene mesh fold over technique. Thirty-five patients met the study criteria with a mean age of 49 years old and mean follow-up of 7.4 years. There were no instances of abdominal hernia and only 2 cases (5.7%) of abdominal bulge. Other abdominal complications included partial umbilical necrosis (14.3%), seroma (11.4%), partial wound dehiscence (8.6%), abdominal weakness (5.7%), abdominal laxity (2.9%), and hematoma (2.9%). The TRAM flap is a reliable option for bilateral autologous breast reconstruction. Using the double mesh repair of the abdominal wall can reduce instances of an abdominal bulge and hernia.

Management of abdominal compartment syndrome after transurethral resection of the prostate.

PubMed

Gaut, Megan M; Ortiz, Jaime

2015-01-01

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25 mmHg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Management of abdominal compartment syndrome after transurethral resection of the prostate].

PubMed

Gaut, Megan M; Ortiz, Jaime

2015-01-01

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25mmHg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

[Clinical Approach to Abdominal Pain as Functional Origin].

PubMed

Ryu, Han Seung; Choi, Suck Chei

2018-02-25

Abdominal pain is a common symptom that patients refer to a hospital. Organic causes should be differentiated in patients with abdominal pain and treatment should be administered in accordance with the causes. A meticulous history taking and physical examination are highly useful in making a diagnosis, and blood tests, imaging modalities, and endoscopy are useful for confirming diagnosis. However, in many cases, patients have functional disorders with no obvious abnormal findings obtained even if many diagnostic tests are performed. Patients with functional disorders usually complain the vague abdominal pain located in the center and other portions of the abdominal area. Although the most representative disease is irritable bowel syndrome, functional abdominal pain syndrome is currently researched as a new disease entity of functional abdominal pain. As various receptors related to functional abdominal pain have been discovered, drugs associated with those receptors are used to treat the disorders, and additional new drugs are vigorously developed. In addition, medical therapy with pharmacological or non-pharmacological psychiatric treatment is effective for treating functional abdominal pain.

Identification of possible recent water/lava source fissures in the Cerberus Plains: stratigraphic and crater count age constraints

NASA Astrophysics Data System (ADS)

Thomas, Rebecca J.

2013-04-01

The Cerberus plains are one of the youngest surfaces on Mars. They are thought to have been formed by lava and/or water flows, but there is considerable debate regarding the source of this material. Much of the material forming the western plains, including the Athabasca Valles outflow channels, appears to have flowed from the region of the Cerberus Fossae graben system [1,2,3] and limited areas forming the eastern plains may have been erupted by low shield volcanoes [4,5]. However, flow of material from west to east is obstructed by a ridge centred on 157°E, 7°N and, prior to this study, vents which might be the source of fluid of a low enough viscosity to form the majority of the flat eastern plains had not been identified. We studied new HiRISE (25cm/px, High Resolution Science Imaging Experiment) images of the ridge between the east and west plains and observed possible source vents for this material: the ridge is cut by a series of pits and fissures which lie at the heads of flows and channels extending towards the surrounding plains. In order to establish the stratigraphic relationships between the vents and plains, this study produced large scale geomorphological maps based on the HiRISE images. The mapping showed that both incised channels and leveed flows extend onto the plain to the south of the ridge and that these were the final phase of plains-forming activity in that region. Conversely, to the north, ridge-sourced deposits only form the plains surface close to the ridge - beyond that, they are overlain by large-scale regional flows that appear to have originated from the direction of Athabasca Valles. In the southeast, a large-scale flow which does not emanate from this ridge forms the plains surface, but there is evidence that the youngest outflow activity from the ridge was contemporaneous with emplacement of this unit. We also performed crater counts to age-date the surfaces and these indicate that plains-forming and ridge-sourced units are of a similar Late Amazonian age (<100Ma), with the latest activity tentatively dating to 10Ma. Thus, this study implies that very recent outflows from these vents contributed to the formation of the Cerberus Plains. It also constrains the timing of other large-scale plains-forming flows in the region and suggests that outflows from this ridge were part of a broader process of Cerberus plains formation from multiple sources [6]. References: [1] Plescia, J. B. (1990) Icarus, 88 (2), 465-490. [2] Burr et al. (2002) Geophysical Research Letters, 29, 1013. [3] Berman & Hartmann (2002) Icarus 159, 1-7. [4] Plescia et al. (2003) Icarus, 164, 79-95. [5] Vaucher et al. (2009) Icarus, 204, 418-442. [6] Thomas, R. (2012) JGR Planets (submitted).

Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review.

PubMed

Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

2014-11-01

Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. A systematic review was conducted. The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma formation and physical function. A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases with the use of abdominal binders. Reduction of pulmonary function during use of abdominal binders has not been revealed. Abdominal binders reduce post-operative psychological distress, but their effect on post-operative pain after laparotomy and seroma formation after ventral hernia repair remains unclear. Due to the sparse evidence and poor quality of the literature, solid conclusions may be difficult to make, and procedure-specific, high-quality randomised clinical trials are warranted.

Extensive Middle Amazonian mantling of debris aprons and plains in Deuteronilus Mensae, Mars: Implications for the record of mid-latitude glaciation

NASA Astrophysics Data System (ADS)

Baker, David M. H.; Head, James W.

2015-11-01

The mid-latitudes of Mars are host to a record of recent episodes of accumulations of ice-rich materials. The record includes debris aprons, interpreted to be debris-covered glaciers, that may represent the preserved remnants of a much more extensive ice sheet. We assessed the possibility of former glacial extents by examining debris aprons and the surrounding plains in Deuteronilus Mensae. Geomorphic units and stratigraphic relationships were mapped and documented from Mars Reconnaissance Orbiter (MRO) Context (CTX) and High Resolution Imaging Science Experiment (HiRISE) camera images, and crater retention ages were estimated from crater size-frequency distributions. Three major units are observed within the study area: debris aprons, lower plains, and upper plains. Debris aprons exhibit characteristics typical for these features documented elsewhere and in previous studies, including integrated flow lineations and patterns, convex-upward profiles, and knobby and brain terrain surface textures. A lower bound on the age for debris aprons is estimated to be 0.9 Ga. Debris aprons are superposed on a lower plains unit having a lower bound age of 3.3-3.5 Ga. A 50-100 m thick upper plains unit superposes both debris apron landforms and lower plains units and has a best-fit minimum age of 0.6 Ga. The upper plains unit exhibits characteristics of atmospherically-emplaced mantle material, including fine-grained nature, sublimation textures, cyclic layering, draping character, and widespread spatial distribution. Fracturing and subsequent sublimation/erosion of upper plains on debris aprons has contributed to many of the surface textures on debris aprons. The upper plains unit has also been eroded from the lower plains and plateaus, evidenced by isolated blocks of upper plains in the interiors of craters and on the walls and tops of plateaus. While no conclusive evidence diagnostic of former cold-based ice sheets are observed in the plains within the study region, such landforms and units may have been poorly developed or absent, as is often the case on Earth, and would have been covered and reworked by later mantling episodes. These observations suggest that emplacement of thick ice-rich mantle deposits extended at least to near the Early/Middle Amazonian boundary and overlapped with the waning stages of glaciation in Deuteronilus Mensae.

Downscaling with a nested regional climate model in near-surface fields over the contiguous United States: WRF dynamical downscaling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jiali; Kotamarthi, Veerabhadra R.

The Weather Research and Forecasting (WRF) model is used for dynamic downscaling of 2.5 degree National Centers for Environmental Prediction-U.S. Department of Energy Reanalysis II (NCEP-R2) data for 1980-2010 at 12 km resolution over most of North America. The model's performance for surface air temperature and precipitation is evaluated by comparison with high-resolution observational data sets. The model's ability to add value is investigated by comparison with NCEP-R2 data and a 50 km regional climate simulation. The causes for major model bias are studied through additional sensitivity experiments with various model setup/integration approaches and physics representations. The WRF captures themore » main features of the spatial patterns and annual cycles of air temperature and precipitation over most of the contiguous United States. However, simulated air temperatures over the south central region and precipitation over the Great Plains and the Southwest have significant biases. Allowing longer spin-up time, reducing the nudging strength, or replacing the WRF Single-Moment 6-class microphysics with Morrison microphysics reduces the bias over some subregions. However, replacing the Grell-Devenyi cumulus parameterization with Kain-Fritsch shows no improvement. The 12 km simulation does add value above the NCEP-R2 data and the 50 km simulation over mountainous and coastal zones.« less

SBML Level 3 package: Hierarchical Model Composition, Version 1 Release 3

PubMed Central

Smith, Lucian P.; Hucka, Michael; Hoops, Stefan; Finney, Andrew; Ginkel, Martin; Myers, Chris J.; Moraru, Ion; Liebermeister, Wolfram

2017-01-01

Summary Constructing a model in a hierarchical fashion is a natural approach to managing model complexity, and offers additional opportunities such as the potential to re-use model components. The SBML Level 3 Version 1 Core specification does not directly provide a mechanism for defining hierarchical models, but it does provide a mechanism for SBML packages to extend the Core specification and add additional syntactical constructs. The SBML Hierarchical Model Composition package for SBML Level 3 adds the necessary features to SBML to support hierarchical modeling. The package enables a modeler to include submodels within an enclosing SBML model, delete unneeded or redundant elements of that submodel, replace elements of that submodel with element of the containing model, and replace elements of the containing model with elements of the submodel. In addition, the package defines an optional “port” construct, allowing a model to be defined with suggested interfaces between hierarchical components; modelers can chose to use these interfaces, but they are not required to do so and can still interact directly with model elements if they so chose. Finally, the SBML Hierarchical Model Composition package is defined in such a way that a hierarchical model can be “flattened” to an equivalent, non-hierarchical version that uses only plain SBML constructs, thus enabling software tools that do not yet support hierarchy to nevertheless work with SBML hierarchical models. PMID:26528566

A Complicated Thread: Abdominal Actinomycosis in a Young Woman with Crohn Disease.

PubMed

Nahum, Ari; Filice, Gregory; Malhotra, Ashish

2017-01-01

Crohn disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. Typical manifestations include fever, weight loss, fatigue, and abdominal pain, and abdominal abscesses and fistulae are frequent complications. Abdominal actinomycosis is a subacute or indolent disease associated with Actinomyces spp. Symptoms can be very similar to those of Crohn disease, and fistulae are also common. Since ulcerations in the intestinal tract are thought to be caused by Actinomyces escaping from the gut lumen and establishing intra-abdominal infection, it seems likely that abdominal actinomycosis may occur in patients with inflammatory bowel disease. We report a case of abdominal actinomycosis in a woman with active Crohn disease.

Constructing a Home on the Range: Homemaking in Early-Twentieth-Century Plains Photograph Albums

ERIC Educational Resources Information Center

Dando, Christina E.

2008-01-01

For people living near the coasts or mountains of America, it must be hard to imagine longing for a "home on the plains"--but many Americans have had, and still have, a home on the Plains. The stereotypical American image of the Plains is flatness, austerity, emptiness. Not all would consider this an ideal landscape for home. So how did…

Global Volcanism on Mercury at About 3.8 Ga

NASA Astrophysics Data System (ADS)

Byrne, P. K.; Ostrach, L. R.; Denevi, B. W.; Head, J. W., III; Hauck, S. A., II; Murchie, S. L.; Solomon, S. C.

2014-12-01

Smooth plains occupy c. 27% of the surface of Mercury. Embayment relations, spectral contrast with surroundings, and morphologic characteristics indicate that the majority of these plains are volcanic. The largest deposits are located in Mercury's northern hemisphere and include the extensive northern plains (NP) and the Caloris interior and exterior plains (with the latter likely including basin material). Both the NP and Caloris deposits are, within statistical error, the same age (~3.8-3.9 Ga). To test whether this age reflects a period of global volcanism on Mercury, we determined crater size-frequency distributions for four smooth plains units in the planet's southern hemisphere interpreted to be volcanic. Two deposits are situated within the Beethoven and Tolstoj impact basins; two are located close to the Debussy and the Alver and Disney basins, respectively. Each deposit hosts two populations of craters, one that postdates plains emplacement and one that consists of partially to nearly filled craters that predate the plains. This latter population indicates that some time elapsed between formation of the underlying basement and plains volcanism, though we cannot statistically resolve this interval at any of the four sites. Nonetheless, we find that the age given by the superposed crater population in each case is ~3.8 Ga, and crater density values are consistent with those for the NP and Caloris plains. This finding supports a global phase of volcanism near the end of the late heavy bombardment of Mercury and may indicate a period of widespread partial melting of Mercury's mantle. Notably, superposition relations between smooth plains, degraded impact structures, and contractional landforms suggest that by this time interior cooling had already placed Mercury's lithosphere in horizontal compression, tending to inhibit voluminous dike-fed volcanism such as that inferred responsible for the NP. Most smooth plains units, including the Caloris plains and our four study sites, are spatially associated with impact structures; even the NP lie in a regional depression that may be impact-related. Because impacts remove overburden, deposit subsurface heat, and relax pre-existing stress, basins and craters may represent preferential sites for volcanic resurfacing on a globally contracting planet.

Great Plains Drought in Simulations of Twentieth Century

NASA Astrophysics Data System (ADS)

McCrary, R. R.; Randall, D. A.

2008-12-01

The Great Plains region of the United States was influenced by a number of multi-year droughts during the twentieth century. Most notable were the "Dust Bowl" drought of the 1930s and the 1950s Great Plains drought. In this study we evaluate the ability of three of the Coupled Global Climate Models (CGCMs) used in the Fourth Assessment Report (AR4) of the IPCC to simulate Great Plains drought with the same frequency and intensity as was observed during the twentieth century. The models chosen for this study are: GFDL CM 2.0, NCAR CCSM3, and UKMO HadCM3. We find that the models accurately capture the climatology of the hydrologic cycle of the Great Plains, but that they tend to overestimate the variability in Great Plains precipitation. We also find that in each model simulation at least one long-term drought occurs over the Great Plains region during their representations 20th Century Climate. The multi-year droughts produced by the models exhibit similar magnitudes and spatial scales as was observed during the twentieth century. This study also investigates the relative roles that external forcing from the tropical Pacific and local feedbacks between the land surface and the atmosphere have in the initiation and perpetuation of Great Plains drought in each model. We find that cool, La Nina-like conditions in the tropical pacific are often associated with long-term drought conditions over the Great Plains in GFDL CM 2.0 and UKMO HadCM3, but there appears to be no systematic relationship between tropical Pacific SST variability and Great Plains drought in CCSM3. It is possible the strong coupling between the land surface and the atmosphere in the NCAR model causes precipitation anomalies to lock into phase over the Great Plains thereby perpetuating drought conditions. Results from this study are intended to help assess whether or not these climate models are credible for use in the assessment of future drought over the Great Plains region of the United States.

The effects of running in place in a limited area with abdominal drawing-in maneuvers on abdominal muscle thickness in chronic low back pain patients.

PubMed

Gong, Wontae

2016-11-21

Based on previous studies indicating that core stabilization exercises accompanied by abdominal drawing-in maneuvers increase the thickness of the transversus abdominis muscle. The purpose of this study was to compare the measurements of abdominal muscle thicknesses during running in place in a limited area with the abdominal drawing-in maneuver. The study classified the subjects into two experimental groups: the training group (M = 2, F = 13), and the control group (M = 2, F = 13). The training group performed three sets of running in place in a limited area with abdominal drawing-in maneuvers each time, three times a week for six weeks. The abdominal muscle thicknesses of the subjects were measured using ultrasonography. Comparing the training group's abdominal muscle thickness before and after this study, there was a statistical significance in all of the external obliquus abdominis, the internal obliquus abdominis, and the transversus abdominis. In particular, thicknesses of external obliquus abdominis and internal obliquus increased remarkably. Running in place in a limited area accompanied by abdominal drawing-in maneuvers increased the thickness of the deep abdominal muscles that are the basis of trunk stabilization.

[Observation on the transient analgesic effect of abdominal acupuncture TENS on pain of neck, shoulder, loin and legs].

PubMed

Wang, Zhang-lian; Chen, Li-fang; Zhu, Wei-ming

2007-09-01

To observe on the transient analgesic effect of abdominal points transcutaneous electrical nerve stimulation (TENS) combined with abdominal acupuncture according to the holographic theory on pain of neck, shoulder, loin and legs. One hundred and twenty cases of pain of neck, shoulder, loin and legs were randomly divided into 4 groups: abdominal acupuncture TENS group, acupoints TENS group, electroacupuneture (EA) group, non-abdominal acupuncture TENS group, 30 cases in each group. All the cases were treated by the same stimulation parameters, but different stimulation points. The VAS scores were recorded before and after treatment. The VAS scores were significantly different before and after treatment in abdominal acupuncture TENS group (P < 0.01); the total effective rate of the transient analgesic effec t was 96.7% in the abdominal acupuncture TENS group, 93.3% in the acupoints TENS group, 96.7% in the EA group with no significant difference among the 3 groups, but with a very significant difference between the abdominal acupuncture TENS group and the non-abdominal acupunctureTENS group (10.0%), P < 0.01. Abdominal acupuncture TENS has a better transient analgesic effect and can use less stimulation points to increase the analgesic effect.

Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty.

PubMed

Lecerf, G; Fessy, M H; Philippot, R; Massin, P; Giraud, F; Flecher, X; Girard, J; Mertl, P; Marchetti, E; Stindel, E

2009-05-01

BACKGROUND OBJECTIVE: Femoral offset is supposed to influence the results of hip replacement but little is known about the accurate method of measure and the true effect of offset modifications. This article is a collection of independent anatomic, radiological and clinical works, which purpose is to assess knowledge of the implications of femoral offset for preoperative templating and total hip arthroplasty. There is a strong correlation between femoral offset, abductors lever arm and hip abductor strength. Hip lateralization is independent of the femoral endomedullary characteristics. The abductors lever arm is highly correlated to the gluteus medius activation angle. There were correlations between femoral offset and endomedullary shape. The hip center was high and medial for stovepipe metaphysis while it was lower and lateralized for champagne - flute upper femur. A study was performed to compare the femoral offset measured by X-ray and CT-scan in 50 patients, demonstrated that plain radiography underestimates offset measurement. The 2D templating cannot appreciate the rotation of the lower limb. Taking into account the horizontal plane is essential to obtain proper 3D planning of the femoral offset. A randomized study was designed to compare femoral offset measurements after hip resurfacing and total hip arthroplasty. This study underlined hip resurfacing reduced the femoral offset, while hip replacement increased offset. However, the reduction of femoral offset after hip resurfacing does not affect the function. A pilot study was designed to assess the results of 120 hip arthroplasties with a modular femoral neck. This study showed that the use of a modular collar ensures an easier restoration of the femoral offset. A cohort of high offset stems (Lubinus 117 degrees) was retrospectively assessed. The survival rate was slightly lower that the standard design reported in the Swedish register. Finally, the measurement of offset and leg length was assessed with the help of computer assistance. The software changed the initial schedule (obtained by templating) in 29%. Therefore, femoral offset restoration is essential to improve function and longevity of hip arthroplasty. CT-scan is more accurate than plain radiography to assess femoral offset. Hip resurfacing decreases offset without effect on function. Modular neck and computer assistance may improve intraoperative calculation and reproduction of femoral offset. Increasing offset with a standard cemented design may decrease long-term fixation. Level IV: Retrospective or historical series.

Thermosensitive hydrogel based on chitosan and its derivatives containing medicated nanoparticles for transcorneal administration of 5-fluorouracil

PubMed Central

Fabiano, Angela; Bizzarri, Ranieri; Zambito, Ylenia

2017-01-01

A thermosensitive ophthalmic hydrogel (TSOH) – fluid at 4°C (instillation temperature), semisolid at 35°C (eye temperature), which coupled the dosing accuracy and administration ease of eyedrops with the increased ocular bioavailability of a hydrogel – was prepared by gelling a chitosan hydrochloride (ChHCl) solution (27.8 mg/mL) medicated with 1.25 mg/mL 5-fluorouracil (5-FU) with β-glycerophosphate 0.8 mg/mL. Polymer mixtures, where Ch was partially (10%, 15%, or 20%) replaced by quaternary ammonium–chitosan conjugates (QA-Ch) or thiolated derivatives thereof, were also used to modulate 5-FU-release properties of TSOH. Also, Ch-based nanoparticles (NPs; size after lyophilization and redispersion 341.5±15.2 nm, polydispersity 0.315±0.45, ζ-potential 10.21 mV) medicated with 1.25 mg/mL 5-FU prepared by ionotropic cross-linking of Ch with hyaluronan were introduced into TSOH. The 5-FU binding by TSOH polymers in the sol state was maximum with plain Ch (31.4%) and tended to decrease with increasing QA presence in polymer mixture. 5-FU release from TSOH with or without NPs was diffusion-controlled and linear in √t. The different TSOH polymers were compared on a diffusivity basis by comparing the slopes of √t plots. These showed a general decrease with NP-containing TSOH, which was the most marked with the TSOH, where Ch was 20% replaced by the derivative QA-Ch50. This formulation and that not containing NP were instilled in rabbits and the 5-FU transcorneal penetration was measured by analyzing the aqueous humor. Both TSOH solutions increased the area under the curve (0–8 hours) 3.5 times compared with the plain eyedrops, but maximum concentration for the NP-free TSOH was about 0.65 µg/mL, followed by a slow decline, while the NP-containing one showed a plateau (0.25–0.3 µg/mL) in a time interval of 0.5–7 hours. This is ascribed to the ability of this TSOH to control drug release to a zero order and that of NPs to be internalized by corneal cells. PMID:28144144

Thermosensitive hydrogel based on chitosan and its derivatives containing medicated nanoparticles for transcorneal administration of 5-fluorouracil.

PubMed

Fabiano, Angela; Bizzarri, Ranieri; Zambito, Ylenia

2017-01-01

A thermosensitive ophthalmic hydrogel (TSOH) - fluid at 4°C (instillation temperature), semisolid at 35°C (eye temperature), which coupled the dosing accuracy and administration ease of eyedrops with the increased ocular bioavailability of a hydrogel - was prepared by gelling a chitosan hydrochloride (ChHCl) solution (27.8 mg/mL) medicated with 1.25 mg/mL 5-fluorouracil (5-FU) with β-glycerophosphate 0.8 mg/mL. Polymer mixtures, where Ch was partially (10%, 15%, or 20%) replaced by quaternary ammonium-chitosan conjugates (QA-Ch) or thiolated derivatives thereof, were also used to modulate 5-FU-release properties of TSOH. Also, Ch-based nanoparticles (NPs; size after lyophilization and redispersion 341.5±15.2 nm, polydispersity 0.315±0.45, ζ-potential 10.21 mV) medicated with 1.25 mg/mL 5-FU prepared by ionotropic cross-linking of Ch with hyaluronan were introduced into TSOH. The 5-FU binding by TSOH polymers in the sol state was maximum with plain Ch (31.4%) and tended to decrease with increasing QA presence in polymer mixture. 5-FU release from TSOH with or without NPs was diffusion-controlled and linear in √t. The different TSOH polymers were compared on a diffusivity basis by comparing the slopes of √t plots. These showed a general decrease with NP-containing TSOH, which was the most marked with the TSOH, where Ch was 20% replaced by the derivative QA-Ch50. This formulation and that not containing NP were instilled in rabbits and the 5-FU transcorneal penetration was measured by analyzing the aqueous humor. Both TSOH solutions increased the area under the curve (0-8 hours) 3.5 times compared with the plain eyedrops, but maximum concentration for the NP-free TSOH was about 0.65 µg/mL, followed by a slow decline, while the NP-containing one showed a plateau (0.25-0.3 µg/mL) in a time interval of 0.5-7 hours. This is ascribed to the ability of this TSOH to control drug release to a zero order and that of NPs to be internalized by corneal cells.

Tracking of abdominal subcutaneous and preperitoneal fat mass during childhood. The Generation R Study.

PubMed

Vogelezang, S; Gishti, O; Felix, J F; van der Beek, E M; Abrahamse-Berkeveld, M; Hofman, A; Gaillard, R; Jaddoe, V W V

2016-04-01

Overweight and obesity in early life tends to track into later life. Not much is known about tracking of abdominal fat. Our objective was to examine the extent of tracking of abdominal fat measures during the first six years of life. We performed a prospective cohort study among 393 Dutch children followed from the age of 2 years (90% range 1.9; 2.3) until the age of 6 years (90% range 5.7; 6.2). At both ages, we performed abdominal ultrasound to measure abdominal subcutaneous and preperitoneal fat distances and areas, and we calculated the preperitoneal/subcutaneous fat distance ratio. High abdominal fat measures were defined as values in the upper 15%. Abdominal subcutaneous fat distance and area, and preperitoneal fat area at 2 years were correlated with their corresponding measures at 6 years (all P-values <0.01), with the strongest coefficients for abdominal subcutaneous fat measures. Preperitoneal fat distance at the age of 2 years was not correlated with the corresponding measure at 6 years. The tracking coefficient for preperitoneal/subcutaneous fat distance ratio from 2 to 6 years was r=0.36 (P<0.01). Children with high abdominal subcutaneous fat measures at 2 years had increased risk of having high abdominal subcutaneous fat measures at 6 years (odds ratios 9.2 (95% confidence interval (CI) 4.1-20.8) and 12.4 (95% CI 5.4-28.6) for subcutaneous fat distance and area, respectively). These associations were not observed for preperitoneal fat measures. Our findings suggest that both abdominal subcutaneous and preperitoneal fat mass measures track during childhood, but with stronger tracking for abdominal subcutaneous fat measures. An adverse abdominal fat distribution in early life may have long-term consequences.

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

PubMed

van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

2013-01-01

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

Geochemistry of shallow ground water in coastal plain environments in the southeastern United States: Implications for aquifer susceptibility

USGS Publications Warehouse

Tesoriero, A.J.; Spruill, T.B.; Eimers, J.L.

2004-01-01

Ground-water chemistry data from coastal plain environments have been examined to determine the geochemical conditions and processes that occur in these areas and assess their implications for aquifer susceptibility. Two distinct geochemical environments were studied to represent a range of conditions: an inner coastal plain setting having more well-drained soils and lower organic carbon (C) content and an outer coastal plain environment that has more poorly drained soils and high organic C content. Higher concentrations of most major ions and dissolved inorganic and organic C in the outer coastal plain setting indicate a greater degree of mineral dissolution and organic matter oxidation. Accordingly, outer coastal plain waters are more reducing than inner coastal plain waters. Low dissolved oxygen (O2) and nitrate (NO 3-) concentrations and high iron (Fe) concentrations indicate that ferric iron (Fe (III)) is an important electron acceptor in this setting, while dissolved O2 is the most common terminal electron acceptor in the inner coastal plain setting. The presence of a wide range of redox conditions in the shallow aquifer system examined here underscores the importance of providing a detailed geochemical characterization of ground water when assessing the intrinsic susceptibility of coastal plain settings. The greater prevalence of aerobic conditions in the inner coastal plain setting makes this region more susceptible to contamination by constituents that are more stable under these conditions and is consistent with the significantly (p<0.05) higher concentrations of NO3- found in this setting. Herbicides and their transformation products were frequently detected (36% of wells sampled), however concentrations were typically low (<0.1 ??g/L). Shallow water table depths often found in coastal plain settings may result in an increased risk of the detection of pesticides (e.g., alachlor) that degrade rapidly in the unsaturated zone.

Hiding in plain sight: use of realistic surrogates to reduce exposure of protected health information in clinical text.

PubMed

Carrell, David; Malin, Bradley; Aberdeen, John; Bayer, Samuel; Clark, Cheryl; Wellner, Ben; Hirschman, Lynette

2013-01-01

Secondary use of clinical text is impeded by a lack of highly effective, low-cost de-identification methods. Both, manual and automated methods for removing protected health information, are known to leave behind residual identifiers. The authors propose a novel approach for addressing the residual identifier problem based on the theory of Hiding In Plain Sight (HIPS). HIPS relies on obfuscation to conceal residual identifiers. According to this theory, replacing the detected identifiers with realistic but synthetic surrogates should collectively render the few 'leaked' identifiers difficult to distinguish from the synthetic surrogates. The authors conducted a pilot study to test this theory on clinical narrative, de-identified by an automated system. Test corpora included 31 oncology and 50 family practice progress notes read by two trained chart abstractors and an informaticist. Experimental results suggest approximately 90% of residual identifiers can be effectively concealed by the HIPS approach in text containing average and high densities of personal identifying information. This pilot test suggests HIPS is feasible, but requires further evaluation. The results need to be replicated on larger corpora of diverse origin under a range of detection scenarios. Error analyses also suggest areas where surrogate generation techniques can be refined to improve efficacy. If these results generalize to existing high-performing de-identification systems with recall rates of 94-98%, HIPS could increase the effective de-identification rates of these systems to levels above 99% without further advancements in system recall. Additional and more rigorous assessment of the HIPS approach is warranted.

Greater soil carbon accumulation in deeper soils in native- than in exotic-dominated grassland plantings in the southern Plains

NASA Astrophysics Data System (ADS)

Wilsey, B. J.; Xu, X.; Polley, H. W.; Hofmockel, K. S.

2017-12-01

Global change includes invasion by non-native plant species, and invasion may affect carbon cycling and storage. We tested predictions in central Texas in an experiment that compares mixtures of all exotic or all native species under two summer irrigation treatments (128 or 0 mm) that varies the amount of summer drought stress. At the end of the eighth growing season after establishment, soils were sampled in 10 cm increments to 100 cm depth to determine if soil C differed among treatments, and if treatments differentially affected soil C in deeper soils. Soil C content was significantly (5%) higher under native plantings than under exotic species plantings (P < 0.001). The difference between native and exotic plantings increased with depth, and native plantings had higher soil C in deeper soil layers than in surface layers (native-exotic x depth, P < 0.001). Exotic plantings had decreasing soil C with depth. Soil C:N ratio and δ13C/12C were also significantly affected by native-exotic status, with soils in exotic plots having a significantly greater C4 contribution than native soils. Soil C was unaffected by summer irrigation treatments. Our results suggest that a significant amount of carbon could be sequestered by replacing exotic plant species with native species in the southern Plains, and that more work should be conducted at deeper soil depths. If we had restricted our analyses to surface soil layers (e.g. top 30 cm), we would have failed to detect depth differences between natives and exotics.

Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway.

PubMed

Young, Victoria Solveig; Eggesbø, Heidi B; Gaarder, Christine; Næss, Pål Aksel; Enden, Tone

2017-07-01

To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. • Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. • MAC implied reduced use of imaging in the emergency department (ED). • CT in ED was restricted to suspected severe head injuries during MAC. • The radiologist should cancel all non-head CTs in the ED during MAC.

Rates and patterns of late Cenozoic denudation in the northernmost Atlantic Coastal Plain and Piedmont

USGS Publications Warehouse

Stanford, S.D.; Ashley, G.M.; Russell, E.W.B.; Brenner, G.J.

2002-01-01

Topography of a 2800 km2 section of the U.S. Atlantic Coastal Plain and Piedmont is reconstructed at five times from the late Miocene to the Holocene. The reconstructions are based on mapping of fluvial, colluvial, and marginal-marine deposits that are dated by radiocarbon, palynostratigraphy, and correlation to adjacent glacial and marine units. Denudation rates and patterns are calculated by subtracting successive topographies, with 60 m horizontal resolution and 6 m vertical resolution. The overall late Miocene to Holocene denudation rate of 10 m/m.y. is similar to other estimates of long-term denudation in the region. The overall rate resolves spatially into a wide range of local rates, varying from a minimum of ???0.2 m/m.y. on residual uplands to as high as 600 m/m.y. in glacially rerouted stream channels. The distribution of local rates shows that denudation is accomplished by stream incision in response to long-term glacio-eustatic decline, followed by slope retreat into residual uplands from the incised channels. Slope retreat replaces the uplands with pediments and straths. Pediment landforms and sediments, and observation of modern scarps and valley heads, indicate that groundwater seepage from the base of residual uplands is an important mechanism of slope retreat. This process is self-limiting because as the volume of residual upland is reduced, seepage diminishes and slope retreat slows until small residuals undergo little or no further reduction. Thus, relict topography is preserved even as most of the landscape actively erodes.

Iodine-129 in the Snake River Plain aquifer at the Idaho National Engineering Laboratory, Idaho

USGS Publications Warehouse

Mann, L.J.; Chew, E.W.; Morton, J.S.; Randolph, R.B.

1988-01-01

From 1953 to 1983, an estimated 0.01 to 0.136 Ci (curies)/year of iodine-129 were contained in wastewater generated by the ICPP (Idaho Chemical Processing Plant) at the Idaho National Engineering Laboratory. The wastewater was directly discharged to the Snake River Plain aquifer through a deep disposal well until February 9, 1984, when the well was replaced by an unlined infiltration pond; a second pond was put into use on October 17, 1985. For 1984-86, the annual amount of iodine-129 in wastewater discharged to the ponds ranged from 0.0064 to 0.039 Ci. In August 1986, iodine-129 concentrations in water from 35 wells near the ICPP ranged from less than the reporting level to 3.6 +or-0.4 pCi/L (picocuries/L). By comparison, in April 1977 the water from 20 wells contained a maximum of 27 +or-1 pCi/L of iodine-129; in 1981, the maximum concentration in water from 32 wells was 41 +or-2 pCi/L. The average concentrations of iodine-129 in water from 18 wells that were sampled in 1977, 1981 and 1986 were 4.0, 6.7 and 1.3 pCi/L, respectively. The marked decrease in the iodine-129 concentration from 1981 to 1986 is the result of three factors: (1) The amount of iodine-129 disposed annually; (2) a change from the routine use of the disposal well to the infiltration ponds; and (3) a dilution of the iodine-129 in the aquifer by recharge from the Big Lost River. (USGS)

Subtropical acarien profile by topography, seasons and change of house furnishings: 80's blueprint to the future.

PubMed

Massey, Douglas G; Hope, Bradley E; Furumizo, Roy T

2010-04-01

In Hawai'i, mortality and morbidity from asthma are significant. In the 80's, there had been no local studies of topography folklore. There had been only one report of seasonal variation in house dust mite (HDM) density in Hawai'i, and this showed no significant variation in O'ahu's Manoa Valley but a definite variation in Waikiki. There were no studies of complete replacement of furnishings. In this pilot study, homes in a valley, coastal, and plain sites were investigated for 12 months in 2 homes on O'ahu. A 3rd home was studied prior to and after arrival of furnishings from Denver, Colorado. Of the 3 homes, #1 was in Palolo Valley Honolulu, #2 coastal at Pearl Harbor and #3 on the plain at Mililani. House dust samples were taken from 4-5 sites in 2 rooms every 5 weeks. Sampling and determination of density and species were those of Furumizo. They were unsupportive of the topography and seasonal variation folklore. Density surged in the 3rd home to > 12000 mites/ gram of dust within 10-15 weeks with the complete change of low density HDM furnishings. D. pteronyssinus (Dp) was dominant in each home year-round. Minor species of mites made up to 1/3 of total mites in 2 homes. The folklore relating improvement in asthma to geography was not supported. 2 of the 3 homes showed minimal seasonal variation in HDM density. Local mites heavily colonized furniture from high altitude Colorado in a surge within 10-15 weeks.

Perceptions of branded and plain cigarette packaging among Mexican youth.

PubMed

Mutti, Seema; Hammond, David; Reid, Jessica L; White, Christine M; Thrasher, James F

2017-08-01

Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and size of cigarette packs, represents a novel policy measure to reduce the appeal of cigarettes. Plain packaging has been studied primarily in high-income countries like Australia and the UK. It is unknown whether the effects of plain packaging may differ in low-and-middle income countries with a shorter history of tobacco regulation, such as Mexico. An experimental study was conducted in Mexico City to examine perceptions of branded and plain cigarette packaging among smoking and non-smoking Mexican adolescents (n = 359). Respondents were randomly assigned to a branded or plain pack condition and rated 12 cigarette packages for appeal, taste, harm to health and smoker-image traits. As a behavioral measure of appeal, respondents were offered (although not given) four cigarette packs (either branded or plain) and asked to select one to keep. The findings indicated that branded packs were perceived to be more appealing (β = 3.40, p < 0.001) and to contain better tasting cigarettes (β = 3.53, p < 0.001), but were not perceived as less harmful than plain packs. Participants rated people who smoke the branded packs as having relatively more positive smoker-image traits overall (β = 2.10, p < 0.001), with particularly strong differences found among non-smokers for the traits 'glamorous', 'stylish', 'popular' and 'sophisticated' (p < 0.001). No statistically significant difference was found for the proportion of youth that accepted when offered branded compared with plain packs. These results suggest that plain packaging may reduce brand appeal among Mexican youth, consistent with findings in high-income countries. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Geochemical signature of provenance, tectonics and chemical weathering in the Quaternary flood plain sediments of the Hindon River, Gangetic plain, India

NASA Astrophysics Data System (ADS)

Mondal, M. E. A.; Wani, H.; Mondal, Bulbul

2012-09-01

The Ganga basin in the Himalayan foreland is a part of the world's largest area of modern alluvial sedimentation. Flood plain sediments of the Hindon River of the Gangetic plain have been analyzed for sediment texture, major and trace elements including rare earth elements (REEs). The results have been used to characterize the source rock composition and to understand the intensity of chemical weathering, tectonics and their interplay in the Hindon flood plain. The sediments of the Hindon flood plain dominantly consist of sand sized particles with little silt and clay. The geochemistry of the Hindon sediments has been compared to the Siwalik mudstone of the Siwalik Group (Siwaliks). The Siwalik sedimentary rocks like sandstones, mudstones and conglomerates are the known source rocks for the Hindon flood plain sediments. Mudstone geochemistry has been considered best to represent the source rock characteristics. The UCC (Upper Continental Crust) normalized major and trace elements of the Hindon flood plain sediments are very similar to the Siwalik mudstone except for Th and Cr. Furthermore, the average chondrite normalized REE pattern of the Hindon flood plain sediments is similar to the Siwalik mudstone. Textural immaturity, K/Rb ratios and the average CIA (Chemical Index of Alteration) and PIA (Plagioclase Index of Alteration) values of the Hindon flood plain sediments indicate that the sediments have not been affected by chemical weathering. Our study suggests that the active tectonics of the Himalayas and monsoon climate enhances only physical erosion of the source rocks (Siwaliks) rather than the chemical alteration. These factors help the Hindon sediments to retain their parental and tectonic signature even after recycling.

Increased abdominal fat levels measured by bioelectrical impedance are associated with histological lesions of nonalcoholic steatohepatitis.

PubMed

Margariti, Aikaterini; Kontogianni, Meropi D; Tileli, Nafsika; Georgoulis, Michael; Deutsch, Melanie; Zafeiropoulou, Rodessa; Tiniakos, Dina; Manios, Yannis; Pectasides, Dimitrios; Papatheodoridis, George V

2015-08-01

Abdominal fat is considered to play an important role in nonalcoholic fatty liver disease (NAFLD), although it is not adequately studied because abdominal fat levels cannot be estimated easily. In this study, associations between abdominal obesity, as assessed by abdominal bioelectrical impedance analysis (BIA), and the characteristics of patients with NAFLD were explored. Seventy-four consecutive NAFLD patients who underwent measurement of abdominal fat levels by BIA were included. Levels of abdominal fat 12.5 or less and more than 12.5 were considered to be average and increased, respectively. The mean±SD BMI was 30±4 kg/m and the mean abdominal fat levels were 16±5, whereas 26% of patients had average abdominal fat levels. Patients with average compared with those with increased abdominal fat levels were more frequently women (50 vs. 12%, P=0.001), had lower BMI (27±3 vs. 31±4 kg/m, P<0.001), lower Homeostasis Model Assessment index (2.6±1.4 vs. 3.9±2.7, P=0.045), and lower median liver stiffness on transient elastography (5.3 vs. 6.8 kPa, P=0.025). In patients with available liver biopsy, steatohepatitis was present more frequently in patients with increased compared with average abdominal fat levels (78 vs. 38%, P=0.030) and in patients with BMI 30 or more compared with less than 30 kg/m (87 vs. 48%, P=0.033), but similar in patients with increased or normal waist circumference (67 vs. 56%, P=0.693). Average levels of abdominal fat, as assessed by abdominal BIA, are mainly present in female patients with NAFLD and are associated with a lower degree of insulin resistance. Increased abdominal fat as assessed by BIA and obesity seem to represent strong risk factors for histological steatohepatitis.

[Abdominal trauma].

PubMed

Sido, B; Grenacher, L; Friess, H; Büchler, M W

2005-09-01

Blunt abdominal trauma is much more frequent than penetrating abdominal trauma in Europe. As a consequence of improved quality of computed tomography, even complex liver injuries are increasingly being treated conservatively. However, missed hollow viscus injuries still remain a problem, as they considerably increase mortality in multiply injured patients. Laparoscopy decreases the rate of unnecessary laparotomies in perforating abdominal trauma and helps to diagnose injuries of solid organs and the diaphragm. However, the sensitivity in detecting hollow viscus injuries is low and the role of laparoscopy in blunt abdominal injury has not been defined. If intra-abdominal bleeding is difficult to control in hemodynamically unstable patients, damage control surgery with packing of the liver, total splenectomy, and provisional closure of hollow viscus injuries is of importance. Definitive surgical treatment follows hemodynamic stabilization and restoration of hemostasis. Injuries of the duodenum and pancreas after blunt abdominal trauma are often associated with other intra-abdominal injuries and the treatment depends on their location and severity.

Charon's Smooth Plains

NASA Astrophysics Data System (ADS)

Beyer, R. A.; Spencer, J. R.; Nimmo, F.; Beddingfield, C.; Grundy, W. M.; McKinnon, W. B.; Moore, J.; Robbins, S.; Runyon, K.; Schenk, P.; Singer, K.; Weaver, H.; Young, L. A.; Ennico, K.; Olkin, C.; Stern, S. A.; New Horizons Science Team

2018-06-01

We hypothesize that Charon's smooth plains result from its global extension that caused crustal blocks to founder. Then, a viscous cryoflow composed of ammonia-rich mantle material rose up, enveloped the sinking blocks, and produced the plains.

Iron deficiency anemia in chronic kidney disease: Uncertainties and cautions.

PubMed

Agarwal, Rajiv

2017-06-01

Anemia in chronic kidney disease is common and iron deficiency is an important cause. To repair iron-deficiency anemia, replacement of iron is needed. Iron can be replaced either by the oral route or by the intravenous route. In a meta-analysis, 5 of the 6 trials were short-term, 1 to 3 months, and compared to oral iron, the mean increase in hemoglobin with intravenous iron was only 0.31 g/dL. However, one of the studies included in this meta-analysis was 6 months long and had a mean decline in hemoglobin of 0.52 g/dL associated with intravenous iron administration. Given the short duration of most of the clinical trials comparing oral with intravenous administration of iron the long-term safety of these modes of administration of supplemental iron could not be assessed. Replacement of iron by the oral route is associated with mostly minor complications such as black stools, constipation, and abdominal discomfort. In contrast, intravenous administration of iron may lead to severe adverse events such as anaphylaxis and, as a more recent randomized trial has suggested, delayed complications such as infections and cardiovascular disease. Delayed complications of repeated intravenous iron use are difficult to recognize at an individual level therefore inpatients who have had recent cardiovascular events or are infected, intravenous iron should probably be avoided. Balancing safety and efficacy would require clinical judgment because 1 size may not fit all till we have better data to support the liberal use of parenteral iron. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Aortic arch/elephant trunk procedure with Sienna(TM) graft and endovascular stenting of thoraco-abdominal aorta for treatment of complex chronic dissection.

PubMed

Wong, Randolph H L; Baghai, Max; Yu, Simon C H; Underwood, Malcolm J

2013-05-01

Aneurismal dilatation of the remaining thoracic aorta after ascending aortic interposition grafting for type 'A' aortic dissection is not uncommon. For such complex cases, one treatment option is total arch replacement and elephant trunk procedure with the Sienna(TM) collared graft (Vascutek, Inchinnan, UK) technique followed by a staged thoracic endovascular aortic repair (TEVAR). The video illustrates our technique in a 56-year-old man with an extensive aortic arch and descending thoracic aortic dissecting aneurysm. For the 'open' procedure femoral arterial and venous cannulation was used along with systemic cooling and circulatory arrest at 22 °C. Upon circulatory arrest, the aortic arch was incised and antegrade cerebral perfusion achieved via selective cannulation to the right brachiocephalic and left common carotid artery, keeping flow rates at 10-15 mL/kg/min and perfusion pressure at 50-60 mmHg. Arch replacement with an elephant trunk component was then performed and after completion of the distal aortic anastomosis antegrade perfusion via a side-arm in the graft was started and the operation completed using a variation of the 'sequential' clamping technique to maximize cerebral perfusion. The second endovascular stage was performed two weeks after discharge. Two covered stents were landing from the elephant trunk to the distal descending thoracic aorta, to secure the distal landing a bare stent of was placed to cover the aorta just distal to the origin of the celiac axis. The left subclavian artery was embolised with fibre coils. Post TEVAR angiogram showed no endoleak Although re-operative total arch replacement and elephant trunk procedure and subsequent TEVAR remained a challenging procedure, we believe excellent surgical outcome can be achieved with carefully planned operative strategy.

Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. The Antibiotic Prophylaxis Study Group.

PubMed

Silver, A; Eichorn, A; Kral, J; Pickett, G; Barie, P; Pryor, V; Dearie, M B

1996-06-01

Twenty-five percent of all nosocomial infections are wound infections. Professional guidelines support the timely use of preoperative prophylaxis for prevention of postoperative wound infections. Barriers exist in implementing this practice. IPRO, the New York State peer review organization, as part of the Health Care Financing Administration's Health Care Quality Improvement Program, sought to determine the proportion of patients receiving timely antibiotic prophylaxis for aortic grafts, hip replacements and colon resections in 44 hospitals in New York State. IPRO conducted a retrospective medical record review of 44 hospitals through out New York State stratified for teaching, nonteaching status. A sample was drawn of 2651 patients, 2256 from Medicare and 395 from Medicaid, undergoing either abdominal aortic aneurysm repair, partial or total hip replacement or large bowel resection. The study determined the proportion of patients who had documentation of receiving antibiotics and those who received antibiotics timely, that is less than or equal to 2 hours preoperatively. Eighty-six percent of patients had documentation of receiving an antibiotic. Forty-six percent of aneurysm repairs and 60% of hip replacements had evidence of receiving timely antibiotic prophylaxis, that is within 2 hours prior to surgery. For colon resections, 73% of cases had either oral prophylaxis or timely parenteral therapy. An increased proportion of patients had received parenteral antibiotics prematurely as the surgical start time occurred later in the day. A total of 44 different antibiotics were recorded for prophylaxis. Antibiotic prophylaxis was performed in 81% to 94% of cases, however, anywhere from 27% to 54% of all cases did not receive antibiotics in a timely fashion. By delegating implementation of ordered antibiotic prophylaxis to the anesthesia team, timing may be improved and the incidence of postoperative wound infections may decrease.

High Plains Regional Ground-water Study web site

USGS Publications Warehouse

Qi, Sharon L.

2000-01-01

Now available on the Internet is a web site for the U.S. Geological Survey's (USGS) National Water-Quality Assessment (NAWQA) Program-High Plains Regional Ground-Water Study. The purpose of the web site is to provide public access to a wide variety of information on the USGS investigation of the ground-water resources within the High Plains aquifer system. Typical pages on the web site include the following: descriptions of the High Plains NAWQA, the National NAWQA Program, the study-area setting, current and past activities, significant findings, chemical and ancillary data (which can be downloaded), listing and access to publications, links to other sites about the High Plains area, and links to other web sites studying High Plains ground-water resources. The High Plains aquifer is a regional aquifer system that underlies 174,000 square miles in parts of eight States (Colorado, Kansas, Nebraska, New Mexico, Oklahoma, South Dakota, Texas, and Wyoming). Because the study area is so large, the Internet is an ideal way to provide project data and information on a near real-time basis. The web site will be a collection of living documents where project data and information are updated as it becomes available throughout the life of the project. If you have an interest in the High Plains area, you can check this site periodically to learn how the High Plains NAWQA activities are progressing over time and access new data and publications as they become available.

Plain packaging of cigarettes and smoking behavior: study protocol for a randomized controlled study.

PubMed

Maynard, Olivia M; Leonards, Ute; Attwood, Angela S; Bauld, Linda; Hogarth, Lee; Munafò, Marcus R

2014-06-25

Previous research on the effects of plain packaging has largely relied on self-report measures. Here we describe the protocol of a randomized controlled trial investigating the effect of the plain packaging of cigarettes on smoking behavior in a real-world setting. In a parallel group randomization design, 128 daily cigarette smokers (50% male, 50% female) will attend an initial screening session and be assigned plain or branded packs of cigarettes to smoke for a full day. Plain packs will be those currently used in Australia where plain packaging has been introduced, while branded packs will be those currently used in the United Kingdom. Our primary study outcomes will be smoking behavior (self-reported number of cigarettes smoked and volume of smoke inhaled per cigarette as measured using a smoking topography device). Secondary outcomes measured pre- and post-intervention will be smoking urges, motivation to quit smoking, and perceived taste of the cigarettes. Secondary outcomes measured post-intervention only will be experience of smoking from the cigarette pack, overall experience of smoking, attributes of the cigarette pack, perceptions of the on-packet health warnings, behavior changes, views on plain packaging, and the rewarding value of smoking. Sex differences will be explored for all analyses. This study is novel in its approach to assessing the impact of plain packaging on actual smoking behavior. This research will help inform policymakers about the effectiveness of plain packaging as a tobacco control measure. Current Controlled Trials ISRCTN52982308 (registered 27 June 2013).

Intra-abdominal abscess demonstrating an unusually large intra-abdominal pattern on an indium-111 leukocyte scan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Black, R.R.; Fernandez-Ulloa, M.; ter Penning, B.

1988-12-01

Indium-111 WBC imaging of a patient with occult septicemia revealed a large focal pattern of radiopharmaceutical distribution within the abdominal cavity at 24 hours post radiopharmaceutical administration. This finding was felt to represent a large intra-abdominal abscess. A five liter peritoneal abscess was found at surgery. This case illustrates an unusual presentation of an intra-abdominal abscess.

Chemical weathering outputs from the flood plain of the Ganga

NASA Astrophysics Data System (ADS)

Bickle, Michael J.; Chapman, Hazel J.; Tipper, Edward; Galy, Albert; De La Rocha, Christina L.; Ahmad, Talat

2018-03-01

Transport of sediment across riverine flood plains contributes a significant but poorly constrained fraction of the total chemical weathering fluxes from rapidly eroding mountain belts which has important implications for chemical fluxes to the oceans and the impact of orogens on long term climate. We report water and bedload chemical analyses from the Ganges flood-plain, a major transit reservoir of sediment from the Himalayan orogen. Our data comprise six major southern tributaries to the Ganga, 31 additional analyses of major rivers from the Himalayan front in Nepal, 79 samples of the Ganga collected close to the mouth below the Farakka barrage every two weeks over three years and 67 water and 8 bedload samples from tributaries confined to the Ganga flood plain. The flood plain tributaries are characterised by a shallow δ18O - δD array, compared to the meteoric water line, with a low δDexcess from evaporative loss from the flood plain which is mirrored in the higher δDexcess of the mountain rivers in Nepal. The stable-isotope data confirms that the waters in the flood plain tributaries are dominantly derived from flood plain rainfall and not by redistribution of waters from the mountains. The flood plain tributaries are chemically distinct from the major Himalayan rivers. They can be divided into two groups. Tributaries from a small area around the Kosi river have 87Sr/86Sr ratios >0.75 and molar Na/Ca ratios as high as 6. Tributaries from the rest of the flood plain have 87Sr/86Sr ratios ≤0.74 and most have Na/Ca ratios <1. One sample of the Gomti river and seven small adjacent tributaries have elevated Na concentrations likely caused by dissolution of Na carbonate salts. The compositions of the carbonate and silicate components of the sediments were determined from sequential leaches of floodplain bedloads and these were used to partition the dissolved cation load between silicate and carbonate sources. The 87Sr/86Sr and Sr/Ca ratios of the carbonate inputs were derived from the acetic-acid leach compositions and silicate Na/Ca and 87Sr/86Sr ratios derived from silicate residues from leaching. Modelling based on the 87Sr/86Sr and Sr/Ca ratios of the carbonate inputs and 87Sr/86Sr ratios of the silicates indicates that the flood plain waters have lost up to 70% of their Ca (average ∼ 50%) to precipitation of secondary calcite which is abundant as a diagenetic cement in the flood plain sediments. 31% of the Sr, 8% of the Ca and 45% of the Mg are calculated to be derived from silicate minerals. Because of significant evaporative loss of water across the flood plain, and in the absence of hydrological data for flood plain tributaries, chemical weathering fluxes from the flood plain are best calculated by mass balance of the Na, K, Ca, Mg, Sr, SO4 and 87Sr/86Sr compositions of the inputs, comprising the flood plain tributaries, Himalayan rivers and southern rivers, with the chemical discharge in the Ganga at Farakka. The calculated fluxes from the flood plain for Na, K, Ca and Mg are within error of those estimated from changes in sediment chemistry across the flood plain (Lupker et al., 2012, Geochemica Cosmochimica Acta). Flood plain weathering supplies between 41 and 63% of the major cation and Sr fluxes and 58% of the alkalinity flux carried by the Ganga at Farakka which compares with 24% supplied by Himalayan rivers and 18% by the southern tributaries.

Child with Abdominal Pain.

PubMed

Iyer, Rajalakshmi; Nallasamy, Karthi

2018-01-01

Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating pediatrician should watch out for underlying serious causes like intestinal obstruction and perforation peritonitis, which require immediate referral to an emergency department (ED). Abdominal pain may be secondary to surgical or non-surgical causes, and will differ as per the age of the child. The common etiologies for abdominal pain presenting to an urgent care clinic are acute gastro-enteritis, constipation and functional abdominal pain; however, a variety of extra-abdominal conditions may also present as abdominal pain. Meticulous history taking and physical examination are the best tools for diagnosis, while investigations have a limited role in treating benign etiologies.

[Differential diagnosis of abdominal pain].

PubMed

Frei, Pascal

2015-09-02

Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

Ground-water conditions in the Plaine de Moustiques, Haiti

USGS Publications Warehouse

Taylor, George C.; Lemoine, Rémy C.

1949-01-01

The Plaine des Moustiques lies on the north coast of Haiti about 12 kilometers west-southwest of Port-de-Paix. During January 1949 the writers made a brief geologic study to determine the availability of ground water in the plain for irrigation. At present irrigation is practiced by diversions from the Rivière des Moustiques. However, the dry-season flow of this stream is generally inadequate for irrigation or is sufficient to cover only a small part of the Irrigable area of the plain. According to Lieurance1 there is a total of about 1,120 hectares of irrigable land in the plain.

Mercurian volcanism questioned

USGS Publications Warehouse

Wilhelms, D.E.

1976-01-01

The Mariner 10 television team has argued that extensive plains on Mercury were formed by volcanism and compared them with the demonstrably lunar maria. I believe, however, that in stratigraphic relations, surface morphology, and albedo contrast, the Mercurian plains more closely resemble the lunar light plains. These lunar plains were interpreted as volcanic on the basis of data comparable to that available to the Mariner 10 investigators but have been shown by the Apollo missions to be of impact origin. The plains on Mercury might also be formed of impact materials, perhaps of impact melt or other basin ejecta that behaved more like a fluid when emplaced that did lunar basin ejecta. ?? 1976.

Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction

PubMed Central

Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

2016-01-01

[Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise. PMID:27065532

Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction.

PubMed

Jung, Halim; Jung, Sangwoo; Joo, Sunghee; Song, Changho

2016-01-01

[Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise.

Measurement the thickness of the transverse abdominal muscle in different tasks.

PubMed

Pang, Ling; Yin, Liquan; Tajiri, Kimiko; Huo, Ming; Maruyama, Hitoshi

2017-02-01

[Purpose] This study examined the measurement of the thickness of the transverse abdominal muscle in different tasks. [Subjects and Methods] The subjects were eleven healthy adult females. Thicknesses of transverse abdominal muscle were measured in seven tasks in the supine position. The tasks were: 1) Resting state, 2) Maximal contraction of transverse abdominal muscle, 3) Maximal contraction of levator ani muscle, 4) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle, 5) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with front side resistance added to both knee, 6) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with diagonal resistance added to both knees, and 7) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with lateral resistance added to both knees. [Results] The thicknesses of transverse abdominal muscle during maximal simultaneous contraction and maximal simultaneous contraction with resistance were greater than during the resting state. [Conclusion] The muscle output during simultaneous contraction and resistance movement were larger than that of each individual muscle.

49 CFR 215.107 - Defective plain bearing box: General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components... service a car, if the car has— (a) A plain bearing box that does not contain visible free oil; (b) A plain...

49 CFR 215.107 - Defective plain bearing box: General.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components... service a car, if the car has— (a) A plain bearing box that does not contain visible free oil; (b) A plain...

49 CFR 215.107 - Defective plain bearing box: General.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components... service a car, if the car has— (a) A plain bearing box that does not contain visible free oil; (b) A plain...

49 CFR 215.107 - Defective plain bearing box: General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components... service a car, if the car has— (a) A plain bearing box that does not contain visible free oil; (b) A plain...

49 CFR 215.107 - Defective plain bearing box: General.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components... service a car, if the car has— (a) A plain bearing box that does not contain visible free oil; (b) A plain...

The Plains of Venus

NASA Astrophysics Data System (ADS)

Sharpton, V. L.

2013-12-01

Volcanic plains units of various types comprise at least 80% of the surface of Venus. Though devoid of topographic splendor and, therefore often overlooked, these plains units house a spectacular array of volcanic, tectonic, and impact features. Here I propose that the plains hold the keys to understanding the resurfacing history of Venus and resolving the global stratigraphy debate. The quasi-random distribution of impact craters and the small number that have been conspicuously modified from the outside by plains-forming volcanism have led some to propose that Venus was catastrophically resurfaced around 725×375 Ma with little volcanism since. Challenges, however, hinge on interpretations of certain morphological characteristics of impact craters: For instance, Venusian impact craters exhibit either radar dark (smooth) floor deposits or bright, blocky floors. Bright floor craters (BFC) are typically 100-400 m deeper than dark floor craters (DFC). Furthermore, all 58 impact craters with ephemeral bright ejecta rays and/or distal parabolic ejecta patterns have bright floor deposits. This suggests that BFCs are younger, on average, than DFCs. These observations suggest that DFCs could be partially filled with lava during plains emplacement and, therefore, are not strictly younger than the plains units as widely held. Because the DFC group comprises ~80% of the total crater population on Venus the recalculated emplacement age of the plains would be ~145 Ma if DFCs are indeed volcanically modified during plains formation. Improved image and topographic data are required to measure stratigraphic and morphometric relationships and resolve this issue. Plains units are also home to an abundant and diverse set of volcanic features including steep-sided domes, shield fields, isolated volcanoes, collapse features and lava channels, some of which extend for 1000s of kilometers. The inferred viscosity range of plains-forming lavas, therefore, is immense, ranging from the extremely fluid flows (i.e., channel formers), to viscous, possibly felsic lavas of steep-sided domes. Wrinkle ridges deform many plains units and this has been taken to indicate that these ridges essentially form an early stratigraphic marker that limits subsequent volcanism to a minimum. However, subtle backscatter variations within many ridged plains units suggest (but do not prove) that some plains volcanism continued well after local ridge deformation ended. Furthermore, many of volcanic sources show little, if any, indications of tectonic modification and detailed analyses have concluded that resurfacing rates could be similar to those on Earth. Improving constraints on the rates and styles of volcanism within the plains could lend valuable insights into the evolution of Venus's internal heat budget and the transition from thin-lid to thick-lid tectonic regimes. Improved spatial and radiometric resolution of radar images would greatly improve abilities to construct the complex local stratigraphy of ridged plains. Constraining the resurfacing history of Venus is central to understanding how Earth-sized planets evolve and whether or not their evolutionary pathways lead to habitability. This goal can only be adequately addressed if broad coverage is added to the implementation strategies of any future mapping missions to Venus.

Lactose and Fructose Intolerance in Turkish Children with Chronic Abdominal Pain.

PubMed

Yuce, Ozlem; Kalayci, Ayhan Gazi; Comba, Atakan; Eren, Esra; Caltepe, Gonul

2016-05-08

To investigate the prevalence of lactose and fructose intolerance in children with chronic abdominal pain. Hydrogen breath tests were done to detect lactose and fructose malabsorption in 86 children with chronic abdominal pain (44 irritable bowel syndrome, 24 functional abdominal pain and 17 functional abdominal pain syndrome as per Rome III criteria) presenting to a Pediatric Gastroentreology department. 14 (16.3%) of patients were diagnosed with lactose intolerance and 11 (12.8%) with fructose intolerance. Lactose and fructose intolerance in children can lead to chronic abdominal pain and symptoms improve with dietary modifications.

Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain.

PubMed

Meuwly, Jean-Yves; Wicky, Stephan; Schnyder, Pierre; Lepori, Domenico

2002-03-01

To describe the sonographic appearance of a poorly recognized cause of low thoracic or upper abdominal pain. Three sonographic descriptions of slipping rib syndrome are presented. The 3 patients had abnormal mobility of a cartilaginous rib, which could slip over an adjacent rib during abdominal muscle contraction. Slipping rib syndrome should be considered in patients with histories of upper abdominal or low thoracic pain of unknown origin. We suggest that high-resolution sonography of the costal margin should be added to abdominal sonography in cases of nonspecific abdominal pain.

Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review.

PubMed

Thabet, Farah Chedly; Ejike, Janeth Chiaka

2017-10-01

To consolidate pediatric intensivists' understanding of the pathophysiology, definition, incidence, monitoring, and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); and to highlight the characteristics related to the pediatric population. This is a narrative review article that utilized a systematic search of the medical literature published in the English language between January 1990 and august 2016. Studies were identified by conducting a comprehensive search of Pub Med databases. Search terms included "intra-abdominal hypertension and child", "intra-abdominal hypertension and pediatrics", "abdominal compartment syndrome and child", and "abdominal compartment syndrome and pediatrics". Intra-abdominal hypertension and ACS are associated with a number of pathophysiological disturbances and increased morbidity and mortality. These conditions have been well described in critically ill adults. In children, the IAH and the ACS have a reported incidence of 13% and 0.6 to 10% respectively; they carry similar prognostic impact but are still under-diagnosed and under-recognized by pediatric health care providers. Intra-abdominal hypertension and ACS are conditions that are regularly encountered in critically ill children. They are associated with an increased morbidity and mortality. Early recognition, prevention and timely management of this critical condition are necessary to improve its outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Does this adult patient have a blunt intra-abdominal injury?

PubMed

Nishijima, Daniel K; Simel, David L; Wisner, David H; Holmes, James F

2012-04-11

Blunt abdominal trauma often presents a substantial diagnostic challenge. Well-informed clinical examination can identify patients who require further diagnostic evaluation for intra-abdominal injuries after blunt abdominal trauma. To systematically assess the precision and accuracy of symptoms, signs, laboratory tests, and bedside imaging studies to identify intra-abdominal injuries in patients with blunt abdominal trauma. We conducted a structured search of MEDLINE (1950-January 2012) and EMBASE (1980-January 2012) to identify English-language studies examining the identification of intra-abdominal injuries. A separate, structured search was conducted for studies evaluating bedside ultrasonography. We included studies of diagnostic accuracy for intra-abdominal injury that compared at least 1 finding with a reference standard of abdominal computed tomography, diagnostic peritoneal lavage, laparotomy, autopsy, and/or clinical course for intra-abdominal injury. Twelve studies on clinical findings and 22 studies on bedside ultrasonography met inclusion criteria for data extraction. Critical appraisal and data extraction were independently performed by 2 authors. The prevalence of intra-abdominal injury in adult emergency department patients with blunt abdominal trauma among all evidence level 1 and 2 studies was 13% (95% CI, 10%-17%), with 4.7% (95% CI, 2.5%-8.6%) requiring therapeutic surgery or angiographic embolization of injuries. The presence of a seat belt sign (likelihood ratio [LR] range, 5.6-9.9), rebound tenderness (LR, 6.5; 95% CI, 1.8-24), hypotension (LR, 5.2; 95% CI, 3.5-7.5), abdominal distention (LR, 3.8; 95% CI, 1.9-7.6), or guarding (LR, 3.7; 95% CI, 2.3-5.9) suggest an intra-abdominal injury. The absence of abdominal tenderness to palpation does not rule out an intra-abdominal injury (summary LR, 0.61; 95% CI, 0.46-0.80). The presence of intraperitoneal fluid or organ injury on bedside ultrasound assessment is more accurate than any history and physical examination findings (adjusted summary LR, 30; 95% CI, 20-46); conversely, a normal ultrasound result decreases the chance of injury detection (adjusted summary LR, 0.26; 95% CI, 0.19-0.34). Test results increasing the likelihood of intra-abdominal injury include a base deficit less than -6 mEq/L (LR, 18; 95% CI, 11-30), elevated liver transaminases (LR range, 2.5-5.2), hematuria (LR range, 3.7-4.1), anemia (LR range, 2.2-3.3), and abnormal chest radiograph (LR range, 2.5-3.8). Symptoms and signs may be most useful in combination, particularly in identification of patients who do not need further diagnostic workup. Bedside ultrasonography has the highest accuracy of all individual findings, but a normal result does not rule out an intra-abdominal injury. Combinations of clinical findings may be most useful to determine which patients do not require further evaluation, but the ideal combination of variables for identifying patients without intra-abdominal injury requires further study.

Genetic variation and differentiation of bison (Bison bison) subspecies and cattle (Bos taurus) breeds and subspecies.

PubMed

Cronin, Matthew A; MacNeil, Michael D; Vu, Ninh; Leesburg, Vicki; Blackburn, Harvey D; Derr, James N

2013-01-01

The genetic relationship of American plains bison (Bison bison bison) and wood bison (Bison bison athabascae) was quantified and compared with that among breeds and subspecies of cattle. Plains bison from 9 herds (N = 136), wood bison from 3 herds (N = 65), taurine cattle (Bos taurus taurus) from 14 breeds (N = 244), and indicine cattle (Bos taurus indicus) from 2 breeds (N = 53) were genotyped for 29 polymorphic microsatellite loci. Bayesian cluster analyses indicate 3 groups, 2 of which are plains bison and 1 of which is wood bison with some admixture, and genetic distances do not show plains bison and wood bison as distinct groups. Differentiation of wood bison and plains bison is also significantly less than that of cattle breeds and subspecies. These and other genetic data and historical interbreeding of bison do not support recognition of extant plains bison and wood bison as phylogenetically distinct subspecies.

Geodatabase compilation of hydrogeologic, remote sensing, and water-budget-component data for the High Plains aquifer, 2011

USGS Publications Warehouse

Houston, Natalie A.; Gonzales-Bradford, Sophia L.; Flynn, Amanda T.; Qi, Sharon L.; Peterson, Steven M.; Stanton, Jennifer S.; Ryter, Derek W.; Sohl, Terry L.; Senay, Gabriel B.

2013-01-01

The High Plains aquifer underlies almost 112 million acres in the central United States. It is one of the largest aquifers in the Nation in terms of annual groundwater withdrawals and provides drinking water for 2.3 million people. The High Plains aquifer has gained national and international attention as a highly stressed groundwater supply primarily because it has been appreciably depleted in some areas. The U.S. Geological Survey has an active program to monitor the changes in groundwater levels for the High Plains aquifer and has documented substantial water-level changes since predevelopment: the High Plains Groundwater Availability Study is part of a series of regional groundwater availability studies conducted to evaluate the availability and sustainability of major aquifers across the Nation. The goals of the regional groundwater studies are to quantify current groundwater resources in an aquifer system, evaluate how these resources have changed over time, and provide tools to better understand a systems response to future demands and environmental stresses. The purpose of this report is to present selected data developed and synthesized for the High Plains aquifer as part of the High Plains Groundwater Availability Study. The High Plains Groundwater Availability Study includes the development of a water-budget-component analysis for the High Plains completed in 2011 and development of a groundwater-flow model for the northern High Plains aquifer. Both of these tasks require large amounts of data about the High Plains aquifer. Data pertaining to the High Plains aquifer were collected, synthesized, and then organized into digital data containers called geodatabases. There are 8 geodatabases, 1 file geodatabase and 7 personal geodatabases, that have been grouped in three categories: hydrogeologic data, remote sensing data, and water-budget-component data. The hydrogeologic data pertaining to the northern High Plains aquifer is included in three separate geodatabases: (1) base data from a groundwater-flow model; (2) hydrogeology and hydraulic properties data; and (3) groundwater-flow model data to be used as calibration targets. The remote sensing data for this study were developed by the U. S. Geological Survey Earth Resources Observation and Science Center and include historical and predicted land-use/land-cover data and actual evapotranspiration data by using remotely sensed temperature data. The water-budget-component data contains selected raster data from maps in the “Selected Approaches to Estimate Water-Budget Components of the High Plains, 1940 Through 1949 and 2000 Through 2009” report completed in 2011 (http://pubs.usgs.gov/sir/2011/5183/). Federal Geographic Data Committee compliant metadata were created for each spatial and tabular data layer in the geodatabases.

Update on the prevention of death from ruptured abdominal aortic aneurysm.

PubMed

Jacomelli, Jo; Summers, Lisa; Stevenson, Anne; Lees, Tim; Earnshaw, Jonothan J

2017-09-01

Objectives To monitor the early effect of a national population screening programme for abdominal aortic aneurysm in 65-year-old men. Setting The study used national statistics for death rates from abdominal aortic aneurysm (Office of National Statistics) and hospital admission data in England (Hospital Episode Statistics). Methods Information concerning deaths from abdominal aortic aneurysm (ruptured and non-ruptured) (1999-2014) and hospital admissions for ruptured abdominal aortic aneurysm (2000-2015) was examined. Results The absolute number of deaths from abdominal aortic aneurysm in men and women aged 65 and over has decreased by around 30% from 2001 to 2014, but as the population has increased, the relative reduction was 45.6% and 40.0%, respectively. Some 65% of all abdominal aortic aneurysm deaths are in men aged over 65; women aged 65 and over account for around 31%. Deaths from ruptured abdominal aortic aneurysm in men aged 60-74 (the screened group) appear to be declining at the same rate as in men aged 75 and over. The relative decline in admissions to hospital with ruptured abdominal aortic aneurysm may be greater in men and women aged 60-74 (which contains the screened group of men), than those older, giving the first possible evidence that abdominal aortic aneurysm screening is having an effect. Conclusion The death rate from abdominal aortic aneurysm is declining rapidly in England. There is the first evidence that screening may be contributing to this reduction.

How useful is abdominal ultrasonography in dogs with diarrhoea?

PubMed

Mapletoft, E K; Allenspach, K; Lamb, C R

2018-01-01

To assess the utility of abdominal ultrasonography in the diagnostic work-up of dogs with diarrhoea. Retrospective cross-sectional study based on a referral population of dogs with diarrhoea. Associations between the clinical signs, use of abdominal ultrasonography, results of abdominal ultrasonography and subsequent work-up were examined. The utility of abdominal ultrasonography was scored as high, moderate, none or counterproductive based on review of medical records. Medical records of 269 dogs were reviewed, of which 149 (55%) had abdominal ultrasonography. The most frequent result was no ultrasonographic abnormalities affecting the intestine in 65 (44%) dogs. Ultrasonography results were associated with subsequent work-up as follows: (1) no detected abnormalities and dietary trial; (2) focal thickening of the intestinal wall, loss of intestinal wall layers or enlarged abdominal lymph nodes and ultrasound-guided fine-needle aspirates; (3) diffuse thickening of the intestinal wall or hyperechoic striations in the small intestinal mucosa and endoscopy; and (4) small intestinal foreign body and coeliotomy. Abdominal ultrasonography was considered to be diagnostic without further testing in only four (3%) dogs: two had a portosystemic shunt identified ultrasonographically, one had a linear foreign body and one had a perforated pyloric ulcer. Abdominal ultrasonography had moderate utility in 56 (38%) dogs and no utility in 79 (53%) dogs. Abdominal ultrasonography was considered counterproductive in 10 (7%) dogs because results were either falsely negative or falsely positive. These results should prompt clinicians to reconsider routine use of abdominal ultrasonography in dogs with diarrhoea. © 2017 British Small Animal Veterinary Association.

[Invasion of the portal vein by a hydatid cyst. Review of the literature].

PubMed

Zubiaurre Lizarralde, Leire; Oyarzabal Pérez, Igor; Ruiz Montesinos, Inmaculada; Guisasola Gorrotxategi, Esther

2006-01-01

We have found only 3 publications in the literature that describe portal vein invasion by a hydatid cyst. This complication is very uncommon but should be kept in mind in the diagnosis of anaphylactic shock. Clinical presentation can vary from abdominal pain and fever to portal hypertension or anaphylactic reaction due to leaking of antigenic material from the cyst. Ultrasound and computed tomography scan can identify hydatid cysts and cavernomatosis, but magnetic resonance imaging shows the presence of multiple daughter vesicles replacing the lumen of the portal vein and a communication between the residual cyst and the portal vein. The treatment of choice is surgery, including removal of the cyst and local instillation of scolicide solution. In addition to surgery, administration of albendazole is recommended. Administration should begin 4 days before extirpation and should be continued for more than 4 weeks.

The ‘cut and push’ technique: is it really safe?

PubMed Central

Peacock, Oliver; Singh, Rajeev; Cole, Andrew; Speake, William

2012-01-01

Percutaneous endoscopic gastrostomy (PEG) feeding is routinely used as an endoscopic and effective method for providing enteral nutrition in those whose oral access has been diminished or lost. One technique for removal of the PEG is cutting the tube at the skin level and allowing the tube and internal flange to pass spontaneously. This is known as the ‘cut and push’ method. Several studies have concluded that the ‘cut and push’ method is a safe and cost-effective method. This case demonstrates a rare cause of small bowel obstruction following the ‘cut and push’ method for PEG replacement, with only a few other cases been reported. This method of removal should be avoided in patients with previous abdominal surgery. It is important that the PEG flange is retrieved endoscopically or an alternative PEG tube (designed to be completely removed through the skin) is used to prevent this complication occurring in such individuals. PMID:22847571

Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty.

PubMed

Elshoury, Amro; Khedr, Maha; Abousayed, Mostafa M; Mehdi, Syed

2015-09-01

Heparin-induced thrombocytopenia syndrome is an acquired potentially life-threatening prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 bound to heparin or heparin-like molecules. It typically occurs after exposure to unfractionated heparin, to a lesser extent after exposure to low-molecular-weight heparins, and rarely after exposure to fondaparinux. Herein, we report the case of a 48-year-old woman who developed severe thrombocytopenia, bilateral pulmonary embolism, and bilateral adrenal hemorrhages after total knee arthroplasty without evidence of heparin exposure. Antibodies to the heparin-platelet factor 4 complex and serotonin-release assay were positive. Spontaneous heparin-induced thrombocytopenia syndrome should be considered in patients with unexplained thrombocytopenia after knee replacement surgery even without heparin exposure, and a high index of suspicion for adrenal hemorrhage is needed in patients with fever, abdominal pain, and shock.

[Gastrocolic fistula as a complication of percutaneous feeding gastrostomy, description of three cases and review of the literature].

PubMed

Jiménez Varo, Ignacio; Gros Herguido, Noelia; Parejo Campos, Juana; Tatay Domínguez, Dolores; Pereira Cunill, José Luis; Serrano Aguayo, Pilar; Socas Macías, María; García-Luna, Pedro Pablo

2014-02-01

Percutaneous gastrostomy, is the procedure of choice to provide enteral access in patients requiring nutritional support in this way in the long run, relegating the surgical gastrostomy. We present three patients requiring percutaneous gastrostomy for nutritional support. In two cases was performed endoscopic gastrostomy and another one using interventional radiology. While performing percutaneous gastrostomy clinical incidents were not detected, but when trying the replacement of gastrostomy tubes, showed the presence of gastrocolic fistula that caused failure or turnover in one case, or abdominal pain and diarrhea in the two other cases. Despite being a safe technique, should be done a proper patient selection in order to minimize the potential complications that may occur, as gastrocolic fistula, recommending in doubtful cases test of image such CT (computerized Tomography). Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Situs ambiguous in a schoolchild

PubMed Central

Tortajada, Miguel; Moreno, Miriam; Gracia, Miguel; Sanchis, Amparo

2010-01-01

We report the case of a 9-year-old child with asthma, atopic dermatitis and allergic rhinoconjunctivitis due to house dust mites, in whom a routine chest x-ray identified by chance abnormal organ position, such as the stomach located on the right side. Abdominal ultrasonography indicated a centralised liver, with polysplenia on the right side and an inferior cava vein located to the left of the aorta with no interruption. Ultrasonography did not show heart defects. Magnetic resonance imaging (MRI) of the abdomen was performed that showed a short pancreas, with no neck, body and tail in it, and a left inferior vena cava with normal outlet of the renal veins, and absence of the intrahepatic part of the inferior vena cava, that was replaced by the left hemiazygos vein. Spinal cord MRI revealed dorsal syringomelia. In view of the results obtained, the diagnosis of situs ambiguous was established. PMID:22121394

[Magnetic resonance enterography: technique and indications. Findings in Crohn's disease].

PubMed

Torregrosa, A; Pallardó, Y; Hinojosa, J; Insa, S; Molina, R

2013-09-01

Radiology with oral contrast, or enteroclysis, have traditionally been the techniques of choice in the examination of the small intestine, due to the excellent visualisation of the mucosal pattern. However, the absence of extra-luminal information and the use of ionising radiation have replaced these examinations with sectional techniques which enable the abdominal cavity to be viewed with good resolution. Magnetic resonance enterography is a simple technique, with no ionising radiation, provided quality images, distends the intestinal lumen well by the administration of non-reabsorbable oral substances, minimises peristalsis, and establishes a protocol which includes sequences with intravenous contrast. These properties can be used in patients with Crohn's disease, achieving good diagnostic precision in the assessment of activity and monitoring of treatment, in intestinal obstruction, in the suspicion of small intestine tumours, and in paediatric patients due to it being harmless. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Adrenocortical carcinoma, an unusual cause of secondary hypertension.

PubMed

Veron Esquivel, Daniel; Batiz, Fernando; Farias Vega, Alfonso; Carrillo Gonzalez, Perla A

2016-12-07

We present the case of a female patient aged 39 years who was admitted to our hospital due to hypertension, severe hypokalaemia and metabolic alkalosis; physical examination was remarkable for plethoric moon face, centripetal obesity and bilateral lower extremity oedema. She was admitted for intravenous potassium replacement and further assessment of hypertension and associated clinical findings. Laboratory testing showed increased levels of aldosterone, renin, cortisol, testosterone and androstenedione. An abdominal CT revealed a large mass in the right adrenal gland with hepatic involvement. The patient was started on antihypertensive medications and underwent laparoscopic surgery for mass and liver biopsy. The pathological diagnosis was adrenocortical carcinoma with liver metastasis. Hyperaldosteronism is a cause of secondary hypertension and its diagnosis is usually benign. Adrenocortical carcinoma is a rare condition and aldosterone secreting tumours are even rarer; associated hypertension usually improves after tumour resection, but with the presence of metastasis, blood pressure control is difficult. 2016 BMJ Publishing Group Ltd.

Small bowel injury after suprapubic catheter insertion presenting 3 years after initial insertion

PubMed Central

Gallagher, Kevin M; Good, Daniel W; Brush, John P; Al-hasso, Ammar; Stewart, Grant D

2013-01-01

A 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no catheter visible. There seemed to be a fistulous tract entering the bladder at the left dome. The urethra was dilated, a urethral catheter was placed and the SPC was removed. A CT demonstrated that the SPC tract transfixed a loop of pelvic small bowel and entered the bladder with no intraperitoneal contrast leak. The patient recovered well and did not require laparotomy. This case emphasises that bowel perforation, although rare, must be considered as a complication of SPC placement even years after initial insertion when catheter problems arise. Unusually, we learn that this complication may not present with abdominal pain or peritonism. PMID:24326435

[A case of ruptured thoracoabdominal aortic aneurysm with aortitis syndrome--operation with selective cold visceral arteries perfusion].

PubMed

Furukawa, K; Ohteki, H; Doi, K

1997-10-01

We report a successful result of treatment for a ruptured thoracoabdominal aortic aneurysm with aortitis syndrome. A 43-year-old male suffered sudden low back pain, that was diagnosed as a ruptured thoracoabdominal aortic aneurysm based on abdominal computed tomography. Preoperative angiography revealed a thoracoabdominal aortic aneurysm with occlusion of the superior mesenteric artery, and well developed Riolan's archade. The aneurysm was replaced by a prosthetic graft with partial femoro-femoral bypass in conjunction with selective cold perfusion for the visceral arteries. Total extracorporeal circulation time, and aortic clamptime, was 187 minutes and 132 minutes, respectively. The postoperative courses of liver and renal function were excellent. The patient recovered from surgery uneventfully. It was suggested that selective cold visceral perfusion was effective for prevention of renal and liver dysfunction associated with a ruptured thoracoabdominal aneurysm.