1,721,020 research outputs found
Ambiguous Anatomy and Its Pain
No full textQuestion: A 46-year-old woman presented to the emergency department with a 1-day history of sudden onset colicky central abdominal pain. She had been passing flatus until that morning and her last bowel motion was the day before. She had been tolerating diet without any nausea or vomiting. She had no significant medical history and had otherwise been previously fit and well throughout her life. She had no previous surgery and no previous endoscopic procedures. She was an active smoker. Her vital signs were normal on surgical review. Initially she appeared comfortable however on serial observations she appeared to develop waves of colicky and severe cramping pain. There was no abdominal distension noted. Her abdomen was generally tender maximally in the epigastrium with localized guarding. Her white cell count was 12.9 × 109/L and her C-reactive protein was 2.0 mg/L. Her serum electrolytes, renal function, liver function tests, and lipase were all normal.Full Tex
An unusual cause of torrential lower gastrointestinal hemorrhage
No full textQuestion: An 84-year-old man presented to the emergency department with 1 episode of large volume rectal bleed. He has a medical history that includes paroxysmal atrial fibrillation, diabetes mellitus, ischemic heart disease, and hypertension for which he takes metformin, insulin, digoxin, pantoprazole, simvastatin, aspirin, and betamin. On initial examination, he was afebrile with a systolic blood pressure (SBP) of 110, pulse rate of 110 and had a SBP postural decrease of 30 mmHg. Gastrointestinal examination revealed generalized pallor, dry mucous membranes, and a soft abdomen with no tenderness or masses on palpation. There was fresh blood and clots on rectal examination. Fluid resuscitation was initiated and his initial hemoglobin returned at 66 g/L with an International Normalized Ratio of 1.09. Two units of pack cells were transfused and a CT mesenteric angiogram was organized.
What are the likely causes of a torrential lower gastrointestinal bleed?No Full Tex
Pulmonary metastasectomy in the era of targeted therapy and immunotherapy
No full textMetastatic melanoma is a fatal malignancy with a high mortality and morbidity. Since the early 1970s, available medical therapies were limited in improving survival. Surgery represented the best chance for a cure. However, surgery could only be offered to selected patients. The current landscape of treatment has radically evolved since the introduction of targeted and immunotherapies including BRAF and MEK inhibitors, and checkpoint blockers, like PD-1 and CTLA-4 antibodies. These new therapies have seen survival rates matching, and in some cases surpassing, that of surgery. Anti-PD1 and CTLA-4 combination treatments are associated with severe side effects and BRAF and MEK inhibitor combinations may trigger initial tumour responses but prolonged use have resulted in the development of resistant tumour clones and disease relapse. This review examines the role of pulmonary metastasectomy for lung metastasis from malignant melanoma in the current landscape of effective targeted therapy and immunotherapy.Full Tex
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Necrotising fasciitis from fulminant pyelonephritis
No full textEmphysematous pyelonephritis (EPN) is a severe urinary tract infection (UTI) that causes kidney necrosis by gas‐producing bacteria. Escherichia coli is most implicated. Type‐2 diabetes mellitus (T2DM) is a common predisposing factor. Necrotising fasciitis (NF) is an uncommon complication of EPN that has severe consequences. It is easily missed due to rarity. We present the case of an 82‐year‐old female nursing home resident with T2DM that presents with NF of the left flank following EPN of the left kidney that has penetrated through the superior lumbar triangle. This is the first time this anatomical pathway has been implicated in NF secondary to EPN in the English literature.No Full Tex
A commentary on concurrent MCL1 and JUN amplification in pseudomyxoma peritonei: a comprehensive genetic profiling and survival analysis
No full textMucinous appendiceal tumors comprise of 1% of all colorectal cancer accounting for about 1500 cases per year in the United States.1 These tumors originate in the appendix but often as a result of its growth within a narrow appendiceal lumen, the tumor perforates or may result in full thickness growth and invasion through the appendix lumen to involve the serosa. Transcoelomic seeding of tumor on the peritoneal surfaces result in the clinical syndrome of pseudomyxoma peritonei. Though this cancer is uncommon, there has been an enormous development in our understanding of the disease biology on the basis of its natural history in the last three decades. Dysplasia occurring in the mucus-secreting epithelium was initially classified histologically by Ronnett et al.2 into three diagnostic categories comprising of disseminated peritoneal adenomucinosis, peritoneal mucinous carcinomatosis and an intermediate grade. This was based on the amount of cellularity, proliferative activity and presence of cytologic features of carcinoma. Today, the Bradley criteria is more commonly used and it dichotomizes the classification into a low- and high-grade group.3 Surgical cytoreduction in combination with hyperthermic intraperitoneal chemotherapy has been demonstrated to be the standard of care achieving long-term survival gains over limited surgical debulking.1 In a recent worldwide collaborative registry study, the 10-year survival of patients wherein a complete macroscopic surgical cytoreduction was not attempted or not possibly achieved operatively was 70% in patients who had a complete macroscopic cytoreduction.4 Inability to achieve a complete cytoreduction may often be considered a surrogate reflection of an aggressive tumor that is more cellular and less mucinous resulting in more extensive invasion of the peritoneal surfaces. Patients with higher volume disease involving a larger extent of the peritoneal surfaces are also at higher risk of surgical morbidity. Further, recent data suggests a role for modern systemic chemotherapy in high-grade appendiceal tumors with radiographic responses demonstrated in 44% of patients.5 If we were able to delineate molecular signatures and identify which tumors bear unfavorable tumor biology in addition to the current prognostic role of the histological classification, this may assist in treatment risk stratification. It will allow identification of suitable patients for surgical cytoreduction and/or for systemic chemotherapy. This would reduce surgical morbidity in patients who would otherwise not benefit from surgery.No Full Tex
Physical and chemical characteristics of mucin secreted by pseudomyxoma peritonei (PMP)
No full textBackground: Pseudomyxoma peritonei (PMP) is a rare disease with excess intraperitoneal mucin secretion. Treatment involves laparotomy, cytoreduction and chemotherapy that is very invasive with patients often suffers from numerous compromises. Hence a mucolytic comprising of bromelain and N-acetyl cystein has been developed to solubilise mucin in situ for removal by catherization. Owing to differences in mucin appearance and hardness, dissolution varies. Therefore the current study investigates the inter-mucin physical and chemical characteristics, in order to reformulate an effective mucolytic for all mucin. Method: PMP mucin, from the three categories (soft, semi hard and hard mucin) was solubilised and then various physical characteristics such as turbidity, density, kinematic viscosity were measured. The water content and the density of solid mucin were also determined. This was followed by the determination of sialic acid, glucose, lipid, Thiol (S-S and S-H) content of the samples. Lastly, the distribution of MUC2, MUC5B and MUC5AC was determined using western blot technique. Results: Both turbidity and kinematic viscosity and sialic acid content increased linearly as the hardness of mucin increased. However, density, hydration, protein, glucose, lipid and sulfhydryl and disulphide content decreased linearly as hardness of mucin increased. The distribution ratio of mucins (MUC2:MUC5B:MUC5AC) in soft mucin is 2.25:1.5:1.0, semi hard mucin is 1:1:1 and hard mucin is 3:2:1. Conclusion: The difference in texture and hardness of mucin may be due to cellular content, hydration, glucose, protein, lipids, thiol and MUC distribution. Soft mucin is solely made of glycoprotein whilst the others contained cellular materials.Full Tex
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