11 research outputs found
Irony. Irony in Dickens' Nicholas Nickleby: Rhetoric, Pragmatics, Voice and Point of View
No full textIn this chapter, an overview of the various rhetorical and pragmatic views of irony is offered. By analyzing Charles Dickens' Nicholas Nickleby, the author identifies a number of ironic stances which go from mere inversion through echoic repetition to what he calls "perspectival disengagement" - Dickens' narrator voicing opinions or sentiments that he does not at all endorse
Interactions between the exocrine and the endocrine pancreas
No full textThe pancreas has two main functions: to produce and secrete digestive enzymes (exocrine function) and to produce hormones that regulate blood glucose and splanchnic secretion (endocrine function). The endocrine and exocrine portions of the pancreas are central regulators in digestion and metabolism, with continuous crosstalk between their deeply interconnected components, which plays a role in disease. Pancreatic neoplasms, inflammation, trauma, and surgery can lead to the development of type 3c diabetes when an insult simultaneously damages both acini and islets, leading to exocrine and endocrine dysfunction. In diabetes mellitus patients, pancreatic exocrine insufficiency is highly prevalent, yet little is known about the associations between diabetes mellitus and pancreatic exocrine function. This review aims to provide an overview of the physiology of the pancreas, summarize the pathophysiology and diagnostic work-up of pancreatic exocrine insufficiency, and explore the relationships between exocrine pancreatic insufficiency and diabetes mellitus
Σύγκριση λαπαροσκοπικής έναντι ανοιχτής χειρουργικής στον ορθοκολικό καρκίνο σε ασθενείς ηλικίας άνω των 75 ετών -Μακροπρόθεσμα αποτελέσματα
No full textΕισαγωγή Ο καρκίνος του παχέος εντέρου είναι δεύτερος στην συχνότητα καρκίνος στις γυναίκες και τρίτος στους άνδρες παγκοσμίως. Ο μέσος χρόνος ζωής έχει αυξηθεί τα τελευταία χρόνια και αυτό βάζει τον χειρουργό σε δίλημμα ποια χειρουργική πρόσβαση, ανοιχτή ή λαπαροσκοπική, είναι κατάλληλη για τους ανθρώπους που πάσχουν από καρκίνο του παχέος εντέρου. Τα τελευταία χρόνια οι μελέτες έχουν δείξει ότι η λαπαροσκοπική προσπέλαση έχει πλεονεκτήματα όπως μικρότερος μετεγχειρητικός πόνος, λιγότερες ημέρες νοσηλείας και καλύτερο αισθητικό αποτέλεσμα κρατώντας ταυτόχρονα το απαραίτητο επίπεδο της ογκολογικής επάρκειας της επέμβασης. Αυτό όμως δεν έχει εξεταστεί με μελέτες σε ηλικιωμένη ομάδα ανθρώπων. Ο σκοπός της εργασίας αυτής είναι η ανάδειξη των μεσοπρόθεσμων αποτελεσμάτων της χειρουργικής αντιμετώπισης καρκίνου του παχέος εντέρου σε άτομα ηλικίας άνω των 75 ετών που έχουν χειρουργηθεί για καρκίνο του παχέος εντέρου σε τριτοβάθμιο νοσοκομείο. Μέθοδος Διενεργήθηκε μία αναδρομική ανάλυση προοπτικά συλλεγμένων στοιχείων ασθενών που υποβλήθηκαν σε λαπαροσκοπική και ανοιχτή κολεκτομή για καρκίνο παχέος εντέρου ανθρώπων ηλικίας άνω των εβδομήντα πέντε ετών στην διάρκεια 5 ετών, από τον Ιανουάριο του 2013 έως και Δεκέμβρη του 2018. Οι ασθενείς έχουν χωριστεί σε δύο ομάδες από 39 ασθενείς όπου η ομάδα 1 έχει υποβληθεί σε ανοιχτή χειρουργική επέμβαση και η ομάδα 2 σε λαπαροσκοπική προσπέλαση. Καταγράφηκαν τα δημογραφικά στοιχεία, το είδος της επέμβασης, η ένδειξη της επέμβασης, οι επιπλοκές, και η διάρκεια της μετεγχειρητικής νοσηλείας όπως και η ογκολογική επάρκεια των επεμβάσεων. Αποτελέσματα Η λαπαροσκοπική προσπέλαση είναι εξίσου ασφαλής μέθοδος για την αντιμετώπιση ασθενών ηλικιακής ομάδας άνω των 75 ετών όπως και η ανοιχτή προσπέλαση όσο αφορά τις επιπλοκές (p-value 0.184). Οι ημέρες νοσηλείας στην μελέτη μας είχαν στατιστικά σημαντική διαφορά στις δύο ομάδες (p-value 0.001) με λιγότερες ημέρες στην ομάδα ασθενών που αντιμετωπίστηκαν με λαπαροσκοπική προσπέλαση. Η συνολική επιβίωση στα βραχυ- και μεσοπρόθεσμα αποτελέσματα δεν ανέδειξαν στατιστικά σημαντική διαφορά μεταξύ των δύο ομάδων. Συμπεράσματα Η λαπαροσκοπική χειρουργική είναι εξίσου ασφαλής και αποτελεσματική μέθοδος αντιμετώπισης του καρκίνου παχέος εντέρου όπως και η ανοιχτή προσπέλαση έχοντας ως πλεονέκτημα τον μικρότερο χρόνο μετεγχειρητικής νοσηλείας.Background Colorectal cancer is the second most common cancer in men and third commonest in women of all ages. Life expectancy has increased and this has created a challenge for surgeons today to decide which approach is better for the elderly patient with colorectal neoplastic disease. The benefit of minimally invasive surgery in colorectal cancer patients has been established, however it is not clear whether these benefits apply to older patients as well. The aim of this study is to present short- and mid-term outcomes in elderly patients, over the age of 75 years, with colorectal cancer who were treated with the laparoscopic approach in comparison with patients that were treated with open surgery in a tertiary hospital. Methods This is a midterm retrospective study of selected patients over the age of seventy-five who underwent laparoscopic and open surgery for colorectal cancer between January 2013 until December 2018 in a tertiary referral center. All patients were > 75 years of age, treated for colorectal cancer, and categorized in two groups: Group 1 patients who had open surgery and Group 2, patients underwent laparoscopic surgery. Demographic, clinical and postoperative data were retrospectively collected and analyzed between the two study groups. Results A minimally invasive procedure in colorectal cancer is equally safe in comparison with the open procedure, considering the similar postoperative complication rate (p-value 0.184). The overall hospital stay postoperatively was in favor of the laparoscopic approach (p-value 0.001). The overall survival in short- and midterm outcomes represents equal results among open and laparoscopic surgical access. Conclusion Laparoscopic surgery is as safe and implementable approach for the elderly patients with colorectal cancer, with equal oncological results, maintaining the benefit of a shorter postoperative hospital stay. Summary This retrospective study compared short and midterm outcomes in elderly patients that underwent elective open or laparoscopic surgery for colorectal cancer
Multiple Small Bowel Diverticula Were an Unexpected Finding During Laparoscopic Enterectomy for Crohn's Disease
No full textIntroduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn's disease (CD) is rarely reported in the current literature. Aim: We present a rare case of concomitant Crohn's disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. Case report: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. Conclusion: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms. © 2020 Ira Sotirova, Antonios Gklavas, Dimitra Papalouka, Sofia Gourtsoyianni, Dimitrios Christodoulou, Ioannis Papaconstantinou
Documenting Collections of Bulgarian Museums. Framing a CIDOC-based Ontological Presentation
No full textReport published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2014The paper offers short analytic survey and comparison between the standard for description of cultural objects, CIDOC-CRM (ISO 21127:2006) and museum passports, inventory books and files, all of which are used in documenting museum artifacts in Bulgaria since 50-s. Three different field-sets have been explored. The fields in use are more than 100. Several case studies and good practices which use CIDOC-CRM, CRMdig, SPECTRUM, LIDO and EDM are shown. The result from their comparison with Bulgarian practices is presented in a table, where 25 fields, taken from Bulgarian passports are listed with respect to three factors: (1) metadata type they are representing, (structural, administrative or descriptive), (2) their corresponding category/class as found in (2) CIDOC-CRM and in (3) EDM. The author is using this correspondence frame for creating a CIDOC-CRM-based referent ontology for description of Bulgarian museum artefacts. A detailed model, based on this frame will be created, with terminology thesaurus attached.Association for the Development of the Information Society, Institute of Mathematics and Informatics Bulgarian Academy of Sciences, Plovdiv University "Paisii Hilendarski
Unusual Case of Urethrorectal Fistula in Adolescence in a Patient with a History of Congenital Anorectal Malformation.
No full textBACKGROUND: Urethrorectal fistula is a rare and debilitating condition. Spontaneous closure is rarely effective, and appropriate management regarding timing of repair and surgical approach remains controversial. CASE PRESENTATION: We present a case of an 18-year-old male found to have a urethrorectal fistula after diagnostic work up for unejaculation. The patient gradually developed recurrent urinary tract infections and urine and semen leak from his rectum. He had a medical history of an anorectal reconstruction in the second postnatal day due to an anorectal malformation. Imaging with a rectal endoscopic ultrasound scan revealed a suprasphincteric urethrorectal fistula that was further confirmed with semirigid urethrocystoscopy and placement of a nitinol guidewire through the urethral fistula orifice. Its anal orifice was 3 cm above the anal verge at the 12th hour of the rectum. The fistula orifice on the rectum was identified with a transanal approach and the fistula was managed with the performance of an advancement mucosal flap and bladder catheterization. The patient developed a recurrence with this approach and finally underwent fistula ligation and reconstruction using a scrotal flap. The patient has not had a recurrence of the fistula during his follow-up. CONCLUSION: This is an unusual case of iatrogenic urethrorectal fistula as it presented in adolescence many years from the initial operation of anorectal reconstruction and with unusual symptoms
“Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report”
No full textAbstractIntroductionPancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of intractable pain which is their main symptom. Decompression options of for the main pancreatic duct are both surgical and advanced endoscopic procedures.Presentation of casesA 64-year-old male with known CP due to alcohol consumption and a 36-year-old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent results.DiscussionOver the last 30 years, endoscopic procedures are developed to manage pancreatic duct strictures and calculi of the main pancreatic duct in CP patients. In both of our cases endoscopic therapy was first attempted but failed to extract the pancreatic duct stones, due to their size and speculations. Modified Puestow procedure was performed for both and it was successful for long term pain relief.ConclusionDespite advancement in endoscopic interventions and less invasive therapies for the management of chronic lithiasic pancreatitis we consider that classic surgical management can be appropriate in certain cases
Liver metastasectomy-cytoreductive surgery- hyperthermic intraperitoneal chemotherapy and ileal pouch-anal anastomosis: A case report
No full textINTRODUCTION: Cytoreductive surgery (CRS) with hyperthermal intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal carcinomatosis that prolong survival in carefully selected patients. At the time of diagnosis, 4-7% of patients with colorectal cancer (CRC) have metastasis to the peritoneum. There is a lack of evidence in the literature if J-pouch can be applied simultaneously with HIPEC to improve quality of life in patients with familial adenomatous polyposis syndrome (FAP) and peritoneal carcinomatosis. CASE PRESENTATION: We describe a case of a 41-year-old Caucasian male with Familial Adenomatous Polyposis which was diagnosed as metastatic colorectal cancer in the liver and peritoneum. He was treated with systemic chemotherapy followed by total proctocolectomy with a J-shaped IPAA, liver metastasectomy, right hemidiaphragm resection, CRS and HIPEC. DISCUSSION: CRS and HIPEC have been implicated with high morbidity and mortality rates. A major independent risk factor correlated with high morbidity is anastomotic failure. J-Pouch formation although considered a technique with high complication rates, improves the quality of life of patients after total proctocolectomy and is related to high patient satisfaction. There are inconclusive data on whether anastomotic failure rates are higher when performing J-Pouch and HIPEC together. CONCLUSIONS: J-Pouch after CRS and HIPEC can be offered as a treatment as long as the patient is carefully selected, in high volume centers with experienced surgeons. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
The Role of TAMIS (Transanal Minimally Invasive Surgery) in the Management of Advanced Rectal Cancer – One Shared Story of Three Exceptional Cases
No full textPurpose of the study: The current gold standard for contemporary treatment of rectal cancer is total mesorectal excision (TME), achieving excellent local disease control and low recurrence rates. However, TME may be associated with postoperative mortality and quality of life deterioration. Therefore, the need to develop less radical treatment strategies has emerged. Transanal minimally invasive surgery (TAMIS) is currently indicated only for early rectal cancer. However, local excision following chemoradiation has yielded promising clinical outcomes in selected cases with more advanced disease. Materials and methods: We describe three cases of patients with advanced rectal cancer, who were managed with TAMIS, either due to patients' unwillingness to tolerate permanent colostomy or due to significant comorbidities. Results: Two of the three patients who also received adjuvant chemoradiation are still in remission for 18 and 15 months respectively. The third patient died early after hospital release due to unrelated causes. Conclusions: Local excision utilizing minimally invasive techniques, alongside with chemoradiotherapy and close follow up can be a viable alternative in carefully selected rectal cancer patients with advanced disease who deny permanent colostomy or are ineligible for major operations
Verbos de movimento do português brasileiro: evidências contra uma tipologia binária / Brazilian Portuguese motion verbs: evidence against a two-way typology
No full textResumo: Neste artigo, analisamos os verbos de movimento do português brasileiro em relação à tipologia linguística binária proposta por Talmy (1985, 2000). Focamos no comportamento sintático dos verbos com o intuito de mostrar que o português brasileiro não se caracteriza como uma língua emoldurada nos verbos (verb-framed language), como proposto pelo autor. Isso ocorre, pois, nessa língua, o sentido de trajetória é representado através de satélites, mesmo em verbos que lexicalizam o sentido de direção em sua raiz. Nós mostramos que o português brasileiro não apresenta um padrão tipológico definido, como tem sido proposto por diferentes autores para várias outras línguas. Concluímos que restrições sintáticas amplas, como a presença de sintagmas preposicionados, de adjuntos adverbiais e de orações subordinadas, determinam como nossa língua expressa as propriedades semânticas trajetória, direção e maneira em sentenças com verbos de movimento.Palavras-chave: português brasileiro; verbos de movimento; tipologia linguística.Abstract: This paper brings an analysis about Brazilian Portuguese motion verbs in relation to the binary linguistic typology proposed by Talmy (1985, 2000). It focuses on the syntactic behavior of those verbs in order to show that Brazilian Portuguese is not a verb-framed language, as proposed by the author. That occurs because in Brazilian Portuguese the meaning of path is expressed by satellites, even in verbs that lexicalize the meaning of direction in their roots. We show that Brazilian Portuguese does not present a definite typological pattern, as has been shown by different authors for several other languages. The conclusion is that broad syntactic constraints, such as the presence of prepositional phrases, adverbial adjuncts and subordinate clauses, determine how Brazilian Portuguese expresses the semantic properties path, direction and manner in sentences with motion verbs.Keywords: Brazilian Portuguese; motion verbs; linguistic typology
