271 research outputs found
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
Systematic review of peri-operative prognostic biomarkers in pancreatic ductal adenocarcinoma
No full textItem does not contain fulltextBACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) continues to be associated with a poor prognosis. This systematic review aimed to summarize the literature regarding potential prognostic biomarkers to facilitate validation studies and clinical application. METHODS: A systematic review was performed (2004-2014) according to PRISMA guidelines. Studies were ranked using REMARK criteria and the following outcomes were examined: overall/disease free survival, nodal involvement, tumour characteristics, metastasis, recurrence and resectability. RESULTS: 256 biomarkers were identified in 158 studies. 171 biomarkers were assessed with respect to overall survival: urokinase-type plasminogen activator receptor, atypical protein kinase C and HSP27 ranked the highest. 33 biomarkers were assessed for disease free survival: CD24 and S100A4 were the highest ranking. 17 biomarkers were identified for lymph node involvement: Smad4/Dpc4 and FOXC1 ranked highest. 13 biomarkers were examined for tumour grade: mesothelin and EGFR were the highest ranking biomarkers. 10 biomarkers were identified for metastasis: p16 and sCD40L were the highest ranking. 4 biomarkers were assessed resectability: sCD40L, s100a2, Ca 19-9, CEA. CONCLUSION: This review has identified and ranked specific biomarkers that should be a primary focus of ongoing validation and clinical translational work in PDAC
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No full textNot AvailableIN THIS PAPER , THE AUTHOR HAS BRIEFLY ENUMERATED SOME OF THE VITAL ISSUES PERTAINING TO AGROFORESTRY RESEARCH. ACCORDING TO HIM, AGROFORESTRY IS A MULTIVARIATE COMPLEX SYSTEM AND ITS ANALYSIS BY SIMPLE DESIGNS OR METHODS GENERALLY USED FOR CROPS HAVE SEVERAL LIMITATIONS. IN AN AGROFORESTRY SYSTEM, POSITION OF TREE REMAINS FIXED WHICH INTRODUCES COMPETITION PHASES IN WELL- DEFINED ORIENTATIONS.Not Availabl
Ileocecal Intussusception Caused by an Appendiceal Neoplasm
No full textMucinous appendiceal neoplasm occurs in less than 1 % of appendicectomies. Majority of what is known in the literature is about pseudomyxoma peritonei, which exists as its disseminated form. Pictorial imagery of its pre-disseminated form is rarely observed. We present in a case report form a case of low-grade mucinous neoplasm of the appendix resulting in focal intussusception including images captured from this unique case that will become a learning case for readers of the journal.No Full Tex
Successful treatment of acute vein graft thrombosis precipitated by delayed sepsis and duodenocaval fistulization
No full text[...]with increasing recognition that adoption of a liberal visceral en bloc resection may achieve greater local control in retroperitoneal sarcomas and that adjuvant radiotherapy may provide additional benefit,2 surgeons are adopting a radical approach toward tumor resection involving the right upper abdominal viscera, which may have contributed to the observation of duodenocaval fistula formation.3, 4 An astute clinical acumen is essential in being able to make an early diagnosis and institute appropriate operative treatment.No Full Tex
Influence of Spherical and Cylindrical Capsules on Pressure Transients in Hydraulic Pipelines
No full textTitle: Influence of Spherical and Cylindrical Capsules on Pressure Transients in Hydraulic Pipelines, Author: Rajbir S. Samra, Location: ThodeThe influence of capsules on pressure transients in hydraulic pipelines has been reported in this dissertation. This experimental investigation was carried out for flow velocities of 1 to 4 ft/sec. for both cylindrical and spherical capsules. Shock waves were generated by a fast closing valve in a 1 in. diameter pipe and pressure transients were measured for a train of cylindrical capsules of diameter 0.875 in. and 0.95 in. The spherical capsules were of diameter 0.75 in. and 0.875 in. A theoretical analysis for this type of waterhammer problem using a perturbation technique has been obtained. The theoretical solution was found to be in agreement with the experimental observations for cylindrical capsules.ThesisMaster of Engineering (ME
Pancreatic Metastasectomy—an Analysis of Survival Outcomes and Prognostic Factors
No full textBackground: The pancreas and peripancreatic region may be a site of metastasis from distant sites. Recent data suggest that pancreatic metastasectomy may achieve long-term survival. We seek to examine our experience with this metastasectomy by reporting the perioperative and survival outcomes. Methods: Patients undergoing resection of isolated pancreatic metastasis were identified from a prospective pancreatic surgical database at the Department of Gastrointestinal Surgery, North Shore campus of the University of Sydney between January 2004 and June 2015 and selected for retrospective review. Data on operative morbidity and mortality were reported. Survival analysis was performed using the Kaplan–Meier method. Results: Fifteen patients underwent pancreatic metastasectomy after a median disease-free interval of 63 months (range 0 to 199). Pancreatoduodenectomy was performed in six patients (40 %), distal pancreatectomy with or without splenectomy in three patients (20 %), and pancreatectomy with other visceral organ resection in six patients (40 %). Major complications occurred in six patients (40 %) without mortality. The median survival was 40 months (95 % CI 24.3 to 53.7), and 1-, 3-, and 5-year survival were 76, 48, and 31 % respectively. Cox proportional hazard model identified margin negative resection (hazard ratio (HR) 10.5; P = 0.044) as a predictor of improved survival. Conclusion: Long-term survival may be achieved in selected patients with pancreatic metastasis through pancreatic metastasectomy with acceptable morbidity. Selection of patients should be individualized and based on their primary disease origin, biological behavior of the tumor, resectability of the tumor, and the relative effectiveness of systemic or targeted therapies.No Full Tex
Systematic Review and Meta-Analysis of Enucleation Versus Standardized Resection for Small Pancreatic Lesions
No full textBackground: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93–98) and 84 % (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.No Full Tex
Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: A meta-analysis
No full textBackground Robotic cholecystectomy is a novel approach that offers the surgeon improved high-definition, 3-dimensional views and enhanced instrument ergonomics, which represent a technical development from previous operative platforms that include conventional and single-incision laparoscopy. This review compares its short-term outcomes with conventional laparoscopic cholecystectomy by a meta-analysis. Methods A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases (January 1990–October 2015). Studies identified were appraised with standard selection criteria. Data were extracted and a meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Results Thirteen studies, 12 retrospective trials and one randomized controlled trial comprising 1,589 patients (laparoscopic cholecystectomy, n = 921; robotic cholecystectomy, n = 668) were examined. There was a trend of a greater median total operative time (115.3 min vs 128.0 min; pooled MD = 31.22, 95% confidence interval = −2.48 to 59.96; Z = 2.13; P = .03) and preoperative time (32.4 min vs 53.4 min; pooled MD = 20.98, 95% confidence interval = 15.74 to 26.23; Z = 7.84; P < .001) in the robotic cholecystectomy group. Intraoperative complications (P = .52), conversion rate (P = .06), estimated blood loss (P = .55), postoperative complications (P = .28), duration of hospital stay (P = .36), and readmission rate (P = .85) were similar between both groups. Conclusion Robotic cholecystectomy is associated with greater operative times related primarily to the preparatory phase of the operation but with similar safety and perioperative outcome as conventional laparoscopic cholecystectomy. For it to gain acceptance, future studies are required to define specific measures to quantify equipment benefits to the surgeon and to evaluate the potential advantage of its use in the acute setting.No Full Tex
The representation of woman in Jasmina Musabegović's novel Skretnice
No full textTITLE: The representation of a woman in Jasmina Musabegović's novel Skretnice AUTHOR: Bc. Samra Kovač DEPARTMENT: Institute of Ethnology and Central European and Balkan Studies SUPERVISOR: doc. PhDr. Alenka Jensterle Doležal, CSc ABSTRACT: The topic of the thesis is the analysis of the 1986 novel Skretnice by Bosnian author Jasmina Musabegović (1941), especially with regard to the position of women and their image in the novel. From a gender perspective, we will be interested in her psychological profile in relation to the other characters, especially in the question of her intimacy and relationship with the other gender. The aim of the thesis will be to explore the position of the woman or her emancipation. Another aim will be to present the inner world of the woman and her experience of the patriarchal world. The thesis will include a literary analysis as well as a study of the historical, cultural and social aspects of the Bosnian reality. I will focus on the period of the modern realist novel, in which modernity is represented by the suggestiveness of the new Bosnian prose and its structure, and I will present the analysis in the context of Bosnian and South Slavic prose at the end of the 20th century. KEYWORDS: Bosnian literature, Jasmina Musabegović, picture of woman in literature, modern women..
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