187,201 research outputs found
Endoscopic Management of Recurrent Acute Pancreatitis
No full textThis review aims to summarize the role of endoscopic therapy in the management and outcomes of recurrent acute pancreatitis (RAP). RAP is a clinical entity characterized by repeated episodes of acute pancreatitis in the setting of a normal gland or chronic pancreatitis (CP). The aetiology of RAP can be identified in about 70% of cases; for the remaining cases, the term “idiopathic” (IRAP) is used. However, advanced diagnostic techniques may reduce the percentage of IRAP to 10%. Recognized causes of RAP are gallstone disease, including microlithiasis and biliary sludge, sphincter of Oddi dysfunction (SOD), pancreatic ductal abnormalities (either congenital or acquired) interfering with pancreatic juice or bile outflow, genetic mutations, and alcohol consumption. SOD, as a clinical entity, was recently revised in the Rome IV consensus, which only recognized type 1 dysfunction as a true pathological condition, while type 2 SOD was defined as a suspected functional biliary sphincter disorder requiring the documentation of elevated basal sphincter pressure to be considered a true clinical entity and type 3 was abandoned as a diagnosis and considered functional pain. Endoscopic therapy by retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) has been proven effective when a mechanical obstruction is found and can be removed. If an obstruction is not documented, few treatment options are available to prevent the recurrence of pancreatitis and progression toward chronic disease. In gallstone disease, endoscopic biliary sphincterotomy (EBS) is effective when a dilated common bile duct or biliary sludge/microlithiasis is documented. In type 1 SOD, biliary or dual sphincterotomy is generally successful, while in type 2 SOD, endotherapy should be reserved for patients with documented sphincter dysfunction. However, in recent years, doubts have been expressed about the real efficacy of sphincterotomy in this setting. When sphincter dysfunction is not confirmed, endotherapy should be discouraged. In pancreas divisum (PD), minor papilla sphincterotomy is effective when there is a dilated dorsal duct, and the success rate is the highest in RAP patients. In the presence of obstructive conditions of the main pancreatic duct, pancreatic endotherapy is generally successful if RAP depends on intraductal hypertension. However, despite the efficacy of endotherapy, progression toward CP has been shown in some of these patients, mainly in the presence of PD, very likely depending on underlying genetic mutations. In patients with IRAP, the real utility of endotherapy still remains unclear; this is because several unknown factors may play a role in the disease, and data on outcomes are few, frequently contradictory or uncontrolled, and, in general, limited to a short period of time
[Giovanni Battista Testoni (1900), funerary sculpture]
No full textFrom Berresford: Giovanni Battista Testoni (1900), Enrico Butti, Cimitero di Giubiano, Varese.Worker at rest.Title from Berresford
L'INASPERIMENTO DELLA PUNIBILITA' DELLA TOSSICODIPENDENZA E L'INVALIDAZIONE DEL LAVORO PSICOTERAPEUTICO
No full textIl presente lavoro , che rispetta l’approccio socio-costruzionista elaborato in Salvini, Testoni, Zamperini (2002), affronta il problema relativo alla revisione in senso proibizionista del DPR 390/90 in discussione in Parlamento con la bozza di disegno di legge secondo la versione del 13.11.2003 . L’articolo intende mostrare come il problema della tossicodipendenza nella società occidentale contemporanea sia un referente simbolico di crisi, ossia si accede ad esso nel dibattito politico per costruire rappresentazioni di una paura – quella provata verso tossicodipendente e il suo mondo – che, per quanto profonda, risulta sostenibile. Ricordando quanto indicato da Galimberti (2002), secondo cui la differenza tra paura e angoscia si gioca all’interno del credere di poter o non poter dominare il pericolo e che per gestire la prima la si riduce all’ambito della seconda, viene ipotizzato che siffatta operazione abbia una funzione difensiva perché permette di creare rappresentazioni ritenute gestibili per proteggersi dall’angoscia più radicale evocata da quanto di realmente pericoloso viene percepito come incontrollabile. Ma questa operazione giocata a livello di rappresentazione ha un costo elevato sulla realtà sociale, che viene pagato dai tossicodipendenti ai quali è dunque attribuita la funzione di capro espiatorio. Lasciando sullo sfondo le modalità con cui il potere dominante facilita e asseconda la costruzione della rappresentazione del “tossicodipendente da punire” per produrre effetti rassicuranti sulla popolazione, si considerano i problemi che derivano per il lavoro terapeutico allorquando tali posizioni politiche invalidino l’intervento di solidarietà sociale. In particolare si considera la vanificazione dell’intervento in Comunità Terapeutica [CT], passando attraverso le considerazioni relative alla fiducia messa in gioco nella relazione di cura, ove – nel rispetto della prospettiva della riduzione del danno – è invece lasciato al tossicodipendente il tempo per attribuire “in prima persona” il senso della propria astinenza per un progetto di vita diverso da quello prodotto dalla coazione all’identità deviante
Implementation in the ANSYS finite element code of the electric vector potential T-Ω,Ω formulation
No full text
TOXICITY AND HEALTH EFFECTS OF ORTHOCHLORO-BENZYLIDENE-MALONONITRILE (CS GAS)
No full textThe CS gas has repeatedly been used as a tear gas by police forces during manifestations and riots, in Europe, in the United States and elsewhere. Our study is aimed to examine toxicity and health effects on humans of CS gas, following the people exposure to CS gas in Valsusa (Italy), during the 2011-2015 period. The claims that the CS gas is not toxic are counterbalanced by many findings by recent studies, showing many toxic effects, especially in case of misuse of the gas, or in weak and sensitive subjects. Adoption of the precaution principle seems, in this case, recommendable. The use of CS gas by police forces for riot control should therefore be abandoned, substituted by other countermeasures
A SUB-MODELING APPROACH FOR THE ELECTROMECHANICAL DISRUPTION ANALYSIS OF THE ITER ICH ANTENNA
No full textA novel approach for the electromechanical disruption analysis of the ITER Ion Cyclotron antenna is proposed. It is based on the use of the sub-modeling technique and can also be used for the analysis of other tokamak's in-vessel and out-vessel components. The disruption phenomenon is simulated by using a Finite Element model of one ITER sector and by imposing the plasma current density decay. A subsequent detailed electromagnetic analysis of the antenna and of the neighbouring components is performed by using the sub-modeling technique considering as boundary conditions the results of the previous analysis. Finally a transient mechanical analysis is performed and stresses, displacements, forces, and torques applied in the antenna structure are computed
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