scholarly journals 719 Colovaginal Fistula from Neglected Vaginal Pessary; Fallouts from the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Oyewole ◽  
A Elzaafarany ◽  
A Tawfik ◽  
T Campbell-Smith
Keyword(s):  
Rectovaginal Fistula ◽  
Uterine Prolapse ◽  
White Cell Count ◽  
Recurrent Utis ◽  
Vaginal Pessary ◽  
Intravenous Antibiotics ◽  
End Colostomy ◽  
Colovaginal Fistula ◽  
History Of

Abstract An 86-year-old lady was admitted with a one-week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106 /L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected, and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.

scholarly journals EP.WE.117Colovaginal fistula from neglected vaginal pessary; Fallouts from the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Tawfik ◽  
Bankole Oyewole ◽  
Ahmed Elzaafarany ◽  
Catherine Gilbert ◽  
Tim Campbell-Smith
Keyword(s):  
Rectovaginal Fistula ◽  
Uterine Prolapse ◽  
White Cell Count ◽  
Recurrent Utis ◽  
Vaginal Pessary ◽  
Intravenous Antibiotics ◽  
End Colostomy ◽  
History Of

Abstract An 86 year old lady was admitted with a one week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106/L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis. She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.

scholarly journals Neglected doughnut pessary in the uterine cavity

2019 ◽  
Vol 12 (4) ◽  
pp. e228415 ◽  
Author(s):  
Chutimon Asumpinwong ◽  
Pichai Leerasiri ◽  
Pattaya Hengrasmee
Keyword(s):  
Pelvic Organ Prolapse ◽  
Rectovaginal Fistula ◽  
Uterine Cavity ◽  
Abdominal Hysterectomy ◽  
Pelvic Organ ◽  
Healthcare Personnel ◽  
Vaginal Pessary ◽  
Adjacent Structures

Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Nevertheless, serious complications can occur in neglected patients such as vesicovaginal and rectovaginal fistula, erosion and impaction in adjacent structures. We report a case of neglected pessary found in the uterine cavity. The patient was treated with abdominal hysterectomy with in situ doughnut pessary. Proper pessary care and regular follow-up should be emphasised among patients, caregivers and related healthcare personnel to early detect as well as to avoid complications.

scholarly journals North polar trough formation due to in-situ erosion as a source of young ice in mid-latitudinal mantles on Mars

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. Alexis P. Rodriguez ◽  
Kenneth L. Tanaka ◽  
Ali M. Bramson ◽  
Gregory J. Leonard ◽  
Victor R. Baker ◽  
...  
Keyword(s):  
Katabatic Wind ◽  
Spiral Pattern ◽  
Near Surface ◽  
Valuable Source ◽  
History Of ◽  
North Polar ◽  
Human Exploration ◽  
Erosional Event

AbstractThe clockwise spiral of troughs marking the Martian north polar plateau forms one of the planet’s youngest megastructures. One popular hypothesis posits that the spiral pattern resulted as troughs underwent poleward migration. Here, we show that the troughs are extensively segmented into enclosed depressions (or cells). Many cell interiors display concentric layers that connect pole- and equator-facing slopes, demonstrating in-situ trough erosion. The segmentation patterns indicate a history of gradual trough growth transversely to katabatic wind directions, whereby increases in trough intersections generated their spiral arrangement. The erosional event recorded in the truncated strata and trough segmentation may have supplied up to ~25% of the volume of the mid-latitude icy mantles. Topographically subtle undulations transition into troughs and have distributions that mimic and extend the troughs’ spiraling pattern, indicating that they probably represent buried trough sections. The retention of the spiral pattern in surface and subsurface troughs is consistent with the megastructure’s stabilization before its partial burial. A previously suggested warm paleoclimatic spike indicates that the erosion could have occurred as recently as ~50 Ka. Hence, if the removed ice was redeposited to form the mid-latitude mantles, they could provide a valuable source of near-surface, clean ice for future human exploration.

scholarly journals Development of a Field Deployable Firebrand Flux and Condition Measurement System

2020 ◽  
Author(s):  
Simone Zen ◽  
Jan C. Thomas ◽  
Eric V. Mueller ◽  
Bhisham Dhurandher ◽  
Michael Gallagher ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Time History ◽  
Infrared Camera ◽  
Thermal Conditions ◽  
Particle Characterization ◽  
Fire Dynamics ◽  
Rate Of Spread ◽  
New Instrument ◽  
History Of

AbstractA new instrument to quantify firebrand dynamics during fires with particular focus on those associated with the Wildland-Urban Interface (WUI) has been developed. During WUI fires, firebrands can ignite spot fires, which can rapidly increase the rate of spread (ROS) of the fire, provide a mechanism by which the fire can pass over firebreaks and are the leading cause of structure ignitions. Despite this key role in driving wildfire dynamics and hazards, difficulties in collecting firebrands in the field and preserving their physical condition (e.g. dimensions and temperature) have limited the development of knowledge of firebrand dynamics. In this work we present a new, field-deployable diagnostic tool, an emberometer, designed to provide measurement of firebrand fluxes and information on both the geometry and the thermal conditions of firebrands immediately before deposition by combining a visual and infrared camera. A series of laboratory experiments were conducted to calibrate and validate the developed imaging techniques. The emberometer was then deployed in the field to explore firebrand fluxes and particle conditions for a range of fire intensities in natural pine forest environments. In addition to firebrand particle characterization, field observations with the emberometer enabled detailed time history of deposition (i.e. firebrand flux) relative to concurrent in situ fire behaviour observations. We highlight that deposition was characterised by intense, short duration “showers” that can be reasonably associated to spikes in the average fire line intensity. The results presented illustrate the potential use of an emberometer in studying firebrand and spot fire dynamics.

scholarly journals In Situ exploration of the giant planets

2021 ◽  
Author(s):  
O. Mousis ◽  
D. H. Atkinson ◽  
R. Ambrosi ◽  
S. Atreya ◽  
D. Banfield ◽  
...  
Keyword(s):  
Solar System ◽  
Giant Planets ◽  
Atmospheric Composition ◽  
Formation History ◽  
History Of ◽  
Composition Structure ◽  
Galileo Probe ◽  
Probe Measurements

AbstractRemote sensing observations suffer significant limitations when used to study the bulk atmospheric composition of the giant planets of our Solar System. This impacts our knowledge of the formation of these planets and the physics of their atmospheres. A remarkable example of the superiority of in situ probe measurements was illustrated by the exploration of Jupiter, where key measurements such as the determination of the noble gases’ abundances and the precise measurement of the helium mixing ratio were only made available through in situ measurements by the Galileo probe. Here we describe the main scientific goals to be addressed by the future in situ exploration of Saturn, Uranus, and Neptune, placing the Galileo probe exploration of Jupiter in a broader context. An atmospheric entry probe targeting the 10-bar level would yield insight into two broad themes: i) the formation history of the giant planets and that of the Solar System, and ii) the processes at play in planetary atmospheres. The probe would descend under parachute to measure composition, structure, and dynamics, with data returned to Earth using a Carrier Relay Spacecraft as a relay station. An atmospheric probe could represent a significant ESA contribution to a future NASA New Frontiers or flagship mission to be launched toward Saturn, Uranus, and/or Neptune.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

scholarly journals Gaia DR1 completeness within 250 pc & star formation history of the Solar neighbourhood

2017 ◽  
Vol 12 (S330) ◽  
pp. 148-151 ◽  
Author(s):  
Edouard J. Bernard
Keyword(s):  
Star Formation ◽  
Star Formation History ◽  
Solar Neighbourhood ◽  
The Sun ◽  
Thick Disc ◽  
Formation History ◽  
Magnitude Diagram ◽  
History Of

AbstractWe took advantage of the Gaia DR1 to combine TGAS parallaxes with Tycho-2 and APASS photometry to calculate the star formation history (SFH) of the solar neighbourhood within 250 pc using the colour-magnitude diagram fitting technique. We present the determination of the completeness within this volume, and compare the resulting SFH with that calculated from the Hipparcos catalogue within 80 pc of the Sun. We also show how this technique will be applied out to ~5 kpc thanks to the next Gaia data releases, which will allow us to quantify the SFH of the thin disc, thick disc and halo in situ, rather than extrapolating based on the stars from these components that are today in the solar neighbourhood.

scholarly journals The merger-driven evolution of massive early-type galaxies

2020 ◽  
Vol 15 (S359) ◽  
pp. 62-66
Author(s):  
Carlo Cannarozzo ◽  
Carlo Nipoti ◽  
Alessandro Sonnenfeld ◽  
Alexie Leauthaud ◽  
Song Huang ◽  
...  
Keyword(s):  
Mass Velocity ◽  
Selection Criteria ◽  
Velocity Dispersion ◽  
Ex Situ ◽  
Scaling Relations ◽  
Early Type ◽  
History Of ◽  
Kinematic Properties ◽  
Shed Light

AbstractThe evolution of the structural and kinematic properties of early-type galaxies (ETGs), their scaling relations, as well as their stellar metallicity and age contain precious information on the assembly history of these systems. We present results on the evolution of the stellar mass-velocity dispersion relation of ETGs, focusing in particular on the effects of some selection criteria used to define ETGs. We also try to shed light on the role that in-situ and ex-situ stellar populations have in massive ETGs, providing a possible explanation of the observed metallicity distributions.

Uretero-Iliac artery fistula: a rare cause of haematuria

2020 ◽  
Vol 13 (9) ◽  
pp. e232189
Author(s):  
Natalia Hernandez ◽  
Bethany Desroches ◽  
Eric Peden ◽  
Raj Satkunasivam
Keyword(s):  
Iliac Artery ◽  
Percutaneous Nephrostomy ◽  
Arterial System ◽  
Endoscopic Evaluation ◽  
Stent Removal ◽  
Retrograde Pyelogram ◽  
History Of ◽  
Gross Haematuria ◽  
Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

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