scholarly journals Extreme Achalasia Presenting as Anorexia Nervosa

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
P. J. Goldsmith ◽  
B. Decadt
Keyword(s):  
Anorexia Nervosa ◽  
Early Stage ◽  
Treatment Options ◽  
Laparoscopic Approach ◽  
Laparoscopic Heller Myotomy ◽  
Feeding Jejunostomy ◽  
Definitive Surgery ◽  
One Year ◽  
Laparoscopic Feeding Jejunostomy

Background. Achalasia may lead to cachexia if not diagnosed in an early stage. Surgery in cachectic patients is hazardous and complications may result in a protracted recovery or even death. Different treatment options have been described. In this paper, we report a stepwise surgical laparoscopic approach which appears to be safe and effective.Methods. Over a one-year period, a patient with a body mass index (BMI) below 17 being treated for anorexia nervosa was referred with dysphagia. Because of the extreme cachexia, a laparoscopic feeding jejunostomy (LFJ) was fashioned to enable long-term home enteral feeding. The patient underwent a laparoscopic Heller myotomy (LHM) when the BMI was normal.Results. The patient recovered well following this stepwise approach.Conclusion. Patients with advanced achalasia usually present with extreme weight loss. In this small group of patients, a period of home enteral nutrition (HEN) via a laparoscopically placed feeding jejunostomy allows weight gain prior to safe definitive surgery.

New advances in the diagnosis and management of hepatocellular carcinoma

BMJ ◽  
2020 ◽  
pp. m3544 ◽  
Author(s):  
Ju Dong Yang ◽  
Julie K Heimbach
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Treatment ◽  
Early Stage ◽  
Treatment Options ◽  
Intermediate Stage ◽  
Phase Iii ◽  
Advanced Hepatocellular Carcinoma ◽  
Long Term Outcomes ◽  
Stage Disease

ABSTRACT Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.

ADDRESS (ADministration of DRotrecogin alfa [activated] in Early stage Severe Sepsis) long-term follow-up: One-year safety and efficacy evaluation*

2007 ◽  
Vol 35 (6) ◽  
pp. 1457-1463 ◽  
Author(s):  
Pierre-Francois Laterre ◽  
Edward Abraham ◽  
Jonathan M. Janes ◽  
Benjamin L. Trzaskoma ◽  
Nancy L. Correll ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Drotrecogin Alfa ◽  
Early Stage ◽  
Efficacy Evaluation ◽  
Safety And Efficacy ◽  
Drotrecogin Alfa Activated ◽  
Long Term Follow Up ◽  
One Year

scholarly journals Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Kenneth Sluis ◽  
Hyon Kim ◽  
Yuling He ◽  
Beatrice Wong ◽  
Xiangbing Wang
Keyword(s):  
Primary Hyperparathyroidism ◽  
Chart Review ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Long Term Stability ◽  
Feasible Option ◽  
One Year

Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.

scholarly journals P161 EMERGENCY LAPAROSCOPIC REPAIR OF A PARASTOMAL HERNIA

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
María Jose Cuevas ◽  
Diego Pinilla ◽  
Alejandro Sánchez ◽  
José Tinoco ◽  
Luis Tallón ◽  
...  
Keyword(s):  
Ct Scan ◽  
Parastomal Hernia ◽  
Laparoscopic Approach ◽  
Synthetic Mesh ◽  
Long Term Results ◽  
Short And Long Term ◽  
One Year ◽  
The One ◽  
Sugarbaker Technique

Abstract Aim The aim of this video is to present the laparoscopic approach to an incarcerated parastomal hernia, using the modified Sugarbaker technique. Material and Methods A 50-year-old man with a definitive terminal colostomy after undergoing an abdominoperineal resection due to a rectal cancer, consulted in the emergency room with abdominal pain and an incarcerated mass below the colostomy, without evidence of intestinal obstruction. A CT scan was performed, with the finding of infarcted epiploic appendages inside the parastomal hernia. After evaluation of the case, emergency surgery was decided, opting for a laparoscopic approach to the parastomal hernia, employing the modified Sugarbaker technique. Results Following the dissection of the hernial sac and resection of the necrotic fat content, a partial closure of the hernial orifice was done. A hernioplasty was performed using a composite synthetic mesh, that was fixated with helical sutures. After surgery, the patient evolved favorably and was discharged 72 hours after the procedure. In the one year of follow-up, the patient was asymptomatic and there were no data of recurrence either on the clinical examination or the control CT scan. Conclusions The laparoscopic approach to an incarcerated parastomal hernia is possible and safe when performed in well-selected cases by the hands of experienced surgeons, offering good short and long-term results.

scholarly journals Biologging of emperor penguins – attachment techniques and associated deployment performance

2021 ◽  
Author(s):  
Aymeric Houstin ◽  
Daniel P. Zitterbart ◽  
Alexander Winterl ◽  
Sebastian Richter ◽  
Víctor Planas-Bielsa ◽  
...  
Keyword(s):  
Early Stage ◽  
Weddell Sea ◽  
Emperor Penguin ◽  
Marine Animals ◽  
Emperor Penguins ◽  
Negative Impacts ◽  
One Year ◽  
Sea Area ◽  
The Three Rs

An increasing number of marine animals are equipped with biologgers, to study their physiology, behaviour and ecology, often for conservation purposes. To minimise the impacts of biologgers on the animals′ welfare, the Refinement principle from the Three Rs framework (Replacement, Reduction, Refinement) urges to continuously test and evaluate new and updated biologging protocols. Here, we propose alternative and promising techniques for emperor penguin (Aptenodytes forsteri ) capture and on–site logger deployment that aim to mitigate the potential negative impacts of logger deployment on these birds. We equipped adult emperor penguins for short–term (GPS, Time–Depth Recorder (TDR)) and long–term (i.e. planned for one year) deployments (ARGOS platforms, TDR), as well as juvenile emperor penguins for long-term deployments (ARGOS platforms) in the Weddell Sea area where they had not yet been studied. We describe and qualitatively evaluate our protocols for the attachment of biologgers on–site at the colony, the capture of the animals and the recovery of the devices after deployment. We report unprecedented recaptures of long–term equipped adult emperor penguins (50% of equipped individuals recaptured after 290 days). Our data demonstrate that the traditional technique of long–term attachment by gluing the biologgers directly to the back feathers is detrimental to the birds. It causes excessive feather breakage and the loss of the devices at an early stage. We therefore propose an alternative method of attachment for back–mounted devices. This technique led to successful year–round deployments on 37.5% of the equipped juveniles. Finally, we also disclose the first deployments of leg–bracelet mounted TDRs on emperor penguins. Our findings highlight the importance of monitoring potential impacts of biologger deployments on the animals and the need to remain critical towards established and new protocols.

scholarly journals Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Rakhee K. Ramakrishnan ◽  
Tarek Kashour ◽  
Qutayba Hamid ◽  
Rabih Halwani ◽  
Imad M. Tleyjeh
Keyword(s):  
Virus Disease ◽  
Treatment Options ◽  
Underlying Disease ◽  
Anxiety And Depression ◽  
Direct Effects ◽  
Daily Life Activities ◽  
Immunological Mechanisms ◽  
Significant Disability ◽  
One Year

More than one year since its emergence, corona virus disease 2019 (COVID-19) is still looming large with a paucity of treatment options. To add to this burden, a sizeable subset of patients who have recovered from acute COVID-19 infection have reported lingering symptoms, leading to significant disability and impairment of their daily life activities. These patients are considered to suffer from what has been termed as “chronic” or “long” COVID-19 or a form of post-acute sequelae of COVID-19, and patients experiencing this syndrome have been termed COVID-19 long-haulers. Despite recovery from infection, the persistence of atypical chronic symptoms, including extreme fatigue, shortness of breath, joint pains, brain fogs, anxiety and depression, that could last for months implies an underlying disease pathology that persist beyond the acute presentation of the disease. As opposed to the direct effects of the virus itself, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be largely responsible for the appearance of these lasting symptoms, possibly through facilitating an ongoing inflammatory process. In this review, we hypothesize potential immunological mechanisms underlying these persistent and prolonged effects, and describe the multi-organ long-term manifestations of COVID-19.

Adjuvant (adj) bevacizumab (B) plus dose-dense (dd) doxorubicin/cyclophosphamide (AC) followed by nanoparticle albumin- bound paclitaxel (nab-p) in early stage breast cancer (BC) patients (pts): Cardiac safety

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 567-567 ◽  
Author(s):  
M. N. Dickler ◽  
T. Traina ◽  
K. Panageas ◽  
R. Steingart ◽  
C. Dang ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Early Stage ◽  
Standard Of Care ◽  
Cardiac Monitoring ◽  
Cardiac Safety ◽  
Lv Dysfunction ◽  
Long Term Follow Up ◽  
One Year ◽  
Dose Dense

567 Background: Dose dense, q2 wk AC-paclitaxel (T) is superior to q3 wk therapy (Rx) (Citron, JCO 2003). The risk of congestive heart failure (CHF) with ddAC-T is not increased at <1%. In MBC, B improves PFS when added to T (Miller, SABCS 2005). It is unclear if doxorubicin plus B increases risk of CHF. Hence, we are testing the cardiac safety of ddAC-nab-p with concurrent B as adj therapy. Based upon the accepted cardiac event (CE) rate of ≤4% in trials with adj trastuzumab (an agent with known cardiac toxicity), we designed this study with similar monitoring & tolerability thresholds. The primary endpoint is cardiac safety, defined as discontinuation of B due to cardiac death from LV dysfunction or symptomatic CHF (dyspnea and LVEF<50%). Secondary endpoints: toxicity, disease-free & overall survival. Methods: Eligible pts have resected HER2(-) BC and normal LVEF. Rx consists of q2wk AC (60/600 mg/m2) ×4 then nab-p (260 mg/m2) x4 with pegfilgrastim on Day 2 plus B for one year (10mg/kg IV q2wk ×8 with chemoRx then B 15mg/kg q3wk); radiation & endocrine Rx per standard of care. MUGA obtained at baseline & mos. 2, 6, 9, 18. Pts with significant asymptomatic ↓LVEF during Rx may have B held per protocol. These pts are not counted as CEs but will have long-term cardiac monitoring. Accrual goal is 75 pts. If ≥3 CE (∼4.7%) or >1 cardiac death from LV dysfunction, B + ddAC-nab-p will not be considered safe. Results: 44 pts have enrolled, median (med) age 46.5 yrs (33–67). 28 pts have baseline & month 2 LVEF data: med baseline LVEF 68% (61–82), med LVEF at mo. 2 after ddAC+B 68% (53–75); 1 pt had an 18 point asymptomatic drop to 53% - B held but reinitiated in 4 wks with repeat LVEF 63%. 12 pts completed nab-p+B but none have reached the 6 mo. MUGA. Rx-related Gr 3/4 toxicity: neutropenia gr4 (6.8%), diarrhea gr3 (2.3%), hypertension gr3 (2.3%), neuropathy gr 3 (2.3%), fatigue gr 3 (2.3%), mucositis gr 3 (2.3%). 4 pts have withdrawn from study Rx, but only 1 due to toxicity including gr3 fatigue, mucositis & neuropathy. Conclusions: No LV dysfunction has been observed with B + ddAC-nab-p; this trial is on-going. Long-term follow-up and analysis of troponin, renin and circulating endothelial & tumor cells are planned. No significant financial relationships to disclose.

scholarly journals CHERISH: Understanding Suicide Clusters tHrough ExploRIng Self Harm behaviours

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Marcos Delpozo-Banos ◽  
Keith Hawton ◽  
David Gunnel ◽  
Keith Lloyd ◽  
Jonathan Scourfield ◽  
...  
Keyword(s):  
Early Stage ◽  
Mixed Methods Study ◽  
Long Term Outcomes ◽  
Psychological Determinants ◽  
The Social ◽  
Self Harm ◽  
Suicide Clusters ◽  
One Year ◽  
Suicide Cluster

ABSTRACTObjectivesIn Wales suicide accounts for 20% of deaths among men aged 15-24 years and almost 10% of deaths among women of that age. Up to 2% of suicides in young people are thought to occur in clusters. Yet, our understanding of the social and psychological determinants of suicide clusters is limited, with none of the cross-discipline theories proposed having been tested via in-depth research on an actual cluster. This HCRW funded mixed methods study had qualitative and quantitative data linkage work packages to explore here the factors that trigger a suicide cluster, cause it to continue and then eventually subside. ApproachThe data of 1866 individuals’ who attended the Princes of Wales Hospital emergency department (ED) with self harm between 1st January 2006 and 31st December 2013 was anonymously linked within the Secure Anonymised Information Linkage (SAIL) databank. We had a matching rate of 99.7. We performed both time-trend analysis on this data around the apparant suicide cluster in 2007-08, and a comparison across three defined populations: those attending ED at the time of the cluster; those attending during the same period, one year before; and those attending one year after. ResultsWe are able to present the characteristics of those who attend ED during a cluster with self harm compared to those who attend at other times and their long term outcomes. ConclusionTo inform the development of appropriate policy to respond to suicide clusters at an early stage.

The Residual Bolt Force and the Sealing Performance of Flanged Connections With Expanded PTFE Gaskets (Based on Test Results for One Year)

2012 ◽  
Author(s):  
Takashi Kobayashi ◽  
Taiki Hagiri ◽  
Kengou Nishiura ◽  
Masaaki Hiratsuka ◽  
Katsutoyo Itoi
Keyword(s):  
Thermal Expansion ◽  
Room Temperature ◽  
Early Stage ◽  
Thermal Characteristic ◽  
Temperature Dependency ◽  
Test Results ◽  
Viscoelastic Characteristic ◽  
Sealing Performance ◽  
One Year

It is known that bolt forces reduce significantly after tightening bolted flanged connections in which expanded PTFE gaskets are used. Bolts are often post-tightened in practice after initial tightening to compensate for the reduction of bolt forces. The viscoelastic characteristic of expanded PTFE gaskets is thought to be the main cause for the phenomenon. Some gasket users are not confident whether the bolt forces remain above a minimum required gasket load until next maintenance. However, the long term characteristics of the residual bolt forces and the sealing performance of flanged connections have not been clarified yet. In this study, using flanged connections with expanded PTFE gaskets, the reduction of bolt forces and the change in the sealing performance were measured at room temperature for one year. Based on the test results, the residual bolt force and the sealing performance were studied. It was clarified that bolt forces converges to a certain level at early stage within almost 1000 hours. After that, the bolt forces were significantly affected by the ambient temperature change. This is because the thermal expansion of PTFE material is high and also the thermal characteristic of PTFE material has a temperature dependency. It was confirmed that although the bolt force reduced significantly at early stage, it is maintained in long-term. The sealing performance was improved due to the increased compression of gasket.

Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele

2019 ◽  
Vol 157 (06) ◽  
pp. 695-705
Author(s):  
Tim Schmid ◽  
Elisabeth Strehl ◽  
Regina Trollmann ◽  
Raimund Forst ◽  
Albert Fujak
Keyword(s):  
Clinical Medicine ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Treatment Options ◽  
Positive Influence ◽  
Lower Limbs ◽  
Duration Of Treatment ◽  
Folic Acid Supplements ◽  
Individual Concepts

Abstract Background Even today, myelomeningocele (MMC) is still encountered in clinical medicine and its incidence has not decreased over the last 20 years despite a known reduction in risk due to the use of folic acid supplements. The spectrum of clinical symptoms is extremely broad and, depending on the level of the defect, varies from mild to severe. Subject to the degree of paralysis, patients are reliant on the use of orthopaedic aids and orthoses for the treatment of primary contractures and deformities and the prevention of secondary ones. This forms the basis for attaining or maintaining mobility in many patients. The objective of the study was to determine the practical application of the proposed Ferrari concept for the provision of orthoses for children and adults. Patients and Material The retrospective study comprised medical records of 180 patients (97 m) with an average age of 19.44 years (3 – 52 years, SD 9.3) at the time of investigation. The average duration of treatment was 15.34 years (1 – 38 years, SD 8.96). Data relating to deformities of the vertebral column and lower limbs, provision of hydrocephalus shunts and orthoses, and patient mobility was evaluated. Results Most patients were given systematic treatment with orthoses at an early stage. In 58,9% of cases, it was possible to implement the proposed concept for providing patients with dynamic orthoses, whereby the treatment concept was more difficult to implement with high lumbar lesions than with lower lesions. Moreover, a decrease in the patientsʼ mobility with increasing age was noticeable. Some 42.3% of adult patients were able to walk with marked variations in mobility in relation to the different levels of lesions. Conclusion Taking into consideration the complexity of both the clinical picture and therefore the provision of orthopaedic devices, the result of the implementation of the proposed orthotic concept can be considered positive. Similarly, early commencement of provision of orthoses and hence the possibility of achieving a positive influence on later mobility can be considered a success. The need for individual concepts and further development in order to increase mobility particularly in the case of patients with thoracic or high lumbar lesions is evident. A more comprehensive provision of information to patients regarding orthotic treatment options and their consequences for prophylaxis and quality of life should be an important component of interdisciplinary long-term patient care.

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