S2054 A Difficult Case of Lymphocytic Esophagitis

<div> <div> <p> </p><div> <div> <div> <p>This work presents the first simulations of the full optical rotation (OR) tensor at coupled cluster with single and double excitations (CCSD) level in the modified velocity gauge (MVG) formalism. The CCSD-MVG OR tensor is origin independent, and each tensor element can in principle be related directly to experimental measurements on oriented systems. We compare the CCSD results with those from two density functionals, B3LYP and CAM-B3LYP, on a test set of 22 chiral molecules. The results show that the functionals consistently overestimate the CCSD results for the individual tensor components and for the trace (which is related to the isotropic OR), by 10-20% with CAM-B3LYP and 20-30% with B3LYP. The data show that the contribution of the electric dipole-magnetic dipole polarizability tensor to the OR tensor is on average twice as large as that of the electric dipole-electric quadrupole polarizability tensor. The difficult case of (1S,4S)-(–)-norbornenone also reveals that the evaluation of the former polarizability tensor is more sensitive than the latter. We attribute the better agreement of CAM-B3LYP with CCSD to the ability of this functional to better reproduce electron delocalization compared with B3LYP, consistently with previous reports on isotropic OR. The CCSD-MVG approach allows the computation of reference data of the full OR tensor, which may be used to test more computationally efficient approximate methods that can be employed to study realistic models of optically active materials. </p> </div> </div> </div> </div> </div>

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The Motivational Power of Moral Beliefs

10.1093/oso/9780198811572.003.0007 ◽

2018 ◽

Author(s):

Joshua May

Keyword(s):

Moral Identity ◽

Motivated Reasoning ◽

Difficult Case ◽

Moral Integrity ◽

Normative Judgment ◽

Moral Beliefs ◽

Moral Hypocrisy ◽

Moral Licensing ◽

Self Interest

Even if we can rise above self-interest, we may just be slaves of our passions. But the motivational power of reason, via moral beliefs, has been understated, even in the difficult case of temptation. Experiments show that often when we succumb, it is due in part to a change in moral (or normative) judgment. We can see this by carefully examining a range of experiments on motivated reasoning, moral licensing, moral hypocrisy, and moral identity. Rationalization, perhaps paradoxically, reveals a deep regard for reason, to act in ways we can justify to ourselves and to others. The result is that we are very often morally motivated or exhibit moral integrity. Even when behaving badly, actions that often seem motivated by self-interest are actually ultimately driven by a concern to do what’s right.

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A141 SPONTANEOUS ESOPHAGEAL PERFORATION: AN UNREPORTED COMPLICATION OF LYMPHOCYTIC ESOPHAGITIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.139 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 128-129

Author(s):

A LAGROTTERIA ◽

A W Collins ◽

A Someili ◽

N Narula

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Case Report ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Esophageal Perforation ◽

Distal Esophagus ◽

Chest Discomfort ◽

History Of ◽

Lymphocytic Esophagitis

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

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Ultrasound-guided Breast Abscess Aspiration in a Difficult Case

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2001.tb02122.x ◽

2001 ◽

Vol 8 (4) ◽

pp. 398-401 ◽

Cited By ~ 24

Author(s):

Michael Blaivas

Keyword(s):

Difficult Case ◽

Breast Abscess ◽

Ultrasound Guided

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P1002Puncture of occluded coronary sinus ostium for left ventricle lead implant Troubleshooting for a difficult case - CASE REPORT

EP Europace ◽

10.1093/ehjci/eux151.183 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii211-iii212

Author(s):

B. Papelbaum ◽

SS. Galvao Filho ◽

JT. Medeiros De Vasconcelos ◽

C. Eduardo Duarte ◽

R. Castro Galvao ◽

...

Keyword(s):

Case Report ◽

Left Ventricle ◽

Coronary Sinus ◽

Difficult Case ◽

Coronary Sinus Ostium ◽

Sinus Ostium

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Students' Perception of a Difficult Case in Psychotherapy

Psychological Reports ◽

10.2466/pr0.1997.81.1.67 ◽

1997 ◽

Vol 81 (1) ◽

pp. 67-75

Author(s):

Sylvia A. Linares ◽

Freddy A. Paniagua ◽

Michael O'Boyle

Keyword(s):

Mental Health ◽

Social Work ◽

Graduate Students ◽

Difficult Case ◽

Health Practice ◽

Mental Health Practice ◽

Present Sample ◽

Definition Of

Paniagua, et al. suggested that the definition of a “difficult” case in psychotherapy implies a relational definition involving the characteristics of the patient, the case, and the therapist. This study concerned this hypothesis with 44 graduate students in social work who received the Difficult Case Questionnaire representing examples of variables across each domain, e.g., motivation of the client, nature of the disorder, generic factors, and orientation of the therapist. The results were compared with the 1993 findings reported by Paniagua, et al., for a group of professionals in mental health practice. As in the earlier study, the present sample also agreed that, although all such domains are important in the formulation of that definition, their importance is not equal. Whereas professionals rated patient's, case's, and therapist's characteristics as the most important order of domains in that definition, students in this study agreed on the order of therapist's, patient's, and case's characteristics.

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