The analysis of the clinical case in the stepped treatment of multiple choledocholithiasis and locally advanced kidney cancer

This article is devoted to the analysis of the clinical case which includes the clinical manifestations and treatment of multiple choledocholithiasis and locally advanced kidney cancer. A staged surgery was performed. Retrograde papillosphincterotomy with cholechocholitholite extraction was done at the first stage. The second stage includes laparotomy, removal of the tumor of the right kidney / adrenal gland as a single block, cholecystectomy after preliminary angiography and embolization of the vessels feeding the tumor. The presented successful observation demonstrates one of the modern approaches in the treatment of patients with comorbid pathology.

Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study

Objective: The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. Methods: A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. Results: 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3–99.5%), negative predictive value of 24.5% (95% CI = 16.2–34.4%), specificity of 88.5% (95% CI = 69.9–97.6%), and sensitivity of 63.8% (95% CI = 56.6–70.5%) for successful observation. Conclusion: The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. Advances in knowledge: The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.

Quantity of hemoperitoneum is associated with need for intervention in patients with stable blunt splenic injury

BackgroundIn patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). We sought to analyze whether the quantity of HP was associated with need for intervention.MethodsThis retrospective cohort study included adult trauma patients with hemodynamically stable BSI admitted to six trauma centers between 2014 and 2016. Quantity of HP was defined as small (perisplenic blood or blood in Morrison’s pouch), moderate (blood in one or both pericolic gutters), or large (additional finding of free blood in the pelvis). Multivariate logistic regression was performed to identify predictors of intervention with SAE or fNOM versus successful observation.ResultsThere were 360 patients: hemoperitoneum was noted in 214 (59%) patients, of which the quantity was small in 92 (43%), moderate in 76 (35.5%), and large in 46 (21.5%). Definitive management was as follows: 272 (76%) were observed and 88 (24%) had intervention (83 SAE, 5 fNOM). The rate of intervention was univariately associated with quantity of HP, even after stratification by American Association for the Surgery of Trauma (AAST) grade. After adjustment, larger quantities of HP significantly increased odds of intervention (p=0.01). Compared with no HP, the odds of intervention were significantly increased for moderate HP (OR=3.51 (1.49 to 8.26)) and large HP (OR=2.89 (1.03 to 8.06)), with similar odds for small HP (OR=1.21 (0.46 to 2.76)). Other independent predictors of intervention were higher AAST grade, older age, and presence of splenic vascular injury.ConclusionGreater quantity of HP was associated with increased odds of intervention, with no difference in risk for moderate versus large HP. These findings suggest quantity of HP should be incorporated in the management algorithm of BSI as a consideration for angiography and/or embolization to maximize splenic preservation and reduce the risk of splenic rupture.Level of evidenceIII, retrospective epidemiological study.

Successful observation of orangutans in the wild with thermal-equipped drones

We investigated the efficacy of a drone equipped with a thermal camera as a potential survey tool to detect wild Bornean orangutans (Pongo pygmaeus) and other tropical primates. Using the thermal camera we successfully detected 41 orangutans and a troop of proboscis monkeys, all of which were confirmed by ground observers. We discuss the potential advantages and limitations of thermal-equipped drones as a tool to complement other methods, and the potential of this technology for use as a future survey tool.

The SOFIA Telescope in Full Operation

The SOFIA telescope is a 2.5[Formula: see text]m class Cassegrain telescope with Nasmyth focus. It is the largest telescope ever integrated into an aircraft. The telescope is exposed to the stratospheric environment during the observations and the fact that the telescope’s foundation, which is a Boeing 747 SP, is vibrating and moving in all degrees of freedom (DoF) requires a highly specialized and sophisticated design. Based on the telescope of its predecessor, the Kuiper Airborne Observatory (KAO), the SOFIA telescope design had to evolve to accommodate a telescope 2.5 times the size of KAO. In several hundred successful observation flights, the telescope proved that it performs not only as specified, but is also extremely reliable. Nevertheless, the telescope’s software and hardware are continuously upgraded to optimize its performance without interfering with the observation schedules to reach even more ambitious image size and pointing jitter goals to enable additional science cases. In addition, manufacturing of the line-replaceable units is in process to ensure that the SOFIA telescope can perform without any major interruptions for the envisioned 20 year lifetime. Some of the main features of the SOFIA telescope are its suspension assembly (SUA), which decouples the telescope from SOFIA’s fuselage with air springs and a spherical oil bearing, the extremely stiff Nasmyth tube (NT), which connects cavity and cabin mounted components of the dumbbell design, and the Secondary Mirror Assembly (SMA), which is used for chopping and fast pointing corrections. This paper aims to give an overview of these and all other major telescope subsystems in operation today. In addition, some of the upgrades, either implemented recently or slated for implementation shortly, are introduced.

Who Has an Unsuccessful Observation Care Stay?

Background: With the recent increase use of observation care, it is important to understand the characteristics of patients that utilize this care and either have a prolonged observation care stay or require admission. Methods: We a conducted a retrospective cohort study utilizing 5% sample data from Medicare patients age ≥65 years that was nationally representative in the year 2013. We performed a generalized estimating equation (GEE) logistic regression analysis to evaluate the relationship between an unsuccessful observation stay (defined as either requiring an inpatient admission from observation or having a prolonged observation stay) compared to having successful observation care. Observation cut offs of “successful” vs. “unsuccessful” were based on the CMS 2 midnight rule. Results: Of 154,756 observation stays in 2013, 19 percent (n = 29,604) were admitted to the inpatient service and 34,275 (22.2%) had a prolonged observation stay. The two diagnoses most likely to have an unsuccessful observation stay were intestinal infections (OR 1.56, 95% CI 1.32–1.83) and pneumonia (OR 1.26, 95% CI 1.13–1.41). Conclusion: We found patients placed in observation care with intestinal infections and pneumonia to have the highest odds of either being admitted from observation or having a prolonged observation stay.

The first successful observation of in-cell NMR signals of DNA and RNA in living human cells

The first observation of NMR signals of DNA/RNA introduced into living human cells by means of pore formation by SLO and resealing.

Eta-mesic nuclei: Past, present, future

Eta-mesic nucleus or the quasibound nuclear state of an eta (η) meson in a nucleus is caused by strong interaction force alone. This new type of nuclear species, which extends the landscape of nuclear physics, has been extensively studied since its prediction in 1986. In this paper, we review and analyze in great detail the models of the fundamental η–nucleon interaction leading to the formation of an η–mesic nucleus, the methods used in calculating the properties of a bound η, and the approaches employed in the interpretation of the pertinent experimental data. In view of the successful observation of the η–mesic nucleus 25 Mg η and other promising experimental results, future direction in searching for more η–mesic nuclei is suggested.

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

ABSTRACT Introduction The management of a pneumothorax (PTX) either by observation or with a tube thoracostomy (TT) has long been dictated by practitioner discretion rather than objective criteria. Many physicians elect to routinely place a TT for traumatic PTX, particularly when patients undergo positive pressure ventilation (PPV). Placement of unnecessary TT exposes patients to avoidable morbidity and may prolong hospitalization. Based on prior work establishing a cutoff, we hypothesized that all PTXs ≤35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for PPV. Materials and methods Retrospective review of all patients diagnosed with a PTX between 1/2009 and 2/2013. All PTXs visible on chest computed tomography (CT) were identified. Any patient with an associated significant hemothorax or those patients who were moribund were excluded. All PTXs were measured by measuring the perpendicular distance of the largest air pocket between the chest wall and the mediastinal or pulmonary structure. Management of the PTX was categorized as observation or TT. Observed PTXs were labeled as success or failure with failure defined as enlargement of the PTX or physiologic deterioration, requiring a TT. Results Out of 165 PTXs, 17 (10.3%) measured >35 mm, whereas 148 (89.7%) measured ≤35 mm. Of the 17 > 35 mm, 15 (88.2%) received immediate TT. Of the two PTXs >35 mm which were observed, one received a delayed TT for a pleural effusion (6 days after PTX diagnosis) and one (5.9 %) was safely observed. Of the 148 PTXs which measured ≤35 mm, 10 (6.8%) received immediate TT. Of the 138 remaining PTXs, 129 (93.5%) were safely managed without TT. Six (4.3%) of the PTXs initially observed eventually required TT placement for enlargement of the PTX. Only one of those six had manifested ongoing desaturations prior to TT. The remaining three cases received TT for reasons unrelated to the PTX. Of the 27 PPV cases in the ≤35 mm cohort, none contributed to the six failures. A cutoff measurement of 35 mm demonstrated a negative predictive value (NPV) of 95.7% in its ability to predict successful observation of the PTX with an area under the receiver operating characteristic (ROC) curve of 0.90. Conclusion All PTXs measuring ≤35 mm perpendicular to the chest wall without physiologic derangement may be safely observed independent of the need for mechanical ventilation. How to cite this article Cropano C, Mesar T, Turay D, King D, Yeh D, Fagenholz P, Velmahos G, de Moya MA. Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe. Panam J Trauma Crit Care Emerg Surg 2015;4(2):48-53.