Transduodenal resection of a choledochocele (type III choledochal cyst) with sphincteroplasty: A case report

AbstractCholedochal cysts are rare congenital anomalies of the biliary tree which may progress to obstruction or malignancy. Of the five Todani variants, choledochocele, or type III choledochal cyst is the rarest. In this case report, we describe a previously healthy 10-year old female who presented with a choledochocele and was treated by near-total excision with transposition of the common channel, resulting in an extended sphincteroplasty

Sudden elevation of liver enzymes in a 64-year-old patient: a case report

Eradication of Helicobacter pylori usually consists of a 7-day course of triple therapy including metronidazole or amoxicillin plus clarithromycin plus a proton pump inhibitor. We report about a rare adverse event of Hp eradication in a patient with moderate chronic and moderate active pangastritis. Shortly after the end of treatment cholestatic hepatitis occurred which was most likely related to clarithromycin, perhaps enhanced by amoxicillin. Since liver dysfunction was self-limited, no further treatment was required. In summary, clinicians should be aware about the presented rare adverse event of Helicobacter pylori eradication treatment for a close monitoring of those patients and rapid management of acute liver failure

Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

The human keratins: biology and pathology

The keratins are the typical intermediate filament proteins of epithelia, showing an outstanding degree of molecular diversity. Heteropolymeric filaments are formed by pairing of type I and type II molecules. In humans 54 functional keratin genes exist. They are expressed in highly specific patterns related to the epithelial type and stage of cellular differentiation. About half of all keratins—including numerous keratins characterized only recently—are restricted to the various compartments of hair follicles. As part of the epithelial cytoskeleton, keratins are important for the mechanical stability and integrity of epithelial cells and tissues. Moreover, some keratins also have regulatory functions and are involved in intracellular signaling pathways, e.g. protection from stress, wound healing, and apoptosis. Applying the new consensus nomenclature, this article summarizes, for all human keratins, their cell type and tissue distribution and their functional significance in relation to transgenic mouse models and human hereditary keratin diseases. Furthermore, since keratins also exhibit characteristic expression patterns in human tumors, several of them (notably K5, K7, K8/K18, K19, and K20) have great importance in immunohistochemical tumor diagnosis of carcinomas, in particular of unclear metastases and in precise classification and subtyping. Future research might open further fields of clinical application for this remarkable protein family

reBURB: Redefining the Suburban Family Unit Under a New Construction Ecology

“Our structures might be machines for living in, but there was no longer much about them that was alive.” -William McDonough, Cradle to Cradle Home ownership is a significant driver within American culture. In Florida single-family homes represent one of the largest components of our built surroundings, significantly impacting the environment through material use and energy consumption. Currently, homes typically are built with little regard to the environmental context. By designing for the immediate goal of separation from the elements, they do not provide for convenient spatial expansion or adaptability, using material assemblies that do not lend themselves to be recycled, reused, or returned to the earth safely. Homes are obsolete before they have been constructed. The Florida single-family home, once closely linked to its environment both physically and experientially, has devolved into a statically defined entanglement of systems with a primary goal of separating humans from natural systems by providing a climatically fixed space with little regard to the environment. This separation has served to detach people and the buildings that they inhabit from their environmental context and responsibilities rendering the underlying physical, biological, and chemical processes of their environmental context irrelevant. By viewing the dwelling unit and its components as not within their end function but part of a greater cycle, this elevates the dwelling unit to more than inanimate machine that separates but to a symbiotic entity within a greater construction ecology. Through the analysis of historical Florida dwellings it is the intent to distill a design approach that reconnects with the environmental context through use of passive systems and experiential environmental connection. Further study is to focus on modular systems and connections within building skins and structures to develop methods that allow for the assembly, disassembly and adaption thus strengthening the construction ecology by facilitating the reuse of materials. By redefining the construction cycle and the connection to the local environment of the Florida single-family home it is the intent to establish a contemporary construction methodology that acts to not only be environmentally efficient but environmentally effective for its user and its context

reBURB: Redefining the Suburban Family Unit Under a New Construction Ecology

“Our structures might be machines for living in, but there was no longer much about them that was alive.” -William McDonough, Cradle to Cradle Home ownership is a significant driver within American culture. In Florida single-family homes represent one of the largest components of our built surroundings, significantly impacting the environment through material use and energy consumption. Currently, homes typically are built with little regard to the environmental context. By designing for the immediate goal of separation from the elements, they do not provide for convenient spatial expansion or adaptability, using material assemblies that do not lend themselves to be recycled, reused, or returned to the earth safely. Homes are obsolete before they have been constructed. The Florida single-family home, once closely linked to its environment both physically and experientially, has devolved into a statically defined entanglement of systems with a primary goal of separating humans from natural systems by providing a climatically fixed space with little regard to the environment. This separation has served to detach people and the buildings that they inhabit from their environmental context and responsibilities rendering the underlying physical, biological, and chemical processes of their environmental context irrelevant. By viewing the dwelling unit and its components as not within their end function but part of a greater cycle, this elevates the dwelling unit to more than inanimate machine that separates but to a symbiotic entity within a greater construction ecology. Through the analysis of historical Florida dwellings it is the intent to distill a design approach that reconnects with the environmental context through use of passive systems and experiential environmental connection. Further study is to focus on modular systems and connections within building skins and structures to develop methods that allow for the assembly, disassembly and adaption thus strengthening the construction ecology by facilitating the reuse of materials. By redefining the construction cycle and the connection to the local environment of the Florida single-family home it is the intent to establish a contemporary construction methodology that acts to not only be environmentally efficient but environmentally effective for its user and its context

SUPRAPAT: A value added patent database -- A personal view and vision

A short look back to the beginnings of patent documentation in industry shows that the austerity of data available in the old patent databases of the 1960s and 1970s (because of insufficient memory and disk space) still has effects on the multitude of present databases. Millions of patent records added each year may lead to frustration of many users when confronted with rising costs and search times. The resulting non-use of some bases is dangerous for patent departments and leads to diminishing revenues for database producers. This gives rise to the proposal of one and only one comprehensive logical (not necessarily physical) patent database containing extended data. Many of them are available in one or the other of the existing databases, but not all together in one file. EPO, Derwent and CA are regarded as centers of competence for bibliographic data collecting and correcting; abstracting; indexing and deep analysis, respectively.