A Case of Chronic Intestinal Pseudo-Obstruction

Scleroderma is a systemic disease characterized by the deposition of excessive collagen and other matrix elements in the skin as well as in multiple internal organs. Scleroderma can be classified into diffuse cutaneous disease and limited cutaneous disease. Limited cutaneous disease is characterized by skin involvement limited to the hands, face, feet, and forearms; it includes the CREST variant (calcinosis, raynauds, esophageal dysmotility, sclerodactyly, and telangiectasia). Diffuse cutaneous disease is characterized by skin involvement as well as early and diffuse visceral involvement. Clinically significant gastrointestinal involvement occurs in approximately 50% of all patients with scleroderma. The esophagus is the most common site of involvement followed by the ano-rectum, small bowel, colon, and stomach. Several recent reviews of the gastrointestinal manifestations of scleroderma have been written. Here, a case of diffuse gastrointestinal scleroderma presenting as chronic intestinal pseudo-obstruction is described

A Case of Facial Pain and Vesicular Rash

The patient is an 81 year old male with a past medical history of non-insulin dependent diabetes mellitus, hypertension, and dyslipidemia who presents with a complaint of facial pain. The pain began 3-4 days before presentation to his primary care physician. It was constant and intense. There was no history of similar head or facial pain, visual changes, jaw claudication, rash, tearing, nasal discharge, photophobia, phonophobia, sinus congestion, tooth ache, nor neurologic complaints. There was no relief with over-the-counter analgesics. A rash subsequently developed over his left forehead and scalp. At presentation, vital signs were stable. Skin examination revealed an erythematous vesicular rash over the left forehead. Eye examination revealed pupils equal, round, and reactive to light. Visual fields and acuity were intact. No papilledema was noted on fundoscopic exam. Ear, nose, mouth, and throat were normal. Neurologic examination revealed normal mental status, intact cranial nerves, full strength and sensation, symmetric normal reflexes, and normal gait. Neck, heart, lung, abdomen, and extremity examinations were normal. The patient was diagnosed with herpes zoster. His condition was complicated by chronic pain in the distribution of the original rash

Nevirapine Hepatotoxicity: Case Report and Discussion

Nevirapine (viramune) is a nonnucleoside reverse transcriptase inhibitor commonly used in combination with other antiretroviral medicines in the treatment of HIV/AIDS. The safety profile of nevirapine, as determined by review of prospective clinical trials, reports rash with an incidence of 16% as the most common side effect. Clinical hepatitis is reported to occur with an incidence of 1%. A review of the literature shows many case reports of nevirapine-induced hepatotoxicity in patients receiving both treatment and prophylaxis for HIV. The purpose of this case report is to stress the importance of early recognition and withdrawal of the offending drug

DSCALE_mod16: A Model for Disaggregating Microwave Satellite Soil Moisture with Land Surface Evapotranspiration Products and Gridded Meteorological Data

Improving the spatial resolution of microwave satellite soil moisture (SM) products is important for various applications. Most of the downscaling methods that fuse optical/thermal and microwave data rely on remotely sensed land surface temperature (LST) or LST-derived SM indexes (SMIs). However, these methods suffer from the problems of “cloud contamination”, “decomposing uncertainty”, and “decoupling effect”. This study presents a new downscaling method, referred to as DSCALE_mod16, without using LST and LST-derived SMIs. This model combines MODIS ET products and a gridded meteorological data set to obtain Land surface Evaporative Efficiency (LEE) as the main downscaling factor. A cosine-square form of downscaling function was adopted to represent the quantitative relationship between LEE and SM. Taking the central part of the United States as the case study area, we downscaled SMAP (Soil Moisture Active and Passive) SM products with an original resolution of 36km to a resolution of 500m. The study period spans more than three years from 2015 to 2018. In situ SM measurements from three sparse networks and three core validation sites (CVS) were used to evaluate the downscaling model. The evaluation results indicate that the downscaled SM values maintain the spatial dynamic range of original SM data while providing more spatial details. Moreover, the moisture mass is conserved during the downscaling process. The downscaled SM values have a good agreement with in situ SM measurements. The unbiased root-mean-square errors (ubRMSEs) of downscaled SM values is 0.035 m3/m3 at Fort Cobb, 0.026 m3/m3 at Little Washita, and 0.055 m3/m3 at South Fork, which are comparable to ubRMSEs of original SM estimates at these three CVS

Urban morphological analysis : contributions of the historic-geographic approach associated with the creation of a multilayers database

The historical-geographical approach emerged from the works of German geographer M.R.G. Conzen and his studies centered on the transformation and permanence of the urban forms. The Conzenian thought structures its morphological analysis on two axioms: [1] the tripartite vision, understood as the systematic and hierarchized composition of the urban form; [2] a periodization of the forms in morphological periods, that is, a temporal organization of the historical and evolutionary periods. In this method, the association of the tripartite vision, in each morphological period, leads to the comprehension of the evolution of the urban landscape (PEREIRA, COSTA et al., 2013). In recent studies regarding urban morphology, the relevance of the historical-geographical approach of the Conzenian School is observed, in the inter national debate and in the increasing influence of its concepts in the urban planning field (WHITEHAND, 2007). However, according to Whitehand (2007), the urban administration of a number of countries limits their historical approach to the architectural scale. As a result, the urban historical process and its relation to the geographic insertion are little explored: “There is little sense of how these relate to one another and are part of a process of change: awareness of historical-geographical processes is poorly developed (WHITEHAND, 2007, p4). Taking this need into account, researchers have adopted the GIS technology (Geographic Information System) as an interdisciplinary analysis tool: The Historical GIS. According to historian-geographer Anne Kelly Knowles, Historical GIS provides the tools to combine history and geography to study patterns of change over space and time (KNOWLES, 2002). In the presented framework, the objective is to contribute to the methodology of the historical-morphological analysis. Considering the increasing Conzenian influence in urban planning (WHITEHAND, 2007), a method for reading the landscape is proposed, which through the Historical GIS, allows the comprehension of the dynamics of the transformation of the territory from the formation period to its current configuration, being able, subsequently, to offer subsidies to the local urban administration. As an object of study, the work covered the district scale, in accordance with its period of one year, and prioritized the districts whose database was incomplete or non-existent. In this context, it chose Sousas, one of six districts of the municipality of Campinas, in the State of São Paulo, located in the east and at a distance of approximately 10km from the city center

Rebleeding rate after interventional therapy directed by capsule endoscopy in patients with obscure gastrointestinal bleeding

<p>Abstract</p> <p>Background</p> <p>The precise role of capsule endoscopy in the diagnostic algorithm of obscure gastrointestinal bleeding has yet to be determined. Despite the higher diagnostic yield of capsule endoscopy, the actual impact on clinical outcome remains poorly defined. The aim of this study was to evaluate the follow-up results of patients with obscure gastrointestinal bleeding to determine which management strategies after capsule endoscopy reduced rebleeding.</p> <p>Methods</p> <p>All patients in whom the cause of obscure gastrointestinal bleeding was investigated between May 2004 and March 2007 were studied retrospectively. We evaluated the clinical outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy using the rebleeding rate as the primary outcome.</p> <p>Results</p> <p>Seventy-seven patients with obscure gastrointestinal bleeding underwent capsule endoscopy. Capsule endoscopy identified clinically significant findings that were thought to be the sources of obscure gastrointestinal bleeding in 58.4% of the patients. The overall rebleeding rate was 36.4%. The rebleeding rate was significantly higher among patients with insignificant findings than among those with significant findings (<it>p </it>= 0.036). Among the patients in whom capsule endoscopy produced significant findings, the rebleeding rate of the patients who underwent therapeutic interventions was significantly lower than that in those who did not undergo intervention (9.5% vs 40.0%, <it>p </it>= 0.046).</p> <p>Conclusion</p> <p>Follow-up and further aggressive interventions are necessary for patients with obscure gastrointestinal bleeding and significant capsule endoscopy findings to reduce the chance of rebleeding.</p

A Case of Jejunal Adenocarcinoma Diagnosed by Preoperative Double Balloon Enteroscopy

Despite a thorough history, physical examination, and complete diagnostic workup, the correct diagnosis of small-intestinal malignancy is established preoperatively in only 50% of cases; an exploratory laparotomy is often required. However, recent advances in endoscopic technologies, such as double-balloon enteroscopy (DBE), have been shown to facilitate the preoperative diagnosis of these tumors. Confirmation of malignancy using DBE in equivocal cases may greatly increase both patients' acceptance of surgery and the confidence of the physician planning a surgical resection. We describe herein the case of a 53-year-old woman with a stage I jejunal adenocarcinoma that was diagnosed by DBE and treated by laparoscopic jejunectomy. Histopathological examination revealed a stage I jejunal adenocarcinoma (T2N0M0) without muscularis propria invasion, lymphovascular invasion, or lymph-node metastasis

Contribution à l'étude du corium d'un réacteur nucléaire accidenté (aspects puissance résiduelle et thermodynamique des systèmes U-UO2 et UO2-ZrO2)

Ce travail est une contribution à l'étude de la délocalisation précoce et au relâchement des produits de fission lors de la formation d'un corium issu d'un accident de réacteur nucléaire. Le premier axe de ce travail est l'analyse du refroidissement du corium. Nous avons calculé la contribution à la puissance de chaque élément du corium au cours du temps. Les éléments majoritaires sont représentés mais l'ajout du Pu, Mo et Nb a été proposé. La prise en compte des dernières données expérimentales de relâchement aboutit à une perte de 25% de puissance résiduelle hors du corium entre l'arrêt d'urgence et dix jours. Le second axe de réflexion concerne la délocalisation précoce observée lors des expériences Vercors. Une sélection critique sur les systèmes U-UO2 et UO2-ZrO2 est réalisée. Pour compléter les données peu nombreuses et incohérentes des mesures d'activité thermodynamique par spectrométrie de masse ont été effectuées. L'activité de UO2 sur UO2-ZrO2 présente une déviation positive par rapport à l'idé à 2200 K et se rapproche de l'idéalité à 2400K. Toutes les données ont été utilisées pour optimiser les systèmes avec Thermo-Calc. Ce travail a permis de calculer les ternaires et de définir l'orientation des conodes nécessaires pour analyser la densité des phrases métalliques et oxydes du corium.GRENOBLE1-BU Sciences (384212103) / SudocSudocFranceF