Esophageal Stents: Placement, Complications, Tips, and Tricks

AbstractEsophageal stents are widely used to treat a variety of problems, most commonly malignant dysphagia. Malignant dysphagia can be present in patients with unresectable, resectable, and potentially resectable cancer. Esophageal stents are also utilized to treat esophageal strictures, fistulas, perforations, and leaks. Stent placement usually requires both endoscopic and fluoroscopic guidances, but can be done with either modality safely. Most stents are placed distally and across the gastroesophageal junction, but proximal stent placement (which requires more precise placement) can also be performed. Complications include bleeding and perforation (which are rare) as well as migration, tumor overgrowth, and tumor ingrowth (which are more common). The techniques of placement of an esophageal stent with some tips and tricks regarding placement and management of complications are reviewed in the given video. This article is part of an expert video encyclopedia

A measurement of the 4He(g,n) reaction from 23 < Eg < 70 MeV

A comprehensive set of 4He(g,n) absolute cross-section measurements has been performed at MAX-lab in Lund, Sweden. Tagged photons from 23 < Eg < 70 MeV were directed toward a liquid 4He target, and neutrons were identified using pulse-shape discrimination and the Time-of-flight Technique in two liquid-scintillator detector arrays. Seven-point angular distributions have been measured for fourteen photon energies. The results have been subjected to complementary Transition-coefficient and Legendre-coefficient analyses. The results are also compared to experimental data measured at comparable photon energies as well as Recoil-Corrected Continuum Shell Model, Resonating Group Method, and Effective Interaction Hyperspherical-Harmonic Expansion calculations. For photon energies below 29 MeV, the angle-integrated data are significantly larger than the values recommended by Calarco, Berman, and Donnelly in 1983.Comment: 16 pages, 14 figures, some more revisions, submitted to Physical Review

Analysis and compensation for errors in electrical impedance tomography images and ventilation-­related measures due to serial data collection

Electrical impedance tomography (EIT) is increasingly being used as a bedside tool for monitoring regional lung ventilation. However, most clinical systems use serial data collection which, if uncorrected, results in image distortion, particularly at high breathing rates. The objective of this study was to determine the extent to which this affects derived parameters. Raw EIT data were acquired with the GOE­MF II EIT device (CareFusion, Höchberg, Germany) at a scan rate of 13 images/s during both spontaneous breathing and mechanical ventilation. Boundary data for periods of undisturbed tidal breathing were corrected for serial data collection errors using a Fourier based algorithm. Images were reconstructed for both the corrected and original data using the GREIT algorithm, and parameters describing the filling characteristics of the right and left lung derived on a breath by breath basis. Values from the original and corrected data were compared using paired t­ tests. Of the 33 data sets, 23 showed significant differences in filling index for at least one region, 11 had significant differences in calculated tidal impedance change and 12 had significantly different filling fractions (p = 0.05). We conclude that serial collection errors should be corrected before image reconstruction to avoid clinically misleading results

On the number of excursion sets of planar Gaussian fields

37 pages, 14 figures37 pages, 14 figures37 pages, 14 figure

Adhesions due to peritoneal carcinomatosis caused by a renal carcinoma leading to mechanical gastric outlet obstruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gastric outlet obstruction is a clinical syndrome caused by a variety of mechanical obstructions. Peptic ulcer disease used to be responsible for most gastric outlet obstruction, but in the last 40 years the prevalence of malignant tumors has risen significantly. Adhesive disease is an infrequent and insidious cause of mechanical gastric outlet obstruction.</p> <p>Case presentation</p> <p>We report the case of a 78-year-old Caucasian man who had a clinical history of a right nephrectomy for malignancy three years earlier and who was admitted for a severe gastric outlet obstruction (score of 1) confirmed both by an upper endoscopy and by a fluoroscopic view after contrast injection. A computed tomography scan and a laparotomy, with omental biopsies, showed a peritoneal carcinomatosis with the development of abdominal adhesions that prompted an abnormal gastric rotation around the perpendicular axis of his antrum with a dislocation in the empty space of his right kidney. Symptoms disappeared after surgical bypass through a gastrojejunostomy.</p> <p>Conclusions</p> <p>Our patient experienced a very rare complication characterized by the development of adhesions due to peritoneal carcinomatosis caused by a renal carcinoma treated with nephrectomy. These adhesions prompted an abnormal dislocation of his antrum, as an internal hernia, in the empty space of his right kidney.</p

Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets

<p>Abstract</p> <p>Background</p> <p>As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method.</p> <p>Methods</p> <p>Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003. Their electronic medical records were reviewed to verify whether the medical records positively indicate presence of a diabetic foot ulcer in diagnoses, medical assessments, or consults. For each method, five measures of accuracy and agreement were evaluated using data from medical records as the gold standard.</p> <p>Results</p> <p>Our medical record reviews show that all methods had sensitivity > 92% but their specificity varied substantially between 74% and 91%. A method used in Harrington et al. (2004) was the most accurate with 94% sensitivity and 91% specificity and produced an annual prevalence of 3.3% among VA users with diabetes nationwide. A new and simpler method consisting of two codes (707.1× and 707.9) shows an equally good accuracy with 93% sensitivity and 91% specificity and 3.1% prevalence.</p> <p>Conclusions</p> <p>Our results indicate that the Harrington and New methods are highly comparable and accurate. We recommend the Harrington method for its accuracy and the New method for its simplicity and comparable accuracy.</p

Reaction rates and transport in neutron stars

Understanding signals from neutron stars requires knowledge about the transport inside the star. We review the transport properties and the underlying reaction rates of dense hadronic and quark matter in the crust and the core of neutron stars and point out open problems and future directions.Comment: 74 pages; commissioned for the book "Physics and Astrophysics of Neutron Stars", NewCompStar COST Action MP1304; version 3: minor changes, references updated, overview graphic added in the introduction, improvements in Sec IV.A.

Dynamics of conflicts in Wikipedia

In this work we study the dynamical features of editorial wars in Wikipedia (WP). Based on our previously established algorithm, we build up samples of controversial and peaceful articles and analyze the temporal characteristics of the activity in these samples. On short time scales, we show that there is a clear correspondence between conflict and burstiness of activity patterns, and that memory effects play an important role in controversies. On long time scales, we identify three distinct developmental patterns for the overall behavior of the articles. We are able to distinguish cases eventually leading to consensus from those cases where a compromise is far from achievable. Finally, we analyze discussion networks and conclude that edit wars are mainly fought by few editors only.Comment: Supporting information adde

A strong conditional mutualism limits and enhances seed dispersal and germination of a tropical palm

Seed predation and seed dispersal can have strong effects on early life history stages of plants. These processes have often been studied as individual effects, but the degree to which their relative importance co-varies with seed predator abundance and how this influences seed germination rates is poorly understood. Therefore, we used a combination of observations and field experiments to determine the degree to which germination rates of the palm Astrocaryum mexicanum varied with abundance of a small mammal seed predator/disperser, Heteromysdesmarestianus, in a lowland tropical forest. Patterns of abundance of the two species were strongly related; density of H. desmarestianus was low in sites with low density of A. mexicanum and vice versa. Rates of predation and dispersal of A. mexicanum seeds depended on abundance of H. desmarestianus; sites with high densities of H. desmarestianus had the highest rates of seed predation and lowest rates of seed germination, but a greater total number of seeds were dispersed and there was greater density of seedlings, saplings, and adults of A. mexicanum in these sites. When abundance of H. desmarestianus was experimentally reduced, rates of seed predation decreased, but so did dispersal of A. mexicanum seeds. Critically, rates of germination of dispersed seeds were 5 times greater than undispersed seeds. The results suggest that the relationship between A. mexicanum and H. desmarestianus is a conditional mutualism that results in a strong local effect on the abundance of each species. However, the magnitude and direction of these effects are determined by the relative strength of opposing, but related, mechanisms. A. mexicanum nuts provide H. desmarestianus with a critical food resource, and while seed predation on A. mexicanum nuts by H. desmarestianus is very intense, A. mexicanum ultimately benefits because of the relatively high germination rates of its seeds that are dispersed by H. desmarestianus