Bouveret\u27s Syndrome: Literature Review.

It was in 1896 that Bouveret\u27s syndrome acquired its name after the French physician Leon Bouveret, who published two case reports in Revue de Medecin. Bouveret\u27s syndrome describes gastric outlet obstruction secondary to an impacted gallstone. The gallstone reaches the small bowel through a bilioenteric fistula as a consequence of chronic inflammation and adherence between the biliary system and the bowels which increase the intraluminal pressure and leads to secondary wall ischemia and wall perforation with gallstone passage into the bowel. Bouveret\u27s syndrome\u27s prevalence is highest among elderly women. Despite the rarity of Bouveret\u27s syndrome, it can cause notable morbidity and mortality rates. We underwent a review of literature about Bouveret syndrome to increase awareness of its occurrence and potentially life-threatening complications

Prevalence of Herpes Simplex Virus 1 and 2 in a Sexually Transmitted Disease Clinic in Miami

The Prevalence of HSV-1 and HSV-2 among STD clinics in Miami is not known. The objective of this study was to evaluate infection rates of HSV 1 and 2, and to describe the socio-demographic characteristics, sexual orientation and co-infection with HIV and other STIs, in individuals attending a Sexually Transmitted Diseases (STD) clinic in Miami. A cross-sectional study of 663 patients tested for HSV type-specific serology or herpes culture during the year 2007 was performed. An overall infection rate of HSV-1 was 42.1% and 36.7% for HSV-2. Statistically higher infection rates for HSV-1and 2 were seen among Hispanics (56.7%, 54.4%) compared to non-Hispanic black (36.80%, 41.70%) and non-Hispanic white patients (6.1%, 3.5%) respectively. Females showed higher HSV-2 infection rates over males, 41.6% vs. 58.4%; p = 0.03. HSV-1 and 2 infection rates were 60.2% and 57.6% among foreign-born individuals, in contrast to 39.8% and 42.4% found among persons born in the United States. Our data shows high infection rates for HSV-1 and 2 in this community, and especially among the Hispanic population. Efforts to decrease acquisition among the Hispanic population should be a focus of future STI prevention programs

Infectious Syphilis in Non-Hispanic Blacks and Hispanics in an Urban STD Clinic

Syphilis is a complex infectious disease caused by Treponema pallidum and acquired through sexual contact or vertical transmission. The natural history of syphilis is divided in primary, secondary, latent and tertiary stages. The syphilis epidemic has evolved over the years. National rates of syphilis infection dropped to the lowest in 2000 and have since increased in certain populations. Men who have sex with men (MSM) account for 60% of new infections and high rates occur in individuals with human immune deficiency virus co-infection. This study describes and compares the demographic characteristics, risk factors, and clinical presentation ofinfectious syphilis cases diagnosed in the Miami-Dade Health Department STD clinic among the two main ethnicities (non-Hispanic Black and Hispanic)

Postoperative fluid collection after hybrid debranching and endovascular repair of thoracoabdominal aortic aneurysms

ObjectiveHybrid thoracic endovascular aneurysm repair (H-TEVAR) to include visceral and renal debranching has emerged as a potential therapeutic option for thoracoabdominal aneurysms (TAAA). This study was performed to characterize the frequently noted development of postoperative fluid collections surrounding the bypass grafts.MethodsAll patients undergoing H-TEVAR from 2000-2010 (n = 39, 43.6% male) were identified. One hundred thirty-two bypasses were constructed (median 4 per patient) using either polyester (30), thin-walled polytetrafluoroethylene (ePTFE, 100) or saphenous vein (2). Follow-up computed tomography (CT) imaging was routinely performed at 1 and 6 months, and annually thereafter.ResultsOf the 37 patients with one follow-up CT, 20 (54.1%) were found to have fluid collections. The natural history of the 17 patients with collections and further follow-up imaging was variable, with 2 resolving, 6 stable, and 9 enlarging. Two patients with collections developed evidence of graft infection requiring reoperation. Two patients with enlarging sterile collections required evacuation for symptoms. By multivariate analysis, both preoperative creatinine (P = .005) and number of bypasses constructed (P = .04) independently correlated with the development of a fluid collection.ConclusionsPostoperative fluid collections following hybrid debranching procedures identified in this series represent a unique complication not previously described. The subsequent clinical course of these fluid collections is variable and ranges from benign to frank graft infection and relate both to patient factors, as well as specific operative strategies. Longer-term studies with more robust numbers of patient numbers are warranted to determine whether this complication may limit the long-term durability of this procedure

Postoperative fluid collection after hybrid debranching and endovascular repair of thoracoabdominal aortic aneurysms

ObjectiveHybrid thoracic endovascular aneurysm repair (H-TEVAR) to include visceral and renal debranching has emerged as a potential therapeutic option for thoracoabdominal aneurysms (TAAA). This study was performed to characterize the frequently noted development of postoperative fluid collections surrounding the bypass grafts.MethodsAll patients undergoing H-TEVAR from 2000-2010 (n = 39, 43.6% male) were identified. One hundred thirty-two bypasses were constructed (median 4 per patient) using either polyester (30), thin-walled polytetrafluoroethylene (ePTFE, 100) or saphenous vein (2). Follow-up computed tomography (CT) imaging was routinely performed at 1 and 6 months, and annually thereafter.ResultsOf the 37 patients with one follow-up CT, 20 (54.1%) were found to have fluid collections. The natural history of the 17 patients with collections and further follow-up imaging was variable, with 2 resolving, 6 stable, and 9 enlarging. Two patients with collections developed evidence of graft infection requiring reoperation. Two patients with enlarging sterile collections required evacuation for symptoms. By multivariate analysis, both preoperative creatinine (P = .005) and number of bypasses constructed (P = .04) independently correlated with the development of a fluid collection.ConclusionsPostoperative fluid collections following hybrid debranching procedures identified in this series represent a unique complication not previously described. The subsequent clinical course of these fluid collections is variable and ranges from benign to frank graft infection and relate both to patient factors, as well as specific operative strategies. Longer-term studies with more robust numbers of patient numbers are warranted to determine whether this complication may limit the long-term durability of this procedure

Open and endovascular repair of the nontraumatic isolated aortic arch aneurysm

ObjectiveRepair of isolated aortic arch aneurysms (nontraumatic) by either open (OAR) or endovascular (TEVAR) methods is associated with need for hypothermic circulatory arrest, complex debranching procedures, or use of marginal proximal landing zones. This study evaluates outcomes for treatment of this cohort.MethodsOf 2153 patients undergoing arch repair (1993-2013), 137 (mean age, 60 years) were treated with isolated arch resection for nontraumatic aneurysms. Treatment was by open (n = 93), hybrid (n = 11), or TEVAR (n = 33) methods, with the last two approaches reserved for poor OAR candidates. Treatment was predominantly for saccular (n = 53) or fusiform (n = 30) aneurysms or dissection (n = 15). Rupture was present in 15%. Prior aortic repair was performed in the ascending (n = 30), arch (n = 40), descending (n = 24), or abdominal (n = 9) aorta. Propensity score adjustment was performed for multivariable analysis to account for baseline differences in patient groups as well as treatment selection bias.ResultsEarly mortality was seen in nine patients (7%). Morbidity included stroke (n = 9), paraplegia (n = 1), and need for dialysis (n = 5) or tracheostomy (n = 10). A composite outcome of death and stroke was independently predicted by advancing age (P = .055) and performance of a hybrid procedure (P = .012). The 15-year survival was 59%, with late mortality predicted by increasing age, presence of peripheral vascular disease, and perioperative stroke (all P < .05). The 10-year freedom from aortic rupture or reintervention was 75% and was higher after OAR (2-year OAR, 94% vs TEVAR or hybrid, 78%; P = .018). After propensity-adjusted Cox regression analysis, both prior abdominal aortic aneurysmectomy (P = .017) and an endovascular or hybrid procedure (P = .001) independently predicted late aortic rupture or need for reintervention.ConclusionsIsolated arch repair remains a high-risk procedure occurring frequently in the reoperative setting. Despite being performed in a higher risk group, endovascular strategies yielded similar outcomes but with an increased risk for aorta-related complications. These data support ongoing efforts to develop branched endografts specifically tailored for arch disease to potentially reduce morbidity related to currently available approaches

Modelling agronomic properties of Technosols constructed with urban wastes

International audienceThe greening of urban and suburban areas requires large amounts of arable earth that is a non-renewable resource. However, concentration of population in cities leads to the production of high amounts of wastes and by-products that are nowadays partly recycled as a resource and quite systematically exported out of urban areas. To preserve natural soil resources, a strategy of waste recycling as fertile substitutes is proposed. Eleven wastes are selected for their environmental harmlessness and their contrasted physico-chemical properties for their potential use in pedological engineering. The aim is (i) to demonstrate the feasibility of the formulation of fertile substrates exclusively with wastes and (ii) to model their physico-chemical properties following various types, number and proportions of constitutive wastes. Twenty-five binary and ternary combinations are tested at different ratios for total carbon, Olsen available phosphorus, cation exchange capacity, water pH, water retention capacity and bulk density. Dose-response curves describe the variation of physico-chemical properties of mixtures depending on the type and ratio of selected wastes. If these mixtures mainly mimic natural soils, some of them present more extreme urban soil features, especially for pH and P Olsen. The fertility of the new substrates is modelled by multilinear regressions for the main soil properties

Hepatitis C Infection Patterns at a Tertiary Care Center in New York: A Cross-Sectional Study.

Introduction In the United States, 2.7 to 3.9 million patients are infected with the hepatitis C virus (HCV) with 3,500 new cases reported yearly. According to the Centers for Disease Control and Prevention, HCV was the underlying or contributing cause of death of 19,659 patients in 2014. These facts underscore the need for a better understanding of the scope of this disease. Our epidemiologic study aimed at analyzing the pattern of occurrence of HCV infection at Staten Island University Hospital (SIUH) by evaluating the characteristics of newly infected patients with hepatitis C in 2014. The identified features served to better distinguish the targets for preventive health care in our particular population. Methodology A cross-sectional study of all newly diagnosed patients with HCV infections in the year 2014 presenting to SIUH was conducted using International Classification of Disease-9 codes (ICD-9) for hepatitis C. We included all patients with a positive HCV antibody confirmed by polymerase chain reaction testing. Patients were divided into groups according to age to simulate the age groups in the 2013 - 2014 Hepatitis B and C Annual Report of the New York City (NYC) Department of Health and Mental Hygiene published in 2016 (abbreviated to 2014 NYCDOH Report, hereafter). Gender and HCV genotypes were also collected. We compared disease frequency between age groups, gender, and genotype with the results of the 2014 NYCDOH Report. Results A total of 378 newly diagnosed HCV cases were identified; 60.05% were men, and 39.95% were women. The rate of infection with genotype 1a was the highest (36. 5%) followed by 1b (25.9%). In women, genotype 1b was predominant (13.76%) versus genotype 1a as the most common in men. The mean age was 54 years for men and 57 years for women. Most cases fell into the 60 to 69-year age group (32.28%), followed by the 50 to 59-year age group (31.48%). More so, all patients 80 years and older were exclusively women. Conclusions We found most new HCV infections at SIUH were diagnosed in patients aged 60 to 69 years, and the 2014 NYC DOH Report indicates most new HCV infections occur in patients aged 40 to 59 years. Also, all HCV infections detected in patients older than 80 years of age were found in women. These findings provide a better understanding of the patient demographics for appropriate HCV screening policies. Increased awareness and strict adherence to screening policies in baby boomers and high-risk populations are paramount in order to diagnose HCV infection early, offer therapy, and prevent HCV-related mortality and morbidity