Civil gunshot injuries of the rectum - 25 years of experience

The first medical literature report for gun shot injuries of the rectum (GIR) appear after the end of the American Civil War. They show a mortality rate of 100%. Our 25 year experience, consisting of 22 cases with GIR is shared. The injuries were from light gun shot weapons and predominantly of criminal character. 12 (54,5%) from the wounded developed shock. The following specific features of GIR have been found out: inner/outer wound in the region above the symphisis - 11 (50,0%); inner/outer wound in the region above the sacrum - 5 (22,7%); inner/outer wound in the region of the perineum - 1 (4,55%); excretion of faeces through the wound - 2 (9,1% ); rectorrhage - 5 (22,7%); blood inrectal touche - 8 (36,4%). 5 (22,7%) intraperitoneal, 13 (59,1%) extraperitoneal supralevatorial and 4 (18,2%) infralevatorial injuries. In addition small intestines have been wounded in 11 (50,0%), urine bladder 8 (36,4%), sigma 4 (18,2%), sacrum 5 (22,7%), urethra 1 (4,55%), anal sphincter 1 (4,55%), aorta 1 (4,55%). The operative interventions for treatment of GIR were: primary suture of the intraperitoneal part (9,1%), primary suture with colostomy 2 (9,1%), Hartmann's operation 7 (31,8%), colostomy with presacral drainage 5 (22,7%), colostomy 7 (31,8%), distal rectal wash out 6 (27,3%). Post operative complications were a result of massive faecal contamination with following severe infection, diffuse peritonitis 18 (81,8%), pelvicphlegmona 7 (31,8%), haemorrhage 3 (13,6%), sepsis 9 (40,1%), necrotic fasciitis 6 (27,3%), pneumonia 8 (36,4%), pulmonary thrombembolism 5 (22,7%). 9 patients died (mortality rate of 40,1%). The most common cause was multiorgan insufficiency 5 (22,7%), followed by pulmonary thrombembolism 3 (13,6%) and severe haemorrhage 1 (4,55%)

Circularly Polarized Aperture Coupled Microstrip Antenna with Resonant Slots and a Screen

A broadband circularly polarized (CP) Aperture Coupled Microstrip Antenna (ACMSA) is described herein. In order to decrease the back radiation of the antenna due to resonant coupling slots (a cross-slot) in the ground plane, a three-layer structure with a screen is proposed. As a result, the back radiation of the antenna is reduced by more than 12 dB and its gain is increased by about 1.3 dB compared to the conventional two-layer ACMSA with nonresonant coupling slots. The antenna is designed to operate within the Ku-band. Keeping its simple and compact construction and high mechanical characteristics it can be used as an element of CP microstrip antenna arrays with various applications in the contemporary communication systems. A comparison with two similar CP antennas with resonant slots, a two-layer ACMSA and a three-layer ACMSA with a patch reflector is accomplished

Association study in the 5q31-32 linkage region for schizophrenia using pooled DNA genotyping

<p>Abstract</p> <p>Background</p> <p>Several linkage studies suggest that chromosome 5q31-32 might contain risk loci for schizophrenia (SZ). We wanted to identify susceptibility genes for schizophrenia within this region.</p> <p>Methods</p> <p>We saturated the interval between markers D5S666 and D5S436 with 90 polymorphic microsatellite markers and genotyped two sets of DNA pools consisting of 300 SZ patients of Bulgarian origin and their 600 parents. Positive associations were followed-up with SNP genotyping.</p> <p>Results</p> <p>Nominally significant evidence for association (p < 0.05) was found for seven markers (D5S0023i, IL9, RH60252, 5Q3133_33, D5S2017, D5S1481, D5S0711i) which were then individually genotyped in the trios. The predicted associations were confirmed for two of the markers: D5S2017, localised in the <it>SPRY4-FGF1 </it>locus (p = 0.004) and IL9, localized within the IL9 gene (p = 0.014). Fine mapping was performed using single nucleotide polymorphisms (SNPs) around D5S2017 and IL9. In each region four SNPs were chosen and individually genotyped in our full sample of 615 SZ trios. Two SNPs showed significant evidence for association: rs7715300 (p = 0.001) and rs6897690 (p = 0.032). Rs7715300 is localised between the <it>TGFBI </it>and <it>SMAD5 </it>genes and rs6897690 is within the <it>SPRY4 </it>gene.</p> <p>Conclusion</p> <p>Our screening of 5q31-32 implicates three potential candidate genes for SZ: <it>SMAD5</it>, <it>TGFBI </it>and <it>SPRY4</it>.</p

Percutaneous management of acute necrotizing pancreatitis

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy (PN) performed under ultrasound control and of endoscopic necrosectomy through secondary sinus track (ENTSST) using nephroscope and cystoscope.MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT).RESULTS: Seventeen patients (74%) treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (range 1-4) ENTSST.CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than open necrosectomy and postoperative lavage. Common solution for these methods has not been reached yet

Evaluation of cumulative cognitive deficits from electroconvulsive therapy

Background Electroconvulsive therapy (ECT) is the most effective acute treatment for severe depression, but widely held concerns about memory problems may limit its use. Aims To find out whether repeated or maintenance courses of ECT cause cumulative cognitive deterioration. Method Analysis of the results of 10 years of cognitive performance data collection from patients who have received ECT. The 199 patients had a total of 498 assessments, undertaken after a mean of 15.3 ECT sessions (range 0–186). A linear mixed-effect regression model was used, testing whether an increasing number of ECT sessions leads to deterioration in performance. Results The total number of previous ECT sessions had no effect on cognitive performance. The major factors affecting performance were age, followed by the severity of depression at the time of testing and the number of days since the last ECT session. Conclusions Repeated courses of ECT do not lead to cumulative cognitive deficits. This message is reassuring for patients, carers and prescribers who are concerned about memory problems and confusion during ECT. Electroconvulsive therapy (ECT) is the most effective acute treatment for severe depression,1 with reported remission rates above 50%.2,3 Although some reports demonstrate even higher remission rates (such as 75% in patients with psychotic depression4), these could be below 50% for treatment-resistant depression or in community settings.5,6 ECT is often portrayed in mainstream media as a barbaric treatment7 and its cognitive side-effects as profound and debilitating, leading to public, patient and carer concerns. ECT does cause retrograde amnesia and acute disorientation immediately following a treatment,8 however, research has suggested that this is only a short-lived side-effect. A meta-analysis by Semkovska & McLoughlin9 analysed the cognitive tests of 2981 patients from 84 studies, performed before and after single courses of ECT, and found that a decline in cognitive performance was limited to the first 3 days following a treatment. Patients showed no cognitive deterioration when tested 2 or more weeks after their last ECT session. This does not apply to retrograde amnesia, which was not part of this analysis, and it cannot be extended to cognitive functions that were not tested. Much less is known about the side-effects of long-term ECT, including maintenance ECT. A major concern of patients and some health professionals is that it could lead to progressive cognitive deficits, especially if given for prolonged periods of time. Small studies and case reports have addressed this question and have found no evidence to support this concern (see Discussion). Over the past 10 years we performed prospective cognitive tests on 199 patients, of whom 96 had >12 ECTsessions during their lifetime (the usual maximum duration of a single ECT course). We wanted to find out whether there was evidence that their cognitive performance deteriorated with the increasing number of ECT sessions