Prescribing Warfarin to a Patient with Oesophageal Varices—A Case Report and Review of the Literature

We describe the case of a 42-year old man who presented with melaena. He was found to have bleeding varices during endoscopic investigation. Subsequent investigation revealed the aetiology to be a portal vein thrombosis (PVT) due to an underlying pro-coagulable state (Factor V Leiden). He was managed with cautious anticoagulation but suffered a life-threatening upper gastrointestinal bleed that was not amenable to endoscopic treatment or transjugular intrahepatic portosystemic shunting (TIPS). As such, the only therapeutic option involved the pursuit of surgical shunt operations. We review the literature regarding this atypical cause of GI-bleeding and discuss medical and surgical considerations for the management of such patients

Perforated Rectal Cancer Presenting as Fournier’s Gangrene in a Confused Older Patient

We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier’s gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the “confused patient”

Modeling erosion sensitivity by Medalus: Application to Bou Hayya watershed, Tunisia

Le bassin versant de Bou Hayya (406 km2) est situé en Tunisie du centre-ouest. L’oued prend sa source dans le massif de Bou Chebka - El Ma Abiod, où les altitudes varient entre 750 et 1312 m. La topographie est contrastée et la pluviométrie est intense et irrégulière, avec une moyenne de 300 mm/an. Le couvert végétal est essentiellement steppique avec une forêt claire sur les reliefs montagneux en amont. Les nappes d'alfa et les steppes d'armoise couvrent les piémonts et les plaines. Ce bassin versant est sujet à une dynamique érosive nécessitant d’identifier les zones les plus vulnérables afin de prioriser les interventions d’aménagement. La cartographie de la sensibilité des sols à l’érosion a été réalisée moyennant un indice de sensibilité dérivé de l’approche développée dans le cadre du projet MEDALUS. La cartographie de l’indice de sensibilité a permis de monter qu’une bonne partie en amont et en aval du bassin versant est très sensible à l’action érosive par les eaux du ruissellement. Elle a permis également d’identifier les zones prioritaires d’intervention. Mots clés: Érosion hydrique,  modélisation, MEDALUS, Indice de Sensibilité à l’ÉrosionThe watershed of Bou Hayya (406 km2) is located in the center oust of Tunisia. The river takes its source in the Massif of Bou Chebka - El My Abiod, where altitudes vary between 750 and 1312 m. Topography is contrasted and rainfall is intense and irregular, with an average of 300 mm/an. Vegetation cover is primarily steppe-like with a clear forest on the mountainous reliefs upstream. Alfa and Artemisia cover the piedmonts and the plains. This watershed is prone to an erosive dynamics that requires the identification of the most vulnerable zones in order to prioritize soil erosion control interventions. The mapping of soil sensitivity to erosion was carried out with the help of an index of sensitivity derived from the approach developed within the framework of MEDALUS project. The mapping of the sensitivity index showed that a good part of the watershed upstream and downstream is very sensitive to erosive by runoff. It also made it possible to identify the priority zones for soil conservation interventions.  Keywords: Water erosion, modeling, Medalus, Erosion sensitivity inde

Effect of Agitation, Temperature, and Quenching Medium on Cooling Curve and cooling rate for Steels

The control of quenching process has been investigated in this study by developing a quench system design to simulate the quenching process and measure the time – temperature history inside the sample during the cooling stage. The main purpose of this quench system is to evaluate the quench power of different quenchant at different conditions (type, temperature and agitation). A stainless steel sample was used with a suitable measurement as a probe in designing this quench system. The performance of two of quenchants (water and brine) with different conditions was investigated, and the designed probe was used to illustrate the effect of quenching parameters (quenchant type, temperature and its agitation) on cooling curves and cooling rate.The quenching system has proven its ability to work effectively and the results showed that heat transfer properties were significantly affected by quenchant parameters

6-thioguanine treatment in inflammatory bowel disease: A critical appraisal by a European 6-TG working party

Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6-12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity. Copyright (c) 2006 S. Karger AG, Basel

Standalone vertex finding in the ATLAS muon spectrometer

A dedicated reconstruction algorithm to find decay vertices in the ATLAS muon spectrometer is presented. The algorithm searches the region just upstream of or inside the muon spectrometer volume for multi-particle vertices that originate from the decay of particles with long decay paths. The performance of the algorithm is evaluated using both a sample of simulated Higgs boson events, in which the Higgs boson decays to long-lived neutral particles that in turn decay to bbar b final states, and pp collision data at √s = 7 TeV collected with the ATLAS detector at the LHC during 2011

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson

UK guidelines on oesophageal dilatation in clinical practice

These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques—including stents—will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop­ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made

Measurement of the top quark-pair production cross section with ATLAS in pp collisions at \sqrt{s}=7\TeV

A measurement of the production cross-section for top quark pairs(\ttbar) in $pp$ collisions at \sqrt{s}=7 \TeV is presented using data recorded with the ATLAS detector at the Large Hadron Collider. Events are selected in two different topologies: single lepton (electron $e$ or muon $\mu$) with large missing transverse energy and at least four jets, and dilepton ($ee$, $\mu\mu$ or $e\mu$) with large missing transverse energy and at least two jets. In a data sample of 2.9 pb-1, 37 candidate events are observed in the single-lepton topology and 9 events in the dilepton topology. The corresponding expected backgrounds from non-\ttbar Standard Model processes are estimated using data-driven methods and determined to be $12.2 \pm 3.9$ events and $2.5 \pm 0.6$ events, respectively. The kinematic properties of the selected events are consistent with SM \ttbar production. The inclusive top quark pair production cross-section is measured to be \sigmattbar=145 \pm 31 ^{+42}_{-27} pb where the first uncertainty is statistical and the second systematic. The measurement agrees with perturbative QCD calculations.Comment: 30 pages plus author list (50 pages total), 9 figures, 11 tables, CERN-PH number and final journal adde