Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??

Classically, until now, the management of cholecystitis has consisted of immediate and judicious clinical assessment of the affected patient, interpolating into the assessment of the physical findings and results from appropriate laboratory, x-ray, and scanning techniques (sonography and scintigraphy) to formulate a clinical impression. Usually, after the diagnosis has been established, the patient is subjected to a cholecystectomy, although the timing of the surgery may vary depending on the clinical condition of the patient. Alternatives to this management (cholecystectomy, medical management) scheme have been suggested, but these are dependent upon the clinical condition ofthe patient and considerations of risks. Percutaneous drainage of the gallbladder or cholecystostomy is sufficient enough to provide drainage, relieve obstruction, and the consequences of infection, i.e., sepsis, and prevent perforation. A contributory role of endoscopic retrograde cholangiopancreatography (ERCP) in this schema has not been a consideration. An ERCP is rarely employed for therapy (or diagnosis) when cholecystitis is suspected but it might assume a more significant role if it is considered an efficacious alternative in specific conditions. We have had the unusual experience of managing 11 patients with cholecystitis employing ERCP and its therapeutic modalities, i.e., sphincterotomy, selective cannulation of the cystic duct, and relieving obstruction of that structure by catheter displacement of an obstructing stone. Endoscopic techniques providing decompression of the gallbladder are described, and the feasibility of utilizing endoscopic procedures for treatment of cholecystitis will be given consideration

Persepsi Masyarakat terhadap Dampak Perkebunan Kelapa Sawit PT. Damai Jaya Lestari di Kecamatan Tanggetada Kabupaten Kolaka, Sulawesi Tenggara, Indonesia

Persepsi masyarakat terhadap perkebunan kelapa sawit PT. Damai Jaya Lestari (DJL), merupakan suatu proses kognitif yang dialami oleh setiap orang (masyarakat) di dalam memahami informasi tentang lingkungannya terkait dampak berdirinya perkebunan kelapa sawit. PT. DJL adalah perusahaan perkebunan kelapa sawit yang bergerak dalam pengolahan hasil sawit minyak mentah. Masyarakat sekitar terkhusus masyarakat Desa Rahanggada, Desa Popalia dan Desa Oneeha merupakan desa-desa yang menjadi akses jalan menuju perusahaan, jarak lokasi yang tidak terlalu jauh antara perusahaan dan pemukiman penduduk desa akan memberikan dampak yang akan dirasakan oleh masyarakat desa, dampak tersebut dari segi ekonomi dan sosial yang bersifat positif maupun negatif. Penelitian ini bertujuan untuk mengetahui bagaimana persepsi masyarakat terhadap dampak berdirinya perkebunan kelapa sawit. Metode penelitian ini menggunakan analisis data deskriptif kualitatif. Sampel ditentukan dengan menggunakan metode proporsional cluster, yakni dari setiap populasi diambil 10 % untuk dijadikan sampel. Berdasarkan hasil penelitian yang telah dilakukan, menunjukkan bahwa dampak ekonomi terhadap perkebunan kelapa sawit PT. DJL di Desa Rahanggada dan Desa Popalia termasuk dalam kategori sangat baik dan baik (berpengaruh positif). Sedangkan di Desa Oneeha termasuk dalam kategori netral. Dampak sosial terhadap perkebunan kelapa sawit PT. DJL di Desa Rahanggada dan Desa Popalia termasuk dalam kategori tidak baik. Dan di Desa Oneeha juga termasuk dalam kategori yang sangat tidak baik (berpengaruh negatif). Dampak lingkungan terhadap perkebunan kelapa sawit PT. DJL di Desa Rahanggada, Popalia dan Oneeha termasuk dalam kategori tidak baik, sangat tidak baik dan (berpengaruh negatif)

Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative

Renal cell cancer without a renal primary

Renal cell carcinoma has been increasing in incidence over the past two decades. Men are affected more than women and metastatic disease at presentation occurs in up to one third of patients. Metastasis can occur to virtually any organ, and involvement of multiple organs is not uncommon. To date, no reports have been found of metastatic disease without a renal primary. We present a case of renal cell cancer initially presenting as a subcutaneous mass with subsequent pancreatic and parotid gland metastases in absence of a primary renal source

Independent Validation of the SWMM Green Roof Module

Green roofs are a popular Sustainable Drainage Systems (SuDS) technology. They provide multiple benefits, amongst which the retention of rainfall and detention of runoff are of particular interest to stormwater engineers. The hydrological performance of green roofs has been represented in various models, including the Storm Water Management Model (SWMM). The latest version of SWMM includes a new LID green roof module, which makes it possible to model the hydrological performance of a green roof by directly defining the physical parameters of a green roof’s three layers. However, to date, no study has validated the capability of this module for representing the hydrological performance of an extensive green roof in response to actual rainfall events. In this study, data from a previously-monitored extensive green roof test bed has been utilised to validate the SWMM green roof module for both long-term (173 events over a year) and short-term (per-event) simulations. With only 0.357% difference between measured and modelled annual retention, the uncalibrated model provided good estimates of total annual retention, but the modelled runoff depths deviated significantly from the measured data at certain times (particularly during summer) in the year. Retention results improved (with the difference between modelled and measured annual retention decreasing to 0.169% and the Nash-Sutcliffe Model Efficiency (NSME) coefficient for per-event rainfall depth reaching 0.948) when reductions in actual evapotranspiration due to reduced substrate moisture availability during prolonged dry conditions were used to provide revised estimates of monthly ET. However, this aspect of the model’s performance is ultimately limited by the failure to account for the influence of substrate moisture on actual ET rates. With significant differences existing between measured and simulated runoff and NSME coefficients of below 0.5, the uncalibrated model failed to provide reasonable predictions of the green roof’s detention performance, although this was significantly improved through calibration. To precisely model the hydrological behaviour of an extensive green roof with a plastic board drainage layer, some of the modelling structures in SWMM green roof module require further refinement

Conference of Soviet and American Jurists on the Law of the Sea and the Protection of the Marine Environment

Included in the papers for the Conference of Soviet and American Jurists on the Law of the Sea and the Protection of the Marine Environment: Introduction by Milton Katz and Richard R. Baxter, p. 1 Freedom of Scientific Research in the World Ocean by A.F. Vysotsky, p. 7 The International Law of Scientific Research in the Oceans by Richard R. Baxter, p. 27 Responsibility and Liability for Harm to the Marine Environment by Robert E. Stein, p. 41 Liability for Marine Environment Pollution Damage in Contemporary International Sea Law by A. L. Makovsky, p. 59 Protection of the Marine Environment from Pollution by Richard A. Frank, p. 73 The Freedom of Navigation and the Problem of Pollution of the Marine Environment by V. A. Kiselev, p. 93 The Freedom of Navigation Under International Law by William E. Butler, p. 107 International Fisheries Management Without Global Agreement: United States Policies and Their Impact on the Soviet Union by H. Gary Knight, p. 119 Some Biological Background for International Legal Acts on Rational Utilization of the Living Resources of the World Ocean by P. A. Moiseev, p. 143 An International Regime for the Seabed Beyond National Jurisdiction by Thomas M. Franck, p. 151 Settlement of Disputes Under the Law of Ocean Use, with Particular Reference to Environmental Protection by John Lawrence Hargrove, p. 18

Study on layer fabrication for 3D structure of photoreactive polymer using DLP projector

This paper presents a research on 3D part fabrication from composition of photo initiator (Phenylbis(2,4,6-trimethylbenzoyl)), photo absorber (Sudan I) and 1, 6- Hexanediol polymer effect based on curing parameters. A DLP projector was used as energy light source which initiated the photo reactive polymer at three different light source distances with three different exposed time to evaluate photoreactive polymer solidification phenomena. The experiment results obtained shows that Sudan I composition, light intensity value and exposure time of the varied photo absorber give significant effect to layer thicknes, surface roughness and hardness value. These works also prove that photo absorber composition solution gave a different mechanical properties effect for 3D microstructure fabrication

Study of electrostatic potential surface around bipyramidal gaas quantum dot

Semiconductor quantum dot have got scientific interest because of their unique electronic nature. In this article, an isolated square bipyramidal gallium arsenide (GaAs) quantum dot has been optimized using DFT method. The size of quantum dot was 1.2 nm2 (square base) and 1.7nm height and consisted of total 84 atoms. The quantum dot was optimized using hybrid B3LYP functional and SBKJC pseudo potential basis sets. The electrostatic potential surface around the optimized GaAs quantum dot was plotted and the result showed the potential on the pyramid surface was polarized with two positive and negative surfaces. This potential was due electronic and nuclear charge of different arrangement on the surface structure of the dot