Occult solitary submucosal jejunal metastasis from esophageal carcinoma

BACKGROUND: Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In esophageal cancer, the liver, lung and the bones are the most common sites of metastases. Metastasis to intestines are very rare. CASE PRESENTATION: A 54-year old male was admitted with esophageal squamous cell carcinoma (SCC) associated with dysphagia II-III and weight loss of 20 kg. Preoperative routine staging failed to detect any metastases. A transthoracic esophagectomy and orthotopic gastric pull-up with collar esophago-gastrostomy, associated with 2-field lymphadenectomy was perfromed. During the digital placement of the naso-jejunal feeding catheter a submucosal jejunal nodule with a diameter of 1 cm, about 40 cm distal to the duodeno-jejunal fold was detected which was completely resected by jejunotomy. Histopathology of jejunal nodule showed metastasis from esophageal squamous cell carcinoma. CONCLUSION: Because of the extensic esophageal lymphatic system, an occult widespread dissemination of the tumor cells into the abdominal cavity is possible. Additional intraoperative evaluation of the small intestine and the complete abdominal cavity should be performed in every operation of esophageal carcinoma to detect possible occult intraabdominal metastases

Complex pleural empyema can be safely treated with vacuum-assisted closure

<p>Abstract</p> <p>Objective</p> <p>For patients with postoperative pleural empyema, open window thoracostomy (OWT) is often necessary to prevent sepsis. Vacuum-assisted closure (VAC) is a well-known therapeutic option in wound treatment. The efficacy and safety of intrathoracal VAC therapy, especially in patients with pleural empyema with bronchial stump insufficiency or remain lung, has not yet been investigated.</p> <p>Methods</p> <p>Between October 2009 and July 2010, eight consecutive patients (mean age of 66.1 years) with multimorbidity received an OWT with VAC for the treatment of postoperative or recurrent pleural empyema. Two of them had a bronchial stump insufficiency (BPF).</p> <p>Results</p> <p>VAC therapy ensured local control of the empyema and control of sepsis. The continuous suction up to 125 mm Hg cleaned the wound and thoracic cavity and supported the rapid healing. Additionally, installation of a stable vacuum was possible in the two patients with BPF. The smaller bronchus stump fistula closed spontaneously due to the VAC therapy, but the larger remained open.</p> <p>The direct contact of the VAC sponge did not create any air leak or bleeding from the lung or the mediastinal structures. The VAC therapy allowed a better re-expansion of remaining lung.</p> <p>One patient died in the late postoperative period (day 47 p.o.) of multiorgan failure. In three cases, VAC therapy was continued in an outpatient service, and in four patients, the OWT was treated with conventional wound care. After a mean time of three months, the chest wall was closed in five of seven cases. However, two patients rejected the closure of the OWT. After a follow-up at 7.7 months, neither recurrent pleural empyema nor BPF was observed.</p> <p>Conclusion</p> <p>VAC therapy was effective and safe in the treatment of complicated pleural empyema. The presence of smaller bronchial stump fistula and of residual lung tissue are not a contraindication for VAC therapy.</p

Alien Registration- Matzi, Frank (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/25753/thumbnail.jp

Alien Registration- Matzi, Frank (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/25753/thumbnail.jp

On the Migdal effect in dark matter direct detection

Das Ziel direkter Detektionsexperimenten liegt darin atomare Streuungsprozesse dunkler Materie Teilchen zu messen. Diese Masterarbeit beschäftigt sich mit der Nachweisbarkeit von dunkler Materie, mit besonderem Fokus auf "Weakly Interacting Massive Particles" (WIMPs) mit Massen unterhalb der GeV-Skala. Im kosmologischen Standardmodel sind WIMPs gravitativ an Galaxien gebunden und bewegen sich mit nichtrelativistischen Geschwindigkeiten im Orbit, wodurch elastische Streuungsprozessen mit Atomen induziert werden. Für Dunkle Materie Teilchen in der Größenordnung von etwa 100GeV kommt es zu Impulsübertragungen von etwa (100 MeV) oder weniger. Die Streuungsprozesse können durch Ionisation, Szintillation und Wärmeerzeugung in den Detektoren nachgewiesen werden. In dieser Arbeit beschreiben wir Ionisatierungsprozesse eines Elektrons durch Streuung von dunklen Materie an isolierten Atomen. Dies ist der sogenannte Migdal-Effekt. Die Arbeit befasst sich mit der Berechnung der Stärke dieses Ionisationssignals unter Verwendung von Elektronenwellenfunktionen, die aus verschiedenen numerischen Methoden erhalten wurden, wie Hartree-Fock-Wellenfunktionen, Coulomb-Wellenfunktionen, ebenen Wellen usw. Der Migdal-Effekt wird für verschiedene Atome wie Xe, I, Ge und Ar berechnet. Die erhaltenen Ergebnisse werden verwendet, um die Wahrscheinlichkeit solcher Streuungsprozesse zu schätzen und sie mit den Ergebnissen herkömmlicher Flüssig-Xenon-Detektoren, wie beispielsweise Xenon1T, zu vergleichen.The focus in direct detection experiments lies on the detectability of dark matter due to nuclear recoil signatures from dark matter particles. The master thesis will focus on the detectability of dark matter particles, especially the weakly interacting massive particles (WIMPs) with masses below the GeV scale. In standard cosmological models the WIMPs are gravitationally bound to the galaxy with nonrelativistic circular velocities, causing elastic nuclear recoils with atomic nuclei with typical momentum transfers of about (100 MeV) or less. The recoil signatures can be detected through ionization, scintillation and the production of heat in the detectors. In the thesis, we study the prompt ionization of an electron that follows a dark matter nucleus scattering event. This is the so called Migdal effect. The thesis is about the calculation and evaluation of the strength of this ionization signal by using electron wave functions obtained through various methods, such as Hartree-Fock-wave functions, Coulomb wave functions, plane waves etc. The Migdal effect will be calculated for various atoms, such as Xe, I, Ge and Ar. The obtained results will be used to calculate dark matter event rates and compare it to the results of conventional liquid xenon detectors, e.g Xenon1T