A retroperitoneal abscess caused by Haemophilus parainfluenza after endoscopic retrograde cholangiopancreatography and open cholecystectomy with a common bile duct exploration: a case report

<p>Abstract</p> <p>Introduction</p> <p>Abscesses after open cholecystectomies have been reported to occur in less than 1% of patients. The majority of these abscesses are colonized by gastrointestinal tract flora. It is clearly known that <it>Haemophilus parainfluenza </it>is a normal inhabitant of the human respiratory tract. However, its origin and route of transmission into the gastrointestinal tract is unknown.</p> <p>Case presentation</p> <p>We present the case of a 68-year-old Caucasian female who developed a retroperitoneal abscess caused by <it>H. parainfluenza </it>after open cholecystectomy and common bile duct exploration. This presented nearly five weeks post-operatively. She underwent a second operation to drain the abscess, and was subsequently placed on appropriate antibiotics.</p> <p>Conclusion</p> <p>A retroperitoneal abscess due to <it>H. parainfluenza </it>is extremely rare. It is a normal inhabitant of the human respiratory tract. To the best of our knowledge, there have been only a few reported cases of these abscesses, and they mainly involve the psoas muscle. The retroperitoneal abscess originated from the oropharynx, most likely after the endoscopic retrograde cholangiopancreatography was performed. With the advent of Natural Orifice Translumenal Endoscopic Surgery, oral decontamination will need to be considered to decrease the potential for such infections.</p

Presentation and survival of gastric cancer patients at an urban academic safety-net hospital

IntroductionGastric cancer is decreasing nationally but remains pervasive globally. We evaluated our experience with gastric cancer at a safety-net hospital with a substantial immigrant population.MethodsDemographics, pathology, and treatment were analyzed for gastric adenocarcinoma at our institution (2004–2017). Chi-square analyses were performed for dependence of staging on demographics. Survival was evaluated with Kaplan-Meier and Cox regression analyses.ResultsWe identified 249 patients (median age 65 years). Patients were predominantly born outside the USA or Canada (74.3%), non-white (70.7%), and federally insured (71.4%), and presented with late-stage disease (52.2%). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and zip code poverty > 20% were associated with late-stage presentation (all p p p p = 0.018), and H. pylori infection (2.02, p = 0.036).ConclusionHispanic ethnicity, Central American birthplace, Medicaid insurance, and increased neighborhood poverty were associated with late-stage presentation of gastric cancer with poor outcomes. Further study of these populations may lead to screening protocols in order to increase earlier detection and improve survival.</div

Ovarian cancer immunotherapy: opportunities, progresses and challenges

Due to the low survival rates from invasive ovarian cancer, new effective treatment modalities are urgently needed. Compelling evidence indicates that the immune response against ovarian cancer may play an important role in controlling this disease. We herein summarize multiple immune-based strategies that have been proposed and tested for potential therapeutic benefit against advanced stage ovarian cancer. We will examine the evidence for the premise that an effective therapeutic vaccine against ovarian cancer is useful not only for inducing remission of the disease but also for preventing disease relapse. We will also highlight the questions and challenges in the development of ovarian cancer vaccines, and critically discuss the limitations of some of the existing immunotherapeutic strategies. Finally, we will summarize our own experience on the use of patient-specific tumor-derived heat shock protein-peptide complex for the treatment of advanced ovarian cancer

Alternative methods for dispoal of low-level radioactive wastes. Task 1. Description of methods and assessment of criteria. [Alternative methods are belowground vaults, aboveground vaults; earth mounded concrete bunkers, mined cavities, augered holes]

The study reported herein contains the results of Task 1 of a four-task study entitled Criteria for Evaluating Engineered Facilities. The overall objective of this study is to ensure that the criteria needed to evaluate five alternative low-level radioactive waste (LLW) disposal methods are available to the Nuclear Regulatory Commission (NRC) and the Agreement States. The alternative methods considered are belowground vaults, aboveground vaults, earth mounded concrete bunkers, mined cavities, and augered holes. Each of these alternatives is either being used by other countries for low-level radioactive waste (LLW) disposal or is being considered by other countries or US agencies. In this report the performance requirements are listed, each alternative is described, the experience gained with its use is discussed, and the performance capabilities of each method are addressed. Next, the existing 10 CFR Part 61 Subpart D criteria with respect to paragraphs 61.50 through 61.53, pertaining to site suitability, design, operations and closure, and monitoring are assessed for applicability to evaluation of each alternative. Preliminary conclusions and recommendations are offered on each method's suitability as an LLW disposal alternative, the applicability of the criteria, and the need for supplemental or modified criteria

Microfabrication of electrode patterns for high-frequency ultrasound transducer arrays

High-frequency ultrasound is needed for medical imaging with high spatial resolution. A key issue in the development of ultrasound imaging arrays to operate at high frequencies (⩾30 MHz) is the need for photolithographic patterning of array electrodes. To achieve this directly on 1–3 piezocomposite, the material requires not only planar, parallel, and smooth surfaces, but also an epoxy composite filler that is resistant to chemicals, heat, and vacuum. This paper reports, first, on the surface finishing of 1–3 piezocomposite materials by lapping and polishing. Excellent surface flatness has been obtained, with an average surface roughness of materials as low as 3 nm and step heights between ceramic/polymer of ∼80 nm. Subsequently, high-frequency array elements were patterned directly on top of these surfaces using a photolithography process. A 30-MHz linear array electrode pattern with 50-μm element pitch has been patterned on the lapped and polished surface of a high-frequency 1–3 piezocomposite. Excellent electrode edge definition and electrical contact to the composite were obtained. The composite has been lapped to a final thickness of ∼55 μm. Good adhesion of electrodes on the piezocomposite has been achieved and electrical impedance measurements have demonstrated their basic functionality. The array was then packaged, and acoustic pulse-echo measurements were performed. These results demonstrate that direct patterning of electrodes by photolithography on 1–3 piezocomposite is feasible for fabrication of high-frequency ultrasound arrays. Furthermore, this method is more conducive to mass production than other reported array fabrication techniques

Surface preparation of 1-3 piezocomposite material for microfabrication of high frequency transducer arrays

A key issue in the development of ultrasound imaging arrays to operate at frequencies above 30 MHz is the need for photolithographic patterning of array electrodes. To achieve this directly on a 1-3 piezocomposite requires planar, parallel and smooth surfaces. This paper reports an investigation of the surface finishing of 1-3 piezocomposite material by mechanical lapping and/polishing that has demonstrated that excellent surface flatness can be obtained. Subsequently, high frequency array elements have been fabricated on these surfaces using a low temperature lift-off photolithography process. A 50 MHz linear array with 30 pm element pitch has been patterned on the lapped and polished surface of a low frequency 1-3 piezocomposite. Good electrode edge definition and electrical contact to the composite were obtained. Additionally, patterning has been demonstrated on a fine-scale composite, itself suitable for operation above 30 MHz.</p