Management of rectal foreign bodies

BACKGROUND: Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. METHODS: Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. RESULTS: All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died. CONCLUSIONS: Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body

Shelf Space Allocation: A Critical Review and a Model with Price Changes and Adjustable Shelf Heights

In today's retail environment, there are many consumer packaged goods (CPG) in the same category with various brands and differential products under the same brand. These differential products appear in different dimension sizes, display facing areas, purchasing costs and selling prices which are competing for a limited space in retail store shelves. Product assortment and space allocation of the chosen products to a limited shelf space is becoming more and more important for retailers. In this thesis we critically review the existing literature of shelf space allocation optimization models and solution techniques. We then propose a comprehensive model for shelf space allocation for a product category. Products are allocated to a two-dimensional area of a shelf section where a shelf section consists of multilevel vertical shelves. We account for adjustable shelf heights and product and brand integrity in a shelf section. Unlike the existing optimization models in the literature, we model our demand not only as a function of the space allocated to a product, in terms of the number of display facings, but also as a function of vertical product location in a shelf section and price sensitivity. Stackability of the products is also considered and products can be stacked depending on their package. Our objective is to maximize the retailer's daily gross profit. We numerically show that incorporating price changes and adjustable shelf spaces can have major impacts on the retailers' profit. Finally, we provide directions and suggestions for future research in this growing area of research.Master of Applied Science (MASc

A New Technique for Surgical Treatment of Vaginal Agenesis Using Combined Abdominal-Perineal Approach

Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent

Anonymous Shopping in the Internet by Separation of Data

Whenever clients shop in the Internet, they provide identifying data of themselves to parties like the webshop, shipper and payment system. These identifying data merged with their shopping history might be misused for targeted advertisement up to possible manipulations of the clients. The data also contains credit card or bank account numbers, which may be used for unauthorized money transactions by the involved parties or by criminals hacking the parties' computing infrastructure. In order to minimize these risks, we propose an approach for anonymous shopping by separation of data. We argue for the feasibility of our approach by discussing important operations like simple reclamation cases and criminal investigations

Optimization Models in Retail Reverse Supply Chains

Unlike most of the existing literature on reverse supply chains, that focuses on product recovery or waste management, in this thesis we consider reverse supply chain operations for an independent retailer. The latter have forward and reverse supply chains that are independent of the manufacturers. We study three major problems related to Retail Reverse Supply Chains (RRSC) for independent retailers. In RRSCs, each retail store holds some products that are not selling (and/or under-selling) and wishes to salvage them optimally. We refer to these products as Ineffective Inventory. Salvage can be in many forms and take place by relocating a product within the reverse supply chain (RSC), such as sending the product from a franchise store back to a Distribution/Return Center (RC) and then forward to another franchise store, or returning it to a vendor, liquidation, etc. The RRSC network may includes system members such as stores (retailer owned and/or franchise), RCs, warehouses, vendors and liquidators. Each of the stores carries some inventory that is underselling, and it is important to reduce the inventory of such products in order to refill the space with inventory that is more likely to sell. In the first problem, we consider a basic RRSC with retail stores, vendors and a warehouse. The retail company allocates a budget for its RRSC activities. We refer to this budget as a Profit-Loss budget, due to lost income from the items that will be removed from the stores that was a part of the gains resulting from the previous year tax calculations. The objective is to use this Profit-Loss budgetary limitation as effectively as possible with the most suitable products to relocate products within the supply chain and/or return them back to their vendor. A heuristic algorithm is developed to solve this problem, by making use of the problem structure, and results are compared with the solutions of an exact state-of-the-art commercial solver. In the second problem, we consider a network optimization model with inventory decisions. The goal is to optimize ineffective inventory levels in stores and the disposition of their returns. We model a comprehensive RRSC network with multiple stores that could be Company-Owned or Franchise Stores, multiple warehouses, multiple RCs, multiple vendors, and liquidators. The objective of the retailer is to minimize costs for relocating some of this ineffective inventory within the network or scrapping. However, individual franchise stores have their own goals of how their excessive inventory should be handled. The franchisee goals may be conflicting with those of the franchisor in terms of how much inventory should be chosen from each store to be relocated. In return, this conflict may lead to a conflict among franchise stores. This issue is addressed and resolved through inventory transparency among all the supply chain members. The tactical decision making process of which RC should be used for handling returns is incorporated into the model. In order to overcome the complexities of the large size problem, a multi-stage heuristic is developed to solve this problem within reasonable times. The results are then compared with the solutions of state-of-the-art commercial solver. In the third problem, we focus on the strategic decision of developing optimal vendor contract parameters for the retailer, using optimization models. Specifically, we identify optimal return penalties and associated return thresholds, between an independent retailer and its vendors. This model will support the retailer in their contract re-negotiation for its RSC activities. Vendors use a multi-layered penalty structure that assigns higher penalties to higher returns. The objective is to find the optimal penalties and/or optimal return thresholds that should be negotiated with the vendors in order to pay a lower penalty in the upcoming return cycles compared to existing penalty structures. We first design a Mixed Integer Non-Linear Program (MINLP) where the model makes the decision of vendor penalty fees and return thresholds simultaneously for each vendor. We generate small size to large size problems and solve them via MINLP solvers such as DICOPT and ANTIGONE. In order to gain insights to the inner workings of the MINLP, the decision variables, vendor penalty fees and return thresholds, are considered as parameters and hence, two models are designed to find the optimal penalty structure and optimal return thresholds, respectively. Useful insights from both of the models’ solutions are derived in order to generate rule-of-thumb methodologies to find approximate solutions close to optimal penalty percentages and return thresholds via identifying all possible scenarios that can exist in the problem structure.ThesisDoctor of Philosophy (PhD)This thesis deals with Retail Reverse Supply Chain (RRSC) management. We consider an independent retail company's and its franchise stores' ineffective inventory which may be constituted of unsold, under-selling, slow-moving, customer-returned, end-of-life, end-of-use, damaged, and faulty products within their inventory. We take into account the retailer's reverse supply chain structure and investigate the following problems: 1) How to manage a store's product returns under a given budgetary limitation for financial planning and taxation reasons, due to lost income from returned items, 2) Inventory optimization by taking into account the reverse supply chain structure of the retailer, and 3) Providing insight to the retailer on how it can best re-negotiate its vendor (buy-back) contracts for its product returns. The thesis covers decision making in all three levels: day-to-day operational decisions such as which products to be returned and where to allocate them within its reverse supply chain options, mid-term tactical decisions such as which Return Centers (RC) to be activated for the Reverse Logistics (RL) activities, and long-term strategic decisions such as what should be the optimal contract terms to re-negotiate with the vendors in order to cut future return costs

Structural Alterations of Zirconia Depending on Sintering Parameters and Effects on Bond Strength After Different Surface Treatments

Objectives: Zirconia having different physical and optical properties is obtained after the application of different sintering parameters. This study aims to investigate structural variations after administering different sintering protocols and to evaluate the effect of different surface treatments on shear bond strength.Materials and Methods: Eighty translucent zirconia specimens (7x3 mm) were divided into two different sintering groups (1480 0C for 180 min; 1510 0C for 30 min), then divided into four subgroups according to surface treatments: control, sandblasted, Er-YAG, and Nd-YAG (n:10). One specimen from each group was analyzed with XRD and one from each subgroup was analyzed with SEM. Ceramics (5x3 mm) were fired onto the zirconia for shear bond strength test using universal testing machine and the failure mode was determined by using stereomicroscope. Translucency and contrast ratio were measured by using spectrophotometer, and biaxial flexural strength test performed by employing universal testing machine on specimens with a diameter (15x1,3 mm) from each sintering group (n:10). Data was analyzed by using two-way ANOVA and Bonferroni Post hoc tests (P<.05).Results: The short sintering group showed higher biaxial flexural strength (943.87±48.69 MPa). The highest surface roughness values were obtained in short sintering groups and within the groups Nd-YAG application was found the most effective method (4.11±0.28 Ra). The highest bond strength value was obtained in sandblasted short time sintered group (29.71±2.52 MPa). The translucency and contrast ratio showed no significant difference. Conclusion: Although a physically stronger zirconia is obtained by short sintering process, long-term sintered zirconia forms a more durable bond strength with ceramics. Sandblasting improve the ceramic-zirconia bond strength may have more benefits than the use of Er-YAG, and Nd-YAG lasers

Anterior spinal cord herniation after multilevel anterior cervical corpectomy: A case report

Many complications related to the resection of an ossified posterior longitudinal ligament via the anterior approach have been reported. Postoperative neurological deterioration is one such complication that may appear due to massive anterior spinal cord herniation related to a dural defect following resection of the ossified posterior longitudinal ligament. Specifically, spinal cord herniations have been reported to be associated with posterior approaches, and a large number of theories regarding this association have been offered by various authors. However, anterior spinal cord herniation is extremely rare, and its pathophysiology has not yet been explained. In this case report, we report a male patient who experienced anterior spinal cord herniation following anterior surgery. Spinal cord herniation may develop following the removal of the anterior cervical corpectomy. Therefore, surgeons should be aware of this condition when planning treatments for cervical spondylotic myelopathy via the anterior approach