Stricture and perforation of the esophagus: Overlooked threats in the Zollinger-Ellison syndrome

This study was undertaken to assess the frequency of significant esophageal involvement in the Zollinger-Ellison syndrome (ZES). In a consecutive series of 24 patients with this disease, 9 (37%) showed endoscopic evidence of acid-induced esophageal lesions ranging from erosive inflammation to ulceration with massive bleeding, severe stricture formation, and perforation. In 3 cases, pronounced esophagitis was known 1–5 years before the underlying disease was diagnosed. Severe esophageal complications developed despite treatment with antisecretory drugs. It is emphasized that the best way to limit such complications is by excision of the underlying gastrin-secreting tumor(s) when possible . Nous avons entrepris cette étude pour établir la fréquence de participation oesophagienne dans le syndrome de Zollinger-Ellison. Pour une série de 24 patients présentant cette maladie, 9 (37%) avaient à l'endoscopie des lésions oesophagiennes dues à l'acidité allant de l'érosion inflammatoire à l'ulcération avec saignement important, sténose sévère, et perforation. Dans 3 cas, une oesophagite importante était connue 1–5 ans avant que la maladie sous-jacente soit diagnostiquée. Des complications oesophagiennes sévères se sont produites malgré le traitement antisécrétoire. Nous insistons sur le fait que le meilleur moyen de limiter ces complications est d'exciser chaque fois que possible la ou les tumeurs sous-jacentes sécrétant la gastrine. El presente estudio fue emprendido con el propósito de determinar la frecuencia de afección ácido péptica significativa del esófago en pacientes con síndrome de Zollinger-Ellison. En una serie de 24 pacientes consecutivos con esta enfermedad, 9 (37%) exhibieron evidencia endoscópica de lesiones esofágicas inducidas por ácido, las cuales variaron entre inflamación erosiva y ulceración con sangrado masivo, estrechez severa, y perforación. En 3 pacientes se conocía la existencia de esofagitis severa entre 1 y 5 años antes del diagnóstico de la enfermedad de base. Se desarrollaron graves complicaciones esofágicas a pesar del tratamiento con drogas antisecretorias en 3 pacientes. Se hace enfasis en que la mejor manera de disminuir tales complicaciones es mediante la resección del tumor(es) secretor de gastrina, cuando ello sea posible.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41287/1/268_2005_Article_BF01658528.pd

From thermal rectifiers to thermoelectric devices

We discuss thermal rectification and thermoelectric energy conversion from the perspective of nonequilibrium statistical mechanics and dynamical systems theory. After preliminary considerations on the dynamical foundations of the phenomenological Fourier law in classical and quantum mechanics, we illustrate ways to control the phononic heat flow and design thermal diodes. Finally, we consider the coupled transport of heat and charge and discuss several general mechanisms for optimizing the figure of merit of thermoelectric efficiency.Comment: 42 pages, 22 figures, review paper, to appear in the Springer Lecture Notes in Physics volume "Thermal transport in low dimensions: from statistical physics to nanoscale heat transfer" (S. Lepri ed.

Clostridium difficile colitis after aortic surgery

Objective:To determine the incidence and outcome of Clostridium difficile colitis (CDC) following aortic surgery.Design:Retrospective clinical study, and case-note review.Patients:Of 180 patients undergoing aortic surgery for either aneurysmal or occlusive disease between 1 September 1994 and 31 August 1996 (24 months), 15 (8.4%) developed CDC. There were 12 male and three female patients of median age 65 (range 46–84).Results:Two patients died from multiple organ failure in association with CDC, one of whom underwent negative relaparotomy for suspected ischaemic bowel because the diagnosis of CDC had not been entertained. Previously identified risk factors for CDC comprised: age >65 (eight); renal impairment (four); chronic obstructive airways disease (seven); coexistent malignancy (three); admission from another hospital (four); H2 antagonist therapy (13); ITU (nine); and/or HDU care (14). Diarrhoea commenced a median of 9 (range 5–26) days, and CDC, was diagnosed a median of 14 (range 10–26) days after operation. All patients received intravenous Cefuroxime, originally prescribed as prophylaxis, for a median of 6 (range 3–16) days prior to onset of CDC. Two patients received 1 additional antibiotic; one received 2; two received 3; and one received 4 prior to onset of CDC.Conclusions:CDC is a common and potentially serious complication of vascular, and in particular, aortic surgery. Although such patients often possess several risk factors for CDC, colitis frequently follows prolonged ‘prophylactic’ cephalosporin administration, which should therefore be avoided

Control of plasma stored energy for burn control using DIII-D in-vessel coils

A new approach has been experimentally demonstrated to control the stored energy by applying a non-axisymmetric magnetic field using the DIII-D in-vessel coils to modify the energy confinement time. In future burning plasma experiments as well as magnetic fusion energy power plants, various concepts have been proposed to control the fusion power. The fusion power in a power plant operating at high gain can be related to the plasma stored energy and hence, is a strong function of the energy confinement time. Thus, an actuator that modifies the confinement time can be used to adjust the fusion power. In relatively low collisionality DIII-D discharges, the application of non-axisymmetric magnetic fields results in a decrease in confinement time and density pumpout. Gas puffing was used to compensate the density pumpout in the pedestal while control of the stored energy was demonstrated by the application of non-axisymmetric fields