Late Epiphrenic-Retroperitoneal Fistula of an Esophageal Diverticulum Ten Years after Surgical Excision: Report of the First Case

Background: Esophageal fistula is a rare complication of an epiphrenic diverticulum and represents a difficult diagnostic challenge. In the majority of cases in the English literature, the fistula is secondary to the spontaneous perforation of the epiphrenic diverticulum and in only one case an esophagobronchial fistula occurs after resection of an epiphrenic diverticulum. No case of esophageal fistula communicating with the retroperitoneum tissues was found. Case Report: We present a case of 84 years old male admitted in 2017 in our Hospital for the appearance of epigastralgia and cough with traces of blood to sputum, asthenia and night sweats. Ten years before he underwent to a hiatal hernia plastic sec. Nissen and subsequently was reoperated for exeresis of diverticulum of the distal third of the esophagus by thoracotomy. In August 2008, because of esophageal substenosis an operation of posterior gastropexy sec. Hill with the demolition of the previous hiatoplasty was performed. In 2017, a computerized tomography shows a voluminous abscess in the right paravertebral region with development along the muscular plane of the ipsilateral psoas and a fistular path of about 4 cm between the posterior wall of the esophagus and the retroperitoneal collection of the abdomen. Conclusions: Esophageal fistula represents a complex problem of epiphrenic diverticulum and rarely a hidden complication of surgery. Surgery is the treatment of choice in suitable patients

Role of desert aerosol in metal fluxes in the Mediterranean area.

Aerosols and precipitations collected over Sardinia are mainly controlled by two end-members: Saharan and European. European background aerosols in Sardinia show a 3 to 25-fold decrease in EFcrust values for Cd, Zn, Pb, and Cr compared with coastal stations in the Western Mediterranean. Partitioning of total atmospheric deposition between the soluble and the insoluble phases shows that Al, Si, Fe and Pb originating from the atmosphere are mostly in the insoluble form. For Ca, Cd, Cr metals the dissolved fraction represents 50-90 % of the total input. Aerosol dissolution experiments performed at particle concentrations ranging from 3 to 300 mg l-1 show Cd and Pb exhibiting low solubility at the high mass particle concentration. Solubility of Pb increases with the EFcrust values and the finest grain-size of the aerosols (<1µm), and is less affected by pH. Al and Fe solubilities appear to be mainly controlled by the particulate load. Dissolution of both metals decreases significantly from 30% (13 % for Fe) at aerosol loads lower than 5 mg l-1, to less than 1% for both metals, at total aerosol concentrations greater than 50 mg l-1, which are encountered during Saharan transport. Fluxes (dry +wet) of metals at Sardinia show that ~ 30% for Cd and Pb, to more than 80 % for Fe and Al are due to Saharan contribution

A case of pulmonary dirofilariasis in Ferrara, Italy

The pulmonary filariasis is a rare entity and it is caused by a dog worm (Dirofilaria) that is transmitted to humans by mosquitoes. The filarial nematode enters the subcutaneous tissue, travels to the right ventricle, dies and then embolizes the pulmonary vessels causing a small pulmonary infarction. Usually it is casually identified by chest radiography, done for other reasons, in asymptomatic patients; the coin-lesion shape is generally presumed to be neoplastic. We reported a case of human pulmonary filariasis in a man who shown multiple lung coin-lesions shaped presumed to be neoplastic. The patient underwent surgery with double-wedge resection of the right lung and he was discharged on the fifth post-operative day. The Dirofilariasis incidence is increasing in the canine population, making human pulmonary dirofilariasis likely to occur. The differential diagnosis of a solitary pulmonary nodule includes primary lung cancer, metastatic cancer, infectious disease, septic embolism, Wegner's granulomatosis, pulmonary echinococcosis and reumatoid nodules. No single preoperative laboratory test has been a diagnostic value. Human pulmonary dirofilariasis should be considered in the differential diagnosis of solitary or multiple subpleural, non calcified pulmonary nodules in the clinical and appropriated epidemiological setting, since more cases of this infectious disease are likely to be found with greater awareness of this condition

Agent-Based Business Process Management with Eclipse

This paper describes WOLF (WOrkflow LiFe cycle management environment), an open-source development environment that leverages the full power of Eclipse to provide users with an industrial-strength business process modelling tool that has already proven its functionality in real-world projects. WOLF provides users with a graphical view of the advanced abstractions related to agent-based BPM (Business Process Management) like agents, workflows, events and messages. The core advantage of such abstractions is their high-level expressiveness that turns agent-based BPM into a solid technology that can be easily understood and mastered by both technical personnel and domain experts. The main feature of WOLF is the support for the graphical definition of workflows by means of a dedicated Eclipse editor; besides that, WOLF also helps developers in setting up Eclipse projects for realizing and managing agent-based business processes

Institutional ableism and the politics of inclusive education : an ethnographic study of an inclusive high school

This thesis explores some of the ways inequalities are maintained and legitimated within the context of reforms that are focused on them. In particular, it looks at the continued marginalization of disabled students in U.S. public Schools. Central to this is the development of the concept of institutional ableism, the idea that there are discriminatory structures and practices and uninterrogated beliefs embedded within society that subvert even the most well intentioned policies. This thesis is an attempt to examine this oppression on both the macro and micro-political levels. Chapter three looks at how institutional ablism works at a policy level. Using a detailed deconstruction of the Individuals with Disabilities Education Improvement act 2004 (IDEA), the first chapter examines the ways in which institutional ableism subverts the stated intentions of IDEA to maintain disabled peoples marginalised status within the education system. The chapter further deconstructs IDEA, focusing on its attempts to address the disproportionate representation of minority students in special education. The Final three chapters look at the micro-politics of school level reforms. Based on a year long ethnography in an inclusive school in the western United States. Chapter four focuses on the relationship between teachers and disabled students examining the mechanisms used to maintain inequalities when traditional ableism has been made inaccessible. Chapter five focuses on peer relationships. It was found that in filling a gatekeepers role nondisabled students utilise the governance of friendship to preserve and regulate the hierarchical relationship between disabled and nondisabled students. Chapter six using case studies of several students looks at the school's disabled students' experience of the school, their teachers and their peers. It is clear from these cases that even with the extensive efforts to dictate and control the positioning within the school, disabled students are still able to create spaces for resistance.EThOS - Electronic Theses Online ServiceGBUnited Kingdo