Hepatic trisegmentectomy and other liver resections

Trisegmentectomy, extended right hepatic lobectomy, is the removal of the true right lobe of the liver in continuity with most or all of the medial segment of the left lobe. Some important features of the operation have not been well described previously. To perform trisegmentectomy, safely, a fusion of liver tissue covering the umbilical fissure at the level of the falciform ligament must first be split open in many patients. The left branches of the portal triad structures are mobilized from the undersurface of the liver nearly to but not into the umbilical fissure. The blood supply and duct drainage of the medial segment originate within the umbilical fissure and feed back toward the right side buried in liver substance. They are found with blunt dissection just to the right of the flaciform ligament, encircled and ligated. Failure to appreciate this switch back anatomic arrangement may lead to injury of the blood supply or biliary drainage of the residual lateral segment. Parenthetically, the mirror image operation of lateral segmentectomy could result in devascularization of the medial segment if dissection and ligation were performed within the umbilical fissure instead of well to the left of this landmark. In most trisegmentectomies, the left portion of the caudate lobe is not removed. This small piece of tissue is interposed between the lateral segment and the inferior vena cava into which it drains by small tributaries. If the left portion of the caudate lobe is to be excised, it is necessary to ligate the last two posteriorly running branches before the main left trunks of the portal triad structures reach the umbilical fissure. Once this step is taken and if the caudate removal is completed, the remaining lateral segment usually has only one remaining outflow, that of the left hepatic vein. The other principles of trisegmentectomy are the same as with less radical subtotal hepatic resection. These include vascular suture closure of the main outflow veins, avoidance of parasegmental planes that leave behind a strip of devitalized tissue, preservation of intersegmental or interlobar veins, omission of techniques that sew shut or otherwise cover the raw surface of the remnant and provision of adequate drainage of dead space. After trisegmentectomy and also after true lobectomy, this last objective is usually met by leaving part of the operative incision open. Using thse guidelines, there has been no mortality with 27 hepatic resections carried out since 1963, including 14 trisegmentectomies

Hepatic transplantation, 1975.

This report reviews experience with 97 patients given liver transplants. We regard out survival statistics as unsatisfactory, but fell they should encourage further work since 22 patients have survived at least one year with a maximum survival of 5 13 YEARS. The Achilles' heel of liver transplantation os bile duct reconstruction. We presently rely upon Roux-en-Y reconstruction, or alternatively, duct-to-duct anastomosis with a T-tube stent. The prime indication for liver replacement is non-neoplastic liver disease, but a favourable malignancy for treatment may prove to be small intrahepatic duct cell carcinomas

Efficacy of an intensive outpatient rehabilitation program in alcoholism: Predictors of outcome 6 months after treatment

Treatment of alcohol-dependent patients was primarily focused on inpatient settings in the past decades. The efficacy of these treatment programs has been evaluated in several studies and proven to be sufficient. However, with regard to the increasing costs in public healthcare systems, questions about alternative treatment strategies have been raised. Meanwhile, there is growing evidence that outpatient treatment might be comparably effective as inpatient treatment, at least for subgroups of alcohol dependents. On that background, the present study aimed to evaluate the efficacy of a high-structured outpatient treatment program in 103 alcohol-dependent patients. 74 patients (72%) terminated the outpatient treatment regularly. At 6 months' follow-up, 95% patients were successfully located and personally re-interviewed. Analyses revealed that 65 patients (64%) were abstinent at the 6-month follow-up evaluation and 37 patients ( 36%) were judged to be non-abstinent. Pretreatment variables which were found to have a negative impact (non-abstinence) on the 6-month outcome after treatment were a higher severity of alcohol dependence measured by a longer duration of alcohol dependence, a higher number of prior treatments and a stronger alcohol craving (measured by the Obsessive Compulsive Drinking Scale). Further patients with a higher degree of psychopathology measured by the Beck Depression Inventory (depression) and State-Trait Anxiety Inventory (anxiety) relapsed more often. In summary, results of this study indicate a favorable outcome of socially stable alcohol-dependent patients and patients with a lower degree of depression, anxiety and craving in an intensive outpatient rehabilitation program

Community wide electronic distribution of summary health care utilization data

BACKGROUND: In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data. METHODS: The development of the community wide data system focused on the following objectives: ongoing monitoring of the health care system, evaluation of community wide individual provider initiatives, identification and development of new initiatives. The system focused on the sharing of data related to hospital acute care, emergency medical services, long term care, and mental health. It was based on the daily distribution of reports among all health care providers related to these services. RESULTS: The development of the summary reports concerning health care utilization produced a system wide view of health care in Syracuse, New York on a daily basis. It was not possible to isolate the results of these reports because of the impact of specific projects and other factors. At the same time, the reports were associated with reduction of hospital inpatient stays, improvement of access to hospital emergency departments, reductions in stays for patients discharged to nursing homes, and increased access of mental health patients to hospital inpatient units. CONCLUSION: The implementation of the system demonstrated that summary electronic utilization data could provide daily information that would support the improvement of health care outcomes and efficiency. This approach could be implemented in a simple, direct manner with minimal expenses

Are Interaction-free Measurements Interaction Free?

In 1993 Elitzur and Vaidman introduced the concept of interaction-free measurements which allowed finding objects without ``touching'' them. In the proposed method, since the objects were not touched even by photons, thus, the interaction-free measurements can be called as ``seeing in the dark''. Since then several experiments have been successfully performed and various modifications were suggested. Recently, however, the validity of the term ``interaction-free'' has been questioned. The criticism of the name is briefly reviewed and the meaning of the interaction-free measurements is clarified.Comment: 11 pages, 3 eps figures. Contribution to the ICQO 2000, Raubichi, Belaru

Climate, cryosphere and carbon cycle controls on Southeast Atlantic orbital-scale carbonate deposition since the Oligocene (30–0 Ma)

The evolution of the Cenozoic cryosphere from unipolar to bipolar over the past 30 million years (Myr) is broadly known. Highly resolved records of carbonate (CaCO_{3}) content provide insight into the evolution of regional and global climate, cryosphere, and carbon cycle dynamics. Here, we generate the first Southeast Atlantic CaCO3 content record spanning the last 30 Myr, derived from X-ray fluorescence (XRF) ln(Ca / Fe) data collected at Ocean Drilling Program Site 1264 (Walvis Ridge, SE Atlantic Ocean). We present a comprehensive and continuous depth and age model for the entirety of Site 1264 (∼ 316 m; 30 Myr). This constitutes a key reference framework for future palaeoclimatic and palaeoceanographic studies at this location. We identify three phases with distinctly different orbital controls on Southeast Atlantic CaCO_{3} deposition, corresponding to major developments in climate, the cryosphere and the carbon cycle: (1) strong ∼ 110 kyr eccentricity pacing prevails during Oligocene–Miocene global warmth (∼ 30–13 Ma), (2) increased eccentricity-modulated precession pacing appears after the middle Miocene Climate Transition (mMCT) (∼ 14–8 Ma), and (3) pervasive obliquity pacing appears in the late Miocene (∼ 7.7–3.3 Ma) following greater importance of high-latitude processes, such as increased glacial activity and high-latitude cooling. The lowest CaCO_{3} content (92 %–94 %) occurs between 18.5 and 14.5 Ma, potentially reflecting dissolution caused by widespread early Miocene warmth and preceding Antarctic deglaciation across the Miocene Climatic Optimum (∼ 17–14.5 Ma) by 1.5 Myr. The emergence of precession pacing of CaCO_{3} deposition at Site 1264 after ∼ 14 Ma could signal a reorganisation of surface and/or deep-water circulation in this region following Antarctic reglaciation at the mMCT. The increased sensitivity to precession at Site 1264 between 14 and 13 Ma is associated with an increase in mass accumulation rates (MARs) and reflects increased regional CaCO3 productivity and/or recurrent influxes of cooler, less corrosive deep waters. The highest carbonate content (%CaCO_{3}) and MARs indicate that the late Miocene–early Pliocene Biogenic Bloom (LMBB) occurs between ∼ 7.8 and 3.3 Ma at Site 1264; broadly contemporaneous with the LMBB in the equatorial Pacific Ocean. At Site 1264, the onset of the LMBB roughly coincides with appearance of strong obliquity pacing of %CaCO_{3}, reflecting increased high-latitude forcing. The global expression of the LMBB may reflect increased nutrient input into the global ocean resulting from enhanced aeolian dust and/or glacial/chemical weathering fluxes, due to enhanced glacial activity and increased meridional temperature gradients. Regional variability in the timing and amplitude of the LMBB may be driven by regional differences in cooling, continental aridification and/or changes in ocean circulation in the late Miocene

Universal Ecological Patterns in College Basketball Communities

The rank abundance of common and rare species within ecological communities is remarkably consistent from the tropics to the tundra. This invariant patterning provides one of ecology's most enduring and unified tenets: most species rare and a few very common. Increasingly, attention is focused upon elucidating biological mechanisms that explain these species abundance distributions (SADs), but these evaluations remain controversial. We show that college basketball wins generate SADs just like those observed in ecological communities. Whereas college basketball wins are structured by competitive interactions, the result produces a SAD pattern indistinguishable from random wins. We also show that species abundance data for tropical trees exhibits a significant-digit pattern consistent with data derived from complex structuring forces. These results cast doubt upon the ability of SAD analysis to resolve ecological mechanism, and their patterning may reflect statistical artifact as much as biological processes

Pulmonary talc granulomatosis mimicking malignant disease 30 years after last exposure: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pulmonary talc granulomatosis is a rare disorder characterized by the development of foreign body granuloma secondary to talc exposure. Previous case reports have documented the illness in current intravenous drug users who inject medications intended for oral use. We present a rare case of the disease in a patient with a distant history of heroin abuse who presented initially with history and imaging findings highly suggestive of malignancy.</p> <p>Case presentation</p> <p>A 53-year-old man reported a 4-month history of increasing dyspnea and weight loss. He had a long history of smoking and admission chest X-ray revealed a density in the right hemithorax. Computed tomography confirmed a probable mass with further speculated opacities in both lung fields suspicious for malignant spread. Biopsies obtained using endobronchial ultrasound-guided aspiration returned negative for malignancy and showed bronchial epithelial cells with foreign body giant cell reaction and polarizable birefringent talc crystals.</p> <p>Conclusion</p> <p>This case demonstrates a rare presentation of talc granulomatosis three decades after the last likely exposure. The history and imaging findings in a chronic smoker were initially strongly suggestive of malignant disease, and we recommend that talc-induced lung disease is considered in any patient with multiple scattered pulmonary lesions and a history of intravenous drug use. Confirmation of the disease by biopsy is essential, but unfortunately there are few successful proven management options for patients with worsening disease.</p

Future changes in tropical cyclone activity in the North Indian Ocean projected by high-resolution MRI-AGCMs

Open Access at publisher's web site: http://www.springerlink.com/content/b682734237171631

Time separation as a hidden variable to the Copenhagen school of quantum mechanics

The Bohr radius is a space-like separation between the proton and electron in the hydrogen atom. According to the Copenhagen school of quantum mechanics, the proton is sitting in the absolute Lorentz frame. If this hydrogen atom is observed from a different Lorentz frame, there is a time-like separation linearly mixed with the Bohr radius. Indeed, the time-separation is one of the essential variables in high-energy hadronic physics where the hadron is a bound state of the quarks, while thoroughly hidden in the present form of quantum mechanics. It will be concluded that this variable is hidden in Feynman's rest of the universe. It is noted first that Feynman's Lorentz-invariant differential equation for the bound-state quarks has a set of solutions which describe all essential features of hadronic physics. These solutions explicitly depend on the time separation between the quarks. This set also forms the mathematical basis for two-mode squeezed states in quantum optics, where both photons are observable, but one of them can be treated a variable hidden in the rest of the universe. The physics of this two-mode state can then be translated into the time-separation variable in the quark model. As in the case of the un-observed photon, the hidden time-separation variable manifests itself as an increase in entropy and uncertainty.Comment: LaTex 10 pages with 5 figure. Invited paper presented at the Conference on Advances in Quantum Theory (Vaxjo, Sweden, June 2010), to be published in one of the AIP Conference Proceedings serie