Modified Bristow-Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation

Retrospective case-control study of authors experience in the modified Bristow-Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation with glenoid bone injury.info:eu-repo/semantics/publishedVersio

A Complex Case of Cholestasis in a Patient with ABCB4 and ABCB11 Mutations

The low-phospholipid-associated cholelithiasis (LPAC) syndrome is a form of symptomatic cholelithiasis occurring in young adults, characterized by recurrence of symptoms after cholecystectomy and presence of hepatolithiasis. The case refers to a healthy 39-year-old Caucasian male who presented with abdominal pain and jaundice. His blood tests showed conjugated hyperbilirubinemia and elevated liver enzymes (total bilirubin 6.65 mg/dL, γ-glutamyltransferase 699 IU/L) and abdominal computed tomography revealed dilation of common bile duct and left intrahepatic ducts. Magnetic resonance cholangiopancreatography identified choledocholithiasis, retrieved by endoscopic retrograde cholangiopancreatography, after which there was a worsening of jaundice (total bilirubin 23 mg/dL), which persisted for several weeks, possibly due to ciprofloxacin toxicity. After an extensive workup including liver biopsy, the identification of two foci of hepatolithiasis on reevaluation abdominal ultrasound raised the hypothesis of LPAC syndrome and the patient was started on ursodeoxycholic acid, with remarkable improvement. Genetic testing identified the mutation c.1954A>G (p.Arg652Gly) in ABCB4 gene (homozygous) and c.1331T>C (p.Val444Ala) in ABCB11 gene (heterozygous). In conclusion, we describe the unique case of an adult male with choledocholithiasis, hepatolithiasis, and persistent conjugated hyperbilirubinemia after retrieval of stones, fulfilling the criteria for LPAC syndrome and with possible superimposed drug-induced liver injury, in whom ABCB4 and ABCB11 mutations were found, both of which had not been previously described in association with LPAC.info:eu-repo/semantics/publishedVersio

Recursive calculation of time to ruin distributions

In this paper we present a different approach on Dickson and Waters [Astin Bulletin 21 (1991) 199] and De Vylder and Goovaerts [Insurance: Mathematics and Economics 7 (1988) 1] methods to approximate time to ruin probabilities. By means of Markov chain application we focus on the direct calculation of the distribution of time to ruin, and we find that the above recursions appear to be less efficient, although giving the same approximation figures. We show some graphs of the time to ruin distribution for some examples, comparing the different shapes of the densities for different values of the initial surplus. Furthermore, we consider the presence of an upper absorbing barrier and apply the proposed recursion to find ruin probabilities in this case..info:eu-repo/semantics/publishedVersio

Recurrent Gastrointestinal Bleeding from Dieulafoy's Lesions in a Patient with Type 1 von Willebrand Disease: A Rare Association

Von Willebrand disease (vWD) is the most prevalent hereditary bleeding disorder, affecting 0.6-1.3% of the population. While gastrointestinal bleeding from angiodysplasia is a well-known complication of vWD, the same is not true for Dieulafoy's lesions (DLs). We report the case of a 21-year-old black male with type 1 vWD and 2 previous hospital admissions for severe anemia with no visible blood loss. In both episodes, DLs were identified and treated endoscopically, one in the stomach and another in the duodenum. The patient presented to the emergency department in September 2016 with dizziness, fatigue, and again no visible blood loss. He was hemodynamically stable, and laboratory workup showed a hemoglobin level of 3.4 g/dL. After transfusion of packed red blood cells, intravenous iron, and von Willebrand factor/factor VIII concentrate infusions, the patient underwent upper endoscopy and colonoscopy, which were normal. Small-bowel capsule endoscopy showed dark blood and a fresh clot in the proximal jejunum. At this site, push enteroscopy identified a pulsatile vessel with an overlying minimal mucosal defect, consistent with a DL, type 2b of the Yano-Yamamoto classification, which was successfully treated with adrenaline and 2 hemoclips. The patient remains stable after 18 months of follow-up, with a hemoglobin level of 13.2 g/dL. This is a case of recurrent severe occult gastrointestinal bleeding from multiple DL in a young patient with vWD who is otherwise healthy. Three other cases of DL bleeding in the setting of vWD have been reported in the literature, suggesting a possible association between these 2 entities.info:eu-repo/semantics/publishedVersio

Some advances on the Erlang(n) dual risk model

The dual risk model assumes that the surplus of a company decreases at a constant rate over time and grows by means of upward jumps, which occur at random times and sizes. It has applications to companies with economical activities involved in research and development. This model is dual to the well known Cram´er-Lundberg risk model with applications to insurance. Existing results on the study of the dual model assume that the random waiting times between consecutive gains follow an exponential distribution, as in the classical Cram´er–Lunderg risk model. We generalize to other compound renewal risk models where such waiting times are Erlang(n) distributed. Using the roots of the fundamental and the generalized Lundberg’s equation, we get expressions for the ruin probability and the Laplace transform of the time of ruin for an arbitrary single gain distribution. Furthermore, we compute expected discounted dividends, as well as higher moments, when the individual common gains follow a Phase–Type, PH(m), distribution. Finally, we perform illustrations working some examples for some particular gain distributions and obtain numerical resultsinfo:eu-repo/semantics/publishedVersio

A Rare Cause of Abdominal Pain in a Patient with Acute Necrotizing Pancreatitis.

INTRODUCTION: Walled-off necrosis (WON) is a potentially lethal late complication of acute pancreatitis (AP) and occurs in less than 10% of AP cases. It can be located in or outside the pancreas. When infected, the mortality rate increases and can reach 100% if the collection is not drained. Its treatment is complex and includes, at the beginning, intravenous antibiotics, which permit sepsis control and a delay in the therapeutic intervention, like drainage. Nowadays, a minimally invasive approach is advised. Depending on the location of the collection, computed tomography (CT)-guided drainage or endoscopic necrosectomy are the primary options, then complemented by surgical necrosectomy if needed. Infected WON of the abdominal wall has been rarely described in the literature and there is no report of any infection with Citrobacter freundii. CASE: We present the case of a 61-year-old man with necrotizing AP complicated by WON of the left abdominal wall, infected with Citrobacter freundii that was successfully treated with CT-guided percutaneous drainage and intravenous antibiotics. CONCLUSION: Infected WON accounts for considerable mortality and its location in the abdominal wall is rare; it can be treated with antibiotics and CT-guided drainage with no need for further intervention.info:eu-repo/semantics/publishedVersio

Ruin probabilities and capital requirement for open automobile portfolios with a bonus-malus system based on claim counts

For a large motor insurance portfolio, on an open environment, we study the impact of experience rating in finite and continuous time ruin probabilities. We consider a model for calculating ruin probabilities applicable to large portfolios with a Markovian Bonus‐Malus System (BMS), based on claim counts, for an automobile portfolio using the classical risk framework model. New challenges are brought when an open portfolio scenario is introduced. When compared with a classical BMS approach ruin probabilities may change significantly. By using a BMS of a Portuguese insurer, we illustrate and discuss the impact of the proposed formulation on the initial surplus required to target a given ruin probability. Under an open portfolio setup, we show that we may have a significant impact on capital requirements when compared with the classical BMS, by having a significant reduction on the initial surplus needed to maintain a fixed level of the ruin probabilityinfo:eu-repo/semantics/publishedVersio