A causal relationship between right paraduodenal hernia and superior mesenteric artery syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately, but their occurrence in combination has not been reported.</p> <p>Case presentation</p> <p>A 46-year-old Japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. An enhanced multidetector-row computed tomography scan of our patient showed a cluster of small intestines with ischemic change in his right lateral abdominal cavity. Emergency surgery was subsequently performed, and strangulation of the distal jejunum along with incidental right paraduodenal hernia was found. His necrotic ileum was resected, and the jejunum encapsulated by the sac was repaired manually without reduction.</p> <p>Three days after the operation, however, our patient developed vomiting. An upper gastrointestinal series revealed a straight line cut-off sign on the third portion of his duodenum. A second enhanced multidetector-row computed tomography scan showed that he had a lower aortomesenteric angle and a shorter aortomesenteric distance compared to his condition before his right paraduodenal hernia was surgically repaired. We strongly suspected that the right paraduodenal hernia repair may have induced superior mesenteric artery syndrome. On the 21st post-operative day, duodenojejunostomy was performed because conservative management had failed.</p> <p>Conclusions</p> <p>In this case, enhanced multidetector-row computed tomography, which permits reconstructed multiplanar imaging, helped us to visually identify these diseases easily. It is important to recognize that surgical repair of a right paraduodenal hernia may cause superior mesenteric artery syndrome.</p

Acute appendicitis caused by endometriosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Endometriosis is a well-recognized gynecological condition in the reproductive age group. Surgical texts present the gynecological aspects of the disease in detail, but the published literature on unexpected manifestations, such as appendiceal disease, is inadequate. The presentation to general surgeons may be atypical and pose diagnostic difficulty. Thus, a definitive diagnosis is likely to be established only by the histological examination of a specimen.</p> <p>Case presentation</p> <p>We report a case of endometriosis of the appendix in a 25-year-old Caucasian woman who presented with symptoms of acute appendicitis and was treated by appendectomy, which resulted in a good outcome.</p> <p>Conclusions</p> <p>We discuss special aspects of acute appendicitis caused by endometriosis to elucidate the pathologic entity of this variant of acute appendicitis.</p

A tailored multi-model ensemble for air traffic management: Demonstration and evaluation for the Eyjafjallajökull eruption in May 2010

High quality volcanic ash forecasts are crucial to minimize the economic impact of volcanic hazards on air traffic. Decision-making is usually based on numerical dispersion modeling with only one model realization. Given the inherent uncertainty of such approach, a multi-model multi-source term ensemble has been designed and evaluated for the Eyjafjallaj&ouml;kull eruption in May 2010. Its use for air traffic management is discussed. Two multi-model ensembles were built: the first is based on the output of four dispersion models and their own implementation of ash ejection. All a priori model source terms were constrained by observational evidence of the volcanic ash cloud top as a function of time. The second ensemble is based on the same four dispersion models, which were run with three additional source terms: (i) a source term obtained with background modeling constrained with satellite data (a posteriori source term), (ii) its lower bound estimate, and (iii) its upper bound estimate. The a priori ensemble gives valuable information about the probability of ash dispersion during the early phase of the eruption, when observational evidence is limited. However, its evaluation with observational data reveals lower quality compared to the second ensemble. While the second ensemble ash column load and ash horizontal location compare well to satellite observations, 3D ash concentrations are negatively biased. This might be caused by the vertical distribution of ash, which is too much diluted in all model runs, probably due to defaults in the a posteriori source term and vertical transport and/or diffusion processes in all models. Relevant products for the air traffic management are horizontal maps of ash concentration quantiles (median, 75 %, 99 %) at a fine-resolved flight level grid. These maps can be used for route optimization in the areas where ash does not pose a direct and urgent threat to aviation. Cost-optimized consideration of such hazards will result in much less impact on flight cancellations, reroutings, and traffic flow congestions.</p

Neuroendocrine–immune disequilibrium and endometriosis: an interdisciplinary approach

Endometriosis, a chronic disease characterized by endometrial tissue located outside the uterine cavity, affects one fourth of young women and is associated with chronic pelvic pain and infertility. However, an in-depth understanding of the pathophysiology and effective treatment strategies of endometriosis is still largely elusive. Inadequate immune and neuroendocrine responses are significantly involved in the pathophysiology of endometriosis, and key findings are summarized in the present review. We discuss here the role of different immune mechanisms particularly adhesion molecules, protein–glycan interactions, and pro-angiogenic mediators in the development and progression of the disease. Finally, we introduce the concept of endometrial dissemination as result of a neuroendocrine-immune disequilibrium in response to high levels of perceived stress caused by cardinal clinical symptoms of endometriosis

Automation and Human Factors in future Air Traffic Management

A framework for implementing higher degrees of automation in future ATM systems based on biological, human automation principles is introduced. To investigate the effects of advanced automation support on operators' task- and workload, an exploratory pre-study was conducted with 7 ATCOs. Manual task execution was compared with a fully automated scenario, and an automated scenario with the option to manually intervene in automated flight paths. Subjective assessment of mental demand, taskload and workload were rated higher during manual trials compared to fully automated trials. Post-experimental interviews illustrated perceived difficulties related to the mixed system of automated and manually navigated aircrafts i.a. resulting from automation outages. Results exemplify the importance of collaborative automation systems that facilitate reciprocal anticipation of control actions

Intelligent Airport Operations and Advanced Arrival Management Algorithms & Decision Support Tools

Improvement of air traffic management procedures might help in coping with the expected growth in air traffic and requests for increased safety, predictability, and efficiency of the European air transportation system. This paper describes how complex airport operations and advanced arrival management procedures can be supported by decision support tools using rule-based artificial intelligence concepts. In addition, we investigate - using an Automatic Speech Recognition (ASR) based ATC scenario - how advanced automation support for arrival management affects air traffic controller's taskload and workload during regular work and in case of unexpected events (e.g. automation outages)