Repair of an inguinoscrotal hernia containing the urinary bladder: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cases of patients with inguinoscrotal hernia containing the urinary bladder are very rare. These patients usually present with frequent episodes of urinary tract infection, difficulty in walking, pollakisuria and difficulty in initiating micturition because of incarceration of the urinary bladder into the scrotum.</p> <p>Case presentation</p> <p>We describe the case of an 80-year-old Caucasian man with an incarcerated urinary bladder into the scrotum who underwent surgical repair with mesh.</p> <p>Conclusions</p> <p>Diagnosis of such cases often requires not only clinical examination but also specialized radiological examinations to show the ectopic position of the urinary bladder. Surgical repair in these patients is a real challenge for surgeons.</p

The Future of Business Discourse Teaching

This chapter will:; ; ; Explore ways in which new media and digital technologies are shaping business communication and highlight the importance of digital communicative competence for learners and teachers;; ; ; Discuss ways in which the digital workplace can be brought into the business discourse classroom;; ; ; Discuss the role of Business English and other business languages in international business and what this means for business discourse teaching;; ; ; Consider how the multicultural workplace can inform business discourse teaching;; ; ; Provide a case study that illustrates some of the above developments, together with a set of tasks appropriate for the business discourse classroom, and a set of further readings

Digestibilité des protéines et disponibilité des acides aminés de quelques matières premières chez le bar (Dicentrarchus labrax)

Protein digestibility of soyabean meal, casein-gelatin mixture and fish hydrolysate was tested in the European sea bass, using increasing substitution levels in a reference diet. The protein digestibility of the latter composed of Norwegian fish meal had already been established (91 %). An accurate estimation of the apparent digestibility coefficient was made by linear regression, for the casein-gelatin mixture and soyabean meal, but not for fish hydrolysate (non significant correlation, p > 0.05). Protein digestibility estimated by extrapolation varied with the substitution level. The estimations obtained with the highest level used for each ingredient were close to those obtained by linear regression. However they exhibited a high variability for soyabean meal and, to a lesser extent, for fish hydrolysate. The availability of individual amino acids was also investigated in each protein source. For some amino acids it was different from that of total nitrogen, suggesting that the availability of essential amino acids should be used for accurate feed formulation. Metabolic fecal nitrogen and amino acids were determined using a protein-free diet, in order to estimate true availabilities. These coefficients were not significantly different from apparent availability coefficients

Comparative effectiveness of ceftriaxone plus metronidazole versus anti-pseudomonal antibiotics for perforated appendicitis in children

Background: Appendicitis is the most common pediatric surgical emergency and one of the most common indications for antibiotic use in hospitalized children. The antibiotic choice differs widely across children's hospitals, and the optimal regimen for perforated appendicitis remains unclear. Methods: We conducted a retrospective cohort study comparing initial antibiotic regimens for perforated appendicitis at a large tertiary-care children's hospital. Children hospitalized between January 2011 and March 2015 who underwent surgery for perforated appendicitis were identified by ICD-9 codes with confirmation by chart review. Patients were excluded if they had been admitted ≥48 hours prior to diagnosis, had a history of appendicitis, received inotropic agents, were immunocompromised, or were given an antibiotic regimen other than ceftriaxone plus metronidazole (CTX/MTZ) or an anti-pseudomonal drug (cefepime, piperacillin/tazobactam, ciprofloxacin, imipenem, or meropenem) within the first two days after diagnosis. The primary outcome of interest was post-operative complications, defined as development of an incisional infection or abscess within six weeks of hospital discharge. Results: Of the 353 children who met the inclusion criteria, 252 (71%) received CTX/MTZ and the others received an anti-pseudomonal regimen. A post-operative complication occurred in 37 (14.7%) of the CTX/MTZ group versus 18 (17.8%) of the anti-pseudomonal group. Antibiotic-related complications occurred in 4.4% of children on CTX/MTZ and 6.9% of children on anti-pseudomonal antibiotics (p = 0.32). In a multivariable logistic regression model adjusting for sex, age, ethnicity, and duration of symptoms prior to presentation, the adjusted odds ratio for post-operative complications in children receiving anti-pseudomonal antibiotics was 1.25 (95% confidence interval 0.66-2.40). Conclusion: Post-operative complication rates did not differ for children treated with CTX/MTZ versus a broader-spectrum regimen