Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis

<p>Abstract</p> <p>Background</p> <p>Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients with mild or absent secondary signs of abdominal pathology. It can mimick diverticulitis or appendicitis on clinical exam. The diagnosis of EA is very infrequent, due in part to low or absent awareness among general surgeons. The objective of this work was to review the authors' experience and describe the clinical presentation of EA.</p> <p>Methods</p> <p>All patients diagnosed with EA between January 2004 and December 2006 at an urban surgical emergency room were retrospectively reviewed by two authors in order to share the authors' experience with this rare diagnosis. The operations were performed by two surgeons. Pathological examinations of specimens were performed by a single pathologist. A review of clinical presentation is additionally undertaken.</p> <p>Results</p> <p>Ten patients (3 females and 7 males, average age: 44.6 years, range: 27–76 years) were diagnosed with symptomatic EA. Abdominal pain was the leading symptom, the pain being localized in the left (8 patients, 80 %) and right (2 patients, 20%) lower quadrant. All patients were afebrile, and with the exception of one patient, nausea, vomiting, and diarrhea were not present. CRP was slightly increased (mean: 1.2 mg/DL) in three patients (33%). Computed tomography findings specific for EA were present in five patients. Treatment was laparoscopic excision (n = 8), excision via conventional laparotomy (n = 1) and conservative therapy (n = 1).</p> <p>Conclusion</p> <p>In patients with localized, sharp, acute abdominal pain not associated with other symptoms such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of EA should be considered. Although infrequent up to date, with the increase of primary abdominal CT scans and ultrasound EA may well be diagnosed more frequently in the future.</p

Cutaneous lesions of the external ear

Skin diseases on the external aspect of the ear are seen in a variety of medical disciplines. Dermatologists, othorhinolaryngologists, general practitioners, general and plastic surgeons are regularly consulted regarding cutaneous lesions on the ear

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Photometric and spectroscopic evolution of the interacting transient AT 2016jbu(Gaia16cfr)

We present the results from a high-cadence, multiwavelength observation campaign of AT 2016jbu (aka Gaia16cfr), an interacting transient. This data set complements the current literature by adding higher cadence as well as extended coverage of the light-curve evolution and late-time spectroscopic evolution. Photometric coverage reveals that AT 2016jbu underwent significant photometric variability followed by two luminous events, the latter of which reached an absolute magnitude of M-V similar to-18.5 mag. This is similar to the transient SN 2009ip whose nature is still debated. Spectra are dominated by narrow emission lines and show a blue continuum during the peak of the second event. AT 2016jbu shows signatures of a complex, non-homogeneous circumstellar material (CSM). We see slowly evolving asymmetric hydrogen line profiles, with velocities of 500 km s(-)(1) seen in narrow emission features from a slow-moving CSM, and up to 10 000 km s(-1) seen in broad absorption from some high-velocity material. Late-time spectra (similar to+1 yr) show a lack of forbidden emission lines expected from a core-collapse supernova and are dominated by strong emission from H, He I, and Ca II. Strong asymmetric emission features, a bumpy light curve, and continually evolving spectra suggest an inhibit nebular phase. We compare the evolution of H alpha among SN 2009ip-like transients and find possible evidence for orientation angle effects. The light-curve evolution of AT 2016jbu suggests similar, but not identical, circumstellar environments to other SN 2009ip-like transients

Red Sea palaeoclimate: stable isotope and element-ratio analysis of marine mollusc shells

The southern Red Sea coast is the location of more than 4,200 archaeological shell midden sites. These shell middens preserve archaeological and climatic archives of unprecedented resolution and scale. By using shells from these contexts, it is possible to link past environmental information with episodes of human occupation and resource processing. This chapter summarises current knowledge about the marine gastropod Conomurex fasciatus (Born 1778) and discusses its use in environmental and climatic reconstruction using stable isotope and elemental ratio analysis. It offers a review of the most recent studies of shell midden sites on the Farasan Islands, their regional importance during the mid-Holocene, theories about seasonal use of the coastal landscape, and preliminary results from new methods to acquire large climatic datasets from C. fasciatus shells

Nonablative laser treatment of facial rhytides

The purpose of this study is to evaluate the safety and effectiveness of the New Star Model 130 neodymium:yttrium aluminum garnet (Nd:YAG) laser system for nonablative laser treatment of facial rhytides (e.g., periorbital wrinkles). Facial rhytides are treated with 1.32 micrometer wavelength laser light delivered through a fiberoptic handpiece into a 5 mm diameter spot using three 300 microsecond duration pulses at 100 Hz pulse repetition frequency and pulse radiant exposures extending up to 12 J/cm2. Dynamic cooling is used to cool the epidermis selectively prior to laser treatment; animal histology experiments confirm that dynamic cooling combined with nonablative laser heating protects the epidermis and selectively injures the dermis. In the human clinical study, immediately post-treatment, treated sites exhibit mild erythema and, in a few cases, edema or small blisters. There are no long-term complications such as marked dyspigmentation and persistent erythema that are commonly observed following ablative laser skin resurfacing. Preliminary results indicate that the severity of facial rhytides has been reduced, but long-term follow-up examinations are needed to quantify the reduction. The mechanism of action of this nonablative laser treatment modality may involve dermal wound healing that leads to long- term synthesis of new collagen and extracellular matrix material. ©2005 Copyright SPIE - The International Society for Optical Engineering