Acute Pancreatitis Complicated with Choledochal Duct Rupture

Recurrent acute pancreatitis is a rare clinical entity in childhood with unknown incidence (Rosendahl et al., 2007) and often occurring in a familial context. Genetic factors such as PRSS1 mutations (cationic trypsinogen gene) can be found in some patients. However, many remain idiopathic. The natural history remains poorly documented and the most frequent complications reported are pain, exocrine pancreatic insufficiency, diabetes mellitus, and pancreatic adenocarcinoma after long-standing hereditary pancreatitis. We describe a patient with hereditary pancreatitis in whom a mild pancreatitis episode was complicated by a perforation of the ductus choledochus

Temporary diverting stoma in therapy-refractory luminal colonic Crohn's disease:an alternative to immediate colorectal resection?

AimCreation of a diverting stoma in patients with Crohn's disease (CD) can counteract luminal inflammation. The clinical utility of a diverting stoma with the prospect of restoration of gastrointestinal continuity warrants further investigation. The aim of this work was to evaluate the long-term effects of creation of a diverting stoma on the disease course in patients with luminal colonic CD.MethodIn this retrospective, multicentre cohort study we investigated the disease course of patients who received a diverting stoma in the biological era. Clinical characteristics, medication use and surgical course were assessed at the time of creation of the diverting stoma and during follow-up. The primary outcome was the rate of successful and lasting reestablishment of gastrointestinal continuity.ResultsThirty six patients with refractory luminal CD from four institutions underwent creation of a diverting stoma. Of the overall cohort, 20 (56%) patients had their gastrointestinal continuity reestablished after initial stoma creation and 14 (39%) who had their stoma reversed remained stoma-free during a median of 3.3 years follow-up (interquartile range 2.1–6.1 years). Absence of stoma reversal was associated with the presence of proctitis (p = 0.02). Colorectal resection after creation of a diverting stoma was performed in 28 (78%) patients, with 7 (19%) having a less extensive resection and 6 (17%) having a more extensive resection compared with the surgical plan before stoma creation.ConclusionA diverting stoma could potentially be an alternative to immediate definitive stoma placement in specific populations consisting of patients with luminal colonic CD, especially in the absence of proctitis

Vegetation in urban streets, squares, and courtyards

One of various ways in which vegetation cover used in the greening of urban areas can help improve the health and well-being of people is in how it changes the acoustic environment. This chapter presents findings of computer simulations and scale modelling to examine and quantify the effectiveness of green roof and green wall (vertical garden) systems in reducing road traffic noise for streets, squares, and roadside courtyards. Noise reduction by sound absorption in reflected and diffracted (over roofs) sound paths is investigated. Particular attention is paid to the importance of vegetation placement relative to the receiver/listening positions. Because the soil substrate used for the vertical walls has good sound absorption properties, it also can be used for green barriers. In this chapter, the effects of a low barrier made of green wall substrate are studied for an installation on the ground and on the top of buildings surrounding a courtyard

Toolbox from the EC FP7 HOSANNA project for the reduction of road and rail traffic noise in the outdoor environment

yesThis paper offers a brief overview of innovative methods for road and rail traffic noise reduction between source and receiver. These include using new barrier designs, planting of trees, treatments of ground and road surfaces and greening of building façades and roofs using natural materials, like vegetation, soil and other substrates in combination with recycled materials and artificial elements. The abatements are assessed in terms of numerically predicted sound level reductions, perceptual effects and cost–benefit analysis. Useful reductions of noise from urban roads and tramways are predicted for 1-m-high urban noise barriers and these are increased by adding inter-lane barriers. A 3 m wide 0.3 m high lattice ground treatment, a carefully planted 15-m-wide tree belt and replacing 50 m of paved areas by grassland are predicted to give similar reductions. Tree belts are shown to be very cost-effective and combining tall barriers with a row of trees reduces the negative impact of wind. Green roofs may significantly reduce the noise at the quiet side of buildings

Optimising the future Belgian offshore wind farm monitoring programme

Six years of monitoring triggered a reflection on how to best continue with the monitoring programme. The basic monitoring has to be rationalised at the level of the likelihood of impact detection, the meaningfulness of impact size and representativeness of the findings. Targeted monitoring should continue to disentangle processes behind the observed impact, for instance the overarching artificial reef effect created by wind farms. The major challenge however remains to achieve a reliable assessment of the cumulative impacts. Continuing consultation and collaboration within the Belgian offshore wind farm monitoring team and with foreign marine scientists and managers will ensure an optimisation of the future monitoring programme

Differences between urban and rural hedges in England revealed by a citizen science project

Background: Hedges are oth ecologically and culturally important and are a distinctive feature of the British landscape. However the overall length of hedges across Great Britain is decreasing. Current challenges in studying hedges relate to the dominance of research on rural, as opposed to urban, hedges, and their variability and geographical breadth. To help address these challenges and to educate the public on the importance of hedge habitats for wildlife, in 2010 the Open Air Laboratories (OPAL) programme coordinated a hedge-focused citizen science survey. Results: Results from 2891 surveys were analysed. Woody plant species differed significantly between urban and rural areas. Beech, Holly, Ivy, Laurel, Privet and Yew were more commonly recorded in urban hedges whereas Blackthorn, Bramble, Dog Rose, Elder and Hawthorn were recorded more often in rural hedges. Urban and rural differences were shown for some groups of invertebrates. Ants, earwigs and shieldbugs were recorded more frequently in urban hedges whereas blowflies, caterpillars, harvestmen, other beetles, spiders and weevils were recorded more frequently in rural hedges. Spiders were the most frequently recorded invertebrate across all surveys. The presence of hard surfaces adjacent to the hedge was influential on hedge structure, number and diversity of plant species, amount of food available for wildlife and invertebrate number and diversity. In urban hedges with one adjacent hard surface, the food available for wildlife was significantly reduced and in rural hedges, one adjacent hard surface affected the diversity of invertebrates. Conclusions: This research highlights that urban hedges may be important habitats for wildlife and that hard surfaces may have an impact on both the number and diversity of plant species and the number and diversity of invertebrates. This study demonstrates that citizen science programmes that focus on hedge surveillance can work and have the added benefit of educating the public on the importance of hedgerow habitats

Endothelin-1-induced constriction in the coronary resistance vessels and abdominal aorta of the guinea pig

The purpose of this study was to examine contractile properties of endothelin-1, a newly discovered vasoactive peptide, in guinea pig coronary resistance vessels and abdominal aorta. Changes in perfusion pressure after injections of endothelin-1 were measured using a constant-flow modified Langendorff preparation. The ED 10 values of coronary perfusion pressure were about 100-fold less for endothelin-1 than for prostaglandin F 2α . After the endothelium was damaged by exposure to free radicals, maximal coronary constriction in response to endothelin-1 (10 −9 moles) was not altered, whereas dilator responses to low doses of endothelin-1 were converted to constrictor responses. Removal of the endothelium from aortic rings significantly increased responsiveness to endothelin-1 and the maximal response to the peptide. In calcium-free medium, endothelin-1 induced small increases both in perfusion pressure in coronary vessles and in tension in the aorta. Reintroduction of calcium in the coronary and aortic preparations produced a rapid increase in perfusion pressure and tension, respectively. Further, endothelin-1-induced coronary constriction was inhibited 59%±7% by nifedipine (10 −7 moles). We conclude that endothelin-1 is a more potent constrictor than prostaglandin F 2α in the coronary vasculature. Endothelin-1-induced constriction in the coronary vasculature of the guinea pig is not mediated through an endogenous constricting factor released from the endothelium or a constrictor prostaglandin. Further, endothelin-1-induced dilation in the coronary vasculature and attenuation of endothelin-1-induced contraction in the abdominal aorta of the guinea pig are mediated through the release of a factor from the endothelium. Endothelin-1-induced coronary constriction and abdominal aortic contraction require extracellular calcium, entering, in part, through nifedipine-sensitive channels.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41586/1/380_2005_Article_BF02058691.pd