Liver surgery: Imaging and image guided therapies

The liver is the most common site of malignant tumors in patients worldwide, including both primary (hepatocellular carcinoma) and metastatic liver cancer (eg colorectal liver metastases). Complete resection or thermal ablation of all tumor deposits currently offers the only potentially curative treatment for patients with a malignancy of the liver. Historically, the liver was considered an organ too fragile and prone to bleeding for elective surgery. Increasing insight in the hepatic vascular and biliary anatomy and the introduction of antisepsis and anesthesia allowed pioneers like Langenbruch and Keene to start performing partial liver resections in the late nineteenth century1,2. Ongoing insight in the hepatic anatomy -like the division of the liver in eight distinct anatomic segments by Couinaud- further encouraged surgeons to perform liver surgery for hepatic neoplasms3. However, until late in the twentieth century, the absence of any form of non-invasive diagnostic imaging severely hampered the application of liver resection at a large scale

A holistic view of the Holy Spirit as agent of ethical responsibility: This view experienced as exciting in Romans 8, but alarming in 1 Corinthians 12

Modern man experiences a crisis which manifests itself across a wide spectrum: ecologically, sociologically and politically. Seen from a holistic perspective, this crisis, caused by the so-called mechanical worldview, calls for a radical change to a new worldview, the so-called postmodern or holistic view. In ecumenical theology, emphasis is also laid on the world in crisis, which calls for renewal on the same levels as in holistic thought. This change and renewal is to be brought about by the Holy Spirit, who is the agent of change in thought, and of involvement in creating a ‘new creation’. It will be argued that the Holy Spirit is indeed involved as the agent of man’s ethical responsibility; in Romans 8:1-17 this is seen as exciting, but, in 1 Corinthians 12:1-11, the alarming danger in ecumenical pneumatology is indicated. Das Echtheitszeichen des Heiligen Geistes is allein das Bekenntnifl: Kyrios Jesus [/ Kor 12, 5]. (Bornkamm 1983:188

Measuring the Milky Way in M-dwarfs

We report 274 M-dwarfs found in the Brightest of Reionizing Galaxies (BoRG) survey for high redshift galaxies. Using these, we fitted a model for the disk and halo with a fixed scale length at h = 2.6 kpc. We found a scale height z0 of 0.60±0.03 kpc, flattening parameter κ of 0.45±0.04 and a powerlaw-index p of 2.4±0.07. For the total number of M-dwarfs in the disk and halo we found 26.7_(-6.2)^(+9.3)×10^9. The upper limit for the halo fraction of M-dwarfs in the halo is 7_(-4)^(+5) %. The total mass upper limit was determined to be 1.99_(-0.5)^(+0.73)×10^9 Solar masses

Comparative Performance Analysis of Different Wind Fields in Southern and North-Western Coastal Areas of the Black Sea

This study determines the qualities of atmospheric wind field data in comparison with wind measurements at five locations along the Black Sea coast. For this purpose, four different wind fields were obtained from three different weather centres (NCEP, NASA, and ECMWF). Three of these are reanalyses winds (Climate Forecast System Reanalysis CFSR, Modern-Era Retrospective-analysis for Research and Applications MERRA, ECMWF reanalyses ERA-Interim) and one is the operational dataset (ECMWF operational). The performance of them was determined using the wind measurements from 2000 to 2014 at five coastal locations along the southern coastline of the Black Sea (Kumköy, Amasra, Sinop, Giresun, Hopa) and from 2006 to 2009 at offshore location (Gloria) off the coast of Romania. Performances of these wind fields were determined based on statistical characteristics (mean, standard deviation and variation coefficient etc.), statistical error analysis for all data and for different wind speed intervals, wind roses and probability distributions. Besides, long-term variations of yearly error values (SI and bias) of wind speeds from wind data sources during 2000 - 2014 were discussed. Finally, it was concluded that the CFSR winds give the best performance at most stations. The ECMWF datasets yield better results along the western side but CFSR wind fields have shown better performance along the eastern side of the Black Sea coast and at Gloria offshore location

De oudere patiënt met multipele ribfracturen

Abstract: Rib fractures resulting from blunt thoracic trauma occur frequently in elderly persons. Although usually due to a low impact trauma mechanism (e.g., fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. This unfavorable clinical course is most often caused by respiratory insufficiency due to lung edema or pneumonia. This cases series presents three elderly patients who sustained multiple rib fractures and were subsequently admitted to a level I trauma center for treatment. Diagnostic challenges as well as different treatment approaches for this population are discussed. More specifically, age specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anesthesiologist, intensive care physician and physical therapist is paramount for the prevention of potentially lethal complications. Samenvatting: Stomp thoracaal letsel met ribfracturen komt veel voor bij ouderen. Hoewel het traumamechanisme vaak van laag-energetische aard is, is het beloop dikwijls gecompliceerd. De morbiditeit en mortaliteit van deze letsels bij oudere patiënten zijn aanzienlijk. Enerzijds wordt dat verklaard door patiëntgerelateerde factoren, zoals een verminderde fysiologische reserve, comorbiditeit en verhoogde vatbaarheid van weefsels voor het ontstaan van letsel. Anderzijds kan de letselernst in deze populatie eenvoudig worden onderschat. Tijdige herkenning van deze factoren en de gevolgen hiervan, alsmede een multidisciplinaire behandeling zijn van essentieel belang om tot een goede diagnose te komen, een adequate behandeling in te stellen en complicaties te voorkomen. Wij illustreren dit aan de hand van 3 casussen