Treatment of Perforated Diverticulitis with Generalized Peritonitis: Past, Present, and Future

The supposed optimal treatment of perforated diverticulitis with generalized peritonitis has changed several times during the last century, but at present is still unclear. The first cases of complicated perforated diverticulitis of the colon were reported in the beginning of the twentieth century. At that time the first therapeutic guidelines were postulated in which an initial nonresectional procedure was provided to be the safest plan of management. After many years in which resection had become standard practice, today, one century later, again (laparoscopic) nonresectional surgery is presented as a safe and promising alternative in treatment of complicated perforated diverticulitis. The question rises what had happened to close the circle? This paper includes a historic summary of changing patterns in surgical strategies in perforated diverticulitis complicated by generalized peritonitis

CROEQS: Contemporaneous Role Ontology-based Expanded Query Search: implementation and evaluation

Searching annotated items in multimedia databases becomes increasingly important. The traditional approach is to build a search engine based on textual metadata. However, in manually annotated multimedia databases, the conceptual level of what is searched for might differ from the high-levelness of the annotations of the items. To address this problem, we present CROEQS, a semantically enhanced search engine. It allows the user to query the annotated persons not only on their name, but also on their roles at the time the multimedia item was broadcast. We also present the ontology used to expand such queries: it allows us to semantically represent the domain knowledge on people fulfilling a role during a temporal interval in general, and politicians holding a political office specifically. The evaluation results show that query expansion using data retrieved from an ontology considerably filters the result set, although there is a performance penalty

Small sample inference for probabilistic index models

Probabilistic index models may be used to generate classical and new rank tests, with the additional advantage of supplementing them with interpretable effect size measures. The popularity of rank tests for small sample inference makes probabilistic index models also natural candidates for small sample studies. However, at present, inference for such models relies on asymptotic theory that can deliver poor approximations of the sampling distribution if the sample size is rather small. A bias-reduced version of the bootstrap and adjusted jackknife empirical likelihood are explored. It is shown that their application leads to drastic improvements in small sample inference for probabilistic index models, justifying the use of such models for reliable and informative statistical inference in small sample studies

Treatment of rectal war wounds

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex

Inactivation of Salmonella , Listeria monocytogenes and Escherichia coli O157:H7 inoculated on coriander by freeze-drying and supercritical CO 2 drying

Coriander, either fresh or inoculated with three strains of Escherichia coli O157:H7, Salmonella or Listeria monocytogenes, was treated with supercritical CO2 (scCO(2), with and without drying) or freeze-dried. After drying in scCO(2) for 150 min at 80 bar and 35 degrees C, the aerobic plate count, yeasts and molds, and the Enterobacteriaceae were reduced by 2.80, 5.03, and 4.61 log CFU/g, respectively. The total count of mesophilic aerobic spores was not significantly reduced by the treatment. Freeze-drying induced lower reductions with 1.23, 0.87, and 0.97 log CFU/g, respectively. After treatment at 100 bar and 40 degrees C without drying, inoculated strains of E. coli O157:H7, Salmonella, and L. monocytogenes were inactivated by > 7.37, > 4.73 and 4.99 log CFU/g, respectively. After drying in scCO 2 for 150 min at 80 bar and 35 degrees C, the strains were reduced by > 5.18 log CFU/g. Freeze-drying resulted in lower reduction with maximum 1.53, 2.03, and 0.71 log CFU/g, respectively. This study indicated that scCO(2) can be used for drying while offering a good inactivation of E. coli O157:H7, Salmonella, and L. monocytogenes as well as most of the bacteria in the vegetative form naturally occurring on coriander. Industrial relevance: Although dried foods are considered microbiological stable foods and show adverse conditions to microbial growth, they may still host pathogenic microorganisms, which may proliferate upon sufficient rehydration. Highly contaminated commodities such as herbs and spices can pose a threat to consumer health if not processed carefully. There is therefore a need to develop or improve drying techniques which can provide dried foods while reducing the initial contamination to acceptable levels in a single process. CO2 is a cheap, accessible solvent, with a low critical point (31 degrees C, 73.8 bar). Moreover, in the supercritical region, CO, exhibits potent microbicidal properties. Therefore, supercritical CO2 drying could be a valuable alternative nonthermal technique for conventional drying methods, such as air-drying or freeze-drying, when medium to high value-added food products with high initial contamination are involved

The synergistic necrohemorrhagic action of Clostridium perfringens perfringolysin and alpha toxin in the bovine intestine and against bovine endothelial cells

Bovine necrohemorrhagic enteritis is a major cause of mortality in veal calves. Clostridium perfringens is considered as the causative agent, but there has been controversy on the toxins responsible for the disease. Recently, it has been demonstrated that a variety of C. perfringens type A strains can induce necrohemorrhagic lesions in a calf intestinal loop assay. These results put forward alpha toxin and perfringolysin as potential causative toxins, since both are produced by all C. perfringens type A strains. The importance of perfringolysin in the pathogenesis of bovine necrohemorrhagic enteritis has not been studied before. Therefore, the objective of the current study was to evaluate the role of perfringolysin in the development of necrohemorrhagic enteritis lesions in calves and its synergism with alpha toxin. A perfringolysin-deficient mutant, an alpha toxin-deficient mutant and a perfringolysin alpha toxin double mutant were less able to induce necrosis in a calf intestinal loop assay as compared to the wild-type strain. Only complementation with both toxins could restore the activity to that of the wild-type. In addition, perfringolysin and alpha toxin had a synergistic cytotoxic effect on bovine endothelial cells. This endothelial cell damage potentially explains why capillary hemorrhages are an initial step in the development of bovine necrohemorrhagic enteritis. Taken together, our results show that perfringolysin acts synergistically with alpha toxin in the development of necrohemorrhagic enteritis in a calf intestinal loop model and we hypothesize that both toxins act by targeting the endothelial cells