Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree

Aproximação de escoamentos de fluidos de Carreau via método Galerkin mínimos quadrados

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Parâmetros microbiológicos e físico-químicos durante a produção e maturação do queijo Fascal

 A produção de produtos lácteos de ovelha pode proporcionar uma alternativa rentável em relação aos produtos de leite bovino, devido ao sabor e à textura específicos. Leites ovino e caprino podem ser utilizados em diferentes aplicações e têm-se tornado um meio muito importante para a economia em distintas regiões geográficas. O objetivo deste trabalho foi avaliar a qualidade do leite de ovelha e do queijo Fascal produzido na região metropolitana de Porto Alegre, RS. As amostras de queijo foram analisadas no 1°, 30°, 60° e 90° dias de maturação, para verificar possíveis alterações nos parâmetros microbiológicos e físico-químicos. Estas amostras foram mantidas em câmara refrigerada durante o período de maturação. Os resultados indicaram ausência de Salmonella spp. em todas as amostras analisadas. As contagens de aeróbios mesófilos, estafilococos coagulase positiva, coliformes totais e coliformes fecais demonstraram resultados considerados aceitáveis, de acordo com a legislação brasileira para leite cru e para produtos lácteos. Os parâmetros físico-químicos do leite ovino apresentaram valores semelhantes aos encontrados em amostras de leite de ovelha provenientes do sul do Brasil. Em função dos resultados, concluiu-se que as características físico-químicas do queijo foram modificadas durante a maturação, com diminuição no conteúdo de umidade e aumento nos teores de proteína e gordura. O produto final foi classificado como um queijo gordo e de baixa umidade

Transport at basin scales: 1. Theoretical framework

The paper describes the theoretical framework for a class of general continuous models of the hydrologic response including both flow and transport of reactive solutes. The approach orders theoretical results appeared in disparate fields into a coherent theoretical framework for both hydrologic flow and transport. In this paper we focus on the Lagrangian description of the carrier hydrologic runoff and of the processes embedding catchment-scale generation and transport of matter carried by runoff. The former defines travel time distributions, while the latter defines lifetime distributions, here thought of as contact times between mobile and immobile phases. Contact times are assumed to control mass transfer in a well-mixed approximation, appropriate in cases, like in basin-scale transport phenomena, where the characteristic size of the injection areas is much larger than that of heterogeneous features. As a result, we define general mass-response functions of catchments which extend to transport of matter geomorphologic theories of the hydrologic response. A set of examples is provided to clarify the theoretical results towards a computational framework for generalized applications, described in a companion paper. © 2006 Author(s). This work is licensed under a Creative Commons License

Transport at basin scales: 2. Applications

In this paper, the second of a series, we apply the models discussed in Part 1 to a significant case study. The nature of the catchment under study, the transport phenomena investigated (i.e. nitrates moving as solutes within runoff waters) and the scales involved in space and time, provide an elaborate test for theory and applications. Comparison of modeling predictions with field data (i.e. fluxes of carrier flow and solute nitrates) suggests that the framework proposed for geomorphic transport models is capable to describe well large-scale transport phenomena driven and/or controlled by spatially distributed hydrologic fields (e.g. rainfall patterns in space and time, drainage pathways, soil coverage and type, matter stored in immobile phases). A sample MonteCarlo mode of application of the model is also discussed where hydrologic forcings and external nitrate applications (through fertilization) are treated as random processes. © 2006 Author(s). This work is licensed under a Creative Commons License

Patterns of hepatocellular carcinoma incidence in Egypt from a population-based cancer registry

Hepatocellular carcinoma (HCC) is increasing worldwide, and is frequently attributed to rising rates of hepatitis C virus infection and interactions between viral and environmental risk factors. Because of Egypt's unique risk factor profile, we analyzed data from the Gharbiah Population-Based Cancer Registry for the period 1999–2003 to characterize demographic and geographic patterns of cases in this province. Methods:  We calculated age- and sex-specific and age- and sex-standardized HCC incidence rates for the eight districts in Gharbiah. We also compared rates from Gharbiah with the USA (US Surveillance Epidemiology and End Results [SEER] database). Results:  The analysis revealed a higher incidence in males than in females, significant geographic variations among districts, and a higher incidence in Gharbiah than that reported by SEER. Conclusion:  The findings of this study document the heterogeneous distribution of HCC at regional and international levels. This population-based registry offers the opportunity for careful representative studies of various etiologies, particularly infectious and/or environmental factors that may contribute to risk.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75374/1/j.1872-034X.2007.00299.x.pd

ACE I/D Gene Polymorphism Can't Predict the Steroid Responsiveness in Asian Children with Idiopathic Nephrotic Syndrome: A Meta-Analysis

The results from the published studies on the association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and the treatment response to steroid in Asian children with idiopathic nephrotic syndrome (INS) is still conflicting. This meta-analysis was performed to evaluate the relation between ACE I/D gene polymorphism and treatment response to steroid in Asian children and to explore whether ACE D allele or DD genotype could become a predictive marker for steroid responsiveness. = 0.85; respectively), however, the result for the association of II genotype with SRNS risk was not stable.Our results indicate that D allele or DD homozygous can't become a significant genetic molecular marker to predict the treatment response to steroid in Asian children with INS

TNFA and IL10 Gene Polymorphisms are not Associated with Periodontitis in Brazilians

IL-10 and TNF-α are cytokines that have complex and opposing roles in the inflammatory responses. G/A polymorphisms at position –1082 of IL10 and –308 of TNFA genes have been reported to influence the expression of IL-10 and TNF-α, respectively. The aim of this study was to investigate the association between the IL10 (-1082) and TNFA (- 308) gene polymorphisms with different clinical forms or severity of periodontitis in a sample of Brazilian individuals. DNA was obtained from oral swabs of 165 Brazilian individuals, which were divided into three groups: individuals with chronic periodontitis, aggressive periodontitis and individuals without clinical evidence of periodontitis. Evaluation of IL10 and TNFA polymorphisms was performed by RFLP analysis. Statistical analysis of data was performed using the χ2 likelihood ratio and Fisher`s exact test. No significant differences in the genotype and allele distribution of either IL10 or TNFA were observed among individuals with different clinical forms or with different degrees of severity of periodontitis. Moreover, combined analysis of IL10 and TNFA polymorphisms did not show any association with periodontal status. As conclusion, the IL10 and TNFA gene promoter polymorphisms investigated are not associated with different clinical forms of periodontitis or with severity of the disease in the Brazilian population polymorphisms