We report the second case of a primary aortoenteric fistula resulting from septic aortitis with a contained aortic leak into the retroperitoneum and finally erosion into the duodenum. An emergency laparotomy revealed a fistula between the third part of the duodenum and a decompressed sac (false aneurysm) arising from a nonaneurysmal, grossly infected pararenal aorta. The purpose of this report is to present this rare case in detail and to review primary aortoenteric fistulas reported in the English language literature. Most fistulas form in association with an abdominal aortic aneurysm and rarely are due to infection. Only 6% of patients presented with the classic triad of abdominal pain, a palpable mass, and gastrointestinal bleeding. Although 29% of patients presented with massive hemorrhage, adequate time usually existed for surgical treatment of these complications. A patient with ill-defined abdominal pain and fever who suddenly develops a palpable abdominal mass should have an emergency ultrasound or CT scan to exclude the possibility of an infected aortic aneurysm or a contained rupture of an infected nonaneurysmal aorta. If the symptoms are associated with bleeding and the patient is hemodynamically stable, emergent endoscopy should also be performed. If a primary aortoenteric fistula or an aortic pseudoaneurysm is confirmed, emergent surgery should be undertaken to avoid rupture into the bowel or retroperitoneum. 相似文献
A clinical incident involving an undetected disconnection occurred during the use of a CPRAM coaxial breathing circuit. The flow resistance of this circuit was evaluated and compared with that of a Bain circuit to determine the factors involved. A differential pressure transducer was used to monitor the pressure drop across each circuit during simulation of controlled ventilation with a fresh gas flow of 6 L.min-1. An Ohio V5 anaesthesia ventilator was adjusted to different flow rates and tidal volumes and a test lung simulated an airway resistance of 2.7 cm H2O.L-1.sec and a compliance of 0.05 L.cmH2O-1. Absolute pressure at the ventilator was also monitored when the circuit was disconnected from the test lung. The CPRAM circuit displayed a pressure drop from the ventilator to the endotracheal tube of 6.3 cm H2O at 60 L.min-1, about twice that found with the Bain. A disconnection at the tracheal connector produced an absolute pressure at the ventilator of 9.6 cm H2O with the CPRAM and 5.5 cm H2O with the Bain. Since the ventilator low pressure alarm was preset to 9.2 cm H2O, the alarm provided a warning with the Bain but not the CPRAM. The elevated flow resistance of the CPRAM circuit was attributed to a restriction in the flow area at the patient end of the circuit. Capnographs or adjustable low-pressure alarms provide more reliable monitoring for breathing circuit disconnects. 相似文献
In high-field MRI severe problems with respect to B(1) (+) uniformity and specific absorption rate (SAR) deposition pose a great challenge to whole-body imaging. In this study the potential of a phased array transmit coil is investigated to simultaneously reduce B(1) (+) nonuniformity and SAR deposition. This was tested by performing electromagnetic simulations of a phased array TEM coil operating at 128 MHz loaded with two different homogeneous elliptical phantoms and four dielectric patient models. It was shown that the wave interference of a circularly polarized RF field with an ellipse and a pelvis produces largely identical B(1) (+) and electric field patterns. Especially for obese patients, this results in large B(1) (+) nonuniformity and global areas with elevated SAR deposition. It is demonstrated that a phased array transmit coil can reduce these phenomena. The technique was especially successful in suppressing SAR hotspots with a decrease up to 50%. The application of optimized settings for an ellipse to the patient models leads to comparable results as obtained with the patient-specific optimizations. This suggests that generic phase/amplitude port settings are possible, requiring no preinformation about patient-specific RF fields. Such a scheme would, due to its simultaneous B(1) (+) homogenization and extra SAR margin, have many benefits for whole-body imaging at 3 T. 相似文献
The aim of this study was to assess alcoholic inpatients' smoking and coffee intake variation following withdrawal. Only moderate smokers (less than 30 cigarettes/day) showed a significant increase of cigarette consumption after alcohol withdrawal. However, their urinary cotinine level did not vary, suggesting a behavioral, and not biological, compensation through smoking following alcohol withdrawal. Heavy smokers (30 cigarettes/day or more) showed no significant clinical or biological variation of smoking behavior. Coffee consumption increased after alcohol withdrawal in all patients, irrespective of smoking habits. 相似文献
Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N?=?675; ages 18–29, M?=?21.93 years, SD?=?3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.
Ghrelin, a recently discovered peptide isolated from the gastric corpus mucosa, is believed to be important in the regulation
of growth hormone secretion and has been shown to increase appetite and food intake as well. It may also have other gastrointestinal
and cardiac functions. Because a cell of origin for ghrelin has not been convincingly identified in the gastric mucosa thus
far, we studied the immunohistochemical expression of ghrelin in proliferative lesions of the enterochromaffin-like (ECL)
cells—a cell that is not only exclusively confined to the gastric corpus mucosa but is its dominant endocrine cell type as
well.
Formalin-fixed, paraffin embedded tissues from three cases of gastric ECL cell hyperplasia and five ECL carcinoids (three
with coexisting foci of diffuse, linear, and micronodular hyperplasia) were immunohistochemically stained for ghrelin, using
a commercially available antibody. The Sevier-Munger stain for ECL cells and immunohistochemical stains for chromogranin,
gastrin, serotonin, somatostatin, and vesicular monoamine transporter-2 (VMAT-2) were performed on parallel sections for correlation
with the ghrelin staining results.
All ECL cell carcinoids and hyperplastic lesions were positive for both the Sevier-Munger and the immunohistochemical stains
for chromogranin and VMAT-2. Immunoreactivity for ghrelin was seen in 4/5 ECL carcinoids, all cases of ECL cell hyperplasia,
as well as in all areas with linear and micronodular hyperplasia adjacent to the ECL cell carcinoids. In each instance, such
staining was confined to the Sevier-Munger, and VMAT-2 positive cells only.
Our findings indicate that the ECL cells are either the ghrelin-producing cells of the gastric mucosa or acquire the capability
to synthesize ghrelin during proliferative states encompassing the entire hyperplasia to neoplasia spectrum. In view of the
orexigenic and other known actions of ghrelin, the functional and/or biologic significance of ghrelin production in such ECL
cell proliferations needs to be investigated further. 相似文献
Spinocerebellar ataxia type 1 (SCA1) is an autosomal dominant
neurodegenerative disorder caused by the expansion of a CAG trinucleotide
repeat which encodes glutamine in the novel protein ataxin-1. In order to
characterize the developmental expression pattern of SCA1 and to identify
putative functional domains in ataxin-1, the murine homolog (Sca1) was
isolated. Cloning and characterization of the murine Sca1 gene revealed
that the gene organization is similar to that of the human gene. The murine
and human ataxin-1 are highly homologous but the CAG repeat is virtually
absent in the mouse sequence suggesting that the polyglutamine stretch is
not essential for the normal function of ataxin-1 in mice. Cellular and
developmental expression of the murine homolog was examined using RNA in
situ hybridization. During cerebellar development, there is a transient
burst of Sca1 expression at postnatal day 14 when the murine cerebellar
cortex becomes physiologically functional. There is also marked expression
of Sca1 in mesenchymal cells of the intervertebral discs during development
of the spinal column. These results suggest that the normal Sca1 gene, has
a role at specific stages of both cerebellar and vertebral column
development.
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