A Multicenter Randomized Clinical Trial of Primary Anastomosis or Hartmann's Procedure for Perforated Left Colonic Diverticulitis With Purulent or Fecal Peritonitis.

OBJECTIVES: : To evaluate the outcome after Hartmann's procedure (HP) versus primary anastomosis (PA) with diverting ileostomy for perforated left-sided diverticulitis. BACKGROUND: : The surgical management of left-sided colonic perforation with purulent or fecal peritonitis remains controversial. PA with ileostomy seems to be superior to HP; however, results in the literature are affected by a significant selection bias. No randomized clinical trial has yet compared the 2 procedures. METHODS: : Sixty-two patients with acute left-sided colonic perforation (Hinchey III and IV) from 4 centers were randomized to HP (n = 30) and to PA (with diverting ileostomy, n = 32), with a planned stoma reversal operation after 3 months in both groups. Data were analyzed on an intention-to-treat basis. The primary end point was the overall complication rate. The study was discontinued following an interim analysis that found significant differences of relevant secondary end points as well as a decreasing accrual rate (NCT01233713). RESULTS: : Patient demographics were equally distributed in both groups (Hinchey III: 76% vs 75% and Hinchey IV: 24% vs 25%, for HP vs PA, respectively). The overall complication rate for both resection and stoma reversal operations was comparable (80% vs 84%, P = 0.813). Although the outcome after the initial colon resection did not show any significant differences (mortality 13% vs 9% and morbidity 67% vs 75% in HP vs PA), the stoma reversal rate after PA with diverting ileostomy was higher (90% vs 57%, P = 0.005) and serious complications (Grades IIIb-IV: 0% vs 20%, P = 0.046), operating time (73 minutes vs 183 minutes, P < 0.001), hospital stay (6 days vs 9 days, P = 0.016), and lower in-hospital costs (US $16,717 vs US $24,014) were significantly reduced in the PA group. CONCLUSIONS: : This is the first randomized clinical trial favoring PA with diverting ileostomy over HP in patients with perforated diverticulitis.

Eosinophilie sanguine: quel bilan, quel cheminement diagnostique [Peripheral blood eosinophilia: diagnostic value and further assessment].

Although not specific, an increased in peripheral blood eosinophils may contribute substantially to the diagnosis of numerous infectious, allergic and inflammatory diseases. The scope of this article is to detail pathologies associated with peripheral eosinophilia by order of frequency and to guide further investigations.

Admissions of patients with alcohol intoxication in the Emergency Department: a growing phenomenon.

QUESTION UNDER STUDY: To investigate the change over time in the number of ED admissions with positive blood alcohol concentration (BAC) and to evaluate predictors of BAC level. METHODS: We conducted a single site retrospective study at the ED of a tertiary referral hospital (western part of Switzerland) and obtained all the BAC performed from 2002 to 2011. We determined the proportion of ED admissions with positive BAC (number of positive BAC/number of admissions). Regression models assessed trends in the proportion of admissions with positive BAC and the predictors of BAC level among patients with positive BAC. RESULTS: A total of 319,489 admissions were recorded and 20,021 BAC tests were performed, of which 14,359 were positive, divided 34.5% female and 65.5% male. The mean (SD) age was 41.7(16.8), and the mean BAC was 2.12(1.04) permille (g of ethanol/liter of blood). An increase in the number of positive BAC was observed, from 756 in 2002 to 1,819 in 2011. The total number of admissions also increased but less: 1.2 versus 2.4 times more admissions with positive BAC. Being male was independently associated with a higher (+0.19 permille) BAC, as was each passing year (+0.03). A significant quadratic association with age indicated a maximum BAC at age 53. CONCLUSION: We observed an increase in the percentage of admissions with positive BAC that was not limited to younger individuals. Given the potential consequences of alcohol intoxication, and the large burden imposed on ED teams, communities should be encouraged to take measures aimed at reducing alcohol intoxication.

Variaciones estacionales en la distribución y biomasa de anchoveta entre 1983 y 2000

Los resultados de 29 cruceros, realizados desde 1983 al 2000, muestran que la anchoveta ha presentado variaciones significativas en su biomasa y distribución, debido a los eventos El Niño 1982-83, 1987, 1992 y 1997-98, que la hicieron replegarse a la costa, migrar hacia el sur y profundizarse hasta lugares inusuales, disminuyendo los valores de las categorías de abundancia. Los mayores estimados de biomasa de anchoveta, se obtuvieron en los cruceros de evaluación hidroacústica de recursos pelágicos 9401-03 (8.700.590 t) y 0001-02 (9.439.027 t). La más alta biomasa estacional promedio por grados de latitud se determinó en primavera en los 8°5 (727.819 t), seguida del verano en los 11°s (701.724 t). Las altas biomasas promedio se encontraron entre los 7°S y 9° S. Los altos desembarques anuales promedio se registraron en verano (1.577.855 1). Los mayores desembarques se obtuvieron en 1994 (9.896.303 t) y en 1996 (7.136.856 t). Según el análisis de los parametros de biomasa y desembarques anuales entre los años de 1983 al 2000, se observa que existe una correlación significativa (r = 0,71) presentando un aceptable ajuste del modelo en R'•0,5 1.

L'Écho de Paris

1886/06/09 (Numéro 819).

Arithmétique de Boèce.

N° 19 des mss envoyés à Paris par Maugerard en octobre 1802; cf. B.n.F., département des Manuscrits, Archives Modernes 497; — abbaye d'Echternach (dioc. de Trèves), cf. titre "Continet"; 1789. Le patrimoine libéré, 152 et n° 96

Inventaire des lettres d'anoblissement, de légitimation et de naturalité, enregistrées à la chambre des comptes de 1349 à 1655.

Contient : a Acte, en latin, du roi CHARLES VIII. Le roi y anoblit Éloi Gigaud et sa postérité. Éloi Gigaud est dit demeurer « in parrochia de Mehers, prope Castriam, in provincia Bituriae ». Plessis lez Tours, mai 1489 ; b Note concernant la famille Nicolay, de 1440 à 1588, où l'on examine à quelle date la qualité de noble à été donnée à Jean Nicolay, père du premier Nicolay qui fut « premier president aux comptes à Paris ». On a joint à cette note la copie de trois actes, en latin, des années 1452, 1469, 1522. Jean Nicolay figure dans les deux premiers, et son fils, le premier président, dans le troisième ; c Acte par lequel le roi LOUIS XIV déclare légitimés ses enfants naturels Louis-Auguste, duc du Maine, Louis-César, comte du Vexin, Louise-Françoise de Nantes. St-Germain-en-Laye, décembre 1673 ; d Le « lieu de Mouchy le Vieil », donné à « Jean, bastard de Tyen, bailly de Senlis, au mois de juin 1422 » ; e « Me Jean Bruslard,... ordonné avocat... du roy en la prevosté de Chastillon sur Marne, par lettres du roy du 28 fevrier 1423 » ; f La famille de Jeanne d'Arc. 1429 et 1473 ; g Un mandement du roi Louis XI « au seigneur de La Roche-Guyon », pour « laisser passer 60 tonneaux de vin », envoyés par ledit roi au roi d'Angleterre, Henri VI. Paris, 16 nov. 1470

Satisfacción y lealtad del modelo empresarial de gestión agroindustrial

Banco del conocimiento

Decew Isometric

An isometric view of the planned Decew Residence.

La relation dynamique entre monnaie, taux de change et inflation en Haïti : une étude empirique.

Rapport de recherche

Capital humain, ouverture et croissance.

Rapport de recherche

Development of a Chinese version WHO Self-Assessment Tool for Evaluating Health Promotion in Hospital

[Support Institutions:] Department of Administration of Health, University of Montreal, Canada Public Health School of Fudan University, Shanghai, China