Pouchitis: extracolonic manifestation of ulcerative colitis?

Pouchitis is the most frequent complication of ileal pouch-anal anastomosis for treatment of ulcerative colitis. There are several possible explanations. Among them, we focus on the one that considers pouchitis as an extracolonic manifestation of ulcerative colitis. The aim of this study was to investigate the association between pouchitis and extra-intestinal manifestations (EIM), which are frequent in these patients. Sixty patients underwent restorative proctocolectomy with an ileal J pouch (IPAA) from September 1984 to December 1998. Pouchitis was defined by clinical, endoscopic, and histologic criteria. The following extra-intestinal manifestations were studied: articular, cutaneous, hepatobiliary, ocular, genitourinary, and growth failure. Thirteen patients, of which 10 were female (76.9%), developed one or more episodes of pouchitis. Twelve patients of this group (92.3%) presented some kind of extra-intestinal manifestation, 4 pre-operatively (exclusively), 2 post-operatively (exclusively), and 6 both pre- and post-operatively (1.7 per patient). Twenty patients (42.7%) of the 47 without pouchitis did not present extra-intestinal manifestations; 10/35 (28.5%) of females had pouchitis, compared to 3/35 (12.0%) of men. Pouchitis was more frequent among females, though not statistically significant. EIM increases the risk of pouchitis. Pouchitis is related to EIM in 92.3 % of cases, corroborating the hypothesis that it could be an extracolonic manifestation of ulcerative colitis.

Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis

Necrotizing enterocolitis is a disease of the newborn that may involve the small intestine and/or the colon, and the stomach. To our knowledge, massive necrosis of the small intestine with concomitant involvement of the esophagus has never been reported. A case of a 6-month-old boy with necrotizing enterocolitis and pan-necrosis of the small intestine, cecum, and the lower third of the esophagus is presented. After 70 days of treatment, intestinal transit was established by an anastomosis between the first centimeter of jejunum and the ascending colon. Finally, esophageal transit was established by a total gastric transposition with cervical esophagogastric anastomosis. The patient was maintained under total parenteral nutrition, and after 19 months he developed fulminant hepatic failure due to parenteral nutrition; he then underwent combined liver and small bowel transplantation. After 2 months, the patient died due to undefined neurologic complications, probably related to infection or immunosuppressive therapy.

Business intelligence in banking: A literature analysis from 2002 to 2013 using Text Mining and latent Dirichlet allocation

telligence applications for the banking industry. Searches were performed in relevant journals resulting in 219 articles published between 2002 and 2013. To analyze such a large number of manuscripts, text mining techniques were used in pursuit for relevant terms on both business intelligence and banking domains. Moreover, the latent Dirichlet allocation modeling was used in or- der to group articles in several relevant topics. The analysis was conducted using a dictionary of terms belonging to both banking and business intelli- gence domains. Such procedure allowed for the identification of relationships between terms and topics grouping articles, enabling to emerge hypotheses regarding research directions. To confirm such hypotheses, relevant articles were collected and scrutinized, allowing to validate the text mining proce- dure. The results show that credit in banking is clearly the main application trend, particularly predicting risk and thus supporting credit approval or de- nial. There is also a relevant interest in bankruptcy and fraud prediction. Customer retention seems to be associated, although weakly, with targeting, justifying bank offers to reduce churn. In addition, a large number of ar- ticles focused more on business intelligence techniques and its applications, using the banking industry just for evaluation, thus, not clearly acclaiming for benefits in the banking business. By identifying these current research topics, this study also highlights opportunities for future research.

Dynamic group formation in mobile computer supported collaborative learning environment

Forming suitable learning groups is one of the factors that determine the efficiency of collaborative learning activities. However, only a few studies were carried out to address this problem in the mobile learning environments. In this paper, we propose a new approach for an automatic, customized, and dynamic group formation in Mobile Computer Supported Collaborative Learning (MCSCL) contexts. The proposed solution is based on the combination of three types of grouping criteria: learner’s personal characteristics, learner’s behaviours, and context information. The instructors can freely select the type, the number, and the weight of grouping criteria, together with other settings such as the number, the size, and the type of learning groups (homogeneous or heterogeneous). Apart from a grouping mechanism, the proposed approach represents a flexible tool to control each learner, and to manage the learning processes from the beginning to the end of collaborative learning activities. In order to evaluate the quality of the implemented group formation algorithm, we compare its Average Intra-cluster Distance (AID) with the one of a random group formation method. The results show a higher effectiveness of the proposed algorithm in forming homogenous and heterogeneous groups compared to the random method.

Clustering barotrauma patients in ICU–A data mining based approach using ventilator variables

Lecture Notes in Computer Science, 9273

The genital atrium armature of some Brazilian sand fly females (Diptera: Phlebotominae)

Phlebotomine sand flies are insects of medical importance. Species in the Neotropical region are highly diverse. Some of these species are considered cryptic species because of their morphological similarity between adult females of different species make identification especially difficult. The aim of this study was to analyze and describe the armature in the genital atrium (AGA) of some adult female sand flies, in order to discover new taxonomic characters that make it possible to distinguish between species that would otherwise be treated as cryptic by analysis of the AGA. The AGA of 16 Phlebotomine sand fly species are described. Distinct differences were found in relation to the shape and size of the armature, the presence or absence of spines on the armature, and the shape, size, and grouping patterns of the spines. These characters made it possible to distinguish between the species studied.

Automatic eye blink detection using consumer web cameras

This research aims to advance blinking detection in the context of work activity. Rather than patients having to attend a clinic, blinking videos can be acquired in a work environment, and further automatically analyzed. Therefore, this paper presents a methodology to perform the automatic detection of eye blink using consumer videos acquired with low-cost web cameras. This methodology includes the detection of the face and eyes of the recorded person, and then it analyzes the low-level features of the eye region to create a quantitative vector. Finally, this vector is classified into one of the two categories considered —open and closed eyes— by using machine learning algorithms. The effectiveness of the proposed methodology was demonstrated since it provides unbiased results with classification errors under 5%

Comunicar em saúde no setor público português: o potencial da comunicação estratégica na promoção da saúde e prevenção do tabagismo

Dissertação de mestrado em Ciências da Comunicação (área de especialização em Publicidade e Relações Públicas)

Anomalous origin of the left coronary artery from the right pulmonary artery with intramural aortic trajectory. Clinicosurgical diagnostic implications

OBJECTIVE: Anomalous origin of the left coronary artery from the right pulmonary artery (AOLCARPA), is a rare entity that is usually associated with other defects. Of the 20 cases of AOLCARPA reported in the literature, 14 (70%) had associations. We describe four patients with AOLCARPA without associated defects, but with a peculiar intramural aortic trajectory. METHODS: Fifty-five patients with anomalous origin of the left coronary artery were operated upon at INCOR-FMUSP. Four of the patients had the anomalous origin from the right pulmonary artery (RPA) without associated defects but with intramural aortic trajectory. Clinical and laboratory examinations were analyzed, as well as surgical findings. RESULTS: All patients had congestive heart failure (CHF) and 3 also had angina pectoris. Two patients had a murmur of mitral regurgitation, signs of myocardial infarction on the ECG and cardiomegaly. The shortening fraction varied from 9% to 23%. The hemodynamic study confirmed the diagnosis of anomalous origin of the coronary artery, but the intramural trajectory and the origin from the RPA were established only at surgery. In 3 patients, the technique of side-to-side anastomosis was performed with a good outcome. One patient, who underwent end-to-side anastomosis, died 6 months after the surgery. CONCLUSION: Association with other defects usually occurs in the AOLCARPA, and the intramural aortic trajectory is difficult to clinically diagnose but easy to surgically correct.

Congenital atresia of the ostium of the left coronary artery. Diagnostic difficulty and successful surgical revascularization in two patients

We report two cases of congenital atresia of the ostium of the left coronary artery. Case 1: a six-month-old infant presenting with serious cardiac insufficiency. A noninvasive diagnosis of dilated myocardiopathy was established and the clinical picture was pharmacologically compensated. When the patient was nine months of age, a hemodynamic study was performed that revealed congenital atresia of the ostium of the left coronary artery; the infant immediately underwent a successful anastomosis of the internal mammary artery with the left coronary artery. Case 2: an eleven-year-old asymptomatic boy with a history of heart murmur from the age of six months on, was refered for surgery with a diagnosis of anomalous origin of the left coronary artery from pulmonary trunk. A definitive diagnosis of atresia of the left coronary ostium was only established during surgery. Successful surgical revascularization with the left internal mammary artery, and left ventricular aneurysmectomy were performed.

Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases

OBJECTIVE: To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS: In the control group (18 patients), surgery was performed with systemic hypothermia at 32ºC and intermittent crossclamping of the aorta. Extracorporeal circulation was used. In the preconditioning group (17 patients), 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. Blood samples for analyses of pH, pCO2, pO2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1), at the end of the first anastomosis (time 2), and at the end of extracorporeal circulation (time 3). RESULTS: No difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. All patients had a good clinical outcome. CONCLUSION: The results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.

Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

OBJECTIVE: To compare immediate and late results in patients with or without fenestration who underwent cavopulmonary anastomosis so that we could assess the efficiency of the technique. METHODS: Sixty-two patients underwent surgery between 1988 and 1999, 41 with fenestration (group I -G I) and 21 without fenestration (group II -G II). Tricuspid atresia was prevalent in group I (23-56%) and single ventricle was prevalent in group II (14-66%). Mean ages at the time of operation were 7.3 years in group I and 7.6 in group II. At late follow-up, mean ages were 10.6 years in group I and 12.8 years in group II. RESULTS: Immediate and late mortality were 7.3% in G-I and 4.7% in G-II. Significant pleural effusion occurred in 41.4% of G-I patients and in 23.8% of G-II patients. Significant pericardial effusion occurred in 29.2% and 14.2%, respectively, in groups I and II. Central venous pressure was greater in G-II, 17.7 cm in H2O, as opposed to 15 cm in G-I. Hospital stay was similar between the groups, 26.3 and 21.8 days, respectively. Cyanosis and arterial insaturation occurred in 5 patients, and 4 patients were in functional class II, all from G-I. At late follow-up, 58 (93.5%) were in functional class I. Sinus rhythm was present in 94%, and pulmonary perfusion was similar in both groups. Eleven patients who underwent spirometry had good tolerance to physical effort. CONCLUSION: Atrial fenestration did not improve the immediate or late follow-up of patients who underwent cavopulmonary anastomosis, and is, therefore, dispensable.

Anomalous origin of the left pulmonary artery from the ascending aorta: successful surgical correction in an infant with fallot's tetralogy

We describe the case of a 40-day-old female patient with a history of breathlessness since birth who was referred to our hospital for surgical correction of common arterial trunk. The invasive investigation disclosed a Fallot¢s tetralogy anatomy associated with an anomalous origin of the left pulmonary artery from the ascending aorta. Immediately after diagnosis, the patient underwent a successful total surgical correction of the defect, including simultaneous anastomosis of the left pulmonary artery to the pulmonary trunk.

Anatomy at a Glance

The study of anatomy has changed enormously in the last few decades. No longer do medical students have to spend long hours in the dissecting room searching fruitlessly for the otic ganglion or tracing the small arteries that form the anastomosis round the elbow joint. They now need to know only the basic essentials of anatomy with particular emphasis on their clinical relevance and this is a change that is long overdue. However, students still have examinations to pass and in this book the authors, a surgeon and an anatomist, have tried to provide a means of rapid revision without any frills. To this end, the book follows the standard format of the at a Glance series and is arranged in short, easily digested chapters, written largely in note form, with the appropriate illustrations on the facing page. Where necessary, clinical applications are included in italics and there are a number of clinical illustrations. We thus hope that this book will be helpful in revising and consolidating the knowledge that has been gained from the dissecting room and from more detailed and explanatory textbooks.

Efficient similarity-based operations for data integration

Similarity-based operations, similarity join, similarity grouping, data integration