Pour une chirurgie définitive d'emblée dans les ulcères gastro-duodénaux compliqués [Definitive surgery in complicated gastroduodenal ulcers].

Indications for surgical therapy in uncomplicated peptic ulcer disease have decreased considerably since the introduction of H2-receptor blocking drugs and more recently omeprazole. On the other side, the number of acute complications such as perforation or hemorrhage has remained nearly constant. The recent literature seems to indicate that the pattern of patients presenting with complications has changed and that the number of acute ulcers has increased. In a review of 283 patients, we found 150 perforated ulcers (PU) and 133 bleeding ulcers (BU). Almost all the patients with PU and 70% of the patients with BU have been treated operatively. The mortality is 14.3% and 12.5%, respectively. The vast majority of our patients have chronic ulcers, and only 7% have acute or subacute lesions confirmed by histologic examination. Based on our experience and the literature, we propose a therapeutic algorythm for these two conditions.

Concurrent use of cisplatin or cetuximab with definitive radiotherapy for locally advanced head and neck squamous cell carcinomas. Strahlentherapie in Kombination mit platinbasierter Chemotherapie oder Cetuximab zur Behandlung von lokal fortgeschrittenen Plattenepithelkarzinomen im Kopf-Hals-Bereich.

AIM: The goal of the present work was to compare outcomes of definitive concurrent cisplatin-based chemoradiotherapy (CRT) with cetuximab-based bioradiotherapy (BRT) in locally advanced head-and-neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Between 2006 and 2012, 265 patients with locally advanced HNSCC were treated at our institution with CRT (n = 194; 73 %) with three cycles of cisplatin (100 mg/m(2), every 3 weeks) or BRT (n = 71; 27 %) with weekly cetuximab. Patients receiving BRT had more pre-existing conditions (Charlson index ≥ 2) than the CRT group (p = 0.005). RESULTS: Median follow-up was 29 months. In all, 56 % of patients treated with CRT received the planned three cycles (92 % at least two cycles) and 79 % patients treated with BRT received six cycles or more. The 2-year actuarial overall survival (OS) and progression-free survival (PFS) were 72 % and 61 %, respectively. In the multivariate analysis (MVA), T4 stage, N2-3 stage, smoking status (current smoker as compared with never smoker), and non-oropharyngeal locations predicted for OS, whereas BRT association with OS was of borderline significance (p = 0.054). The 2-year actuarial locoregional control (LRC) and distant control (DC) rates were 73 and 79 %, respectively. CRT was independently associated with an improved LRC (2-year LRC: 76 % for CRT vs. 61 % for BRT) and DC (2-year LRC: 81 % for CRT vs. 68 % for BRT) in comparison with BRT (p < 0.001 and p = 0.01 in the MVA). Subgroup analyses showed that T4 patients benefited significantly from CRT (vs. BRT) in LRC, while T1-3 did not. BRT patients had more G3-4 skin complications (p < 0.001) and CRT patients had higher rates of feeding tube placement (p = 0.006) and G3-4 gastrointestinal toxicities (p < 0.001). CONCLUSION: This retrospective analysis showed a better LRC in locally advanced HNSCC treated by cisplatin-based CRT than cetuximab-based BRT, and a nonsignificant trend towards an improved OS.

Percutaneous drainage and sclerotherapy as definitive treatment of renal lymphangiomatosis.

We report the technique and outcome of percutaneous drainage and sclerotherapy as primary treatment of renal lymphangiomatosis. Between January and May 2009, two patients presenting with symptomatic renal lymphangiomatosis were treated in our department by a minimally invasive modality combining percutaneous drainage with repeated sclerotherapy. We retrospectively analysed recurrence, complications and patient satisfaction. In this limited case series, percutaneous drainage and repeated sclerotherapy proved to be safe and effective for treating renal lymphangiomatosis. This procedure provides a minimally invasive option for selected patients, potentially avoiding a surgical procedure and any risk of complications.

We All Have an Accent: Welcoming International Students to the Library

an overview of ways to make international students feel welcome in the library

The national third reader; containing exercises in articulation, accent, emphasis, pronunciation, and punctuation...

UANL

L'encadrement des fonds de couverture au Canada: une réflexion sur les principaux enjeux

Dans un contexte d'instabilité économique, force est de constater que les remises en question du libéralisme économique s'intensifient, mettant ainsi l'accent sur l'importance de la réglementation pour la protection des investisseurs ainsi que l'efficience des marchés financiers. Souvent associés aux conséquences d'un manque d'encadrement, les fonds de couverture représentent des cibles de choix pour ceux qui cherchent à expliquer l'effondrement majeur des marchés, tout en prônant un interventionnisme accru des autorités gouvernementales. Pour mieux comprendre les tenants et aboutissants de cette industrie, la présente étude propose une vue d'ensemble des caractéristiques fondamentales des fonds de couverture, tant sous l'angle de leur structure organisationnelle que de leur encadrement réglementaire. À cet égard, il importe de jauger les principaux enjeux découlant des règles applicables à l'administration d'un fonds, particulièrement sur le plan de la transparence informationnelle et au niveau de la gouvernance interne. Ces deux éléments constituant les pierres angulaires de la présente analyse, notre étude offrira finalement une réflexion sur l'approche réglementaire à privilégier, et ce, en tenant compte des particularités des fonds de couverture. Dans un même ordre d'idées, le rôle des divers intermédiaires professionnels sera abordé afin d'élargir notre compréhension de la question sous étude. L'objet de cette étude n'est pas d'apporter une solution complète et définitive à ces enjeux, mais bien d'offrir des pistes de réflexions pouvant servir de balises à une étude subséquente de la question, laquelle devra par ailleurs tenir compte du rôle assumé par les fonds de couverture ainsi que du statut particulier qu'ils occupent sur les marchés financiers.

Wildlife of Britain : the definitive visual guide.

Aporta información sobre la riqueza de la vida silvestre en el Reino Unido. Se centra en la actividad que puede hacerse para ayudar a la conservación de esta diversidad. Hay secciones de información sobre hábitats, precedido por un mapa de la geología de las Islas Británicas, para establecer el contexto. A continuación siguen las secciones de información sobre las costas, agua dulce, montañas, bosques y tierras agrícolas a través de las cuatro estaciones. Todas las fechas y los lugares están ilustradas por fotografías. Tiene glosario e índice alfabético.

Art : the definitive visual guide.

Guía de pintura y escultura, desde la prehistoria hasta la actualidad, con más de dos mil quinientos cuadros y esculturas más conocidos del mundo. Empieza con una breve sección que detalla cómo los artistas usan el color, la composición, la luz y la sombra, la perspectiva, y diferentes medios para llevar sus ideas a buen término. Se explica claramente cada movimiento artístico, junto con sus orígenes e influencias, estilos y técnicas. Explora temas comunes, tales como paisajes, desnudos y animales. Tiene glosario e índice alfabético.

The adult learner : the definitive classic in adult education and human resource development.

Es una lectura esencial para los profesionales del aprendizaje de adultos, estudiantes y profesionales de los recursos humanos, pues proporciona un marco teórico para la comprensión de los problemas del aprendizaje de adultos, tanto en los entornos docentes como en los lugares de trabajo. Se divide en tres partes: la primera parte estudia 'Las raíces de la andragogía', se traza el desarrollo de esta teoría y las características de los estudiantes adultos; en la segunda parte 'Los avances en el aprendizaje de adultos', se explican sus perspectivas de futuro en la investigación y la práctica y, en la última parte, 'Practica en el aprendizaje de adultos', se presentan lecturas seleccionadas que desarrollan los aspectos específicos de la andragogía en la práctica y que incluye estrategias para implementar los supuestos básicos, para adaptar el aprendizaje a las diferencias individuales, y para implementar la educación de adultos en las organizaciones. De especial interés son dos instrumentos de autoevaluación, 'the Core Competency Diagnostic and Planning Guide' y 'the Personal Adult Learning Style Inventory' que permiten al lector ponerse en camino del desarrollo personal en el aprendizaje de adultos.

Fluxing the logic of definitive differences

Focusing on Fluxus, a loosely knit association of artists from America, Europe and Asia whose work centers around intermediality, this article explores the notion of relationality without relata. Intermediality refers to works that fall conceptually between media – such as visual poetry or action music – as well as between the general area of art media and those of life media(Higgins). Departing from two Fluxus intermedia – the event score, a performative score in the form of words, and the Fluxkit, a performative score in the form of objects – I investigate the logic of co-constitutivity within which every element is both subject and object, both constitutive and constituted. To be more precise, I trace the cross-categorial interplay of differences that explodes the logico-linguistic structure of binary oppositions, such as those between foreground and background, word and action, sound and silence, identity and alterity. Aided by Jacques Derrida’s concept of ‘de-centered play’ and Shigenori Nagatomo’s concept of ‘interfusion’ this article seeks to articulate the ways in which the Fluxus works mobilise the ‘silent background’ to dismantle the dualistic logic of definite differences.