Examination report on the City of Newhall, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Newhall, Iowa for the period July 1, 2012 through June 30, 2013

Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps.

OBJECTIVE: Prospective non-randomised comparison of full-thickness pedicled diaphragm flap with intercostal muscle flap in terms of morbidity and efficiency for bronchial stump coverage after induction therapy followed by pneumonectomy for non-small cell lung cancer (NSCLC). METHODS: Between 1996 and 1998, a consecutive series of 26 patients underwent pneumonectomy following induction therapy. Half of the patients underwent mediastinal reinforcement by use of a pedicled intercostal muscle flap (IF) and half of the patients by use of a pedicled full-thickness diaphragm muscle flap (DF). Patients in both groups were matched according to age, gender, side of pneumonectomy and stage of NSCLC. Postoperative morbidity and mortality were recorded. Six months follow-up including physical examination and pulmonary function testing was performed to examine the incidence of bronchial stump fistulae, gastro-esophageal disorders or chest wall complaints. RESULTS: There was no 30-day mortality in both groups. Complications were observed in one of 13 patients after IF and five of 13 after DF including pneumonia in two (one IF and one DF), visceral herniations in three (DF) and bronchopleural fistula in one patient (DF). There were no symptoms of gastro-esophageal reflux disease (GERD). Postoperative pulmonary function testing revealed no significant differences between the two groups. CONCLUSIONS: Pedicled intercostal and diaphragmatic muscle flaps are both valuable and effective tools for prophylactic mediastinal reinforcement following induction therapy and pneumonectomy. In our series of patients, IF seemed to be associated with a smaller operation-related morbidity than DF, although the difference was not significant. Pedicled full-thickness diaphragmatic flaps may be indicated after induction therapy and extended pneumonectomy with pericardial resection in order to cover the stump and close the pericardial defect since they do not adversely influence pulmonary function.

Examination report on the City of Gilmore City, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Gilmore City, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Swea City, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Swea City, Iowa for the period July 1, 2012 through June 30, 2013

Perforation colique néonatale focale spontanée en dehors de la grande prématurité : rare et potentiellement insidieuse [Focal spontaneous colic perforation in term or near-term neonates: rare and potentially insidious].

Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7 °C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59 mg/l). The abdomen x-ray was erroneously considered normal. The infant's condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months of age. A normal sweat test excluded cystic fibrosis. All colic and rectal biopsies revealed nonspecific inflammatory signs and excluded necrotizing enterocolitis and Hirschsprung disease. Nonspecific irregular thinning of muscularis mucosae and muscularis propria were observed in the two resected colic segments. The boy is now a healthy 7-year-old. The incidence of neonatal focal spontaneous colic perforations at term or close to term is unknown but probably very rare. Our department is the neonatal referral center for approximately 14,000 annual births. In the last 10 years (2000-2009), out of 5115 neonatal admissions in our unit, only ten cases have presented a neonatal spontaneous intestinal perforation, seven of ten in very-low-birth-weight infants and three of ten in term or near-term neonates (one with Hirschsprung disease and the two cases reported herein). In the same period, 108 infants suffered from necrotizing enterocolitis, seven of 108 were term infants and 6 out of 7 had a congenital heart disease. The medical literature is poor on the subject of focal spontaneous colic perforations at term; no risk factor is described. The most specific clinical sign seems to be the abdominal distension. The presence of pneumoperitoneum on an abdominal x-ray is the most sensitive paraclinical sign. In case of an intestinal perforation, surgery must be performed quickly. The vital prognosis seems to be good. The objective of this study was to draw pediatricians' attention to focal spontaneous colic perforations in term or close to term newborns. In the cases reported, the diagnostic delays could have been prevented if the entity - with its radiological manifestation - had been well known.

Gene-mediated restoration of normal myofiber elasticity in dystrophic muscles.

Dystrophin mediates a physical link between the cytoskeleton of muscle fibers and the extracellular matrix, and its absence leads to muscle degeneration and dystrophy. In this article, we show that the lack of dystrophin affects the elasticity of individual fibers within muscle tissue explants, as probed using atomic force microscopy (AFM), providing a sensitive and quantitative description of the properties of normal and dystrophic myofibers. The rescue of dystrophin expression by exon skipping or by the ectopic expression of the utrophin analogue normalized the elasticity of dystrophic muscles, and these effects were commensurate to the functional recovery of whole muscle strength. However, a more homogeneous and widespread restoration of normal elasticity was obtained by the exon-skipping approach when comparing individual myofibers. AFM may thus provide a quantification of the functional benefit of gene therapies from live tissues coupled to single-cell resolution.

Examination report on the City of Lansing, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Lansing, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Atkins, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Atkins, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Remsen, Iowa and the Remsen Municipal Utilities for the period July 1, 2012 through June 30, 2013

Examination report on the City of Remsen, Iowa and the Remsen Municipal Utilities for the period July 1, 2012 through June 30, 2013

Examination report on the City of Manly, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Manly, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Hamburg, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Hamburg, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Villisca, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Villisca, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the Villisca Municipal Power Plant in Villisca, Iowa for the period January 1, 2013 through December 31, 2013

Examination report on the Villisca Municipal Power Plant in Villisca, Iowa for the period January 1, 2013 through December 31, 2013

Examination report on the City of Ocheyedan, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Ocheyedan, Iowa for the period July 1, 2012 through June 30, 2013

Examination of Closing the Existing Highway Maintenance Garage at Hamlin, Iowa, 1983

An optimum allocation model has been utilized to examine the existing allocation of highway segments to maintenance garages in the Hamlin study area. The model has also been used to evaluate the financial effect of closing the garage at Hamlin. The examination of the study area shows that only three of 48 highway segments should be reallocated at an annual operational savings of approximately $1,400. The study concludes there would be an annual operational savings of approximately 128,700 if the garage at Hamlin were closed.