965 resultados para Triple endoscopy


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AIM: With capsule endoscopy (CE) it is possible to examine the entire small bowel. The present study assessed the diagnostic yield of CE in severe obscure-overt gastrointestinal bleeding (OOGIB). METHODS: During a 3-year period, 15 capsule examinations (4.5% of all CE in a single institution) were carried out in 15 patients (11 men; mean age 69.9 +/- 20.1 years) with severe ongoing bleeding, defined as persistent melena and/or hematochezia, with hemodynamic instability and the need for significant red blood cell transfusion. CE was carried out after non-diagnostic standard upper and lower endoscopy. The mean time from admission until CE was 4.1 +/- 4.4 days (0-15 days). RESULTS: CE revealed active bleeding in seven patients and signs of recent bleeding in four. Etiology of bleeding was correctly diagnosed in 11 patients (73.3%) (portal hypertension enteropathy, three patients; subepithelial ulcerated lesion, two patients; angiodysplasia, two patients; jejunal ulcer with visible vessel, one patient; multiple small bowel ulcers, one patient; jejunal tumor, one patient; jejunal mucosa irregularity with adherent clot, one patient). One patient (6.7%) had active bleeding but no visible lesion. As a consequence of the capsule findings, specific therapeutic measures were undertaken in 11 patients (73.3%) with five managed conservatively, four endoscopically and two surgically. Two patients experienced bleeding recurrence. One of them, with a probable small bowel tumor, refused any other interventions. CONCLUSIONS: CE is useful in patients with severe OOGIB by providing positive findings in the majority of patients, with subsequent impact on therapeutic procedures.

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Integration of multiple herbicide-resistant genes (trait stacking) into crop plants would allow over the top application of herbicides that are otherwise fatal to crops. The US has just approved Bollgard II® XtendFlex™ cotton which has dicamba, glyphosate and glufosinate resistance traits stacked. The pace of glyphosate resistance evolution is expected to be slowed by this technology. In addition, over the top application of two more herbicides may help to manage hard to kill weeds in cotton such as flax leaf fleabane and milk thistle. However, there are some issues that need to be considered prior to the adoption of this technology. Wherever herbicide tolerant technology is adopted, volunteer crops can emerge as a weed problem, as can herbicide resistant weeds. For cotton, seed movement is the most likely way for resistant traits to move around. Management of multiple stack volunteers may add additional complexity to volunteer management in cotton fields and along roadsides. This paper attempts to evaluate the pros and cons of trait stacking technology by analysing the available literature in other crop growing regions across the world. The efficacy of dicamba and glufosinate on common weeds of the Australian cotton system, herbicide resistance evolution, synergy and antagonisms due to herbicide mixtures, drift hazards and the evolution of herbicide resistance to glyphosate, glufosinate and dicamba were analysed based on the available literature.

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In this paper, we show that if X is a smooth variety of general type of dimension m≥3 for which the canonical map induces a triple cover onto Y, where Y is a projective bundle over P1 or onto a projective space or onto a quadric hypersurface, embedded by a complete linear series (except Q3 embedded in P4), then the general deformation of the canonical morphism of X is again canonical and induces a triple cover. The extremal case when Y is embedded as a variety of minimal degree is of interest, due to its appearance in numerous situations. For instance, by looking at threefolds Y of minimal degree we find components of the moduli of threefolds X of general type with KX3=3pg−9,KX3≠6, whose general members correspond to canonical triple covers. Our results are especially interesting as well because they have no lower dimensional analogues.

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Las úlceras por presión representan un importante problema de salud pública y tienen un importante impacto económico en los sistemas de salud. La mayoría de los estudios para prevenir las úlceras por presión se han llevado a cabo en contextos hospitalarios, usando ácidos grasos hiperoxigenados (AGHO) y hasta la fecha, no se ha realizado ningún estudio específico con aceite de oliva virgen extra (AOVE) en el entorno domiciliario. Material y método Objetivo principal: evaluar si la utilización de AOVE no es inferior a los AGHO en la prevención de úlceras por presión (UPP) en pacientes inmovilizados en el entorno domiciliario. Diseño: Ensayo clínico aleatorizado multicéntrico, paralelo, a triple ciego, de no inferioridad. Ámbito: Población consultante de centros de salud andaluces. Muestra: 831 pacientes inmovilizados en riesgo de padecer UPP. Resultados El período de seguimiento fue de 16 semanas. En el análisis por protocolo, ninguna de las zonas evaluadas presentó diferencias de riesgo de incidencia de las úlceras por presión que superasen el valor delta establecido (10%). Sacro: AOVE 8 (2,55%) vs AGHO 8 (3,08%), RAR 0,53 (-2,2 a 3,26). Talón derecho: AOVE 4 (1,27%) vs AGHO 5 (1,92)%, RAR 0,65 (-1,43 a 2,73). Talón izquierdo: AOVE 3 (0,96%) vs AGHO 3 (1,15%), RAR 0.2 (-1,49 a 1,88). Trocánter Derecho: AOVE 0 (0%) vs AGHO 4 (1,54%), RAR 1,54 (0,04-3,03). Trocánter izquierdo: AOVE 1 (0,32%) vs AGHO 1 (0,38%), RAR 0.07 (-0,91 a 1,04). Discusión Este ensayo clínico pretendía evaluar si la prevención de las UPP usando una fórmula de AOVE no era inferior a la prevención de UPP con el uso AGHO, en el entorno domiciliario y con pacientes inmovilizados de alto riesgo. Los resultados han mostrado esta no inferioridad al no observarse diferencias que hayan superado el límite inferior del intervalo de confianza y convierte al aceite de oliva en un producto eficaz para la prevención de UPP en este tipo de pacientes. Se necesitan más estudios para investigar el mecanismo de acción del AOVE en la prevención de las UPP y relacionarlo con la etiopatogenia de éstas. Bibliografía 1. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009 Jul;57(7):1175–83. 2. Yamamoto Y, Hayashino Y, Higashi T, Matsui M, Yamazaki S, Takegami M, et al. Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers. J Eval Clin Pract. 2010 Jun;16(3):585–9. 3. Hanson D, Langemo DK, Anderson J, Thompson P, Hunter S. Friction and shear considerations in pressure ulcer development. Adv Skin Wound Care. 2010 Jan;23(1):21–4. 4. Soldevilla Agreda JJ, Torra i Bou J-E, Verdú Soriano J, López Casanova P. 3.er Estudio Nacional de Prevalencia de Úlceras por Presión en España, 2009: Epidemiología y variables definitorias de las lesiones y pacientes. Gerokomos. 2011 Jun;22(2):77–90. 5. Kottner J, Lahmann N, Dassen T. [Pressure ulcer prevalence: comparison between nursing homes and hospitals]. Pflege Z. 2010 Apr;63(4):228–31. 6. Wilborn D, Halfens R, Dassen T, Tannen A. [Pressure ulcer prevalence in German nursing homes and hospitals: what role does the National Nursing Expert Standard Prevention of Pressure Ulcer play?]. Gesundheitswesen Bundesverb Ärzte Öffentl Gesundheitsdienstes Ger. 2010 Apr;72(4):240–5. 7. Tubaishat A, Anthony D, Saleh M. Pressure ulcers in Jordan: a point prevalence study. J Tissue Viability. 2011 Feb;20(1):14–9. 8. James J, Evans JA, Young T, Clark M. Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set. Int Wound J. 2010 Jun;7(3):147–52. 9. Defloor T, Schoonhoven L, Katrien V, Weststrate J, Myny D. Reliability of the European Pressure Ulcer Advisory Panel classification system. J Adv Nurs. 2006 Apr;54(2):189–98

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Background: There is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 – 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana. Objectives: This study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: This study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy. Results: Of 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAIDuse. H. pylori was associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003. Conclusion: H. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.

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Background: Aspirin, dipyridamole and clopidogrel are effective in secondary vascular prevention. Combination therapy with three antiplatelet agents might maximise the benefit of antiplatelet treatment in the secondary prevention of ischaemic stroke. Methodology/Principal Findings: A randomised, parallel group, observer-blinded phase II trial compared the combination of aspirin, clopidogrel and dipyridamole with aspirin alone. Adult patients with ischaemic stroke or transient ischaemic attack (TIA) within 5 years were included. The primary outcome was tolerability to treatment assessed as the number of patients completing randomised treatment. Recruitment was halted prematurely after publication of the ESPRIT trial (which confirmed that combined aspirin and dipyridamole is more effective than aspirin alone). 17 patients were enrolled: male 12 (71%), mean age 62 (SD 13) years, lacunar stroke syndrome 12 (71%), median stroke/TIA onset to randomisation 8 months. Treatment was discontinued in 4 of 9 (44%) patients receiving triple therapy vs. none of 8 taking aspirin (p = 0.08). One recurrent stroke occurred in a patient in the triple group who was noncompliant of all antiplatelet medications. The number of patients with adverse events and bleeding complications, and their severity, were significantly greater in the triple therapy group (p,0.01). Conclusions/Significance: Long term triple antiplatelet therapy was asociated with a significant increase in adverse events and bleeding rates, and their severity, and a trend to increased discontinuations. However, the patients had a low risk of recurrence and future trials should focus on short term therapy in high risk patients characterised by a very recent event or failure of dual antiplatelet therapy.

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Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.

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Background and Objectives: The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. pylori in children, and to determine the level of patients’ tolerance. Patients and Methods: This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit. Results: There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19). Conclusions: The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups. Keywords: Treatment,

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Opto-acoustic imaging is a growing field of research in recent years, providing functional imaging of physiological biomarkers, such as the oxygenation of haemoglobin. Piezo electric transducers are the industry standard detector for ultrasonics, but their limited bandwidth, susceptibility to electromagnetic interference and their inversely proportional sensitivity to size all affect the detector performance. Sensors based on polymer optical fibres (POF) are immune to electromagnetic interference, have lower acoustic impedance and a reduced Young's Modulus compared to silica fibres. Furthermore, POF enables the possibility of a wideband sensor and a size appropriate to endoscopy. Micro-structured POF (mPOF) used in an interferometric detector has been shown to be an order of magnitude more sensitive than silica fibre at 1 MHz and 3 times more sensitive at 10 MHz. We present the first opto-acoustic measurements obtained using a 4.7mm PMMA mPOF Bragg grating with a fibre diameter of 130 μm and present the lateral directivity pattern of a PMMA mPOF FBG ultrasound sensor over a frequency range of 1-50 MHz. We discuss the impact of the pattern with respect to the targeted application and draw conclusions on how to mitigate the problems encountered.

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The background material of the study consists of articles about French literature gathered between 2010 and 2014 in the Swedish press. The aim of the article is to isolate the most widely discussed French literature from France in the Swedish press during the period, in order to explore why the transfer of this literature persists over time, how it is perceived, and which type of mediators bring about this transmission. The study raises questions about the image of French literature in Swedish media, Sweden’s impact on the transnational circulation of literature, and the use of French literature to place Sweden on the literary map. The results of the reception study show that French literature is presented as both aesthetically disruptive with innovative features and as a normative and traditional model. It incarnates an image of tradition as well as of modernity. French literature from France is principally mediated by orthodox journalists with a consistent symbolic capital, and the posture of these journalists is analyzed through Sapiro’s model, inspired by Bourdieu. The orthodox journalists manage to redirect the symbolic capital inherent to consecrated French literature at three levels: national, personal, and transnational. Firstly, the importation of French literature increases Swedish literature’s symbolic capital. Secondly, this transfer allows for an auto-consecration of the orthodox journalists themselves. Thirdly, this use of highly valued imported literature engenders a supplementary consecration (surconsecration) of a national literature and its dominating language. In conclusion, these observed bilateral literary exchanges show the often overlooked importance of peripheral countries in transnational literary transmission. The results modify Casanova’s (2002) model, since they display the impact on the market from the margins. The transfer of central national literatures in dominating languages towards peripheral countries allows for dominated languages and minor national literatures to take an active part in the construction and reconstruction of the relations on the global literary map.

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Malgré l'augmentation constante de l'efficacité des cellules photovoltaïques multi-jonctions destinées au photovoltaïque concentré, des pertes de performances subsistent à haute concentration solaire. Elles sont principalement causées par un ombrage excessif dû aux métallisations ou par effet Joule à cause de la résistance série. Une des solutions à ce problème est de reporter le contact métallique en face avant sur la face arrière grâce à des vias métallisés et isolés électriquement. Avec cette architecture, les pertes dues à l'effet Joule et à l'ombrage seront limitées et des gains en efficacité sont attendus. Toutefois, l'intégration de vias sur des cellules photovoltaïques triple jonction favorise la recombinaison électron-trou en surface et peut provoquer une perte de performances de ces dispositifs. Ce mémoire présente les travaux de recherche effectués visant à étudier précisément cette problématique ainsi qu'à proposer des solutions pour limiter ces pertes. L'objectif est d'évaluer les pertes de performances de cellules photovoltaïques triple jonction suite à l'intégration de vias. Dans un second temps, l'objectif secondaire vise à limiter les pertes grâce à des traitements de passivation. Les résultats et solutions qu'apporte ce projet représentent une étape clé dans la réalisation de cette nouvelle architecture de contact électrique pour cellules photovoltaïques. En effet, les conclusions de ce projet de recherche permettent de valider la possibilité d'obtenir des gains en efficacité grâce à cette architecture. De plus, les procédés de microfabrication présentés dans ce projet de recherche proposent des solutions afin d'intégrer des vias sur ces hétérostructures tout en limitant les pertes en performances.

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El grupo fundamentalista Hezbollah, nació en el Líbano y propagó su ideología por el mundo a finales del siglo XX y principios del siglo XXI. En el punto más álgido de su expansión, instaló una de sus células en el límite entre Argentina, Brasil y Paraguay, generando un riesgo para la región. Por esto, se hizo necesario crear políticas conjuntas de seguridad en la Triple Frontera con el fin de combatir la amenaza en la zona entre los años 2001 y 2006. Aunque teóricamente es necesario instaurar un Complejo Regional de Seguridad para mitigar los efectos de la amenaza, esto representó una complicación para los actores estatales, principalmente por sus divergencias geopolíticas, sociales, así como, las distintas percepciones sobre el grupo terrorista presente. Esto, resultó por dificultar la respuesta acertada en temas seguridad en la frontera.