Persistence of a Gastrocutaneous Fistula after gastrostomy removal in children: Incidence and predictive factors

Background/Purpose: The aims of this study were to determine the incidence of persistent gastrocutaneous fistulas (GCF) after gastrostomy removal and to identify associated risk factors. Methods: This retrospective study included 75 children from the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland who had a gastrostomy performed between 1988 and 2010. The records of the children were reviewed for sex, age at the time of gastrostomy removal, underlying disease, type of gastrostomy placement and length of use, and then analyzed in order to find a correlation between the GCF and these parameters. Results: The gastrostomy orifice did not close spontaneously within the first month in 33 of the patients (44%), and 15 subsequently underwent surgical closure. The mean duration of gastrostomy use was significantly longer in children who developed a persistent GCF (30 vs. 19 months, P = 0.03). The other parameters studied did not show any significant association with the persistence of a GCF. Conclusions: The only predictive factor determining the persistence of a GCF was found to be the timespan between the placement and removal of the gastrostomy appliance. Elective surgical closure of the gastrostomy orifice should be considered after 1 month of persistent GCF.

Servidor d'escriptoris remots

El projecte que s'ha dut a terme és un estudi introductori del funcionament de la tecnologia NX fent ús d'una eina lliure com és FreeNX. Aquesta tecnologia està destinada a millorar el rendiment dels processos de comunicació que s'estableixen quan volem accedir a un escriptori remot. El resultat d'aquest estudi s'ha plasmat en un appliance que integra el servidor esmentat juntament amb una aplicació que s'ha desenvolupat per a la gestió d'escriptoris remots utilitzant el servidor FreeNX i els corresponents clients NX. L'appliance s'ha generat amb la distribució de Linux OpenSUSE 12.1 fent ús de l'eina SUSE Studio i s'ha optimitzat per a que faci funcionar l'aplicatiu web desenvolupat en mode kiosk tant bon punt aquest es posa en funcionament conjuntament amb el servidor d'escriptoris remots FreeNX.

Treball Final de Master - Servidor de Comunicacions Unificades

L'objectiu d'aquest projecte és la creació d'una prova de concepte de comunicacions unificades utilitzant productes de programari lliure existents. Aquesta prova de concepte servirà per poder fer demostracions del funcionament general del programari implicat amb el mínim de preparacions, instal·lacions i configuracions prèvies possibles. El projecte es dividirà en dos appliances o LiveCD, creats a traves de Suse Studio, anomenats Comunicacions Unificades i Comunicacions Unificades 2.Els productes de programari lliure que composen el Servidor de Comunicacions Unificades els podem classificar en productes principals, plugins o addons dels productes i productes secundaris.Com a productes principals tenim els següents servidors que cobreixen les necessitats principals del Servidor de Comunicacions Unificades:Asterisk v1.8.3 : Servidor de telefonia amb veu sobre IP (VoIP).FreePBX v2.9.0beta2 : GUI de control i administració d'Asterisk.Openfire v3.7.0 : Servidor de IM basat en el protocol XMPP.BigBlueButton v0.71a : Sistema de conferència web. Pendent finalitzar-ne l'implementació.I els seguents productes principals que cobreixen les necessitats del servidor de Comunicacions Unificades 2:Zimbra v7.0.1 : Servidor de correu electrònic i de calendari. Pendent resoldre conflicte inicialització LDAP.Funambol v9.0.0 : Sincronització Zimbra amb mòbils.Com a plugins o addons del productes tenim, classificats segons el producte:Asterisk addons: chan_jingle i chan_gtalkZimlets: Asterisk, Google Translator, Funambol i SocialsOpenfire pugins: Asterisk, Facebook i GmailCom a productes secundaris tenim els clients necessaris per poder utilitzar l'appliance:Firefox: Navegador web que servirà com a interfície d'usuari per les diferents eines d'administració i la demostració.Pigdin o Spark: Clients de missatgeria instantània, per l'appliance Comunicacions Unificades.A més d'instal·lar aquests productes, s'implementa una interfície web, mitjançant Drupal, en format HTML per enllaçar les diferents eines d'administració dels productes, per a cadascun dels dos appliances i es realitzara un Kiosk appliance per a familiaritzar-se amb l'entorn SuseStudio.

Secondary Aural Symptoms in Relation to Cranio-Cervical and General Disorders

The present thesis comprises two study populations. The first study sample (SS1) consisted of 411 adults examined and interviewed at three annual visits. The second study sample (SS2) consisted of 1720 adults who filled in a mailed questionnaire about secondary otalgia, tinnitus and fullness of ears. In the second phase of the SS2, 100 subjects with otalgia were examined and interviewed by specialist in stomatognathic physiology and otorhinolaryngology. In the third phase, 36 subjects participated in a randomized, controlled and blinded trial of effectiveness of occlusal appliance on secondary otalgia, facial pain, headache and treatment need of temporomandibular disorders (TMD). The standardized prevalence of recurrent secondary otalgia was 6%, tinnitus 15% and fullness of ears 8%. Aural symptoms were more frequent among young than old subjects. They were associated with other, simultaneous aural symptoms, TMD pain, head and neck region pain, and visits to a physician. The subjects with aural symptoms more often had tenderness on palpation of masticatory muscles and clinical signs of temporomandibular joint than the subjects without. 85% of the subjects reporting secondary otalgia had cervical spine or temporomandibular disorder or both. In SS1, the final model of secondary otalgia included active need treatment for TMD, elevated level of stress symptoms, and bruxism. In SS2, the final models of aural symptoms included associated aural symptoms, young age, TMD pain, headache and shoulder ache. Stabilization splint more effectively alleviated secondary otalgia and active treatment need for TMD than a palatal control splint. In patients with aural pain, tinnitus or fullness of ears, it is important to first rule out otologic and nasopharyngeal diseases that may cause the symptoms. If no explanation for aural symptoms is found, temporomandibular and cervical spine disorders should be rouled out to minimize unnecessary visits to a physician.

Major Home Appliances,2008

If you haven’t been in the market for new appliances during the past several years, you’re going to be surprised at how innovative and energy-efficient appliances have become. You’ll find energy-smart appliance choices in almost all price ranges. Before heading to the local appliance retailer or “big-box” store, measure the space the new appliance will occupy to make sure it will fit—and that there’s enough room to fully open the door (or lid), as well as adequate clearances for ventilation, plumbing connections and other hookups. Then go to the appliance manufacturers’ Web sites to look at product information, and make a list of questions and “must-have” and “nice-to-have-but-not-essential” features.

Major Home Appliances, 2011

If you haven’t been in the market for new appliances during the past several years, you’re going to be surprised at how innovative and energy-efficient appliances have become. You’ll find energy-smart appliance choices in almost all price ranges. Before heading to the local appliance retailer or “big-box” store, measure the space the new appliance will occupy to make sure it will fit—and that there’s enough room to fully open the door (or lid), as well as adequate clearances for ventilation, plumbing connections and other hookups. Then go to the appliance manufacturers’ Web sites to look at product information, and make a list of questions and “must-have” and “nice-to-have-but-not-essential” features.

Prise en charge des fentes labio-maxillo-palatines au CHUV = [Children born with a cleft: treatment at the CHUV in Lausanne]

A cleft can be labial, labial-maxillary, unilateral or bilateral labial-maxillary-palatal, or isolated palatal. A multidisciplinary team includes several specialists who will handle the diverse problems of children born with a cleft. This team will follow the child through each developmental stage and assemble an optimal treatment plan, thus reducing the onus on the family. Depending on the type of cleft and the age of the child, feeding, speech, ORL, dental, orthodontic, esthetic and possibly also psychological problems will be taken care of. This is why cleft treatment starts at the time it is diagnosed, before or after birth, and ends when the child is fully grown. It requires a complete interdisciplinary team and the collaboration with obstetricians and geneticians.

Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications

Objective: To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device. Materials and Methods: Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P Less-than .05). Results: Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort. Conclusions: Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.

Gefäßchirurgische Ausbildung in endovaskulärer Technik in Lausanne

Between 1995 and 2005, the number of aortic aneurysms treated annually using endovascular techniques (EVAR) increased from 0 to 50, including all aortic stages. Our organization includes a large team of surgeons, a stock of three complete families of endoprostheses (straight, conical and bifurcated), a mobile trolley with accessories (arterial introducer/introducer sheath, guide wire, catheters, balloons, etc.) and an appliance on wheels for intravascular ultrasound examination (IVUS). This appliance, together with a mobile fluoroscopy device (c-arm), allows endovascular aneurysms analysis of every operating room in our institution, usually without angiography or the use of contrast medium. In general, we are therefore not depending on substantial preoperative imaging in order to identify candidates for endovascular aneurysms repair and can treat abdominal and thoracic aortic ruptures without delay. For endovascular aortic aneurysms repair we distinguish between process steps on the one hand (determining indications, imaging of the access vessels, measurement using IVUS and road mapping via fluoroscopy, selection of implant, implant insertion, positioning, setting the implant, determining success, reconstruction of the access vessel and follow-up) and the level of competence on the other (assistant, senior and directing physicians). Our ultrasound supported technique for endovascular aneurysms repair has been successfully brought to other hospitals using an IVUS transporter and telementoring.

Verkkovaihtosuuntaajan vektorisäädön toteutus FPGA-piirillä

Verkkovaihtosuuntaajalla pystytään muuntamaan tasajännite vaihtojännitteeksi ja päinvastoin. Verkkovaihtosuuntaajan toiminta perustuu tehokytkinten ohjaukseen ja sopivan modulointimenetelmän käyttöön. Vektorisäädössä vaihtosuuntaajanvirrat ja jännitteet esitetään kompleksitasossa, jolloin virta- ja jännitekomponentit voidaan esittää vektoreina. Vektorisäädössä verkkovaihtosuuntaajan ohjaustoteutetaan laskemalla kompleksitasossa vektoreille arvot, jotka tuottavat vaihtosuuntaajan lähtöön halutun vektorin. Koska FPGA-piirit mahdollistavat nopean rinnakkaisen laskennan, soveltuvat ne hyvin vektorisäädön toteuttamiseen. FPGA-piirien rakenteesta johtuen on säätöjärjestelmän suunnittelussa huomioitava kiinteän pilkun lukujen riittävä bittileveys ja järjestelmän diskretointiaika. Työssä suunnitellaan verkkovaihtosuuntaajan vektorisäätö ja tutkitaan bittileveyden vaikutusta säädön toteuttamiseen FPGA-piirillä. Bittileveyden tarkasteluun esitetään käytettäväksi tilastollisia menetelmiä. Työssä tarkastellaan kiinteän pilkun järjestelmän ja liukulukujärjestelmän erosuureen tilastollisia tunnusmerkkejä sekä histogrammia. Tarkasteluissa huomattiin, että maksimivirhe itsessään ei tarjoa riittävästi tietoa erosuureen jakautumisesta. Näin ollen maksimivirhe ei ole kaikissa tilanteissa sovelias menetelmä riittävän bittitarkkuuden määrittämiseen. Työssä esitetään riittävän bittitarkkuuden määrittelemiseen käytettäväksi otossuureista otosvarianssia, keskipoikkeamaa ja vaihteluväliä.

LTO- laitteiden vuosihyötysuhteiden vertailututkimus

Tämän työn tavoitteena oli laskea ja vertailla eroja lämmön talteenottolaitteistojen vuosihyötysuhteissa. Tavoitteena oli erityisesti löytää selkeät perusteet Suomen Rakennusmääräyskokoelman osassa D2 esitetyille arvoille vuosihyötysuhdetta laskettaessa. Työn kirjallisuusosassa on käsitelty yleisellä tasolla erityyppisten lämmön talteenottolaitteistojen teoriaa, toimintaperiaatteita ja soveltuvuutta erilaisiin käyttöolosuhteisiin. Työn empiirisessä osassa selvitettiin laboratorio-olosuhteissa virtauksessa mitattujen lämpötila- ja kosteusolosuhteiden vaikutusta lämmön talteenottolaitteiden toimintaan. Lisäksi työssä esitellään yleisellä tasolla mittauksissa käytettyjen mittalaitteiden toimintaa. Suoritettujen mittausten ja laskennan perusteella havaittiin, että laitteistojen vuosihyötysuhteiden välille saatiin odotetunlaisia eroja. Parhaimpiin tuloksiin päästiin regeneratiivisella lämmön talteenottolaitteella.

Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results: The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease-including pericoronitis- was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology

Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique

Objectives: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. Study design: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. Results: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient"s subjective esthetic evaluation was more favorable for the control teeth in most of the cases. Conclusions: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.

Klammt's elastic open activator: Ricketts' cephalometrics results

The purpose of this study is to investigate the orthodontic and orthopaedic real effects of the Klammt's Elastic Open Activator (EOA) in 25 Class II Division 1 patients in growing period. We wanted to determine statistically the cephalometrics changes produced in the patients, comparing the lateral cranium teleradiographies we took for the diagnosis with the ones we took at the end of treatment. At the end of this study we confirm that by using the EOA we obtained the desired effects, especially reducing the molar relation 2.53 mm and the overjet 2.56 mm. The EOA corrected the inclination and protrusion of incisors, although we cannot avoid the use of fixed appliances to round off. The reduction of 2.48 mm of facial convexity stands out as the most important skeletal effect; the facial depth angle increases 0.8 degree, and the maxillary depth decreases 1.16 degrees. The length of the mandibular corpus also increases 6.7 mm, although this change is mainly due to the growth of the patient. The changes in the aesthetic profile do not stand out

Ship Leases under IAS 17, case Fortum Shipping

International accounting standards will be applied from the1st of January 2005 in accounting of member states of the EU with a view of harmonizing the accounting practices in Europe, and on the long term even more widely. The purpose of adopting IAS accounting standards is to make the financial statements and financial information received from companies more comparable and more transparent for investors and other interest groups. IAS 17 introduces the treatment of a lease agreement in the light of the new accounting standards. Finnish companies have used finance leases widely as an alternative, off-balance sheet form of financing capital investments consistently with Finnish GAAP. Along with the appliance of IAS 17 the off-balance-sheet financing possibility of leases classified as finance leases will no longer exist. IAS 17 states that finance leases are going to be recognized in the balance sheet as both assets, in form of fixed assets, and loans in liabilities classified as long and short term loans. IAS 17 will make two major changes to the income statement. Firstly, the lease payments formerly treated as variable costs are moved below the operating profit level to finance costs. Secondly, the depreciations from the leased assets are also introduced. The effects to the case company's, Fortum Shipping's, income statement and balance sheet are remarkable. Along with the appliance of IAS Fortum Shipping's net assets are somewhat going to be doubled, the amount of liabilities increases significantly and the earnings before interests and taxes increases moderately. The preceding factors have a big effect on the case company's financial key figures. So, the IAS originated effects on balance sheet and income statement have essential impacts on a company's key financial indicators. Most significant changes can be found in key ratios measuring profitability, capital structure, and efficiency. This means that when comparing the IAS calculated profits of companies with the profits calculated prior with Finnish GAAP, the analysis should be made with prudence because the figures are not comparable on straight-forward basis.