A new type of internal hernia after laparoscopic Roux-en-Y gastric bypass.

Roux-en-Y gastric bypass (RYGBP) is currently the most common bariatric procedure. One of its late complications is the development of internal hernia, which can lead to acute intestinal obstruction or recurrent colicky abdominal pain. The aim of this paper is to present a new, unusual, and so far not reported type of internal hernia. A common computerized database is maintained for all patients undergoing bariatric surgery in our departments. The charts of patients with the diagnosis of internal hernia were reviewed. Three patients were identified who developed acute intestinal obstruction due to an internal hernia located between the jejunojejunostomy and the end of the biliopancreatic limb, directly between two jejunal limbs with no mesentery involved. Another seven patients with intermittent colicky abdominal pain, re-explored for the suspicion of internal hernia, were found to also have an open window of the same location apart from a hernia at one of the typical hernia sites. Since this gap is systematically closed during RYGBP, no other patient has been observed with this problem. Even very small defects can lead to the development of internal hernias after RYGBP. Patients with suggestive symptoms must be explored. Closure of the jejunojejunal defect with nonabsorbable sutures prevents the development of an internal hernia between the jejunal loops at the jejunojejunostomy.

La relació entre el valor N30 de L'SPT i la resistència a la compressió simple

The unconfined compression strength is a geotechnical parameter frequently used to determine the bearing capacity of foundations on clayey soils. Its value can be obtained from the unconfined compression test and, among several in situ tests, the standard penetration test (SPT). However, a comparison between the values of such a strength determined by both tests in CL, CL-ML and CH soils shows that it does not exist an approximate relationship. In any case it is remarkable that values of the test conducted in the laboratory fit between the lower and the higher ones calculated from the standard penetration number. This is very important for those geotechnical reports in which the unconfined compression strength is only based on the SPT. In this way, if the lower value is taken to evaluate the ultimate soilbearing capacity the result will not be very accurate but it will probably be by the side of safety

Rebuild Iowa Office Quarterly Report, July 2009

The RIO’S 90-page July Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, April 2009

The 70-page report provides an overview of the disaster assistance programs that have been implemented to help impacted Iowans; outreach to communities to assist with long-term planning; flood mitigation efforts; charts detailing the flow of disaster-related funding to impacted citizens; disaster recovery activities undertaken by various state departments; and photos taken of disaster-stricken areas. Long-term recovery challenges and goals remaining for Iowa are also addressed.

Cost-effective utilization of a private facility to perform outpatient surgery in public hospital waiting list patients.

Background: Public hospitals' long waiting lists make outpatient surgery in private facilities very attractive provided a standardized protocol is applied. The aim of this study was to assess this kind of innovative collaboration in abdominal surgery from a clinical and economical perspective. Methods: All consecutive patients operated on in an outpatient basis in a private facility by a public hospital abdominal surgeon and an assistant over a 5-year period (2004-2009) were included. Clinical assessment was carried out from patients' charts and satisfaction questionnaire, and economic assessment from the comparison between the surgeons' charges paid by the private facility and the surgeons' hospital salaries during the days devoted to surgery at the private facility. Results: Over the 5 years, 602 operative procedures were carried out during 190 operative days. All patients could be discharged the same day and only 1% of minor complications occurred. The patients' satisfaction was 98%. The balance between the surgeons' charges paid by the private facility and their hospital salary costs was positive by 25.8% for the senior surgeon and 12.6% for the assistant or, on average, 21.9% for both. Conclusion: Collaboration between an overloaded university hospital surgery department and a private surgical facility was successful, effective, safe, and cost-effective. It could be extended to other surgical specialities. Copyright (C) 2011 S. Karger AG, Basel

Neuropathological analysis of lacunes and microvascular lesions in late-onset depression.

M. Santos, G. Gold, E. Kövari, F. R. Herrmann, P. R. Hof, C. Bouras and P. Giannakopoulos (2010) Neuropathology and Applied Neurobiology36, 661-672
Neuropathological analysis of lacunes and microvascular lesions in late-onset depression Aims: Previous neuropathological studies documented that small vascular and microvascular pathology is associated with cognitive decline. More recently, we showed that thalamic and basal ganglia lacunes are associated with post-stroke depression and may affect emotional regulation. The present study examines whether this is also the case for late-onset depression. Methods: We performed a detailed analysis of small macrovascular and microvascular pathology in the post mortem brains of 38 patients with late-onset major depression (LOD) and 29 healthy elderly controls. A clinical diagnosis of LOD was established while the subjects were alive using the DSM-IV criteria. Additionally, we retrospectively reviewed all charts for the presence of clinical criteria of vascular depression. Neuropathological evaluation included bilateral semi-quantitative assessment of lacunes, deep white matter and periventricular demyelination, cortical microinfarcts and both focal and diffuse gliosis. The association between vascular burden and LOD was investigated using Fisher's exact test and univariate and multivariate logistic regression models. Results: Neither the existence of lacunes nor the presence of microvascular ischaemic lesions was related to occurrence of LOD. Similarly, there was no relationship between vascular lesion scores and LOD. This was also the case within the subgroup of LOD patients fulfilling the clinical criteria for vascular depression. Conclusions: Our results challenge the vascular depression hypothesis by showing that neither deep white matter nor periventricular demyelination is associated with LOD. In conjunction with our previous observations in stroke patients, they also imply that the impact of lacunes on mood may be significant solely in the presence of acute brain compromise.

Características geológicas y geotécnicas de los lodos de flotación de la Sierra Minera de Cartagena-La Unión (SE España)

We present the results of a geological and geotechnical characterization of the metallurgic waste from the Sierra Minera de Cartagena-La Union. We have studied eight tailings dams from which we collected and analysed 42 samples of metallurgic waste. We measured grainsize distribution, the specific gravity of solid particles, plasticity index, permeability, both in situ and in the laboratory, direct shear characteristicsand moisture content. According to size distribution the tailings can be classified as sandy silt. Their plasticity index ranges from medium to nil. The internal friction angle varies between 28 and 42 degrees. Cohesion is between 0 and 2.2 t/m2. The specific gravity of the solid particles ranges widely from 1.8 to 4 g/cm3. The saturated hydraulic conductivity values vary between 1.3x 10-5 and 3.2x 10-9 m/s.The water content measured in situ shows that the degree of saturation remains relatively high despite low rainfall and high evaporation rates. Several tailings dams have failed. The leading causes of tailings-dam failure are: 1) slope instability; 2) overflow; 3) erosion; and 4) subsidence or collapse. The main factor leading to dam failure is that the tailings stored in the ponds are highly saturated

Rebuild Iowa Office Quarterly Report, October 2009

The RIO’S October Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Secondary UBVRI-CCD standard stars in the neighbourhood of Landolt standard stars

A list of 681 UBVRI secondary standard stars for CCD photometry is presented. Visual magnitude ranges from 9.7 to 19.4, and the B-V colour index varies from 1.15 to 1.97. The stars are grouped into 11 different fields, each of them is generally observable in a single CCD frame. The stars are located near Landolt UBVRI equatorial standards, accessible to telescopes in both hemispheres, and mainly within the 5 - 8 hours range of right ascension. Photometry, equatorial coordinates and finding charts are provided.

Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma.

BACKGROUND: : Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients. METHODS: : The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit. RESULTS: : Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula. CONCLUSION: : Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

Rebuild Iowa Office Quarterly Report, January 2010

The RIO’S January 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, April 2010

The RIO’S April 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, July 2010

The RIO’S July 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.

Rebuild Iowa Office Quarterly Report, October 2010

The RIO’S October 2010 Quarterly Report details the economic recovery strategy in housing; business; workforce development; infrastructure investments; individual services and guidance; local economic recovery; smart growth; mitigation planning; floodplain and watershed management; floodplain mapping; quality of life; and emergency management.The report also includes an updated selection of charts showing the flow of federal and state disaster recovery funding to the state, counties, cities and individuals affected by the 2008 disasters.