Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter?

Background The aim if this study was to compare percutaneous drainage (PD) of the gallbladder to emergency cholecystectomy (EC) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis (ACC/AAC).Methods Between 2001 and 2007, all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed. Cases were collected from a prospective database. Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach. Patients' general condition and organ dysfunction were assessed by two validated scoring systems (SAPS II and SOFA, respectively). Morbidity, mortality, and long-term outcome were systematically reviewed and analyzed in both groups.Results Forty-two patients [median age = 65.5 years (range = 32-94)] were included; 45% underwent EC (ten laparoscopic, nine open) and 55% PD (n = 23). Both patient groups had similar preoperative characteristics. Percutaneous drainage and EC were successful in 91 and 100% of patients, respectively. Organ dysfunctions were similarly improved by the third postoperative/postdrainage days. Despite undergoing PD, two patients required EC due to gangrenous cholecystitis. The conversion rate after laparoscopy was 20%. Overall morbidity was 8.7% after PD and 47% after EC (P = 0.011). Major morbidity was 0% after PD and 21% after EC (P = 0.034). The mortality rate was not different (13% after PD and 16% after EC, P = 1.0) and the deaths were all related to the patients' preexisting disease. Hospital and ICU stays were not different. Recurrent symptoms (17%) occurred only after ACC in the PD group.Conclusions In high-risk patients, PD and EC are both efficient in the resolution of acute cholecystitis sepsis. However, EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible. Percutaneous drainage represents a valuable intervention, but secondary cholecystectomy is mandatory in cases of acute calculous cholecystitis.

Service Correlation of the Traffic Simulator, HR-100, 1967

A study was undertaken by the Bituminous Research Laboratory of the Engineering Research Institute at Iowa State University, under the sponsorship of the Iowa Highway Research Board, project HR 100, to ascertain the effects of a number of characteristics and properties of asphaltic concrete mixes upon the service behavior of the mixes as evaluated by the Traffic Simulator and by field observations. The study included: Investigations of the relations, of gradation, fraction and resistance to wear of aggregates; of stability, cohesion, per cent voids and asphalt content: of a number of laboratory and field mixes to service behavior as indicated by the Traffic Simulator under various test conditions. Based upon the results of the tests and the relationships noted, tentative criteria for the Traffic Simulator test were devised, subject to verification by observations and measurements of field service behavior of the mixes.

Audit report on the Regional Utility Service Systems Commission for the year ended June 30, 2013

Audit report on the Regional Utility Service Systems Commission for the year ended June 30, 2013

Salon d'art décoratif moderne : [Catalogue] / [Couv.ill. par Henry de Waroquier]

[Exposition internationale. Gand. 1913]

Merveilles de la force et de l'adresse : agilité, souplesse, dextérité, les exercices du corps chez les Anciens et chez les Modernes (4e éd.) / par Guillaume Depping ; ill. de 69 grav. dessinées sur bois par E. Ronjat, P. Sellier, etc.

Collection : Bibliothèque des merveilles

Le Simple Jean : [impression photomécanique] / conte de Pierre Veber, ill. de Jean Veber

Collection : The New York Herald, Paris

Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections.

OBJECTIVES: To determine the prevalence, predictors, and clinical significance of electrographic seizures (ESz) and other continuous electroencephalographic monitoring findings in critically ill patients with central nervous system infections. DESIGN: Retrospective cohort study. SETTING: Eighteen-bed neurocritical care unit. PATIENTS: We identified 42 consecutive patients with primary central nervous system infection (viral, 27 patients [64%]; bacterial, 8 patients [18%]; and fungal or parasitic, 7 patients [17%]) who underwent continuous electroencephalographic monitoring between January 1, 1996, and February 28, 2007. MAIN OUTCOME MEASURES: Presence of ESz or periodic epileptiform discharges (PEDs). RESULTS: Electrographic seizures were recorded in 14 patients (33%), and PEDs were recorded in 17 patients (40%). Twenty patients (48%) had either PEDs or ESz. Of the 14 patients with ESz, only 5 (36%) had a clinical correlate. Periodic epileptiform discharges (odds ratio=13.4; P=.001) and viral cause (odds ratio=13.0; P=.02) were independently associated with ESz. Both ESz (odds ratio=5.9; P=.02) and PEDs (odds ratio=6.1; P=.01) were independently associated with poor outcome at discharge (severe disability, vegetative state, or death). CONCLUSIONS: In patients with central nervous system infections undergoing continuous electroencephalographic monitoring, ESz and/or PEDs were frequent, occurring in 48% of our cohort. More than half of the ESz had no clinical correlate. Both ESz and PEDs were independently associated with poor outcome. Additional studies are needed to determine whether prevention or treatment of these electrographic findings improves outcome.

2014 Iowa Commercial Air Service Retention and Expansion Committee - Plan

Senate File 2355 Sec. 19 (Iowa Code §328.13) created a commercial air service retention and expansion committee within the aviation office of the department of transportation. The membership of the committee consisted of the director or the director’s designee; the managers of each airport in Iowa with commercial air service; two members of the senate, one appointed by the majority leader of the senate and one appointed by the minority leader of the senate; and two members of the house of representatives, one appointed by the speaker of the house and one appointed by the minority leader of the house. The committee was to develop a plan by December 31, 2014 for the retention and expansion of passenger air service in Iowa. The committee is to meet as the committee deems necessary to assess progress in implementing the plan and, if necessary, to update the plan.

Midwest Regional Rail Passenger Initiative and Passenger Rail Service in Iowa, 2015

This report provides the status of the Passenger Rail Service Revolving Fund and the development and operation of the midwest regional rail system and the state's passenger rail service.