A Rubber Band Around an Atlantic Croaker

A rubber band permanently girdled an Atlantic croaker, Micropogon undulatus, resulting in considerable malformation and pathological alterations of the fish. On 12 July 1973 at Graveline Bayou, Jackson County, Mississippi, Mrs. Buster Blades caught on hook and line a 175 mm standard length (102.1 g) croaker that she immediately separated from the rest of her catch as a suspected parasitized fish. Later upon closer examination, she realized that a rubber band encircled the fish, and so she brought the fish to us. The band had deformed the prepelvic isthmus, restricted movement of the pectoral fins, and permanently encircled the fish through a hole in the dorsum. Much of the elasticity was lost, but the band was entire and free to rotate through the perforation below the first dorsal fin. The tissue above the perforation, including the tissue of the dorsal fin, was complete and not severed, although several scales were regenerated. These observations, in addition to the malformed ventral area, suggest a lengthy association between band and fish.

Endoscopic band ligation without resection in selected patients for small and superficial upper gastrointestinal tract lesions

Background and aim: The aim of this study was to evaluate the efficacy of endoscopic band ligation (EBL) in carefully selected patients who would benefit from this method of resection. Methods: Patients with early upper gastrointestinal and small (< 15 mm) lesions treated with EBL (Duette® Multi-Band Mucosectomy) were prospectively recruited and retrospectively analyzed between 2010 and 2015. All cases were discussed in a multidisciplinary cancer committee and it was concluded that, owing to patient conditions, surgery was not possible and that not conducting histology would not change the clinical management. A first endoscopic control with biopsies was planned at 4-8 weeks. If there was no persistence of the lesion, new controls were programmed at 6 and 12 months. Results: The group (n = 12) included 5 esophagus lesions (adenosquamous carcinoma, n = 1; carcinoma squamous, n = 2; adenocarcinoma, n = 2); 4 gastric lesions (high grade dysplasia, n = 1; adenocarcinoma, n = 2; neuroendocrine tumor [NET], n = 1), and 3 duodenal lesions (NETs) (n = 3). The mean tumor diameter was 9.6 ± 2.8 mm (range 4-15). Only one minor adverse event was described. At first follow-up (4-8 weeks), there was 91.6% and 75% of endoscopic and histological remission, respectively. At 6-month follow-up there was 70% of both endoscopic remission and negative biopsies. And at 12 months, there was 100% and 75% of endoscopic and histological remission, respectively. Persisting lesions were T1 cancers. The median follow-up was 30.6 months. Conclusion: EBL without resection is an easy and safe technique that should be considered in patients with multiple morbidities and small superficial UGI lesions.

Day case stapled haemorrhoidopexy for prolapsing haemorrhoids

Objective Conventional surgical management of prolapsing haemorrhoids is by excisional haemorrhoidectomy. Postoperative pain has restricted the application of such procedures in the day case setting. These operations remain associated with a period of restricted activity. The use of circular stapling devices as an alternative to the excisional approach in the management of haemorrhoids has been described. This study reports our experience of stapled haemorrhoidopexy as a day case procedure.

Methods Patients with third or fourth degree haemorrhoids were eligible for the procedure. Patients were considered suitable candidates for day case surgery based on conventional parameters. Symptoms were assessed using a previously validated symptom severity rating score. Stapled haemorrhoiclopexy was carried out using a circular stapling device. Pain scores were obtained prior to discharge. Patients were admitted if pain was uncontrolled despite oral analgesia. Symptoms were re-scored at six-week follow-up.

Results Over a 70-month period 168 consecutive stapled haemorrhoidopexies were performed or directly supervised by one consultant colorectal surgeon. One hundred and ten (65%) patients were considered appropriate candidates for day case surgery by conventional criteria. Ninety-six (87.3%) patients successfully underwent stapled haemorrhoidopexyon a day case basis. Fourteen (12.7%) patients required admission on the day of surgery (5 for early Postoperative bleeding, 4 for pain necessitating continuing opiate analgesia, two for urinary retention and three for surgery performed late in the day). Six (5%) patients were re-admitted postoperatively; four for pain relief and two because of urinary retention. Of the day case patients, 91 (82.7%) and 56 (50.9%) had been seen for 6 week and 6 month review, respectively, at the time of analysis. Symptom scores were 6 (pre-operatively) vs 0 (postoperatively) (P <0.01). 76/91 (83.5%) patients reviewed at 6/52 were asymptomatic.

Conclusion Stapled haemorrhoidopexy is a safe and effective procedure that can be carried out on selected patients on a day case basis. Complications are of a similar nature to excisional haemorrhoidectomy.

[Oesophageal and fundic variceal bleeding]

Oesophageal and fundic varices belong to the most frequent complications of cirrhosis and portal hypertension. Due to their significant morbidity and mortality, bleedings from oesophageal or fundic varices represent a challenge for the emergency medical team as well as for the gastroenterologist. The patient with a variceal bleeding should be accurately monitored and his/her hemodynamic parameters should be maintained stable with the administration of plasma expanders and blood units when indicated. An antibiotic prophylaxis in this setting--norfloxacin or ceftriaxon--has been demonstrated to significantly reduce morbidity and mortality. Additionally, the early administration of vasoactive compounds, such as terlipressin, somatostatin or octreotide, is associated with beneficial effects in reducing the bleeding. An upper gastrointestinal endoscopy should be generally performed within the first twelve hours from the beginning of the bleeding in order to obtain an accurate diagnosis and to provide an adequate treatment. Endoscopic procedures to control the bleeding include the rubber band ligation, the treatment of the varix with a sclerosing agent or the injection of tissue glue into the varix. In case of recurrent bleeding, beyond the above methods, different techniques, such as the transjugular porto-caval shunt, surgical shunt procedures, as well as embolisation of splanchnic blood vessels, represent additional therapeutic options. However, they are associated with very high mortality rates and their indication has to be discussed case by case by an interdisciplinary team of experts. Future therapies include the optimisation and the improvement of the current medical and endoscopic armamentarium, as well as the application of treatments to novel targets, such as the coagulation cascade.

Nötige und unnötige Behandlungen beim Hämorrhoidalleiden: Der Patient bestimmt mit

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate. These relatively "new" procedures equally qualify for the treatment of grade III and IV hemorrhoids, and, in the case of stapled hemorrhoidopexy, may even be employed in the emergency situation of an acute anal prolapse. While under certain circumstances different treatment options are equivalent, there is a clear specificity with respect to the application of those procedures in other situations. The respective pros and cons need to be discussed separately with every patient. According to their own requirements a treatment strategy has to be defined according to their individual requirements.

A mathematical description of the acoustic coupling of the mass/spring model

This paper describes hybrid mathematical model which couples the mechanics of the mass/spring model to the acoustic wave propagation model for use in generating the acoustic signal emitted by complex structures of paper fibres under strain. A discussion of the coupling method is presented including remarks on the errors encountered intrinsic to the discretisation scheme. The numerical results of a vibrating rubber band and a vibrating paper fibre are compared to their experimental counterparts. The fundamental frequencies of the acoustic signals are compared showing a close agreement between the experimental and numerical results

Pancreatic hemangioma manifesting as variceal gastroesophageal bleeding during pregnancy: case report

There are only 10 reported cases of pancreatic hemangiomas in adults, only one of them causing digestive bleeding. We present a case of variceal bleeding and portal hypertension caused by a pancreatic hemangioma. The patient had 19 year-old and was received at her 16th week of pregnancy. She had massive hematemesis, controlled after variceal band ligation. Her image exams revealed a cystic lesion of 164 cm³ in the pancreas tail and signs of portal hypertension. Two months after, the ultrassonographic exam documented the lesion growth, achieving 200 cm³ at that time. The patient was submitted to distal pancreatectomy, and the histopathological analysis revealed a pancreatic hemangioma of 11 x 9 x 8 cm. Therefore, we report the second case of digestive bleeding caused by a pancreatic hemangioma, which had a well documented growth during the pregnancy. Additionally, we review the previous reports of pancreatic hemangiomas and discuss the hypothesis of hormonal infl uence on the natural history of these tumors.

Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy

BACKGROUND & AIMS Patients with cirrhosis and variceal hemorrhage have a high risk of rebleeding. We performed a prospective randomized trial to compare the prevention of rebleeding in patients given a small-diameter covered stent vs those given hepatic venous pressure gradient (HVPG)-based medical therapy prophylaxis. METHODS We performed an open-label study of patients with cirrhosis (92% Child class A or B, 70% alcoholic) treated at 10 medical centers in Germany. Patients were assigned randomly more than 5 days after variceal hemorrhage to groups given a small covered transjugular intrahepatic portosystemic stent-shunt (TIPS) (8 mm; n = 90), or medical reduction of portal pressure (propranolol and isosorbide-5-mononitrate; n = 95). HVPG was determined at the time patients were assigned to groups (baseline) and 2 weeks later. In the medical group, patients with an adequate reduction in HVPG (responders) remained on the drugs whereas nonresponders underwent only variceal band ligation. The study was closed 10 months after the last patient was assigned to a group. The primary end point was variceal rebleeding. Survival, safety (adverse events), and quality of life (based on the Short Form-36 health survey) were secondary outcome measures. RESULTS A significantly smaller proportion of patients in the TIPS group had rebleeding within 2 years (7%) than in the medical group (26%) (P = .002). A slightly higher proportion of patients in the TIPS group experienced adverse events, including encephalopathy (18% vs 8% for medical treatment; P = .05). Rebleeding occurred in 6 of 23 patients (26%) receiving medical treatment before hemodynamic control was possible. Per-protocol analysis showed that rebleeding occurred in a smaller proportion of the 32 responders (18%) than in nonresponders who received variceal band ligation (31%) (P = .06). Fifteen patients from the medical group (16%) underwent TIPS placement during follow-up evaluation, mainly for refractory ascites. Survival time and quality of life did not differ between both randomized groups. CONCLUSIONS Placement of a small-diameter, covered TIPS was straightforward and prevented variceal rebleeding in patients with Child A or B cirrhosis more effectively than drugs, which often required step-by-step therapy. However, TIPS did not increase survival time or quality of life and produced slightly more adverse events. Clinical Trial no: ISRCTN 16334693.

A microwave absorber based on strontium ferrite–carbon black–nitrile rubber for S and X-band applications

Flexible and thin single layer microwave absorbers based on strontium ferrite–carbon black–nitrile rubber composites have been fabricated employing a specific recipe and their reflection loss characteristics were studied in the S (2–4 GHz) and X-bands (8–12 GHz). The incorporation of carbon black not only reinforces the rubber by improving the mechanical properties of the composite but also modifies the dielectric permittivity of the composite. Strontium ferrite when impregnated into a rubber matrix imparts the required magnetic permeability to the composite. The combination of strontium ferrite and carbon black can then be employed to tune the microwave absorption characteristics of the resulting composite. The complex dielectric permittivity and permeability were measured by employing a cavity perturbation technique. The microwave absorption characteristics of composites were modelled in that an electromagnetic wave incident normally on the metal terminated single layer absorber. The influence of filler volume fraction, frequency, absorber thickness on the bandwidth of absorption are discussed and correlated

Effect of nickel nanofillers on the dielectric and magnetic properties of composites based on rubber in the X-band

Nickel–rubber nanocomposites were synthesized by incorporating ferromagnetic nickel nanoparticles in a natural rubber as well as neoprene rubber matrix. Complex dielectric permittivity and magnetic permeability of these composites were evaluated in the X-band microwave frequencies at room temperature using cavity perturbation technique. The dielectric loss in natural rubber is smaller compared to neoprene rubber. A steady increase in the dielectric permittivity is observed with increase in the content of nickel in both the composites. The magnetic permeability exhibits a steady decrease with increase in frequency and magnetic loss shows a relaxation at 8 GHz. The suitability of these composites as microwave absorbers is modeled based on the reflection loss which is dependant on the real and imaginary components of the complex dielectric permittivity and magnetic permeability.

In situ epoxidation of ethylene propylene diene rubber by performic acid

In this paper, epoxidation of ethylene propylene diene rubber by in situ generated performic acid is discussed. The samples have been characterized by infra-red and H-1-nuclear magnetic resonance analyses. Quantitative analysis of the reaction products is made possible by using the methyl deformation band at 1377 cm(-1) as internal standard. The conversion of double bonds increases rapidly within the first 1 h, then gradually, over 2 h, has only a slight increase. The maximum conversion ratio of double bonds is about 70%. The relative content of epoxy groups has a top value at about 7 h. The side reactions are also discussed. (C) 1997 Elsevier Science Ltd.

Investigations on The Finite Size Effects of Some Inverse Spinels and Studies on Their Composites Based on Nitrile Rubber

Magnetism and magnetic materials have been an ever-attractive subject area for engineers and scientists alike because of its versatility in finding applications in useful devices. They find applications in a host of devices ranging from rudimentary devices like loud speakers to sophisticated gadgets like waveguides and Magnetic Random Access Memories (MRAM).The one and only material in the realm of magnetism that has been at the centre stage of applications is ferrites and in that spinel ferrites received the lions share as far as practical applications are concerned.It has been the endeavour of scientists and engineers to remove obsolescence and improve upon the existing so as to save energy and integrate in to various other systems. This has been the hallmark of material scientists and this has led to new materials and new technologies.In the field of ferrites too there has been considerable interest to devise new materials based on iron oxides and other compounds. This means synthesising ultra fine particles and tuning its properties to device new materials. There are various preparation techniques ranging from top- down to bottom-up approaches. This includes synthesising at molecular level, self assembling,gas based condensation. Iow temperature eo-precipitation, solgel process and high energy ball milling. Among these methods sol-gel process allows good control of the properties of ceramic materials. The advantage of this method includes processing at low temperature. mixing at the molecular level and fabrication of novel materials for various devices.Composites are materials. which combine the good qualities of one or more components. They can be prepared in situ or by mechanical means by the incorporation of fine particles in appropriate matrixes. The size of the magnetic powders as well as the nature of matrix affect the processability and other physical properties of the final product. These plastic/rubber magnets can in turn be useful for various applications in different devices. In applications involving ferrites at high frequencies, it is essential that the material possesses an appropriate dielectric permittivity and suitable magnetic permeability. This can be achieved by synthesizing rubber ferrite composites (RFC's). RFCs are very useful materials for microwave absorptions. Hence the synthesis of ferrites in the nanoregirne.investigations on their size effects on the structural, magnetic, and electrical properties and the incorporation of these ferrites into polymer matrixes assume significance.In the present study, nano particles of NiFe204, Li(!5Fe2S04 and Col-e-O, are prepared by sol gel method. By appropriate heat treatments, particles of different grain sizes are obtained. The structural, magnetic and electrical measurements are evaluated as a function of grain size and temperature. NiFel04 prepared in the ultrafine regime are then incorporated in nitrile rubber matrix. The incorporation was carried out according to a specific recipe and for various loadings of magnetic fillers. The cure characteristics, magnetic properties, electrical properties and mechanical properties of these elastomer blends are carried out. The electrical permittivity of all the rubber samples in the X - band are also conducted.

”Investigations on The Finite Size Effects of Some Inverse Spinels and Studies on Their Composites Based on Nitrile Rubber”

In the present study, nano particles of NiFe3O4, I_.l()5Feg5O4 and CoFegO4 are prepared by sol gel method. By appropriate heat treatments, particles of different grain sizes are obtained. The structural, magnetic and electrical measurements are evaluated as a function of grain size and temperature. NiFe3O4 prepared in the ultrafine regime are then incorporated in nitrile rubber matrix. The incorporation was carried out according to a specific recipe and for various loadings of magnetic fillers. The cure characteristics, magnetic properties, electrical properties and mechanical properties of these elastomer blends are carried out. The electrical permittivity of all the rubber samples in the X — band are also conducted

Flexible microwave absorbers based on barium hexaferrite, carbon black, and nitrile rubber for 2–12 GHz applications

Flexile single layer electromagnetic wave absorbers were designed by incorporating appropriate amounts of carbon black in a nitrile butadiene rubber matrix along with an optimized amount of magnetic counterpart, namely, barium hexaferrite for applications in S, C, and X-bands. Effective dielectric permittivity and magnetic permeability were measured using cavity perturbation method in the frequency range of 2–12 GHz. The microwave absorbing characteristics of the composites were studied in the S, C, and X-bands employing a model in which an electromagnetic wave is incident normally on a metal terminated single layer. Reflection loss exceeding 20 dB is obtained for all the samples in a wide frequency range of 2–12 GHz when an appropriate absorber thickness between 5 and 9mm is chosen. The impact of carbon black is clearly observed in the optimized composites on the mechanical strength, thickness, band width of absorption, dielectric properties,

The influence of natural rubber/Au nanoparticle membranes on the physiology of Leishmania brasiliensis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)