Longer small bowel segments are resected in emergency surgery for ileocaecal Crohn's disease with a higher ileostomy and complication rate.

BACKGROUND: Repeated intestinal resections may have disabling consequences in patients with Crohn's disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn's disease. METHODS: A prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn's disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn's disease undergoing elective surgery; (2) patients with ileocaecal Crohn's disease undergoing emergency surgery; (3) patients with recurrent Crohn's disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes. RESULTS: One hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn's disease. CONCLUSIONS: Patients undergoing emergency surgery for Crohn's disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel.

Assessment of reduced-order unscented Kalman filter for parameter identification in 1-dimensional blood flow models using experimental data.

This work presents a detailed investigation of a parameter estimation approach on the basis of the reduced-order unscented Kalman filter (ROUKF) in the context of 1-dimensional blood flow models. In particular, the main aims of this study are (1) to investigate the effects of using real measurements versus synthetic data for the estimation procedure (i.e., numerical results of the same in silico model, perturbed with noise) and (2) to identify potential difficulties and limitations of the approach in clinically realistic applications to assess the applicability of the filter to such setups. For these purposes, the present numerical study is based on a recently published in vitro model of the arterial network, for which experimental flow and pressure measurements are available at few selected locations. To mimic clinically relevant situations, we focus on the estimation of terminal resistances and arterial wall parameters related to vessel mechanics (Young's modulus and wall thickness) using few experimental observations (at most a single pressure or flow measurement per vessel). In all cases, we first perform a theoretical identifiability analysis on the basis of the generalized sensitivity function, comparing then the results owith the ROUKF, using either synthetic or experimental data, to results obtained using reference parameters and to available measurements.

A reduced-order modeling for efficient design study of artificial valve in enlarged ventricular outflow tracts.

A computational approach is proposed for efficient design study of a reducer stent to be percutaneously implanted in enlarged right ventricular outflow tracts (RVOT). The need for such a device is driven by the absence of bovine or artificial valves which could be implanted in these RVOT to replace the absent or incompetent native valve, as is often the case over time after Tetralogy of Fallot repair. Hemodynamics are simulated in the stented RVOT via a reduce order model based on proper orthogonal decomposition, while the artificial valve is modeled as a thin resistive surface. The reduced order model is obtained from the numerical solution on a reference device configuration, then varying the geometrical parameters (diameter) for design purposes. To validate the approach, forces exerted on the valve and on the reducer are monitored, varying with geometrical parameters, and compared with the results of full CFD simulations. Such an approach could also be useful for uncertainty quantification.

Buccal plate preservation with immediate post-extraction implant placement and provisionalization: preliminary results of a new technique.

Bone resorption and remodelling are inevitable sequelae of dental extraction and begin immediately after the extraction procedure. The buccal plate is especially predisposed to these phenomena, and if affected, may result in an increased risk of facial soft-tissue recession and other adverse clinical effects that may decrease the predictability of implant placement or impair the final aesthetic result. Buccal plate preservation is a new technique aimed at maintaining or improving the appearance of the soft and hard tissues after dental extraction procedures. The aim of this case series is to evaluate the effectiveness of this technique to maintain or improve soft tissue contours in aesthetic areas when used in conjunction with immediate implant placement. Buccal plate preservation as described may help to maintain or improve the appearance and contours of the ridge after tooth extraction, laying the groundwork for optimal functional and aesthetic replacement of the missing tooth with an implant-supported prosthesis.

The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy.

STUDY OBJECTIVE: To evaluate the independent and mutual effects of neighbourhood deprivation and of individual socioeconomic conditions on mortality and to assess the trends over the past 30 years and the residual neighbourhood heterogeneity. DESIGN: General and cause specific mortality was analysed as a function of time period, highest educational level achieved, housing conditions, and neighbourhood deprivation, using multilevel Poisson models stratified by gender and age class. SETTING: The study was conducted in Turin, a city in north west Italy with nearly one million inhabitants and consisting of 23 neighbourhoods. PARTICIPANTS: The study population included three cohorts of persons aged 15 years or older, recorded in the censuses of 1971, 1981, and 1991 and followed up for 10 years after each census. MAIN RESULTS: Individual and contextual socioeconomic conditions showed an independent and significant impact on mortality, both among men and women, with significantly higher risks for coronary heart and respiratory diseases among people, aged less than 65 years, residing in deprived neighbourhoods (9% and 15% excess for coronary heart diseases, 20% and 24% for respiratory diseases, respectively for men and women living in deprived neighbourhoods compared with rich). The decreasing time trend in general mortality was less pronounced among men with lower education and poorer housing conditions, compared with their more advantaged counterparts; the same was found in less educated women aged less than 65 years. CONCLUSIONS: These results and further developments in the evaluation of impact and mechanisms of other contextual effects can provide information for both health and non-health oriented urban policies.

Dynamics and thermodynamics of the spherical frustrated Blume-Emery-Griffiths model.

We introduce a spherical version of the frustrated Blume-Emery-Griffiths model and solve exactly the statics and the Langevin dynamics for zero particle-particle interaction (K=0). In this case the model exhibits an equilibrium transition from a disordered to a spin glass phase, which is always continuous for nonzero temperature. The same phase diagram results from the study of the dynamics. Furthermore, we note the existence of a nonequilibrium time regime in a region of the disordered phase, characterized by aging, as occurs in the glassy phase. Due to a finite equilibration time, the system displays in this region the pattern of interrupted aging.

Histologic response to intraligament injections using a computerized local anesthetic delivery system. A pilot study in mini-swine.

BACKGROUND: Intraligamentary (periodontal ligament) injection has been used to locally control pain with minimal anesthetic dose. The purpose of the present study was to determine the histologic effect of using a computer-controlled local anesthesia delivery system (CCLADS) for the administration of a periodontal ligament injection in the mini-swine model system. METHODS: Thirty-two sites in 3 mini-swine pigs with healthy periodontium were selected. Each site was notched on the mesial-lingual line angle of the tooth to allow a reference for needle placement and provide a histologic marker. An anesthetic cartridge was used with a 30-gauge needle attached to the handpiece of the CCLADS. This provided a controlled flow rate for 2 minutes. The control sites were treated with the same needle in place for 20 seconds. The animals were sacrificed and provided observation periods of 1 hour, 1, 4, 7, 21, and 49 days. Specimens were stained with hematoxylin and eosin and trichrome. RESULTS: Twenty-four hours after injection, limited localized inflammation was present. By 7 days, the ligament appeared within normal limits. Apical migration of the junctional epithelium extended to the apical limit of the notch and was similar in test and control specimens. CONCLUSIONS: Within the limits of this study, the histologic results showed that tissue responses following intraligament injections using a CCLADS demonstrated limited inflammatory responses within the first 24 hours, which abated by 7 days postinjection. Similar migration of the junctional epithelium was seen in test and control specimens and was probably related to tooth injury rather than anesthetic injections. Further investigations are warranted using CCLADS to determine whether clinical benefits will translate in the human model system.

Odontogenic sinusitis causing orbital cellulitis.

BACKGROUND: Odontogenic sinusitis is a well-recognized condition that usually is responsive to standard medical and surgical treatment. Current antibiotic therapy recommendations are directed against the usual odontogenic and sinus flora. CASE DESCRIPTION: The authors present a case of a patient with acute sinusitis initiated by a complicated tooth extraction that did not yield readily to standard treatment. The case was complicated by orbital extension of the sinusitis. The authors isolated methicillin-resistant Staphylococcus aureus, or MRSA, species from the affected sinus that usually is not encountered in uncomplicated acute nonnosocomial or odontogenic sinusitis. CLINICAL IMPLICATIONS: Though such forms of resistant microbial flora as MRSA are rare, they may be seen in patients who have a history of intravenous, or i.v., drug use and in immunocompromised patients. Management of patients with orbital extension of sinusitis requires hospitalization and i.v. antibiotic treatment.

Lidocaine toxicity.

Local anesthetics are the most commonly used drugs in dentistry. The number of adverse reactions reported, particularly toxic reactions, are extraordinarily negligible. This article reports a case of lidocaine toxicity with its typical manifestation in a 37-yr-old healthy male. The toxic reaction followed transoral/transpharyngeal topical spraying of lidocaine preoperatively during preparation for general anesthesia. A review of dosages of the most commonly used local anesthetic drugs in dentistry and the management of a toxic reaction is presented. Clinicians need to be in a position to recognize and successfully manage this potential adverse reaction.

[Quality of life after treatment in patients with laryngeal carcinoma]. / La qualità della vita post-trattamento nei pazienti affetti da carcinoma laringeo.

Today laryngeal cancer can be cured by means of a variety of treatments (nearly 60% of the patients in an unselected population are still alive after 5 years). Despite the low incidence, this form of cancer can present a significant social problem because the form of treatment can have an impact on the esthetic, functional and emotional aspects affecting the quality of life (QOL). In the present study 690 laryngeal cancer patients treated with 6 different forms of therapy (total laryngectomy, partial laryngectomy, cordectomy, radiotherapy alone, total laryngectomy plus post-operative radiotherapy, partial laryngectomy plus post-operative radiotherapy) were asked to fill out a specific EORTC CORE QOL Questionnaire (EORTC QLQ C-30) as well as a specific head and neck questionnaire. Six multi-item function scales, 3 symptom scales and 6 individual items assessing both symptoms and economic consequences of the disease were evaluated. A total of 517 patients (74.92%) filled out the questionnaire. For each form of therapy the patients were divided by age (under and over 65 years of age). The results indicate that the quality of life is better in those patients who underwent a single form of treatment (i.e. radiotherapy alone, partial laryngectomy, total laryngectomy) than in those who underwent combination treatments (i.e. surgery plus radiotherapy). Moreover, the results were better in the older patients. Quite often laryngeal cancer patients are subject to psychosocial problems although this did not show up in the present study where the patients tended to consider surgery as a liberation. The social-cultural level of the patient has a significant effect on the quality of life as it proved better in those social classes were physical strength is of prime importance as opposed to those dominated by social parameters such as socialization, communication and aesthetics.

[Characteristics of articular caps of the elbow in relation to flex-extension movement]. / Caratteristiche dei capi articolari del gomito in relazione al movimento di flesso-estensione.

Considering the factors limiting flexo-extension movements of the elbow, particular importance has been given to the possible existing contact between its articular ends in the final stage of the movement. However, this factor has different importance according to the angle formed by the ulnar and humeral diaphysis with their respective epiphysis. Some authors assert that humeral and ulnar articular ends do not come into any contact during the first stage of the sigmoid cavity movement on the trochlea, according to their opinion, in fact, an angle of 45 degrees should exist between the prolongation of the humeral diaphysis axis and the lower epiphysis and the great ulnar sigmoid cavity should be oriented forward and high forming an axis that is inclined of 45 degrees the horizontal plane. In order to verify this affirmation, we have measured the width of these angles in 50 soaked humeri and 50 ulnas. The same angle has been measured in 50 radiograms of partially flexed laterally projected elbows. The mean observed values have been of about 34 degrees for the distal epiphysis-diaphysis angle in humeri and of about 25 degrees for the inclination angle of the orientation axis of the great ulnar sigmoid cavity. The results show that - when humeral epiphysis-diaphysis angle is larger or eventually equal to the ulnar one - it is sufficient that the considered angles are less than 45 degrees to get a correct and complete flexo-extension movement.

Auditory effects of noise on infant and adult guinea pigs.

This pilot study compared the susceptibility of the infant (48 hr) and adult (120 days) guinea pig to the effects of noise. Subjects were exposed to a narrow band of noise (center frequency 4 kHz) at an intensity of 115 dB sound pressure level (SPL) for 1 hr. Postexposure thresholds were obtained by a conditioned suppression technique. Results indicated that the infant animals displayed a mean hearing threshold of 25 dB SPL that significantly differed from the adult mean threshold of 7.5 dB SPL.