[Delirium as the only symptom of COVID-19 pneumonia in the elderly]. / Delier als enige symptoom van COVID-19-pneumonie bij ouderen.

Early descriptions about the presentation of COVID-19 focused primarily on respiratory symptoms. However, we now know that COVID-19 can also present with one or more atypical symptom(s). With this case-report we want to draw attention to atypical presentations of COVID-19 that can occur in psychiatric practice, especially in the elderly. We report the case of an elderly woman with an atypical presentation of a COVID-19 pneumonia, namely without the often mentioned respiratory symptoms, gastrointestinal symptoms or fever, but with acute confusion. It is important to swiftly consider the possibility of a COVID-19 infection in (elderly) patients who present with delirium, as missing an infection can have important negative consequences, both for the treatment of the patient and for further spread within the (hospital) environment.

Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group.

BACKGROUND: Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions. METHODS: From 2010 to 2018, 925 MGB-OAGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was the identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years. RESULTS: Twenty-two patients [2.3%] required revisional surgery after MGB-OAGB. Five patients [0.5%] developed severe diarrhoea managed by shortening the bilio-pancreatic limb to 150 cm. Four patients [0.4%] developed afferent loop syndrome and bile reflux was reported in another 3 [0.3%] cases; all were managed by either conversion to Roux en Y Gastric Bypass or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients [0.3%]. Liver decompensation that was reported in 2 patients [0.2%] was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis [0.2%], one perforated ulcer [0.1%], one patient [0.1%] with excessive weight loss and one case [0.1%] of protein malnutrition. None of the 22 patients undergoing revisional surgery after MGB-OAGB died. Lost to follow up rate was 0.2%. CONCLUSION: Complications requiring revisional surgery after MGB-OAGB are uncommon [2.3%] and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.

Effects of non-local exchange on core level shifts for gas-phase and adsorbed molecules.

Density functional theory calculations are often used to interpret experimental shifts in core level binding energies. Calculations based on gradient-corrected (GC) exchange-correlation functionals are known to reproduce measured core level shifts (CLS) of isolated molecules and metal surfaces with reasonable accuracy. In the present study, we discuss a series of examples where the shifts calculated within a GC-functional significantly deviate from the experimental values, namely the CLS of C 1s in ethyl trifluoroacetate, Pd 3d in PdO and the O 1s shift for CO adsorbed on PdO(101). The deviations are traced to effects of the electronic self-interaction error with GC-functionals and substantially better agreements between calculated and measured CLS are obtained when a fraction of exact exchange is used in the exchange-correlation functional.

[Primary peritonitis combined with streptococcal toxic shock syndrome following an upper respiratory tract infection caused by Streptococcus pyogenes]. / Primaire peritonitis in samenhang met streptokokken-toxischeshocksyndroom na bovensteluchtweginfectie door Streptococcus pyogenes.

A 52-year-old woman with no previous history of major health problems presented with an acute abdomen and symptoms of shock. Three days earlier she had been diagnosed as having acute laryngitis which was treated with steroids. On admission she was suffering from hypotension, renal failure, liver failure and coagulopathy. Emergency laparotomy revealed purulent fluid spread diffusely throughout the abdominal cavity. Streptococcus pyogenes was grown in culture from this fluid, enabling a diagnosis of streptococcal toxic shock syndrome (STSS) with primary peritonitis to be made. This combination is rare, and has been described only a few times. Only one other patient is known in whom this combination was preceded by respiratory symptoms. The treatment consists of abdominal lavage, intravenous administration of antibiotics and immunoglobulins, and support for renal function, liver function, respiration and coagulation.

Spontaneous plaquette formation in the SU(4) spin-orbital ladder.

The low-energy properties of the SU(4) spin-orbital model on a two-leg ladder are studied by a variety of analytical and numerical techniques. As in the case of SU(2) models, there is a singlet-multiplet gap in the spectrum, but the ground state is twofold degenerate. An interpretation in terms of SU(4)-singlet plaquettes is proposed. The implications for general two-dimensional lattices are outlined.

Low-grade fibromyxoid sarcoma.

Described is a low-grade fibromyxoid sarcoma (LGFMS) of the abdominal wall muscles in a 38-year-old black woman. There was no evidence of metastatic disease. A 5.2-kg LGFMS - the largest case ever reported - was resected. One year after surgery, the patient is alive without any sign of local recurrence or distant metastasis. Follow-up comprises abdominal and thoracic CT scans at 6-month intervals.

Video-assisted thoracoscopic repair of an intercostal pulmonary hernia.

Pulmonary hernias are extremely rare. They are usually treated with open surgical procedures. We describe a case in which a large, spontaneously acquired intercostal pulmonary hernia was successfully repaired by video-assisted thoracoscopic surgery (VATS).

Choledochal cyst in adults.

A case of choledochal cyst in an adult is presented. Preoperative diagnosis was established by CT-scanning and MRI. The patient was treated with cyst excision and Roux-en-Y hepaticojejunostomy. A review of the literature is presented.

Combined laparoscopic treatment of gastric leiomyoma and gallstones.

Laparoscopic treatment of benign gastric disease is rapidly expanding. Gastric leiomyoma, a benign gastric neoplasm, can now be resected laparoscopically. A wide variety of laparoscopic procedures is presented in case reports during the last few years. The authors report a successful laparoscopic enucleation of a gastric leiomyoma combined with laparoscopic cholecystectomy for cholelithiasis.

Hand-assisted laparoscopic splenectomy for hydatid cyst.

Splenic hydatidosis is a rare condition. We performed a hand-assisted laparoscopic splenectomy for a large hydatid cyst localized in the center of the spleen. We discuss the advantages of the "helping hand."

Activation of thick targets by energetic heavy ions and the resultant radiation levels.

This study completes data collected for thick targets exposed to carbon and oxygen ions accelerated at 86 MeV/u. The radioactivity induced in carbon and tungsten targets bombarded by argon projectiles at 95 MeV/u has been studied in order to assess the relative contributions of the incoming heavy ion and the mass number of the bombarded nuclei to the consequent radiation hazards related to the production of radioactive ion beams. Induced radioactivity measurements are only rarely made under controlled irradiation conditions, in order to derive from the measured activities the dose rates after beam bombardment and a prediction of radiation protection constraints.

Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation.

Controversy surrounds the treatment of open femoral shaft fractures, especially in the multiply injured. We report on 54 patients with 57 open femoral shaft fractures. They were treated according to our policy which deals with the severity of the soft-tissue damage. Low-grade open femoral fractures were primarily treated with internal fixation. A temporary external fixator was used for high-grade open fractures and in multiply injured patients where primary intramedullary nailing was contra-indicated. The external fixator was converted into an intramedullary nail as soon as the local soft-tissue disorders and the general condition of the patient permitted. There were no cases of deep infection. There was one case of malunion. Functional outcome was good to excellent in all cases. The aim of this paper is to show that low-grade open femoral fractures can be safely treated with primary intramedullary nailing and that temporary external fixation of severe open fractures followed by conversion into an intramedullary nail can be done without deep infection.

Extracorporeal shock wave lithotripsy for urinary stone disease: clinical experience with the electromagnetic lithotriptor 'Lithostar'.

400 urinary stone patients were treated with the electromagnetic lithotriptor Siemens 'Lithostar': 66.3% had renal stones and 33.7% had ureteral stones. Ninety percent of the treatments were performed under intravenous sedation only: 14.5% of the patients had more than one session. After 3 months more than 80% of the patients with a single stone smaller than 1.5 cm and 46% of the patients with stones larger than 2.5 cm were 'stone-free'.