Infected Necrosis in Severe Pancreatitis - Combined Nonsurgical Multi-Drainage with Directed Transabdominal High-Volume Lavage in Critically Ill Patients

Background: Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. Patients and Methods: Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. Results: In all patients, pancreatic necrosis/liquid collections could be resolved completely by the presented regime. No patient died in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopic interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. Conclusion: This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopic necrosectomy was necessary in any of our patients. Copyright (C) 2009 S. Karger AG, Basel and IA

Webinar: State-Wide Pedestrian and Bicycle Miles Traveled: Can We Estimate It?

Heard of Vehicle Miles Traveled (VMT)? Wouldn’t it be great to know the corresponding value for walking and cycling? This webinar discusses options for estimating the miles people walk and bicycle on the state-wide level, by investigating the practical considerations of trying to compute these values for one study state. What strategies can be used, and what data sources do these require? How do these strategies compare? How do PMT/BMT estimates vary based on data? Find out what researchers found and what obstacles they encountered when they tried to estimate bicycle and pedestrian miles traveled in the State of Washington.https://pdxscholar.library.pdx.edu/trec_webinar/1015/thumbnail.jp

ERCP in Evaluating The Mode of Therapy in Pancreatic Pseudocyst

Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stensosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage

Sormien jännevammat

Vertaisarvioitu.Sormien jännevammat syntyvät lävistävien tai sulkeisten vammojen seurauksena. Kliininen tutkimus ja tarvittaessa natiiviröntgenkuvaus riittävät usein diagnosointiin. Jännevammoihin voi liittyä jänteen kiinnityskohdan avulsio- eli repeämismurtuma. Avoimiin vammoihin liittyy usein hermo- ja verisuonivammoja. Sulkeiset ojentajajännevammat hoidetaan yleensä lastoilla. Vasarasormen (mallet finger) lastahoito voidaan toteuttaa perusterveydenhuollossa. Avoimet ja muut kirurgisesti korjattavat jännevammat kuuluvat käsikirurgiseen yksikköön. Hyvän toiminnallisen tuloksen saavuttaminen edellyttää leikkauksen jälkeistä kuntoutusta ja potilaan sitoutumista siihen.Peer reviewe

Ressursoptimalisering gjennom leanimplementering hos Byggmakker Tiller

Bacheloroppgave i Økonomistyring og investeringsanalyse fra Handelshøyskolen BI, 2013Oppgaven bygger på følgende problemstilling: ”Hvordan kan Byggmakker Tiller optimalisere ressursbruk ved hjelp av implementering av lean?” Innledningsvis har vi gitt en grundig beskrivelse av butikken og organisasjonen for og kunne identifisere situasjoner hvor det forekommer sløsing. I intern og ekstern analyse har vi gitt et ytterligere bilde av momenter ved butikken, kundene og konkurrentene. Deretter gir vi en innføring i konseptet lean og dens historiske utviklingen. Videre retter vi teorien mot de aspektene av lean-teori som er relevant med problemstillingen; lean i operasjonelt nivå, strategisk nivå og lean i servicebransjen. Avslutningsvis supplerer vi med teori innen kommunikasjon og motivasjon begrunnet i at servicen er definert som hovedproduktet. I metodekapitlet beskriver vi hvilke metoder som er benyttet for innhenting av data. Vi definerte målområdene sammen med daglig leder og med inspirasjon fra tidligere undersøkelser gjort ved bygget og konsernet. Av dette utarbeidet vi en kundeundersøkelse og en ansattundersøkelse, og videre presenterer vi sekundærdata som er benyttet fra byggevarebransjen. I resultat og analyse kommer vi frem til at pris, service, utvalg av produkter og kvalitet på produktet er de viktigste kundeverdiene. Begrensningene i oppgaven legger grunnlaget for at vi analyserer service og utvalg av produkter. Dette legger grunnlaget for de resterende faktorene vi analyserer. I kapittelet om tiltak presenterer vi våres løsninger som kan redusere sløsing og øke kundeverdi gjennom ressursoptimalisering, og konkluderer avslutningsvis med implementering av følgende tiltak: • Produsere kartbrosjyre • Økt opplæring hos de ansatte • Etablere avdelingsmøter • Endring i rutiner i henhold til betjeningen av kunder Og en oppfordring om å lage et strategidokument spesifikt for Byggmakker Tiller

Enchondromas of the Hand : Curettage With Autogenous Bone vs. Bioactive Glass S53P4 for Void Augmentation

Background/Aim Enchondroma is the most common primary bone tumour of the hand. When surgery is indicated, curettage with or without void augmentation has been described. However, only few comparative studies exist. The aim of this study was to compare the outcomes of hand enchondromas treated with autologous bone graft (AG) and bioactive glass S53P4 (BAG). Patients and Methods: A retrospective comparative analysis was conducted among patients surgically treated for hand enchondromas at a tertiary referral centre during a 17-year period. Results: A total of 190 patients (116 AG vs. 74 BAG) with 205 enchondromas were included. No statistically significant differences in outcome measures were observed. A reoperation was performed in five patients in the autologous bone-graft group; one patient presented a rare malignant transformation from enchondroma to chondrosarcoma after the primary operation. No reoperations were performed in the BAG group. Conclusion: Although AG is the gold standard for filling bony cavities, bone-graft retrieval can cause complications and postoperative pain. Our results suggest that S53P4 BAG is a safe and effective bone-graft material alternative for filling of enchondroma-evacuated cavities.Peer reviewe

Systemic Predictive Safety Analysis of Pedestrian Crashes for Montgomery County’s Vision Zero Program

The goal of Vision Zero is the prevention of all traffic fatalities and serious injuries. Although traditional transportation planning is reactive to locations where serious crashes occur, some agencies are taking a more proactive approach to safety to improve locations with high expected crashes before someone is seriously injured or killed. This paper presents the results of a systemic safety analysis that produced two pedestrian-related safety performance functions for Montgomery County, MD, including 1) motor vehicle crashes with pedestrians at intersections at night and 2) through-movement motor vehicle crashes with pedestrians at road sections. These models were built using negative binomial regression of police-reported crash data collected from 2015 to 2019 for most of the county road network integrated with land use-, demographic-, and roadway variables collected by the Montgomery County Planning Department for 16,387 intersections (stop-controlled and signalized) and 29,715 segments (all functional classifications except freeways). Both models identified key transportation-related exposure variables, including motor vehicle and pedestrian volumes, proximity to transit, and crosswalk locations; they also presented land use contexts that may explain where pedestrians are likely to walk and be exposed to crash risks. These results build on current systemic safety literature and demonstrate the data collection and analysis methods that can be used in a county-level Vision Zero context to improve safety for all who walk. This paper summarizes the analysis approach, including exposure modeling, crash modeling, and applications for identifying both high-risk locations and potential mitigations. Considerations for equity and long-term planning are also discussed

Yläraajan tapaturmaiset hermovammat

Vertaisarvioitu.Tapaturmaiset yläraajan hermovammat syntyvät tyypillisesti terävästi tai tylpällä mekanismilla venytyksen, puristuksen tai turvotuksen seurauksena. Hermovamma aiheuttaa vauriotason mukaisen tuntopuutoksen, liikehäiriön ja usein kivun. Diagnoosi tehdään anamneesin ja kliinisen tutkimuksen perusteella. Hoitolinja määräytyy hermovamman vaikeuden (neurapraksia, aksonotmeesi, neurotmeeesi) perusteella. Terävästi syntynyt hermovamma vaatii yleensä välittömän kirurgisen korjauksen. Jos tylpällä mekanismilla syntynyt hermovamma ei toivu muutaman viikon kuluessa vammasta, tulee epäillä aksonaalista vauriota. Mikäli tällöin aksoniregeneraatio ei etene vammatasosta anatomian mukaisesti muutaman kuukauden kuluessa, potilas on syytä lähettää hermovammoja hoitavalle kirurgille arvioon. Kirurginen hoito vaatii mikrokirurgisten tekniikoiden hallintaa ja kuntoutus asiantuntemusta. Toipuminen hermokorjauksen jälkeen voi kestää 1-2 vuotta.Peer reviewe

Measuring pedestrian level of stress in urban environments: Naturalistic walking pilot study

Walking is the most basic and sustainable mode of transportation, and many jurisdictions would like to see increased walking rates as a way of reducing congestion and emission levels and improving public health. In the United States, walking trips account for 10.5% of all trips undertaken. To increase this rate, additional research on what makes people feel more comfortable while walking is needed. Research on pedestrian quality of service (QOS) has sought to quantify the performance of the pedestrian facilities from a pedestrian’s perspective. However, the impact of pedestrian safety countermeasures on pedestrian QOS for roadway crossings is largely unknown. The objective of this study is to discern pedestrian QOS based on physiological measurements of pedestrians performing normal walking activities in different traffic contexts. The naturalistic walking study described in this paper recruited 15 pedestrians and asked each to wear an instrumented wristband and GPS recorder on all walking trips for one week. Surprisingly, the findings from the study showed no correlation between participants’ stress levels and individual crossing locations. Instead, stress was associated with roadway conditions. Higher levels of stress were generally associated with walking in proximity to collector and arterial streets and in areas with industrial and mixed (e.g., offices, retail, residential) land uses. Stress levels were tempered in lower-density residential land uses, as well as in forest, park, and university campus environments. The outcomes from this study can inform how planners design urban environments that reduce pedestrian stress levels to promote walkability