Left recurrent laryngeal nerve palsy secondary to left pulmonary artery stent in a child

We report a 10‐year‐old girl who developed persistent hoarseness after stent placement for the treatment of left pulmonary artery stenosis. Laryngoscopy performed 21 months after stent placement revealed left vocal cord paralysis, presumed secondary to compression of the left recurrent laryngeal nerve by the stent. Pediatric cardiologists should be reminded of this possible rare complication after stent placement. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93559/1/23472_ftp.pd

Can the United States Afford a “No-Fault” System of Compensation for Medical Injury?

One of the key issues separating US critics of a no-fault alternative to the tort system for compensating victims of medical injury from supporters is its anticipated cost. Results from a study are presented that estimate the costs of a no-fault system, one that is similar to the system now in operation in Sweden, within the context of the US health care system

Disturbances in the tropical upper troposphere.

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Meteorology, 1970.Bibliography: leaves 58-61.M.S

Synchronous mucinous adenocarcinoma of the rectosigmoid seeding onto a pre-existing anal fistula

Carcinoma within a long-standing fistula-in-ano is rare and may be defined by specific neoplastic involvement of the fistulous track in the absence of rectal mucosal carcinoma. The presence of a carcinoma of mucinous histology occurring synchronously in the perianal region and the colon is exceptionally rare. We present a case with a review of the literature concerning its aetiopathogenesis and treatment. A 72-year-old man with a 2 months history of dark red rectal bleeding and mucus per rectum with alternating constipation and diarrhoea, was observed. Clinical examination and a barium enema showed a perianal fistula and an annular stenosing lesion of the rectosigmoid. Preoperative CT scan confirmed the colonic lesion. Colonic resection and wide fistula excision were performed. Histology showed an adenocarcinoma with a clear resection margins. The fistula also showed a similar histology. Chemoradiation (5-Fluorouracil (425 mg/m(2)) and Leucovorin (20 mg/m(2)) with 4500 cGy external beam radiotherapy was utilized. Subsequent clinical follow-up and CT examination of the patient has not revealed recurrent disease at 14 months

Personalizing Learning through Technology in EFL Context

Technology has revolutionized the field of EFL education, offering innovative ways to personalize learning and enhance student engagement. The efficacy of technology in language instruction has been demonstrated, including its capacity to serve as a source of motivation and facilitate authentic learning. This study explores how various technological tools and platforms can create individualized learning experiences for ESL students. Adaptive learning platforms like Duolingo and Rosetta Stone tailor lessons to individual proficiency levels, providing immediate feedback and customized learning paths. Gamified tools such as Kahoot! and Quizlet engage students through interactive quizzes and games, reinforcing language concepts in a fun and motivating way. Nevertheless, there are still drawbacks to utilizing technology in the classroom. Students may become readily distracted and may misuse the technology. In addition, the potential for students to consider critically may be restricted by their frequent use of technology. This study also addresses personal learning potential drawbacks, including access and equity issues, over-reliance on technology, privacy and data security concerns, technical issues, and variability in content quality. The digital divide remains a significant challenge, as not all students have equal access to technological resources. Balancing technology integration with traditional teaching methods and addressing these challenges is essential for maximizing the benefits of technology in EFL education. By doing so, educators can create more engaging, effective, and equitable learning experiences for all EFL students

Perineal rectosigmoidectomy for rectal prolapse:the preferred procedure for the unfit elderly patient? 10 years’ experience from a UK tertiary centre

Background: Rectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age.Methods: All patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured.Results: A total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5–86.5), ASA grade III and median follow-up of 20 months (range 8.5–45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the &lt; 80 and ≥ 80 age group.Conclusions: Perineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality.</p

Extended abdominoperineal resection in women: the barbadian experience

BACKGROUND AND OBJECTIVES: We report our results of a selective approach to primary direct appositional vaginal repair versus transverse rectus abdominis flap repair (TRAM) in patients with extensive rectal/anal cancer or in cases with primary cancer of cervix, vagina or vulva involving the anal canal and anal sphincters. METHODS: Eighteen female patients (mean age: 62.9 years; range: 44–81 years) with a median follow-up of 14 months (range: 2–36 months) undergoing extended abdominoperineal reconstruction with total mesorectal excision between May 2002 and September 2005, were studied. RESULTS: Twelve patients underwent an extended abdominoperineal resection with hysterectomy and vaginectomy, with 6 patients undergoing primary TRAM flap reconstruction following pelvic exenteration. Exenterative procedures were performed in 2 cases of primary vaginal cancer, following Wertheim hysterectomy for carcinoma of the cervix with recurrence after radiation and in 2 further cases of anal cancer with extensive pelvic recurrence after primary chemoradiation. Fifteen cases are alive on follow-up with no evidence of disease; 2 patients who had recurrent carcinoma of the cervix and who underwent TRAM flap reconstruction, have recurrent disease after 5 and 6 months of follow-up, respectively. DISCUSSION: Our experience shows that careful primary closure of an extended abdominoperineal resection wound is effective and safe. Our one case of wound breakdown after primary repair underwent external beam and intracavitary irradiation primarily with wound breakdown of a primary repair followed by a delayed pedicled graciloplasty. TRAM flap reconstruction has been reserved in our unit for patients undergoing total pelvic extenteration. In general, we would recommend the use of TRAM flap reconstruction in younger sexually active patients where there has been external irradiation combined with brachytherapy