Percutaneous endoscopic gastrostomy (PEG) in upper gastrointestinal tract occlusion in gynecologic oncology

BACKGROUND AND AIMS: Intestinal obstruction is a frequent cause of death in patients suffering from gynecological cancer, who have undergone multiple treatment in the form of surgery and/or chemotherapy and/or radiotherapy. The usual form of rescue treatment consists in the use of a nasogastric tube to administer support and analgesic treatment. Surgical gastrostomy is not a viable proposition in these extremely weak patients with large masses compressing and displacing the stomach. Percutaneous endoscopic gastrostomy (PEG), a technique first introduced for nutritional purposes, can be beneficially used to achieve decompression in these patients. METHODS: PEG was performed in a total of 67 patients who had already undergone multiple treatment for abdominal-pelvic neoplasia with upper gastrointestinal obstruction, who could no longer be operated and who had a life expectancy of less than sixty days. In three cases positioning was not possible owing to the lack of transillumination of the gastric and abdominal wall. 54/64 patients had previously undergone at least two operations. RESULTS: Esophagogastric lesions were found in 29% of patients, some of which were attributed to the nasogastric tube. Symptomatic wellbeing was obtained in 76.5% a few days after PEG. PEG remained in situ from 4 to 472 days. Slight peristomal infection was observed in 9% of cases. In seven cases it was necessary to add octreotide owing to the reappearance of symptoms. CONCLUSIONS: PEG is relatively easy to use and allows obstructive symptoms to be resolved in the majority of patients. Special medical skills are not required and the patient may be easily managed at home together with support therapy and pain management. Once PEG has been performed, it is possible to take fluids and semi-liquid foods, offering the patient a chance to taste flavours which have often been forgotten. PEG enables neoadjuvant chemotherapy to be performed in patients with previously untreated intestinal obstruction.     

Design Procedures for Three-Stage CMOS OTAs With Nested-Miller Compensation

Design procedures for three-stage CMOS operational transconductance amplifiers employing nested-Miller frequency compensation are presented in this paper. After describing the basic methodology on a Class-A topology, some modifications, to increase swing, slew-rate and current drive capability, are subsequently discussed for a Class-AB solution. The approaches developed are simple as they do not introduce unnecessary circuit constraints and yield accurate results. They are hence suited for a pencil-and-paper design, but can be easily integrated into an analog knowledge-based computer-aided design tool. Experimental prototypes, designed in a 0.35-mum technology by following the proposed procedures, were fabricated and tested. Measurement results were found in close agreement with the target specifications     

Creating biomimetic micro-environments with synthetic polymer-peptide hybrid molecules

In designing polymers that can act as tissue engineering templates it is beneficial to consider methods of mimicking the natural support structures used by the human body to guide the behavior and development of cells within tissues. The well-known RGD cell adhesion ligand provides a simple mechanism of creating polymer surfaces that mimic the extracellular matrix. This paper considers the methods that have been used to attach such motifs to synthetic polymers. In general there are two strategies: the formation of polymer-peptide hybrid molecules, or the immobilization of the ligand on the fabricated surface of the polymer. The three major synthetic strategies of creating polymer-peptide hybrids are reviewed.     

Use of ultrasonography methods in the diagnosis of neurogenic paraosteoarthropathy in spinal cord injury

To assess the role of the ultrasonic imaging evaluation of articular lesions suspected to be the initial presentation of heterotopic ossifications (HO), 59 consecutive injured patients were studied. 32 out of 59 patients showed clinical signs of local inflammation in one of the articular sites of the upper or lower limbs, sonographic scans proved to be diagnostic of HO in 7 out of those 32 patients before their radiographic findings. Serial sonographic examinations were performed utilizing a 7.5 MegaHertz transducer probe for 2 months. The imaging abnormalities were correlated with biochemical levels of serum alkaline phosphatase, modifications of radiographic features and bone 99nTC scintigraphy. Scintigraphy revealed to have a high sensitivity but a low specificity for the diagnosis of HO. Also the serum levels of alkaline phosphatase were not a sensitive indicator of early HO in our group of patients. Moreover serial sonographic scans confidently excluded the HO in the 25 patients with no initial signs of the disease without any false negative results. Thus, early sonographic assessment of patients, with spinal cord injury in which local signs of inflammation suggest initial HO formation, revealed to be superior to the other utilized technique for the diagnosis of HO and may be considered a valuable alternative in particular to evaluate the evolutive pattern of this disease.     

Microfluidic platform for controlled synthesis of polymeric nanoparticles

A central challenge in the development of drug-encapsulated polymeric nanoparticles is the inability to control the mixing processes required for their synthesis resulting in variable nanoparticle physicochemical properties. Nanoparticles may be developed by mixing and nanoprecipitation of polymers and drugs dissolved in organic solvents with nonsolvents. We used rapid and tunable mixing through hydrodynamic flow focusing in microfluidic channels to control nanoprecipitation of poly(lactic- co-glycolic acid)- b-poly(ethylene glycol) diblock copolymers as a model polymeric biomaterial for drug delivery. We demonstrate that by varying (1) flow rates, (2) polymer composition, and (3) polymer concentration we can optimize the size, improve polydispersity, and control drug loading and release of the resulting nanoparticles. This work suggests that microfluidics may find applications for the development and optimization of polymeric nanoparticles in the newly emerging field of nanomedicine.     

Intrathoracic alimentary tract duplication cysts treated in utero by thoracoamniotic shunting

Studying the electrophysiological characteristics of the various types of Charcot-Marie-Tooth disease is important in the understanding of its pathophysiology. The purpose of this study was to identify the frequency of fibrillation potentials and positive sharp waves (FP/PWs) in HMSN I and II and, since they are indices of denervation, to elucidate whether they are correlated with the amplitude of compound muscle action potentials (CMAP). We reviewed the electrophysiological findings of 47 patients who have been studied in our hospital and found to suffer from Charcot-Marie-Tooth polyneuropathy. FP/PW were graded according to a 4-grade scale and the 38 m/sec criterion for motor conduction velocity (MCV) was used for distinction between HMSN I and II subgroups. Seventy percent of HMSN II patients and 81% of HMSN I patients showed fibrillation potentials in the upper or lower limbs. There was no difference in the frequency of FP/PW appearance between the two groups. In the HMSN II group the FP/PW grade correlated with CMAP amplitude in the upper limbs. In both groups there was no correlation between FP/PW grade and MCV. Our findings might indicate that in HMSN I there is a considerable axonal destruction that occurs concurrently with myelin loss.     

Regional mapping of the human galactocerebrosidase gene (GALC) to 14q31 by in situ hybridization

The cDNA for human galactocerebrosidase (GALC) has recently been cloned and expressed. A portion of this cDNA was used for in situ hybridization, and the region of strongest signal corresponded to human chromosome region 14q31. This agrees with recent linkage studies that localized Krabbe disease (globoid cell leukodystrophy) to the same region. This information will be useful in future studies for mapping this gene in animal models of GALC deficiency.     

Automatic evaluation of plastic collapse conditions for planar frames with vertical irregularities

Engineering with Computers - The plastic load and failure modes of vertically irregular planar frames are studied by means of an original software code developed in the agent-based programming...     

Energy Dissipation in Transient Gaseous Cavitation

The aim of the paper is to examine nonfriction energy dissipation in transient cavitating flows and to verify whether they can be attributed to thermic exchange between gas bubbles and the surrounding liquid or to gas release and solution process. A two-dimensional (2D) numerical model for liquid flow with a small amount of free gas is proposed. The results of the numerical runs are compared with experimental data of pressure head oscillations in transient cavitating flow. Both thermic exchange and gas release can explain some of the dissipation if a relaxation process is assumed. However, the 2D model, including the thermodynamics of the gaseous phase, does not seem to fully explain the observed dissipation. The 2D model with gas release allows for a good simulation of the experimental data after a suitable calibration of the model parameters.