Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed ...to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45–100), 94.3 % (87.2–100), 14 (9.81–19.9), and 0.24 (0.05–1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95–1.11;
p
= 0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64–156.9;
p
= 0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52–1217.3;
p
= 0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50–202.8;
p
= 0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31–132.7;
p
= 0.2). The overall agreement was 0.40 (95 % CI, 0.09–0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.
Background
Surgery used to be the treatment of choice in cases of blunt hepatic injury, but this approach gradually changed over the last two decades as increasing non‐operative management (NOM) of ...splenic injury led to its use for hepatic injury. The improvement in critical care monitoring and computed tomographic scanning, as well as the more frequent use of interventional radiology techniques, has helped to bring about this change to non‐operative management. Liver trauma ranges from a small capsular tear, without parenchymal laceration, to massive parenchymal injury with major hepatic vein/retrohepatic vena cava lesions. In 1994, the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST) revised the Hepatic Injury Scale to have a range from grade I to VI. Minor injuries (grade I or II) are the most frequent liver injuries (80% to 90% of all cases); severe injuries are grade III‐V lesions; grade VI lesions are frequently incompatible with survival. In the medical literature, the majority of patients who have undergone NOM have low‐grade liver injuries. The safety of NOM in high‐grade liver lesions, AAST grade IV and V, remains a subject of debate as a high incidence of liver and collateral extra‐abdominal complications are still described.
Objectives
To assess the effects of non‐operative management compared to operative management in high‐grade (grade III‐V) blunt hepatic injury.
Search methods
The search for studies was run on 14 April 2014. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In‐Process & Other Non‐Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (Ovid), PubMed, ISI WOS (SCI‐EXPANDED, SSCI, CPCI‐S & CPSI‐SSH), clinical trials registries, conference proceedings, and we screened reference lists.
Selection criteria
All randomised trials that compare non‐operative management versus operative management in high‐grade blunt hepatic injury.
Data collection and analysis
Two authors independently applied the selection criteria to relevant study reports. We used standard methodological procedures as defined by the Cochrane Collaboration.
Main results
We were unable to find any randomised controlled trials of non‐operative management versus operative management in high‐grade blunt hepatic injury.
Authors' conclusions
In order to further explore the preliminary findings provided by animal models and observational clinical studies that suggests there may be a beneficial effect of non‐operative management versus operative management in high‐grade blunt hepatic injury, large, high quality randomised trials are needed.
Tranexamic acid substantially reduces death in bleeding trauma patients. So why are the World Health Organization, the United Nations, the World Bank, and Unicef not ensuring global implementation, ...ask Ian Roberts and colleagues
The solvability of nonlinear equations has awakened great interest among mathematicians for a number of centuries, perhaps as early as the Babylonian culture (3000300 B.C.E.). However, we intend to ...bring to our attention that some of the problems studied nowadays appear to be amazingly related to the time of Bolzano's era (17811848). Indeed, this Czech mathematician or perhaps philosopher has rigorously proven what is known today as the intermediate value theorem, a result that is intimately related to various classical theorems that will be discussed throughout this work.
El uso y aplicación de la Geomática está siendo incorporado a los procesos de planificación local y regional, fortaleciendo la gestión de las instituciones que la utilizan y de esta forma, ...contribuyendo al desarrollo económico y social de la población. Conocer la ubicación exacta de una carencia social en particular y su distribución en el territorio, es el punto de partida para enfrentar el problema y llevar a cabo las acciones conducentes a su solución. En este contexto, el presente estudio tuvo como finalidad dar a conocer nuevas tecnologías empleadas para representar la distribución espacial de viviendas y la disponibilidad o carencia de servicios básicos que éstas presentan. Para ello, se utilizó la información generada a partir del "Catastro Digital de Viviendas para la Ordenación del Territorio. Comunas de Longaví, Retiro y Parral", proyecto financiado por el Fondo Nacional de Desarrollo Regional (FNDR) y ejecutado por la Universidad de Talca durante los años 2004-2005, donde se consideró la vivienda como mínima unidad de representación espacial. Mediante un análisis geoespacial de los servicios básicos, se identificaron y clasificaron las viviendas de acuerdo a su estado de carencia. Los resultados indicaron que un 9,3% de los hogares presentan un alto grado de carencia, el 18,1% corresponde a hogares con regular grado de carencia y el 72,6% dispone de un bajo grado de carencia.
Tales4Us Aguilar, María Sofía Morales; Morales, Carlos Francisco H.
Proceedings of the 8th Latin American Conference on Human-Computer Interaction,
11/2017
Conference Proceeding
According to the World Health Organization, 285 million people are estimated to be visually impaired worldwide, they have some drawbacks due to the nature of smartphones, and because there is a ...shortage of mobile applications designed for them. This Project seeks to expand knowledge about the interaction of educational platforms in smartphone devices with children who have vision impairment. In this experiment we will design the prototype of a mobile application which will serve to share stories between children, forming a community that promotes creativity, development and learning with a platform adapted to their needs.
This platform has 3 easy to use basic functions, adapted to people with vision impairment, the functions are as follows:
1. Play: The user can play stories from his personal library.
2. Share: The user can record a new story and share it with the community.
3. Download: The user can download stories that other users of the community have shared.
The goal is to improve the interaction between people with vision impairment and mobile Apps, following a methodology of user centered design.
The liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for ...these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management.
We performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications.
During the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management.
The need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing.
El concepto de familia, desde el inicio de los tiempos, ha sido observado como una entidad dirigida a canalizar vínculos, afectos y descendencia, regularmente con fines comunes. No obstante, en ...el desarrollo evolutivo de los pueblos, tal concepto tiene sus variantes precisas enfocadas en una praxis propia, de acuerdo a la cultura, y a los imaginarios sociales creados en cada ámbito territorial, de conformidad con sus propias normas y procedimientos, pero cuya eficacia y legalidad depende de su condición de apego a las normas impuestas por el Estado en esa territorialidad. Los cambios producidos han generado detractores, sobre todo, cuando se desvirtúa el concepto de aquella familia tradicional de inicio, irrumpiendo contra todo principio o valor primigenio fundado. Bajo tales premisas controvertidas se fundamenta este estudio, con el objetivo de analizar los nuevos roles del concepto de familia, desde la perspectiva de los cambios de los últimos tiempos, donde la familia homoparental surge de manera abrupta, quizá intempestiva, a ultranza de cualquier contrario. Con tales fines, se produce un estudio comparativo versado en la legislación y la praxis de Colombia y Venezuela, buscando hacer la determinación de las transformaciones culturales sucedáneas. En tal sentido, se realiza una investigación enfocada bajo el paradigma cualitativo-interpretativo, utilizado en las ciencias sociales, y se aplican métodos relativos a la etnografía y a la hermenéutica, con la finalidad de hacer la interpretación de los documentos recabados, y con base en jurisprudencia de los países examinados. Los resultados encontrados develan firmes transformaciones socio-culturales, así como políticas y jurídicas, develando impactos criteriales, de razonamientos y de comportamientos, lo que induce al investigador a su análisis pretendiendo sistematizar las opiniones suscitadas y los conflictos generados entre las partes intervinientes en ellos.
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