Background and Aims Perforation during colonoscopy remains the most worrisome adverse event and usually requires urgent surgical rescue. The aim of this study was to evaluate the feasibility and ...effectiveness of endoscopic closure of full-thickness colonic perforations. Methods We performed a retrospective analysis of all consecutive patients with endoscopically closed colonic perforations over the past 6 years (2009-2014). Colonic perforations were closed by using endoscopic clips or an endoscopic suturing device. Most patients were admitted for treatment with intravenous antibiotics and kept on bowel rest. If their clinical condition deteriorated, urgent surgery was performed. If patients remained stable, oral feeding was resumed, and patients were discharged with subsequent clinical and endoscopic follow-up. Results Twenty-one patients had iatrogenic colonic perforations closed with an endoscopic suturing device or endoscopic clips during the study period. Primary closure of a colonic perforation was performed with endoscopic clips in 5 patients and sutured with an endoscopic suturing device in 16 patients. All 5 patients after clip closure had worsening of abdominal pain and required laparoscopy (4 patients) or rescue colonoscopy with endoscopic suturing closure (1 patient). Two patients had abdominal pain after endoscopic suturing closure, but diagnostic laparoscopy confirmed complete and adequate endoscopic closure of the perforations. The other 15 patients did not require any rescue surgery or laparoscopy after endoscopic suturing. The main limitation of our study is its retrospective, single-center design and relatively small number of patients. Conclusion Endoscopic suturing closure of colonic perforations is technically feasible, eliminates the need for rescue surgery, and appears more effective than closure with hemostatic endoscopic clips.
PREPACKAGED ASBESTOS BANKRUPTCIES: DOWN BUT NOT OUT Green, Eric D; Fitzpatrick, Lawrence; Patton, James L ...
New York University annual survey of American law,
04/2008, Letnik:
63, Številka:
4
Journal Article
As a result of overwhelming asbestos claims, numerous companies have filed for bankruptcy, hoping to resolve their asbestos liabilities in an efficient and cost-effective manner. However, a company ...with an urgent need to file for bankruptcy typically is not an ideal candidate for a prepackaged plan. Prepacks allow companies to stay under bankruptcy court supervision for less time and with fewer bankruptcy-related costs and risks. Here, Green et al explain the reasons on why prepacks have been, and still remain, a valuable option for companies saddled with large asbestos liabilities. They address the role of the future claimant representative (FCR) in both conventional and prepackaged asbestos bankruptcies and shows how the appointment of an experienced FCR can benefit future claimants.
Using data from computerized patient records, the authors attempted to identify characteristics of first admissions to state psychiatric facilities who would later become recidivists. In an ...examination of 22,062 first admissions to all state hospitals in Tennessee, they found six variables with significant ability to predict recidivism: age, delusional beliefs, assaultive acts, out-of-state residence, indigence, and living with parents. A risk profile that predicted future recidivism with statistical significance at all five Tennessee state bospitals was subsequently developed, but the predictive accuracy was too low for the profile to be clinically useful. The authors believe the benefits of early identification of patients at risk justify further research.
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