Esophagectomy for cancer is one of the most complex procedures in visceral surgery. Postoperative complications negatively affect the patient's overall survival. They are not influenced by the ...histology type (adenocarcinoma (AC)/squamous cell carcinoma (SCC)), or the surgical approach (open, laparoscopic, or robotic-assisted). Among those dreadful complications are anastomotic leak (AL), esophago-respiratory fistula (ERF), and chylothorax (CT).
In this review, we summarize the methods to avoid these complications, the diagnostic approach, and new therapeutic strategies.
In the last 20 years, both centralization of the medical care, and the development of endoscopy and radiology have positively influenced the management of postoperative complications. For the purpose of their prevention, perioperative measures have been applied. The treatment includes conservative, endoscopic, and surgical approaches.
Post-esophagectomy complications are common. Prevention measures should be known. Early recognition and adequate treatment of these complications save lives and lead to better outcomes.
An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a ...complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.
The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which ...represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.
The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.
A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience.
Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
A presente dissertação tem por objectivo analisar a evolução e a situação contemporânea do nacionalismo búlgaro e das identidades nacionais no país que se foram desenvolvendo durante os anos sob a ...pressão da integração europeia. Partindo das principais teorias sobre nacionalismo pretendemos analisar como um caso específico, o da Bulgária, se insere nas tendências mundiais e como acontecimentos importantes, como a transição do sistema político e a adesão à EU influenciaram a sociedade búlgara. No trabalho, iremos destacar questões relacionadas com as teorias de Benedict Anderson e Eric Hobsbawm, entre outros, e como estas teorias podem ser aplicadas ao caso búlgaro. Iremos avaliar as políticas nacionais em relação às minorias étnicas e religiosas no país, como também as tendências mundiais de homogeneização cultural e o seu impacto na Bulgária. Adoptando uma perspectiva político-cultural iremos verificar como importantes acontecimentos no país influenciaram a vida dos cidadãos das diferentes etnias.
Introduction and importanceThe foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might ...be volvulated, which represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.Case presentationThe authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.Clinical discussionA delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience.ConclusionReporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
Different patterns can be created on the surface of growing crystals, among which the step bunches and/or step meanders are two of the most studied. The Ehrlich–Schwoebel effect at the surface steps ...is considered one of the “usual suspects” of such patterning. A direct step barrier is when it is easier to attach a particle to the step from the lower terrace than from the upper terrace. Thus, during the process of crystal growth leads to the formation of meanders, while an inverse barrier leads to step bunching. Based on our vicinal Cellular Automaton model, but this time in (2 + 1)D, we show that the combination of a direct and inverse step barrier and the proper selection of the potential of the well between them leads to the formation of bunched step structures. Following this is the formation of anti-bands. In addition, changing the height of the direct step barrier leads to the growth of nanocolumns, nanowires, and nanopyramids or meanders, in the same system.
The bunching of steps at the surface of growing and sublimating crystals can be induced by both directions of the electromigration force acting on the adatoms, step-up and step-down. The processes ...happen in different intervals of the adatom concentration and differ in character. In this modeling study, we show that the overall picture of the bunching process changes entirely when steps cannot overlap, thus forming macrosteps. The step–step exclusion rule that forbids the steps to coalesce is introduced in our atomistic scale model of vicinal crystal growth, and we show how it distinguishes between the step-up and step-down directions of the destabilizing diffusional bias; the model surface destabilized by the step-up driving force smoothens, while the surface destabilized by the step-down driving force changes its character from vertical (01)-faceted macrosteps toward regular (11)-faceted bunches. We also clearly demonstrate how the step–step exclusion switches on another second length scale next to the bunch height, that is the bunch width, instead of the macrostep height. The bunch profiles, stability diagrams, and time-scaling dependences of the bunch properties are heavily affected by the step–step exclusion, and we quantify this effect by showing how it changes the overall scaling behavior of the phenomenon. Making step–step exclusion conditional by introducing a probability for exclusion brings additional features, and a new characteristic time scale emerges as an effect of the interplay between (01)-faceted macrosteps and (11)-faceted bunches.
In recent years there has been an extensive search for nature-based products with functional potential. All structural parts of Physalis alkekengi (bladder cherry), including fruits, pulp, and ...less-explored parts, such as seeds and peel, can be considered sources of functional macro- and micronutrients, bioactive compounds, such as vitamins, minerals, polyphenols, and polyunsaturated fatty acids, and dietetic fiber. The chemical composition of all fruit structural parts (seeds, peel, and pulp) of two phenotypes of P. alkekengi were studied. The seeds were found to be a rich source of oil, yielding 14–17%, with abundant amounts of unsaturated fatty acids (over 88%) and tocopherols, or vitamin E (up to 5378 mg/kg dw; dry weight). The predominant fatty acid in the seed oils was linoleic acid, followed by oleic acid. The seeds contained most of the fruit’s protein (16–19% dw) and fiber (6–8% dw). The peel oil differed significantly from the seed oil in fatty acid and tocopherol composition. Seed cakes, the waste after oil extraction, contained arginine and aspartic acid as the main amino acids; valine, phenylalanine, threonine, and isoleucine were present in slightly higher amounts than the other essential amino acids. They were also rich in key minerals, such as K, Mg, Fe, and Zn. From the peel and pulp fractions were extracted fruit concretes, aromatic products with specific fragrance profiles, of which volatile compositions (GC-MS) were identified. The major volatiles in peel and pulp concretes were β-linalool, α-pinene, and γ-terpinene. The results from the investigation substantiated the potential of all the studied fruit structures as new sources of bioactive compounds that could be used as prospective sources in human and animal nutrition, while the aroma-active compounds in the concretes supported the plant’s potential in perfumery and cosmetics.
In the 12,000 years preceding the Industrial Revolution, human activities led to significant changes in land cover, plant and animal distributions, surface hydrology, and biochemical cycles. Earth ...system models suggest that this anthropogenic land cover change influenced regional and global climate. However, the representation of past land use in earth system models is currently oversimplified. As a result, there are large uncertainties in the current understanding of the past and current state of the earth system. In order to improve representation of the variety and scale of impacts that past land use had on the earth system, a global effort is underway to aggregate and synthesize archaeological and historical evidence of land use systems. Here we present a simple, hierarchical classification of land use systems designed to be used with archaeological and historical data at a global scale and a schema of codes that identify land use practices common to a range of systems, both implemented in a geospatial database. The classification scheme and database resulted from an extensive process of consultation with researchers worldwide. Our scheme is designed to deliver consistent, empirically robust data for the improvement of land use models, while simultaneously allowing for a comparative, detailed mapping of land use relevant to the needs of historical scholars. To illustrate the benefits of the classification scheme and methods for mapping historical land use, we apply it to Mesopotamia and Arabia at 6 kya (c. 4000 BCE). The scheme will be used to describe land use by the Past Global Changes (PAGES) LandCover6k working group, an international project comprised of archaeologists, historians, geographers, paleoecologists, and modelers. Beyond this, the scheme has a wide utility for creating a common language between research and policy communities, linking archaeologists with climate modelers, biodiversity conservation workers and initiatives.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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