Center

Background Increasingly, laparoscopic biliary surgeons are undertaking laparoscopic cholecystectomy and laparoscopic common bile duct exploration for patients with cholelithiasis and choledocholithiasis. In laparoscopic common bile duct exploration a flexible choledochoscope is ordinarily used, and with this instrument the surgeon usually fails to remove large impacted stones. In contrast with use of a rigid nephroscope it is possible to remove all common bile duct stones irrespective of size and degree of impaction. The present study evaluates the efficiency of rigid nephroscope for managing common bile duct stones laparoscopically. Methods In the present study laparoscopic common bile duct exploration for stones was performed in 80 patients via standard laparoscopic cholecystectomy port sites. Patients with a common bile duct diameter >10 mm were included in this study. The rigid nephroscope was passed through the epigastric port and negotiated into the common bile duct through a choledochotomy. Stones were removed with graspers. Large hard stones were fragmented by pneumatic lithotripsy. Results Of the 80 patients treated in this manner, 72 (90%) had multiple common bile duct calculi, and 8 (10%) had a solitary common bile duct calculus. Mean common bile duct diameter was 15.3 mm (range: 10–37 mm). Conversion to open common bile duct exploration was necessary in 1 case (1.25%) because of difficult dissection secondary to extensive dense adhesions. In 7 patients (8.75%) a pneumatic lithotripter was used to fragment stones. Choledochotomy was managed by placing a T-tube in 21 (26.25%) patients, by effecting primary closure in 58 (72.5%) patients, and by choledochoduodenostomy in 1 (1.25%) patient. The mean operative time in this series was 83 min (range: 53–135 min). The mean postoperative hospital stay was 4.2 days (range: 3–19 days). One patient (1.25%) developed cholangitis 5 months after laparoscopic common bile duct exploration; the cause was a residual common bile duct stone. Conclusions A rigid nephroscope can be used for managing all types of common bile duct calculi irrespective of site, size, composition, or degree of impaction. Its use can be expected to become the standard for laparoscopic common bile duct exploration, especially for removing large calculi from a dilated common bile duct.

Purpose: To compare thickness measurements of the central 6.0 mm of the cornea obtained with the Orbscan® II topography system and topographical ultrasound pachymetry. Setting: School of Optometry, University of Santiago de Compostela, Galicia, Spain. Methods: In 24 right eyes, pachymetric measurements were taken at the center and 1.2 mm and 3.0 mm on the superior and inferior hemimeridians. A 1‐sample t test was applied to assess the significance of the relationship between Orbscan II and ultrasound methods. The relationship between the 2 was assessed by analyzing regression and plotting the differences against the mean corneal thickness. Orbscan II data were analyzed in 3 ways: (1) without the application of an acoustic equivalent correction factor; (2) with a correction factor of 0.92, as recommended by the manufacturer; (3) with correction using the equations derived in this study. The data were systematically compared with those of ultrasound pachymetry. Results: Before the cor...

Abstract: A driving force in standards-based educational reform was the 1983 release of" A Nation at Risk: The Imperative for Educational Reform"(National Commission of Excellence in Education [NCEE], 1983). The report called for" an end to the minimum competency ...

Résumé À défaut d’un champ littéraire francophone proprement dit, il existe un système francophone dont le fonctionnement peut être analysé à partir de la relation réciproque de centre à périphérie. Au sein de ce système, on peut distinguer, par rapport au centre franco-parisien, différentes positions qui déterminent certaines stratégies rhétoriques de la part des auteurs de la périphérie, lesquelles agissent à leur tour sur le mode de réception de ces oeuvres par le centre (assimilation ou exotisation). Parmi toutes les stratégies rhétoriques employées, le discours identitaire apparaît à la fois comme un vecteur privilégié et comme une condition de reconnaissance par le centre, dont la demande pour l’exotisme est fort importante à l’égard de certaines zones périphériques.

Adrenalectomy continues to play an important role in the management of Cushing’s syndrome (CS). Untreated CS causes considerable physical and mental morbidity and mortality. However, little information is available on the effect of adrenalectomy in ameliorating functional disabilities in CS patients. Our study assesses the long-term outcome of adrenalectomy in patients with CS. This is a retrospective analysis of CS patients managed during 1990–2005 at a tertiary care center. We analyzed the clinical presentation, endocrine evaluation, and surgical management preoperatively and following adrenalectomy. The subjects were 37 patients with CS (age 24.5 ± 15 years, range 1–60 years; male:female 1.0:1.2). There were various etiologies—unilateral adrenocortical adenoma (n = 11), adrenocortical carcinoma (n = 13), pituitary ACTH-secreting adenoma with failed transsphenoidal surgery (n = 4), ectopic unidentified ACTH source (n = 7), bilateral adrenal macronodular hyperplasia (n = 1), primary pigmented nodular adrenal hyperplasia (n = 1) —for which the patients underwent adrenalectomy: unilateral (n = 22), bilateral (n = 13), or adrenonephrectomy (n = 2). Two patients died during the perioperative period owing to chest infection and sepsis. At the median follow-up of 60 months (range 6–144 months), the patients exhibit significant persistence of obesity (41%), proximal muscle weakness (44%), menstrual irregularity (8%), hypertension (31%), and insulin-dependent diabetes (29%). Hirsutism and psychological abnormalities persisted to a lesser extent. All patients had biochemical cure of CS following surgery evidenced by the 8 a.m. basal cortisol ≤ 5 μg/dl. The hypothalamic-pituitary-adrenal axis recovered as shown by normalization of the short synacthen-stimulated cortisol level (peak level ≥ 20 μg/dl) after a median follow-up of 9 months (range 6–18 months). Incomplete clinical recovery following adrenalectomy emphasizes the need of early recognition and prompt treatment of CS. Surgery for adrenocortical adenoma is safe and effective; however, survival of patients with CS due to adrenocortical carcinoma remains poor. Bilateral adrenalectomy provides early control of hypercortisolism in selected cases of unlocalized ectopic ACTH syndrome or failed transsphenoidal surgery. Even though functional recovery is incomplete after adrenalectomy, quality of life improves considerably.

В настоящей статье на базе теории принципов производства и производственных революций мы показываем взаимосвязь между К-волнами и крупнейшими технологическими переворотами в истории, а также делаем прогнозы об особенностях шестой К-волны в свете идущей с 1950-х годов кибернетической революции. Мы предполагаем, что шестая кондратьевская волна в 2030–2040-х годах сольется с завершающей фазой кибернетической революции (которую мы назвали фазой самоуправляемых систем). Этот период будет характеризоваться прорывом в медицинских технологиях, которые смогут объединить вокруг себя много других технологий и в целом составят комплекс МБНРИК-технологий (медико-био-нано-робото-инфо-когнитивных технологий). В статье даются некоторые прогнозы о развитии данных технологий.


In the present paper, on the basis of the theory of production principles and produc-tion revolutions, we reveal the interrelation between K-waves and major technological breakthroughs in history and make forecasts about features of the sixth Kondratieff wave in the light of the Cybernetic Revolution that, from our point of view, started in the 1950s. We assume that the sixth K-wave in the 2030s and 2040s will merge with the final phase of the Cybernetic Revolution (which we call a phase of self-regulating systems). This period will be characterized by the breakthrough in medical technologies which will be capable to combine many other technologies into a single complex of MBNRIC-technologies (med-bio-nano-robo-info-cognitive technologies). The article offers some forecasts concerning the development of these technologies.

Hacilar was a smaller town than Çatal Hüyük, equaling about 50 houses. Location was 220 km west of Çatal Hüyük and 60 km from the Aurignacian site of Antalya. Both communities shared numerous commonalities: settled, prosperous, balanced matrilineal societies that show little evidence of social or political stratification. Mellaart adds that these settlements owed their size and prosperity to the likelihood of being the ‘spiritual center of the Konya plain’ (NNE: 106; SGM: 34; RGS). (RGS: 7250-6150, Çatal Hüyük, Anatolia Central Turkey).

Bei ausgewählten Indikationen wurden exzellente Ergebnisse nach Lebertransplantation berichtet. Die Ergebnisse in unserem Zentrum wurden über 23 Jahre mit 2114 konsekutiven Lebertransplantationen in 1773 Patienten untersucht (Epochen I–III jeweils 5,5 Jahre, Epoche IV 6,5 Jahre). Nach 20 Jahren erreichte das Gesamtüberleben 29,8%. Die häufigsten führenden Todesursachen waren Infektionen unterschiedlicher Genese (30%), Tumorrezidive (14,2%) und Pneumonie (8,4%). Die häufigsten führenden Ursachen für den Transplantatverlust waren Infektionen unterschiedlicher Genese (19,6%), initiale Nichtfunktion des Transplantates (14,6%) und Tumorrezidive (9,6%). Das Patientenüberleben und das Transplantatüberleben waren beide signifikant besser nach primärer Transplantation als nach erster Retransplantation (p Liver transplantation has been reported to reach excellent results for selected indications. We analysed the results of liver transplantation in our centre over a period of 23 years, with a total of 2,114 consecutive liver transplants in 1,773 patients (eras I–III 5.5 years each, era IV 6.5 years). Overall 20-year survival after liver transplantation was 29.8%. The most frequent leading causes of death were infections of various origins (30%), tumour recurrence (14.2%), and pneumonia (8.4%). The most frequent leading causes for graft loss were infection of various origins (19.6%), initial nonfunction of the graft (14.6%), and tumour recurrence (9.6%). Both long-term patient and graft survival were significantly better after primary liver transplantation than after first retransplantation (P

In most currently available geography books, spatial representations group sets of differentiated location-objects, which can be located (directly or indirectly) on the surface of the Earth, using latitude, longitude and altitude, and systems projecting this surface on a map. But in fact spaces defined with the help of cartographic projection systems are independent of the locations-objects which are represented there. That being so, once the location-object is represented with the aid of a projection space, the cartographic spaces which have been generated can combine the locations-objects so that they can be seen as geometrizations, giving rise to geovisualizations. But these geo-visualo-metrizations—presumed to be objective—can be used to formulate geo-interpretations, determined on the one hand by the a priori choice the observer made of a projection system and, on the other hand, by beliefs and ideologies expressed with the aid of explicit or implicit geovisions. One of the bes...

Bei ausgewählten Indikationen wurden exzellente Ergebnisse nach Lebertransplantation berichtet. Die Ergebnisse in unserem Zentrum wurden über 23 Jahre mit 2114 konsekutiven Lebertransplantationen in 1773 Patienten untersucht (Epochen I–III jeweils 5,5 Jahre, Epoche IV 6,5 Jahre). Nach 20 Jahren erreichte das Gesamtüberleben 29,8%. Die häufigsten führenden Todesursachen waren Infektionen unterschiedlicher Genese (30%), Tumorrezidive (14,2%) und Pneumonie (8,4%). Die häufigsten führenden Ursachen für den Transplantatverlust waren Infektionen unterschiedlicher Genese (19,6%), initiale Nichtfunktion des Transplantates (14,6%) und Tumorrezidive (9,6%). Das Patientenüberleben und das Transplantatüberleben waren beide signifikant besser nach primärer Transplantation als nach erster Retransplantation (p Liver transplantation has been reported to reach excellent results for selected indications. We analysed the results of liver transplantation in our centre over a period of 23 years, with a total of 2,114 consecutive liver transplants in 1,773 patients (eras I–III 5.5 years each, era IV 6.5 years). Overall 20-year survival after liver transplantation was 29.8%. The most frequent leading causes of death were infections of various origins (30%), tumour recurrence (14.2%), and pneumonia (8.4%). The most frequent leading causes for graft loss were infection of various origins (19.6%), initial nonfunction of the graft (14.6%), and tumour recurrence (9.6%). Both long-term patient and graft survival were significantly better after primary liver transplantation than after first retransplantation (P