Intestinal microbiota in pathophysiology and management of irritable bowel syndrome.

Science.gov (United States)

Lee, Kang Nyeong; Lee, Oh Young

2014-07-21

Irritable bowel syndrome (IBS) is a functional bowel disorder without any structural or metabolic abnormalities that sufficiently explain the symptoms, which include abdominal pain and discomfort, and bowel habit changes such as diarrhea and constipation. Its pathogenesis is multifactorial: visceral hypersensitivity, dysmotility, psychosocial factors, genetic or environmental factors, dysregulation of the brain-gut axis, and altered intestinal microbiota have all been proposed as possible causes. The human intestinal microbiota are composed of more than 1000 different bacterial species and 10(14) cells, and are essential for the development, function, and homeostasis of the intestine, and for individual health. The putative mechanisms that explain the role of microbiota in the development of IBS include altered composition or metabolic activity of the microbiota, mucosal immune activation and inflammation, increased intestinal permeability and impaired mucosal barrier function, sensory-motor disturbances provoked by the microbiota, and a disturbed gut-microbiota-brain axis. Therefore, modulation of the intestinal microbiota through dietary changes, and use of antibiotics, probiotics, and anti-inflammatory agents has been suggested as strategies for managing IBS symptoms. This review summarizes and discusses the accumulating evidence that intestinal microbiota play a role in the pathophysiology and management of IBS.

The impact of stoma for bowel management after spinal cord injury.

Science.gov (United States)

Coggrave, M J; Ingram, R M; Gardner, B P; Norton, C S

2012-11-01

Multi-centre, retrospective self-report postal survey. To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction. Five UK spinal cord injury centres. A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres. Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma. The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.

Management of inflammatory bowel disease in pregnancy.

Science.gov (United States)

Smith, M A; Sanderson, J D

2010-06-01

Inflammatory bowel disease (IBD) affects body image, relationships, family planning, fertility and pregnancy outcomes. However, the common misconception that IBD is a contraindication, or serious concern, in pregnancy is essentially a myth. Most patients with IBD can expect to have uneventful pregnancies. We present an overview of the management of IBD during pregnancy, including management in those planning pregnancy, the suitability of relevant medication during pregnancy and breast feeding, investigation and monitoring of IBD during pregnancy, surgical management and considerations relating to delivery. While there are some definite alterations required in the management of IBD during pregnancy, management is essentially unchanged. With close attention to aspects such as nutrition and smoking cessation, and optimal disease control in the run-up to and during pregnancy, we have an opportunity to help our patients with IBD achieve good pregnancy outcomes.

A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia.

Science.gov (United States)

Inskip, Jessica A; Lucci, Vera-Ellen M; McGrath, Maureen S; Willms, Rhonda; Claydon, Victoria E

2018-05-01

Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.

Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

Directory of Open Access Journals (Sweden)

Mohamed Moftah

2012-08-01

Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

Science.gov (United States)

Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

2016-10-01

Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

The nursing management of diarrhoea and constipation before and after the implementation of a bowel management protocol.

Science.gov (United States)

McKenna, S; Wallis, M; Brannelly, A; Cawood, J

2001-02-01

Intensive care unit (ICU) patients frequently suffer problems associated with both diarrhoea and constipation. Strategies to optimise the management of these conditions need to focus on improving the communication between staff and ensuring effective treatment is implemented. The team involved in this study developed a Bowel Management Protocol (BMP). The effect of this BMP on the documentation of assessment and management of diarrhoea and constipation was evaluated using a quasi-experimental research design. Data were collected via a retrospective audit of medical records. Two groups of patient records were randomly sampled. The records of 60 patients who were admitted to ICU in the 6 months before the introduction of the BMP were accessed together with the records of 60 patients admitted in the 6 months following the introduction of the BMP. Data were collected regarding patient demographics and the assessment and management of bowel function before and after BMP introduction. The results indicated that a BMP improved documentation of the assessment of bowel function. In addition, there was an improvement in the documentation of nursing intervention in the presence of constipation and diarrhoea. These results have to be interpreted with caution because, despite random sampling over two 6 month periods, there were statistically significant differences in age, length of stay, method of feeding and medical diagnosis between the two groups. Further research into the effectiveness of using a BMP is recommended.

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survviors

Science.gov (United States)

Sun, Virginia; Grant, Marcia; Wendel, Christopher S.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M.; Herrinton, Lisa J.; Hornbrook, Mark C.; Krouse, Robert S.

2015-01-01

BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship. PMID:26159443

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors.

Science.gov (United States)

Sun, Virginia; Grant, Marcia; Wendel, Christopher S; McMullen, Carmit K; Bulkley, Joanna E; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M; Herrinton, Lisa J; Hornbrook, Mark C; Krouse, Robert S

2015-12-01

Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale.

Science.gov (United States)

Tulsky, David S; Kisala, Pamela A; Tate, Denise G; Spungen, Ann M; Kirshblum, Steven C

2015-05-01

To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. Seven hundred fifty-seven adults with traumatic SCI. The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.

Managing neurogenic bowel dysfunction: what do patients prefer? A discrete choice experiment of patient preferences for transanal irrigation and standard bowel management

Directory of Open Access Journals (Sweden)

Nafees B

2016-02-01

Full Text Available Beenish Nafees,1 Andrew J Lloyd,2 Rachel S Ballinger,2 Anton Emmanuel3 1Health Outcomes Research, Nafees Consulting Limited, London, 2Patient-Reported Outcomes Research, ICON plc, Oxford, 3Department of Gastroenterology and Nutrition, University College Hospital, London, UK Background: Most patients with bowel dysfunction secondary to neurological illness are managed by a range of nonsurgical methods, including dietary changes, laxatives, and suppository use to transanal irrigation (TAI. The aim of the present study was to explore individuals’ preferences regarding TAI devices and furthermore investigate willingness to pay (WTP for attributes in devices in the UK. Methods: A discrete choice experiment survey was conducted to evaluate the patients’ perceived value of TAI devices. Attributes were selected based upon a literature review and input from clinicians. Interviews were conducted with three clinicians and the survey was developed and finalized with the input from both patients and professionals. The final attributes were “risk of urinary tract infections” (UTIs, “risk of fecal incontinence” (FI, “frequency of use”, “time spent on toilet”, “ease of use”, “level of control/independence”, and “cost”. Participants were recruited by a patient panel of TAI device users in the UK. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log odds ratios (ORs of preference for attributes. WTP was also estimated for each attribute. Results: A total of 129 participants were included in the final analyses. Sixty two percent of the participants had suffered from three UTIs in the preceding year and 58% of patients reported currently experiencing FI using their current device. All attributes were significant predictors of choice. The most important attributes for participants were the “risk of FI”, “frequency of use”, and “risk of UTIs�

Understanding and managing conservation conflicts.

Science.gov (United States)

Redpath, Steve M; Young, Juliette; Evely, Anna; Adams, William M; Sutherland, William J; Whitehouse, Andrew; Amar, Arjun; Lambert, Robert A; Linnell, John D C; Watt, Allan; Gutiérrez, R J

2013-02-01

Conservation conflicts are increasing and need to be managed to minimise negative impacts on biodiversity, human livelihoods, and human well-being. Here, we explore strategies and case studies that highlight the long-term, dynamic nature of conflicts and the challenges to their management. Conflict management requires parties to recognise problems as shared ones, and engage with clear goals, a transparent evidence base, and an awareness of trade-offs. We hypothesise that conservation outcomes will be less durable when conservationists assert their interests to the detriment of others. Effective conflict management and long-term conservation benefit will be enhanced by better integration of the underpinning social context with the material impacts and evaluation of the efficacy of alternative conflict management approaches. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effectiveness of an organized bowel management program in the management of severe chronic constipation in children.

Science.gov (United States)

Russell, Katie W; Barnhart, Douglas C; Zobell, Sarah; Scaife, Eric R; Rollins, Michael D

2015-03-01

Chronic constipation is a common problem in children. The cause of constipation is often idiopathic, when no anatomic or physiologic etiology can be identified. In severe cases, low dose laxatives, stool softeners and small volume enemas are ineffective. The purpose of this study was to assess the effectiveness of a structured bowel management program in these children. We retrospectively reviewed children with chronic constipation without a history of anorectal malformation, Hirschsprung's disease or other anatomical lesions seen in our pediatric colorectal center. Our bowel management program consists of an intensive week where treatment is assessed and tailored based on clinical response and daily radiographs. Once a successful treatment plan is established, children are followed longitudinally. The number of patients requiring hospital admission during the year prior to and year after initiation of bowel management was compared using Fisher's exact test. Forty-four children with refractory constipation have been followed in our colorectal center for greater than a year. Fifty percent had at least one hospitalization the year prior to treatment for obstructive symptoms. Children were treated with either high-dose laxatives starting at 2mg/kg of senna or enemas starting at 20ml/kg of normal saline. Treatment regimens were adjusted based on response to therapy. The admission rate one-year after enrollment was 9% including both adherent and nonadherent patients. This represents an 82% reduction in hospital admissions (phospital admissions in children with severe chronic constipation. Copyright © 2015 Elsevier Inc. All rights reserved.

Adaptive social impact management for conservation and environmental management.

Science.gov (United States)

Kaplan-Hallam, Maery; Bennett, Nathan J

2018-04-01

Concerns about the social consequences of conservation have spurred increased attention the monitoring and evaluation of the social impacts of conservation projects. This has resulted in a growing body of research that demonstrates how conservation can produce both positive and negative social, economic, cultural, health, and governance consequences for local communities. Yet, the results of social monitoring efforts are seldom applied to adaptively manage conservation projects. Greater attention is needed to incorporating the results of social impact assessments in long-term conservation management to minimize negative social consequences and maximize social benefits. We bring together insights from social impact assessment, adaptive management, social learning, knowledge coproduction, cross-scale governance, and environmental planning to propose a definition and framework for adaptive social impact management (ASIM). We define ASIM as the cyclical process of monitoring and adaptively managing social impacts over the life-span of an initiative through the 4 stages of profiling, learning, planning, and implementing. We outline 14 steps associated with the 4 stages of the ASIM cycle and provide guidance and potential methods for social-indicator development, predictive assessments of social impacts, monitoring and evaluation, communication of results, and identification and prioritization of management responses. Successful ASIM will be aided by engaging with best practices - including local engagement and collaboration in the process, transparent communication of results to stakeholders, collective deliberation on and choice of interventions, documentation of shared learning at the site level, and the scaling up of insights to inform higher-level conservation policies-to increase accountability, trust, and perceived legitimacy among stakeholders. The ASIM process is broadly applicable to conservation, environmental management, and development initiatives at various

Conserving and managing the subnivium.

Science.gov (United States)

Zuckerberg, Benjamin; Pauli, Jonathan N

2018-02-08

In regions where snowfall historically has been a defining seasonal characteristic of the landscape, warming winters have reduced the depth, duration, and extent of snowpack. However, most management and conservation has focused on how aboveground wildlife will be affected by altered snow conditions, even though the majority of species that persist through the winter do so under the snowpack in a thermally stable refugium: the subnivium. Shortened winters, forest management practices, and winter recreation can alter subnivium conditions by increasing snow compaction and compromising thermal stability at the soil-snow interface. To help slow the loss of the subnivium in the face of rapidly changing winter conditions, we suggest managers adopt regional conservation plans for identifying threatened snow-covered environments; measure and predict the effects land cover and habitat management has on local subnivium conditions; and control the timing and distribution of activities that disturb and compact snow cover (e.g., silvicultural practices, snow recreation, and road and trail maintenance). As a case study, we developed a spatially explicit model of subnivium presence in a working landscape of the Chequamegon National Forest, Wisconsin. We identified landscapes where winter recreation and management practices could threaten potentially important areas for subnivium persistence. Similar modeling approaches could inform management decisions related to subnivium conservation. Current climate projections predict that snow seasons will change rapidly in many regions, and as result, we advocate for the immediate recognition, conservation, and management of the subnivium and its dependent species. © 2018 Society for Conservation Biology.

Ageing with neurogenic bowel dysfunction

DEFF Research Database (Denmark)

Nielsen, S D; Faaborg, Pia Møller; Finnerup, Nanna Brix

2017-01-01

The aim of this longitudinal study with postal survey was to describe changes in the patterns of neurogenic bowel dysfunction and bowel management in a population of people with spinal cord injury (SCI) followed for two decades. In 1996, a validated questionnaire on bowel function was sent to the...

Stricturoplasty—a bowel-sparing option for long segment small bowel Crohn's disease

OpenAIRE

Limmer, Alexandra M.; Koh, Hoey C.; Gilmore, Andrew

2017-01-01

Abstract Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes...

Long-term bladder and bowel management after spinal cord injury: a 20-year longitudinal study.

Science.gov (United States)

Savic, Gordana; Frankel, Hans L; Jamous, Mohamed Ali; Soni, Bakulesh M; Charlifue, Susan

2018-02-16

Prospective observational. The aim of this study was to analyse changes in bladder and bowel management methods in persons with long-standing spinal cord injury (SCI). Two spinal centres in UK. Data were collected through interviews and examinations between 1990 and 2010 in a sample of persons injured more than 20 years prior to 1990. For the 85 participants who completed the 2010 follow-up, the mean age was 67.7 years and the mean duration of injury was 46.3 years, 80% were male, 37.7% had tetraplegia AIS grade A, B, or C, 44.7% paraplegia AIS A, B, or C, and 17.6% an AIS D grade regardless of level. In all, 50.6% reported having changed their bladder method, 63.1% their bowel method, and 40.5% both methods since they enroled in the study. The reasons for change were a combination of medical and practical. In men, condom drainage remained the most frequent bladder method, and in women, suprapubic catheter replaced straining/expressing as the most frequent method. The use of condom drainage and straining/expressing bladder methods decreased, whereas the use of suprapubic and intermittent catheters increased. Manual evacuation remained the most frequent bowel management method. The percentage of participants on spontaneous/voluntary bowel emptying, straining and medications alone decreased, whereas the use of colostomy and transanal irrigation increased over time. More than half the sample, all living with SCI for more than 40 years, required change in their bladder and bowel management methods, for either medical or practical reasons. Regular follow-ups ensure adequate change of method if/when needed.

Experience of 49 longitudinal intestinal lengthening procedures for short bowel syndrome.

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Hosie, S; Loff, S; Wirth, H; Rapp, H-J; von Buch, C; Waag, K-L

2006-06-01

Forty-nine patients with a mean age of 25 months underwent a longitudinal intestinal lengthening procedure for short bowel syndrome (SBS) in our institution. Indications for the operation were dependence on parenteral nutrition in spite of adequate conservative management. The small bowel was lengthened from a mean of 27 cm to a mean of 51 cm. There was no intraoperative mortality. The following early complications occurred in our early series: ischemia of a short bowel segment of 2 cm, requiring resection in two patients, insufficiency of the longitudinal anastomosis in two patients and an intra-abdominal abscess in one. Four of 9 non-survivors died of liver failure and 3 of sepsis. Follow-up showed that 19 patients were weaned from parenteral nutrition after a mean of 9.1 months. Long-term complications encountered were dismotility with malabsorption due to bacterial overgrowth caused by progressive dilatation of the bowel, d-lactic acidosis, cholelithiasis and urolithiasis. A longitudinal intestinal lengthening procedure is an effective and safe surgical approach for SBS, provided it is performed in time, the patient's preoperative condition is optimized and technical surgical details are taken into account.

Anaesthetic Management of a patient with Myasthenia Gravis and Small Bowel Intussusception for Jejuno-Ileal Anastomoses

Directory of Open Access Journals (Sweden)

Pawan Kumar Jain

2016-01-01

Full Text Available Myasthenia gravis is a chronic autoimmune disease affecting voluntary skeletal muscles. The altered sensitivity of acetylcholine receptors to muscle relaxants and concomitant treatment with anticholinesterase in these patients affect their anaesthetic management. Patients who have undergone bowel anastomosis and are on regular anticholinesterase treatment are susceptible to anastomotic leaks. We report successful anaesthetic management of class I myasthenic patient with coexisting small bowel intussusception operated for jejuno-ileal anastomoses using regional, inhalational and intravenous (i.v anaesthesia based on train of four responses, and avoiding the use of reversal (anticholinesterase.

Guidelines on the irritable bowel syndrome: mechanisms and practical management

Science.gov (United States)

Spiller, R; Aziz, Q; Creed, F; Emmanuel, A; Houghton, L; Hungin, P; Jones, R; Kumar, D; Rubin, G; Trudgill, N; Whorwell, P

2007-01-01

Background IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. Aim To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. Methods Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Results Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5‐HT3 antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5‐HT4 agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. Conclusions Better ways of identifying which patients will respond to specific treatments are urgently needed. PMID:17488783

Short bowel syndrome.

LENUS (Irish Health Repository)

Donohoe, Claire L

2012-02-01

The short bowel syndrome (SBS) is a state of malabsorption following intestinal resection where there is less than 200 cm of intestinal length. The management of short bowel syndrome can be challenging and is best managed by a specialised multidisciplinary team. A good understanding of the pathophysiological consequences of resection of different portions of the small intestine is necessary to anticipate and prevent, where possible, consequences of SBS. Nutrient absorption and fluid and electrolyte management in the initial stages are critical to stabilisation of the patient and to facilitate the process of adaptation. Pharmacological adjuncts to promote adaptation are in the early stages of development. Primary restoration of bowel continuity, if possible, is the principle mode of surgical treatment. Surgical procedures to increase the surface area of the small intestine or improve its function may be of benefit in experienced hands, particularly in the paediatric population. Intestinal transplant is indicated at present for patients who have failed to tolerate long-term parenteral nutrition but with increasing experience, there may be a potentially expanded role for its use in the future.

Beliefs about personal control and self-management in 30-40 year olds living with Inflammatory Bowel Disease: a qualitative study.

Science.gov (United States)

Cooper, Joanne M; Collier, Jacqueline; James, Veronica; Hawkey, Christopher J

2010-12-01

Inflammatory Bowel Disease is a collective term for two distinct long term conditions: Ulcerative Colitis and Crohn's disease. There is increasing emphasis on patients taking greater personal control and self-management of this condition, reflecting earlier research into the management of chronic illness. Nurses play a pivotal role in this process, yet how optimal personal control is self-assessed and self-managed in Inflammatory Bowel Disease is poorly understood. This study set out to explore beliefs about personal control and self-management of Inflammatory Bowel Disease. It focused on the role of physical, psychological and socio-economic factors within the individual's life experience. A qualitative approach was used comprising 24, one-to-one, semi-structured interviews with participants aged 30-40 years. Participants with a histological diagnosis of Inflammatory Bowel Disease for at least 12 months were eligible and recruited by gastrointestinal specialist staff from outpatient clinics at a large National Health Service Trust in the United Kingdom. Interviews were transcribed verbatim. Data analysis was informed by existing theories of personal control and used the 'systematic framework analysis' approach. In addition to existing theories of personal control, self-discrepancy theory helped to explain how people viewed the control and self-management of Inflammatory Bowel Disease. One main theme emerged from the findings: 'Reconciliation of the self in IBD', this was supported by three sub-themes and eight basic themes. Some participants found that being unable to control and predict the course of their condition was distressing, however for others this limited control was not viewed as a negative outcome. Being able to share control of IBD with specialist health care staff was beneficial, and participants stated that other priorities in life were as equally important to manage and control. A key barrier to ensuring greater personal control and self-management

Stricturoplasty-a bowel-sparing option for long segment small bowel Crohn's disease.

Science.gov (United States)

Limmer, Alexandra M; Koh, Hoey C; Gilmore, Andrew

2017-08-01

Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes the performance of 12 Heineke-Mikulicz stricturoplasties in a 23-year-old patient with multiple short fibrotic strictures.

Surgical management of irradiation-induced small bowel damage

Energy Technology Data Exchange (ETDEWEB)

Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

1985-04-01

Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups.

Surgical management of irradiation-induced small bowel damage

International Nuclear Information System (INIS)

Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

1985-01-01

Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups

American college of gastroenterology monograph on the management of irritable bowel syndrome.

Science.gov (United States)

Camilleri, Michael

2015-04-01

This editorial reviews a recently published guideline on management of irritable bowel syndrome. The guideline illustrates problems arising from the quality of clinical trials used in systematic reviews and the potential impact of the inherent weaknesses of those trials on rating the strength of evidence and the resulting recommendations.

Contribution of multi-detector row CT (MDCT) to decision making in the management of patients with small bowel obstruction or ileus

International Nuclear Information System (INIS)

Osada, Hisato; Watanabe, Wataru; Okada, Taketomo

2007-01-01

We retrospectively evaluated the contribution of multi-detector row CT (MDCT) to patient management decisions in 62 patients with small bowel obstruction or ileus. The sensitivity and specificity of MDCT diagnosis of small bowel obstruction with strangulation or closed loop were 78.9% (15/19) and 93.0% (40/43), respectively. In 19 patients with small bowel obstruction with strangulation or closed loop, the median interval between CT examination and the commencement of surgery was significantly longer in misdiagnosed patients than in those correctly diagnosed (43.3 vs. 4.5 hours, p<0.05). Only two patients displayed severe physical signs that required urgent surgical treatment. Our results suggest that MDCT plays a key role in the management of patients with small bowel obstruction. (author)

Percutaneous endoscopic sigmoid colostomy for irrigation in the management of bowel dysfunction of adults with central neurologic disease.

Science.gov (United States)

Ramwell, A; Rice-Oxley, M; Bond, A; Simson, J N L

2011-10-01

Bowel dysfunction results in a major lifestyle disruption for many patients with severe central neurologic disease. Percutaneous endoscopic sigmoid colostomy for irrigation (PESCI) allows antegrade irrigation of the distal large bowel for the management of both incontinence and constipation. This study prospectively assessed the safety and efficacy of PESCI. A PESCI tube was placed endoscopically in the sigmoid colon of 25 patients to allow antegrade irrigation. Control of constipation and fecal incontinence was improved for 21 (84%) of the 25 patients. These patients were followed up for 6-83 months (mean, 43 months), with long-term success for 19 (90%) of the patients. No PESCI had to be removed for technical reasons or for PESCI complications. Late removal of the PESCI was necessary for 2 of the 21 patients. A modified St. Marks Fecal Incontinence Score to assess bowel function before and after PESCI showed a highly significant improvement (P irrigation in the management bowel dysfunction for selected patients with central neurologic disease. A successful PESCI is very likely to continue functioning satisfactorily for a long time without technical problems or local complications.

Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life.

Science.gov (United States)

Pardee, Connie; Bricker, Diedre; Rundquist, Jeanine; MacRae, Christi; Tebben, Cherisse

2012-01-01

To investigate the association between characteristics of individuals with spinal cord injury and neurogenic bowel and their perceived quality of life. The study design is an exploratory, descriptive correlational design. To measure the variables of the study the Quality of Life Survey developed by Randell et al. (2001) was used to measure perceived quality of life related to bowel management. Individual bowel management preferences and subjective costs and benefits of the preferences were gathered through the Neurogenic Bowel Characteristics Survey. PARTICIPANTS/METHOD: Data were collected from a random half of the individuals who met the inclusion criteria from the patient database (n=1193). Two hundred and forty one surveys were analyzed for this study. More than half of the sample (n=134) provided their own bowel management consisting of digital stimulation, suppositories, and other aids; 8% (n=19) had a colostomy. Regardless of the bowel management program 54% (n=127) were satisfied with current methods. Although time reported to complete bowel programs ranged from 1 to 120 minutes, there was no difference in rating of satisfaction with time. There was a statistically significant difference between those satisfied and dissatisfied with current bowel management and quality of life; those satisfied demonstrated a higher quality of life on three subscales, work function (p= .021), bowel problems (p< .001), and social function (p< .001). Those dissatisfied with their bowel program perceived a lower quality of life and indicated problems of time (p= .001), pain or discomfort (p= .033), and poor results (p< .001). Research data provide the patient's perspective on bowel management characteristics, complications, satisfaction, and their perceived quality of life. Results of this research will be incorporated into bowel management education and possible modification of the current inpatient bowel management program. © 2012 Association of Rehabilitation Nurses.

Pain management in patients with inflammatory bowel disease: insights for the clinician

Science.gov (United States)

Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

2012-01-01

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

Science.gov (United States)

Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

2011-01-01

Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

Gastrografin in the management of adhesive small bowel ...

African Journals Online (AJOL)

stay time. Results An oral administration of gastrografin successfully completed the conservative management in eight of 12 patients (66.6%), thus avoiding surgery and subsequently reducing hospital stay. Conclusion Gastrografin may have a valuable role in the management of ASBO, whether diagnostic or therapeutic,.

Green campus management based on conservation program in Universitas Negeri Semarang

Science.gov (United States)

Prihanto, Teguh

2018-03-01

Universitas Negeri Semarang (UNNES) has a great commitment in the development of higher education programs in line with its vision as a conservation - minded and internationally reputable university. Implementation of conservation programs with respect to the rules or conservation aspects of sustainable use, preservation, provisioning, protection, restoration and conservation of nature. In order to support the implementation of UNNES conservation program more focused, development strategies and development programs for each conservation scope are covered: (1) Biodiversity management; (2) Internal transportation management; (3) energy management; (4) Green building management; (5) Waste and water management; (6) Cultural conservation management. All related to conservation development strategies and programs are managed in the form of green campus management aimed at realizing UNNES as a green campus, characterized and reputable at the regional and global level.

Energy conservation prospects through electric load management

Energy Technology Data Exchange (ETDEWEB)

El-Shirbeeny, E H.T.

1984-04-01

In this paper, concepts of electric load management are discussed for effective energy conservation. It is shown that the conservation program must be comprehensive to provide solutions to the problems facing the electric consumer, the electric utility and the society by reducing the rate of growth of energy consumption and power system peak demand requirements. The impact of energy management programs on electric energy conservation is examined, with emphasis on efficiency, storage, cogeneration and controls with computers.

The research progress of acute small bowel perforation

Directory of Open Access Journals (Sweden)

Rudolf Schiessel

2015-08-01

Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

Science.gov (United States)

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is

A study of diagnosis and manegement of mechanical small-bowel obstruction

International Nuclear Information System (INIS)

Kawasaki, Masayasu; Kurumi, Yoshimasa; Naitoh, Hiroyuki

2007-01-01

We tried to clarify the most appropriate management for simple bowel obstruction and effective methods for diagnosis of strangulated bowel obstruction. Consecutive 252 cases of mechanical small-bowel obstruction treated in the hospital from 2000 to 2005 were assessed retrospectively. There were 219 cases of simple obstructions and 33 cases of strangulated obstruction. Seventy-eight percent of simple obstruction cases were treated conservatively (fasting in 82, decompression tube treatment in 88 and operation in 49). The average duration for indwelling the decompression tube was 5.2 days and the amount of discharge from the tube decreased day by day. In the cases of operation, the operation was performed on the 4.5th day after admission on the average, and the average amount of tube discharge before the operation was more than 450 ml/day. On the other hand, strangulation was most frequently diagnosed by enhanced abdominal CT scan, followed by physical examination, and the properties of decompression tube discharge in this order, and the blood data were only used for reference. Simple small-bowel obstruction should be treated by surgical therapy if symptomatic remission could not be gained by five days after beginning of the treatment. Enhanced abdominal CT scan is the most useful method for diagnosis of strangulation in an early stage of ischemia. (author)

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

International Nuclear Information System (INIS)

Poletti, Pierre-Alexandre; Becker, Christoph D.; Wintermark, Max; Schnyder, Pierre

2002-01-01

Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

Energy Technology Data Exchange (ETDEWEB)

Poletti, Pierre-Alexandre; Becker, Christoph D. [Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Wintermark, Max; Schnyder, Pierre [Department of Diagnostic and Interventional Radiology, CHUV, Lausanne (Switzerland)

2002-05-01

Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic ''contrast blush'' sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT. (orig.)

Pharmacological treatment of bowel obstruction in cancer patients.

LENUS (Irish Health Repository)

O'Connor, Brenda

2012-02-01

INTRODUCTION: Malignant bowel obstruction (MBO) is a common complication of advanced cancer, occurring most frequently in gynaecological and colorectal cancer. Its management remains complex and variable. This is in part due to the lack of evidence-based guidelines for the clinicians involved. Although surgery should be considered the primary treatment, this may not be feasible in patients with a poor performance status or advanced disease. Advances have been made in the medical management of MBO which can lead to a considerable improvement in symptom management and overall quality of life. AREAS COVERED: This review emphasizes the importance of a prompt diagnosis of MBO with early introduction of pharmacological agents to optimize symptom control. The authors summarize the treatment options available for bowel obstruction in those patients for whom surgical intervention is not a feasible option. The authors also explore the complexities involved in the introduction of parenteral hydration and total parenteral nutrition in this group of patients. EXPERT OPINION: It is not always easy to distinguish reversible from irreversible bowel obstruction. Early and aggressive management with the introduction of pharmacological agents including corticosteroids, octreotide and anti-cholinergic agents have the potential to maintain bowel patency, and allow for more rapid recovery of bowel transit. A combination of analgesics, anti-emetics and anti-cholinergics with or without anti-secretory agents can successfully improve symptom control in patients with irreversible bowel obstruction.

Conservation, management, and restoration of coral reefs.

Science.gov (United States)

Chavanich, Suchana; Soong, Keryea; Zvuloni, Assaf; Rinkevich, Baruch; Alino, Porfirio

2015-04-01

The 8th International Conference on Coelenterate Biology (ICCB 8) was held in Eilat, Israel from December 1st to 5th 2013. The conference included 15 sessions, one of which discussed the latest information on the conservation, management, and restoration of Coelenterata in different parts of the world. A total of 16 oral presentations and 5 posters were presented in this session. Of these 21 papers, 11 were related to conservation issues, 7 described management, and 3 discussed restoration. This session provided insights on the current conservation, management, and restoration of coelenterates in different parts of the world. Copyright © 2015 Elsevier GmbH. All rights reserved.

Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

Science.gov (United States)

Adams, Vanessa M.; Game, Edward T.; Bode, Michael

2014-08-01

Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments.

Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

International Nuclear Information System (INIS)

Adams, Vanessa M; Game, Edward T; Bode, Michael

2014-01-01

Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments. (paper)

Pelvic actinomycosis presenting with a large abscess and bowel stenosis with marked response to conservative treatment: a case report

Directory of Open Access Journals (Sweden)

Nozawa Hiroaki

2007-11-01

Full Text Available Abstract Pelvic actinomycosis is a rare disease that can result in abscess formation, bowel obstruction, and other serious complications. Moreover, the correct diagnosis can seldom be established before radical surgery because the disease often mimics pelvic neoplasms. It has been recently recognized that pelvic actinomycosis is associated with long-term use of an intrauterine contraceptive device. We report a woman with a long-standing intrauterine contraceptive device who visited our hospital complaining of symptoms mimicking large bowel ileus with a subacute course. X-ray fluorography and sigmoidoscopy showed marked stenosis in the sigmoid colon but rejected the possibility of colon cancers. Abdomino-pelvic CT and MRI revealed a huge abscess lying over the urinary bladder and anterior to the uterus. Furthermore, a cervical Papanicolaou smear disclosed Actinomyces species. We removed the intrauterine device from the patient. Subsequent high-dose ampicillin administration led to dramatic shrinkage of the abscess and improved the management of the bowel movement quickly. This is a successful case of symptomatic pelvic actinomycosis that was correctly diagnosed and treated without unnecessary surgical intervention.

Fetal bowel anomalies - US and MR assessment

Energy Technology Data Exchange (ETDEWEB)

Rubesova, Erika [Stanford University, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

2012-01-15

The technical quality of prenatal US and fetal MRI has significantly improved during the last decade and allows an accurate diagnosis of bowel pathology prenatally. Accurate diagnosis of bowel pathology in utero is important for parental counseling and postnatal management. It is essential to recognize the US presentation of bowel pathology in the fetus in order to refer the patient for further evaluation or follow-up. Fetal MRI has been shown to offer some advantages over US for specific bowel abnormalities. In this paper, we review the normal appearance of the fetal bowel on US and MRI as well as the typical presentations of bowel pathologies. We discuss more specifically the importance of recognizing on fetal MRI the abnormalities of size and T1-weighted signal of the meconium-filled distal bowel. (orig.)

The challenges of managing and following-up a case of short bowel in eastern europe

Directory of Open Access Journals (Sweden)

Henry Ifeanyi Osakwe

2016-01-01

Conclusion: The lack of sufficient mucosal surface followed by long time intestinal adaptation process is crucial in determining bowel functional capacity. Long time hospital stay and cost was reduced through a parental home healthcare management training scheme.

Management of inflammatory bowel disease flares in the emergency department [digest].

Science.gov (United States)

Burg, Michael D; Riccoboni, Steven T; Nusbaum, Jeffrey; Gupta, Nachi

2017-11-22

Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support. [Points & Pearls is a digest of Emergency Medicine Practice.].

Surgical management of inflammatory bowel disease: A low prevalence, developing country perspective.

Science.gov (United States)

Nasim, Sana; Chawla, Tabish; Murtaza, Ghulam

2016-03-01

To determine the outcomes of surgical management of inflammatory bowel disease. The retrospective case series was conducted at Aga Khan University Hospital, Karachi, and comprised medical record of adult patients operated between January 1986 and December 2010 for inflammatory bowel disease. Outcomes consisted of complications till last follow-up and 30-day mortality (disease or procedure related). Functional status of patients with ileal pouch was determined via telephone. SPSS 16 was used to analyse data. Of the 36 patients whose records were reviewed, 21(58%) were males, and body mass index was less than 23 in 34(91%). A total of 27(75%) patients underwent elective surgery for their condition. Ileal pouch was formed in 9(25%). Overall mortality was 14(38.8%). Overall incidence of complications was 26(72%), with wound infection being the most common early morbidity in 11(30.5%). Late morbidity included pouchitisin 4/9 (44.9%) and strictures 2/36 (5.5%).On telephonic follow-up, 6 of the remaining 7patients (85%) with ileal pouch were satisfied with the functional results of the procedure. The retrospective case series represents results from a developing country with low prevalence of inflammatory bowel disease and hence limited experience.

Bowel management systems in critical care: a service evaluation.

Science.gov (United States)

Ritzema, Jennifer

2017-01-25

Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (Pcritically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.

Inflammatory Bowel Disease in Primary Immunodeficiencies.

Science.gov (United States)

Kelsen, Judith R; Sullivan, Kathleen E

2017-08-01

Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

Inflammatory bowel disease.

Science.gov (United States)

Gibson, Peter R; Iser, John

2005-04-01

Inflammatory bowel disease (IBD) is increasing in frequency in Australia. General practitioners play an important role in early diagnosis and in a multidisciplinary approach to managing such patients. Keeping abreast of evolving concepts, particularly in treatment, is challenging. This article aims to address key issues in diagnosis and management to better equip general practitioners for their role in multidisciplinary management of patients with IBD. Making the diagnosis can be difficult, but is facilitated by appropriate clinical suspicion and sensible judgment as to who undergoes diagnostic tests such as colonoscopy. Treatment of ulcerative colitis has changed little in recent years, except for our improved ability to deliver mesalazine to the large bowel via the recent availability of several oral and rectal preparations. Prevention of relapse using these is an important strategy in the majority of patients. Treatment of Crohn disease is changing due to more realistic concepts of the natural history of the disease and the development of new, powerful anti-inflammatory therapies. Attention to issues other than intestinal inflammation such as nutrition, education and counselling, remain important in achieving optimal management.

Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

OpenAIRE

Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

2017-01-01

Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also...

Psychosocial and Behavioral Factors Associated with Bowel and Bladder Management after SCI

Science.gov (United States)

2013-10-01

qualitative methods and Dr. Cathy Lysak, Associate Professor at Wayne State University with an occupational therapy background and experience in SCI...family in the Jersey Shore and we stopped in Hershey, Pennsylvania. We stopped there for the night and we were thinking we’d go tour the chocolate ...such as medical or therapy appointment)? (If YES, please describe briefly) SECTION 3: BOWEL AND BLADDER MANAGEMENT ACTIVITIES: We interested in

Organizational determinants of energy-conservation management

Energy Technology Data Exchange (ETDEWEB)

Selmer, J. (Hong Kong Baptist Coll., Kowloon (Hong Kong). Dept. of Management)

1994-10-01

Energy-conservation activities require new functional and technical activities in all participating organizations and the prospects of effectively managing such activities are contingent upon the specific organizational setting. Based on a previous large-scale investigation in which we identified five organizational archetypes, in-depth longitudinal case studies were undertaken of five organizations in Sweden during 5 years, each organization representing a different archetype. The five organizations have distinct organizational prerequisites and separate basic motivations to engage and succeed in energy-conservation management. Implications for government policy and managerial action are discussed in detail. (author)

Understanding and managing compliance in the nature conservation context.

Science.gov (United States)

Arias, Adrian

2015-04-15

Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preliminary guidelines for electricity distributor conservation and demand management activities : a guide for conservation and demand management investment

International Nuclear Information System (INIS)

2004-01-01

In May 2004, electricity distributors in Ontario were asked to submit deferral accounts to the Ontario Energy Board to track expenditures on conservation and demand management initiatives. The deferral accounts must be established before the distributor could recover the costs through the next installment of the allowable return on equity in March 2004. The Board will determine the appropriateness of the actual expenditures. These guidelines offer short-term assistance to distributors in establishing conservation and demand management plans and initiatives. The following specific measures may be supported by the Board: energy efficiency; operational changes to smart control systems; load management measures which facilitate interruptible and dispatchable loads, dual fuel applications, thermal storage and demand response; fuel switching measures; programs targeted to low income and hard to reach consumers; and, distributed energy options such as tri-generation, cogeneration, ground source heat pumps, wind and biomass systems. These guidelines described the regulatory treatment of conservation and demand management investments along with cost effectiveness, allocation of costs, monitoring, evaluation, and implementation. 1 appendix

Changing treatment paradigms for the management of inflammatory bowel disease.

Science.gov (United States)

Im, Jong Pil; Ye, Byong Duk; Kim, You Sun; Kim, Joo Sung

2018-01-01

Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD. This approach can be applied to selected groups based on prognostic factors to control disease activity and prevent progressive disease. Therapeutic targets have been shifted from clinical remission mainly based on symptoms to objective parameters such as endoscopic healing due to the discrepancies observed between symptoms, objectively evaluated inf lammatory activity, and intestinal damage. The concept of treat-to-target in IBD has been supported by population-based cohort studies, post hoc analysis of clinical trials, and meta-analysis, but more evidence is needed to support this concept to be applied to the clinical practice. In addition, individualized approach with tight monitoring of non-invasive biomarker such as C-reactive protein and fecal calprotectin and drug concentration has shown to improve clinical and endoscopic outcomes. An appropriate de-escalation strategy is considered based on patient demographics, disease features, current disease status, and patients' preferences.

Using perceptions as evidence to improve conservation and environmental management.

Science.gov (United States)

Bennett, Nathan James

2016-06-01

The conservation community is increasingly focusing on the monitoring and evaluation of management, governance, ecological, and social considerations as part of a broader move toward adaptive management and evidence-based conservation. Evidence is any information that can be used to come to a conclusion and support a judgment or, in this case, to make decisions that will improve conservation policies, actions, and outcomes. Perceptions are one type of information that is often dismissed as anecdotal by those arguing for evidence-based conservation. In this paper, I clarify the contributions of research on perceptions of conservation to improving adaptive and evidence-based conservation. Studies of the perceptions of local people can provide important insights into observations, understandings and interpretations of the social impacts, and ecological outcomes of conservation; the legitimacy of conservation governance; and the social acceptability of environmental management. Perceptions of these factors contribute to positive or negative local evaluations of conservation initiatives. It is positive perceptions, not just objective scientific evidence of effectiveness, that ultimately ensure the support of local constituents thus enabling the long-term success of conservation. Research on perceptions can inform courses of action to improve conservation and governance at scales ranging from individual initiatives to national and international policies. Better incorporation of evidence from across the social and natural sciences and integration of a plurality of methods into monitoring and evaluation will provide a more complete picture on which to base conservation decisions and environmental management. © 2016 Society for Conservation Biology.

Built heritage monitoring conservation management

CERN Document Server

Boriani, Maurizio; Guidi, Gabriele

2015-01-01

This book provides a comprehensive, up-to-date overview on the most pressing issues in the conservation and management of archaeological, architectural, and urban landscapes. Multidisciplinary research is presented on a wide range of built heritage sites, from archaeological ruins and historic centers through to twentieth century and industrial architectural heritage. The role of ICT and new technologies, including those used for digital archiving, surveying, modeling, and monitoring, is extensively discussed, in recognition of their importance for professionals working in the field. Detailed attention is also paid to materials and treatments employed in preventive conservation and management. With contributions from leading experts, including university researchers, professionals, and policy makers, the book will be invaluable for all who seek to understand, and solve, the challenges faced in the protection and enhancement of the built heritage.

Diet in irritable bowel syndrome

OpenAIRE

El-Salhy, Magdy; Gundersen, Doris Irene

2015-01-01

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that is characterized by intermittent abdominal pain/discomfort, altered bowel habits and abdominal bloating/distension. This review aimed at presenting the recent developments concerning the role of diet in the pathophysiology and management of IBS. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, and there is no evidence that gluten causes the debated new diagnosis of non-coel...

Heterotaxy syndromes and abnormal bowel rotation

Energy Technology Data Exchange (ETDEWEB)

Newman, Beverley [Stanford University, Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Koppolu, Raji; Sylvester, Karl [Lucile Packard Children' s Hospital at Stanford, Department of Surgery, Stanford, CA (United States); Murphy, Daniel [Lucile Packard Children' s Hospital at Stanford, Department of Cardiology, Stanford, CA (United States)

2014-05-15

Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates. (orig.)

Heterotaxy syndromes and abnormal bowel rotation

International Nuclear Information System (INIS)

Newman, Beverley; Koppolu, Raji; Sylvester, Karl; Murphy, Daniel

2014-01-01

Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates. (orig.)

Land Management Restrictions and Options for Change in Perpetual Conservation Easements

Science.gov (United States)

Rissman, Adena; Bihari, Menka; Hamilton, Christopher; Locke, Christina; Lowenstein, David; Motew, Melissa; Price, Jessica; Smail, Robert

2013-07-01

Conservation organizations rely on conservation easements for diverse purposes, including protection of species and natural communities, working forests, and open space. This research investigated how perpetual conservation easements incorporated property rights, responsibilities, and options for change over time in land management. We compared 34 conservation easements held by one federal, three state, and four nonprofit organizations in Wisconsin. They incorporated six mechanisms for ongoing land management decision-making: management plans (74 %), modifications to permitted landowner uses with discretionary consent (65 %), amendment clauses (53 %), easement holder rights to conduct land management (50 %), reference to laws or policies as compliance terms (47 %), and conditional use permits (12 %). Easements with purposes to protect species and natural communities had more ecological monitoring rights, organizational control over land management, and mechanisms for change than easements with general open space purposes. Forestry purposes were associated with mechanisms for change but not necessarily with ecological monitoring rights or organizational control over land management. The Natural Resources Conservation Service-Wetland Reserve Program had a particularly consistent approach with high control over land use and some discretion to modify uses through permits. Conservation staff perceived a need to respond to changing social and ecological conditions but were divided on whether climate change was likely to negatively impact their conservation easements. Many conservation easements involved significant constraints on easement holders' options for altering land management to achieve conservation purposes over time. This study suggests the need for greater attention to easement drafting, monitoring, and ongoing decision processes to ensure the public benefits of land conservation in changing landscapes.

Riparian Meadow Response to Modern Conservation Grazing Management

Science.gov (United States)

Oles, Kristin M.; Weixelman, Dave A.; Lile, David F.; Tate, Kenneth W.; Snell, Laura K.; Roche, Leslie M.

2017-09-01

Riparian meadows occupy a small proportion of the public lands in the western United States but they provide numerous ecosystem services, including the production of high-quality forage for livestock grazing. Modern conservation management strategies (e.g., reductions in livestock stocking rates and adoption of new riparian grazing standards) have been implemented to better balance riparian conservation and livestock production objectives on publicly managed lands. We examined potential relationships between long-term changes in plant community, livestock grazing pressure and environmental conditions at two spatial scales in meadows grazed under conservation management strategies. Changes in plant community were not associated with either livestock stocking rate or precipitation at the grazing allotment (i.e., administrative) scale. Alternatively, both grazing pressure and precipitation had significant, albeit modest, associations with changes in plant community at the meadow (i.e., ecological site) scale. These results suggest that reductions in stocking rate have improved the balance between riparian conservation and livestock production goals. However, associations between elevation, site wetness, precipitation, and changes in plant community suggest that changing climate conditions (e.g., reduced snowpack and changes in timing of snowmelt) could trigger shifts in plant communities, potentially impacting both conservation and agricultural services (e.g., livestock and forage production). Therefore, adaptive, site-specific management strategies are required to meet grazing pressure limits and safeguard ecosystem services within individual meadows, especially under more variable climate conditions.

Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

Science.gov (United States)

Chen, Longtu; Ilham, Sheikh J.; Feng, Bin

2017-01-01

Context Visceral pain is a leading symptom for patients with irritable bowel syndrome (IBS) that affects 10% - 20 % of the world population. Conventional pharmacological treatments to manage IBS-related visceral pain is unsatisfactory. Recently, medications have emerged to treat IBS patients by targeting the gastrointestinal (GI) tract and peripheral nerves to alleviate visceral pain while avoiding adverse effects on the central nervous system (CNS). Several investigational drugs for IBS also target the periphery with minimal CNS effects. Evidence of Acquisition In this paper, reputable internet databases from 1960 - 2016 were searched including Pubmed and ClinicalTrials.org, and 97 original articles analyzed. Search was performed based on the following keywords and combinations: irritable bowel syndrome, clinical trial, pain, visceral pain, narcotics, opioid, chloride channel, neuropathy, primary afferent, intestine, microbiota, gut barrier, inflammation, diarrhea, constipation, serotonin, visceral hypersensitivity, nociceptor, sensitization, hyperalgesia. Results Certain conventional pain managing drugs do not effectively improve IBS symptoms, including NSAIDs, acetaminophen, aspirin, and various narcotics. Anxiolytic and antidepressant drugs (Benzodiazepines, TCAs, SSRI and SNRI) can attenuate pain in IBS patients with relevant comorbidities. Clonidine, gabapentin and pregabalin can moderately improve IBS symptoms. Lubiprostone relieves constipation predominant IBS (IBS-C) while loperamide improves diarrhea predominant IBS (IBS-D). Alosetron, granisetron and ondansetron can generally treat pain in IBS-D patients, of which alosetron needs to be used with caution due to cardiovascular toxicity. The optimal drugs for managing pain in IBS-D and IBS-C appear to be eluxadoline and linaclotide, respectively, both of which target peripheral GI tract. Conclusions Conventional pain managing drugs are in general not suitable for treating IBS pain. Medications that target

Structure and content components of self-management interventions that improve health-related quality of life in people with inflammatory bowel disease: a systematic review, meta-analysis and meta-regression.

Science.gov (United States)

Tu, Wenjing; Xu, Guihua; Du, Shizheng

2015-10-01

The purpose of this review was to identify and categorise the components of the content and structure of effective self-management interventions for patients with inflammatory bowel disease. Inflammatory bowel diseases are chronic gastrointestinal disorders impacting health-related quality of life. Although the efficacy of self-management interventions has been demonstrated in previous studies, the most effective components of the content and structure of these interventions remain unknown. A systematic review, meta-analysis and meta-regression of randomised controlled trials was used. A systematic search of six electronic databases, including Pubmed, Embase, Cochrane central register of controlled trials, Web of Science, Cumulative Index of Nursing and Allied Health Literature and Chinese Biomedical Literature Database, was conducted. Content analysis was used to categorise the components of the content and structure of effective self-management interventions for inflammatory bowel disease. Clinically important and statistically significant beneficial effects on health-related quality of life were explored, by comparing the association between effect sizes and various components of self-management interventions such as the presence or absence of specific content and different delivery methods. Fifteen randomised controlled trials were included in this review. Distance or remote self-management interventions demonstrated a larger effect size. However, there is no evidence for a positive effect associated with specific content component of self-management interventions in adult patients with inflammatory bowel disease in general. The results showed that self-management interventions have positive effects on health-related quality of life in patients with inflammatory bowel disease, and distance or remote self-management programmes had better outcomes than other types of interventions. This review provides useful information to clinician and researchers when

Oak woodland conservation management planning in southern CA - lessons learned

Science.gov (United States)

Rosi Dagit

2015-01-01

The California Oak Woodlands Conservation Act (AB 242 2001) established requirements for the preservation and protection of oak woodlands and trees, and allocated funding managed by the Wildlife Conservation Board. In order to qualify to use these funds, counties and cities need to adopt an oak conservation management plan. Between 2008 and 2011, a team of concerned...

Effectiveness of the bowel management program in children with constipation secondary to anorectal malformations

Directory of Open Access Journals (Sweden)

Santos Jasso Karla A.

2014-07-01

Full Text Available Introduction: One thousand children with anorectal malformation (ARM are born in Mexico every year. In spite of surgical correction, these children continue to present functional fecal problems (constipation and fecal incontinence. We conducted an Intestinal Rehabilitation Program (IRP which consists of an initial rectal disimpaction followed by administration of stimulant-type laxative (senna, with favorable results. The objective of this paper is to describe the effectiveness of the Intestinal Rehabilitation Program/bowel management program (IRP/BMP in children with constipation secondary to surgically corrected ARM. Materials and methods: A descriptive, retrospective, cross-sectional study, describing which was the IRP effectiveness in children with constipation secondary to ARM. The effectiveness was measured by means of a construct of three variables (presence of daily bowel movements, absence of fecal staining, and having a plain abdominal radiograph without fecal residue in left colon and rectum after passing stool. All children who had surgically corrected ARM and constipation in two referral centers were included. Results. One hundred and fifty one children with ARM were included: 21.85% had fecal incontinence, and 67.33% had constipation. Of this group 88.1% showed good response to the BMP. The mean dose of sennoside was 8.45 mg/kg, 95% CI: 5.94-11.12 mg/kg (199.5 mg total dose, 95% CI: 139.50-259.50 mg. Colicky abdominal pain occurred in 5.8% of the patients. Discussion. The use of sennoside has had a positive impact on our patients by means of colonic and rectal emptying without fecal soiling. Key words: Constipation, Anorrectal Malformation, Bowel Managment Program, Sennoside.

Effectiveness of alternative management strategies in meeting conservation objectives

Science.gov (United States)

Richards S. Holthausen; Carolyn Hull Sieg

2007-01-01

This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

Operative and conservative management of primary gastric lymphoma: interim results of a German multicenter study

International Nuclear Information System (INIS)

Willich, Normann A.; Reinartz, Gabriele; Horst, Ekkehard J.; Delker, Georg; Reers, Berthold; Hiddemann, Wolfgang; Tiemann, Markus; Parwaresch, Reza; Grothaus-Pinke, Bernward; Kocik, Juergen; Koch, Peter

2000-01-01

Purpose/Objective: Biology and appropriate management of gastrointestinal (GI) lymphomas are matters of an ongoing controversial debate. To evaluate histological features, sites of involvement and management of primary GI-lymphomas, a prospective multicentric study was initiated in 10/1992. Aim of study was the further standardization of operative and conservative treatment modalities. Materials and Methods: Study started 10/1992 and was closed 11/1996. A total of 381 evaluable patients had been accrued then. Standardized diagnostic workup included endoscopic and radiological evaluation of the complete GI-tract as well as a central histological review. Diagnosis was established after Lewin, stage classification was made after Musshoff, and histological classification was made after Isaacson. Treatment decision concerning operative or conservative management was due to the initially acting physician. Patients with resection of low grade lymphoma received total abdominal irradiation 30 Gy + 10 Gy boost to incompletely resected areas. After resection of high grade lymphoma CHOP chemotherapy (4 cycles for stage IE, 6 cycles for higher stages) after McKelvy was followed by total abdominal irradiation 30 Gy for stage IE respectively involved field irradiation 30 Gy for higher stages with 10 Gy boost to incompletely resected areas. Primary conservative treatment consisted of six cycles COP chemotherapy after Bagley for low grade lymphomas stage >IE and total abdominal irradiation 30 Gy + 10 Gy boost to involved areas for all stages. Patients with high grade lymphomas received 4 x CHOP followed by total abdominal irradiation 30 Gy + 10 Gy boost to involved areas or 6 x CHOP plus involved field radiation therapy with 40 Gy. 257 patients are considered for analysis due to exclusion criteria of the study, 190 of them were suffered from gastric lymphoma. Their median observation time is 29 months, maximum observation time is 68 months. Results: Sites of involvement were

Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute.

Science.gov (United States)

Khanna, Sahil; Shin, Andrea; Kelly, Ciarán P

2017-02-01

The purpose of this expert review is to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying inflammatory bowel disease. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Best Practice Advice 1: Clinicians should test patients who present with a flare of underlying inflammatory bowel disease for Clostridium difficile infection. Best Practice Advice 2: Clinicians should screen for recurrent C difficile infection if diarrhea or other symptoms of colitis persist or return after antibiotic treatment for C difficile infection. Best Practice Advice 3: Clinicians should consider treating C difficile infection in inflammatory bowel disease patients with vancomycin instead of metronidazole. Best Practice Advice 4: Clinicians strongly should consider hospitalization for close monitoring and aggressive management for inflammatory bowel disease patients with C difficile infection who have profuse diarrhea, severe abdominal pain, a markedly increased peripheral blood leukocyte count, or other evidence of sepsis. Best Practice Advice 5: Clinicians may postpone escalation of steroids and other immunosuppression agents during acute C difficile infection until therapy for C difficile infection has been initiated. However, the decision to withhold or continue immunosuppression in inflammatory bowel disease patients with C difficile infection should be individualized because there is insufficient existing robust literature on which to develop firm recommendations. Best Practice Advice 6: Clinicians should offer a referral for fecal microbiota transplantation to inflammatory bowel disease patients with recurrent C difficile infection. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Surgical therapy for injuries of bowels by radiation

International Nuclear Information System (INIS)

Yamada, Akiyoshi; Sasaki, Hiroaki; Oomori, Naofumi; Hamano, Kyoichi; Kobayashi, Seiichiro

1980-01-01

A group of patients with damage of the GI tract by therapeutic irradiation for intra-abdominal neoplasma such as the carcinoma of uterus and rectum has been presented. With regard to the location of radiation damage, 32 cases of them are limited in the recto-sigmoid colon, 3 cases in the small bowel and 4 cases in both bowels. Among 19 cases who underwent an operation, radiation damage was found in the colon of 12 cases. Colostomy was made in all cases and in 2 cases colon resection was also performed. If radiation damage is noticed only in the rectum, colostomy is good indicated except for the cases in which a massive bleeding is seen. As to small bowel damages, if the symptoms of patient do not respond to the conservative treatment, operative intervention is necessary. At operation, the surgeon should be aware of the risks involved in performing adhesiolysis. (author)

The role of laparoscopic surgery in the management of children and adolescents with inflammatory bowel disease.

Science.gov (United States)

Page, Anna E; Sashittal, Shikha G; Chatzizacharias, Nikolaos A; Davies, R Justin

2015-05-01

Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric population is not well established. The aim of this narrative review was to analyze the published evidence comparing laparoscopic and open resection in the management of children and adolescents with IBD. The Pubmed and Embase databases were searched using the terms "inflammatory bowel disease," "children," "adolescents," "laparoscopic," and "colectomy." The review identified 10 appropriate studies. Even though laparoscopic surgery generally resulted in longer operating times (between a mean of 40 and 140 min), benefits included reduced postoperative pain (mean duration of opiate use 3 vs 6 days) and reduced length of stay (median length of stay 5-8 vs 10.5-19 days) compared with open surgery. Postoperative complication rates were similar following both approaches. Due to the limited available data and the small sample size of the published series, definite recommendations are not able to be drawn. Nevertheless, current evidence indicates that laparoscopic colorectal resection is safe and feasible in the management of IBD in the paediatric population, with reductions in postoperative pain and length of hospital stay achievable.

Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management

DEFF Research Database (Denmark)

Larsen, Signe; Bendtzen, Klaus; Nielsen, Ole Haagen

2010-01-01

Abstract Extraintestinal manifestations occur rather frequently in inflammatory bowel disease (IBD), e.g. ulcerative colitis (UC) and Crohn's disease (CD). The present paper provides an overview of the epidemiology, clinical characteristics, diagnostic process, and management of rheumatic......, metabolic, dermatologic (mucocutaneous), ophthalmologic, hepatobiliary, hematologic, thromboembolic, urinary tract, pulmonary, and pancreatic extraintestinal manifestations related to IBD. Articles were identified through search of the PubMed and Embase databases, the Cochrane Library, and the web sites......', 'thromboembolism', and 'treatment'. The search was performed on English-language reviews, practical guidelines, letters, and editorials. Articles were selected based on their relevance, and additional papers were retrieved from their reference lists. Since some of the diseases discussed are uncommon, valid...

Infantile Short Bowel Syndrome: short and long term evaluation

NARCIS (Netherlands)

J.F. Olieman (Joanne)

2009-01-01

textabstractInfantile short bowel syndrome is a condition which is characterized by malabsorption of nutrients, as a result of congenital intestinal shortening or massive small bowel resection. Survival rates have improved over the years, but morbidity remains high and clinical management of these

Maximizing conservation benefit for grassland species with contrasting management requirements

NARCIS (Netherlands)

Teeffelen, van A.J.A.; Cabeza, M.; Poyry, J.; Raatikainen, K.; Kuussaari, M.

2008-01-01

Conservation management often encompasses multiple, alternative management actions on a given site, involving habitat restoration and maintenance for example. Which actions are preferable depends on the conservation goals, the expected outcomes of actions, and their associated costs. When actions

Management of perforated essure with migration into small and large bowel mesentery.

Science.gov (United States)

Braginsky, Lena; George, Sean T; Locher, Stephen R

2015-01-01

The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Surgical management of short bowel syndrome by construction of an isoperistaltic intestinal valve: an experimental study in dogs.

Science.gov (United States)

Papaziogas, T; Tassiopoulos, A; Papaziogas, B; Koutsias, S; Alexandrakis, A; Sakellaridis, D; Galanis, N

1999-08-01

To develop of an isoperistaltic invaginated valve for the treatment of short bowel syndrome. Randomised experimental study University Hospital, Greece 8 mongrel dogs 90% resection of the small bowel, followed by construction of an invaginated valve one month later. weight loss, fat excretion in the faeces, radiographic and histological examination of the valve, pressure curve along the valve. Weight loss and steatorrhoea were reversed over a period of 2-3 months without evidence of intestinal obstruction in any of the animals. The construction of an isoperistaltic invaginated valve could be a solution to the management of the short gut syndrome.

Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition

NARCIS (Netherlands)

Fishman, Laurie N.; Barendse, Renée M.; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

2010-01-01

Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the

Effects of threat management interactions on conservation priorities.

Science.gov (United States)

Auerbach, Nancy A; Wilson, Kerrie A; Tulloch, Ayesha I T; Rhodes, Jonathan R; Hanson, Jeffrey O; Possingham, Hugh P

2015-12-01

Decisions need to be made about which biodiversity management actions are undertaken to mitigate threats and about where these actions are implemented. However, management actions can interact; that is, the cost, benefit, and feasibility of one action can change when another action is undertaken. There is little guidance on how to explicitly and efficiently prioritize management for multiple threats, including deciding where to act. Integrated management could focus on one management action to abate a dominant threat or on a strategy comprising multiple actions to abate multiple threats. Furthermore management could be undertaken at sites that are in close proximity to reduce costs. We used cost-effectiveness analysis to prioritize investments in fire management, controlling invasive predators, and reducing grazing pressure in a bio-diverse region of southeastern Queensland, Australia. We compared outcomes of 5 management approaches based on different assumptions about interactions and quantified how investment needed, benefits expected, and the locations prioritized for implementation differed when interactions were taken into account. Managing for interactions altered decisions about where to invest and in which actions to invest and had the potential to deliver increased investment efficiency. Differences in high priority locations and actions were greatest between the approaches when we made different assumptions about how management actions deliver benefits through threat abatement: either all threats must be managed to conserve species or only one management action may be required. Threatened species management that does not consider interactions between actions may result in misplaced investments or misguided expectations of the effort required to mitigate threats to species. © 2015 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of Society for Conservation Biology.

Emergency department patients with small bowel obstruction: What is the anticipated clinical course?

Institute of Scientific and Technical Information of China (English)

Sarah E Frasure; Amy Hildreth; Sukhjit Takhar; Michael B Stone

2016-01-01

BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.

Functional bowel disorders and functional abdominal pain

OpenAIRE

Thompson, W; Longstreth, G; Drossman, D; Heaton, K; Irvine, E; Muller-Lissner, S

1999-01-01

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed ...

Use of Peristeen® transanal colonic irrigation for bowel management in children: a single-center experience.

Science.gov (United States)

Pacilli, Maurizio; Pallot, David; Andrews, Afiya; Downer, Angela; Dale, Louiza; Willetts, Ian

2014-02-01

Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling. Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen® transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10-20 ml/kg of water with schedules depending on patient response. Data are reported as median (range). Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2-15) years. Median follow-up is 2 (0.7-3.4) years. Diagnoses include the following: spina bifida (n=11), anorectal anomaly (n=6), Hirschsprung's (n=1), and other complex anomalies (n=5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling. In our experience, Peristeen® transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen® transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling

River use, conservation and management among riverine ...

African Journals Online (AJOL)

However the problem remains that many water resource planning and management regimes do not capture the views of the myriad of stakeholders and the many benefits of ecological services. This paper examines river use, conservation and management among riverine communities in South Eastern Nigeria using ...

76 FR 28954 - International Conservation and Management Measures Recognized by the United States

Science.gov (United States)

2011-05-19

... International Conservation and Management Measures Recognized by the United States AGENCY: National Marine... international conservation and management measures recognized by the United States. To fulfill this requirement, a list of agreements resulting in international conservation and management measures was first...

Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease

DEFF Research Database (Denmark)

Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet

2015-01-01

Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement...... available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library......, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia...

The effect of scientific evidence on conservation practitioners' management decisions.

Science.gov (United States)

Walsh, Jessica C; Dicks, Lynn V; Sutherland, William J

2015-02-01

A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions' effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process-the Delphi method. We used the effectiveness scores to assess the practitioners' level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners' willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation management

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

Science.gov (United States)

Firetto, Maria Cristina; Sala, Francesco; Petrini, Marcello; Lemos, Alessandro A; Canini, Tiberio; Magnone, Stefano; Fornoni, Gianluca; Cortinovis, Ivan; Sironi, Sandro; Biondetti, Pietro R

2018-04-27

Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

Lap-belt syndrome: management of aortic intimal dissection in a 7-year-old child with a constellation of injuries

International Nuclear Information System (INIS)

Khanna, Paritosh C.; Bulas, Dorothy I.; Rothenbach, Patricia; Guzzetta, Philip C.

2007-01-01

We present a case of lap-belt motor vehicle injury in a 7-year-old male who was admitted with abdominal ecchymoses and pain with associated aortic intimal flap, bowel injury, hemoperitoneum, and retroperitoneal hematoma at initial imaging with CT. Most of these findings were confirmed at subsequent laparotomy, and the patient underwent operative repair of bowel injuries. His aortic intimal flap was followed with US and color Doppler imaging during which time he was treated conservatively until there was sonographic evidence of intimal healing. This patient illustrates a multimodality approach to imaging and conservative management. (orig.)

Localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

Energy Technology Data Exchange (ETDEWEB)

Stevens, J M; Northover, J M.A.; Raphael, M J; Slack, W W [Middlesex Hospital, London (UK)

1981-10-01

Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated.

Bowel obstruction and delirium: managing difficult symptoms at the end of life.

Science.gov (United States)

Lynch, Maureen; Dahlin, Constance; Bakitas, Marie

2012-08-01

Palliative care has become an essential component of oncology care, with a focus on maximizing quality of life and optimizing function, as well as promoting pain and symptom management. This article focuses on the care of a patient experiencing bowel obstruction and delirium, two common issues in patients with advanced cancer, and demonstrates the integration of palliative care and oncology care to achieve an individualized care plan. Management focuses on identifying and treating reversible causes and improving quality of life while respecting the patient's values and goals. Sometimes the causes are not easily identified or treatment of the cause may impair quality of life, at least temporarily. At other times, the causes may be irreversible and the focus is exclusively on quality of life. Determination of best care for individual patients requires synthesis of data from holistic assessment, including the patient's goals of care and values, as well as knowledge of the patient's disease state with evidence-based approaches to management.

Evidence, models, conservation programs and limits to management

Science.gov (United States)

Nichols, J.D.

2012-01-01

Walsh et al. (2012) emphasized the importance of obtaining evidence to assess the effects of management actions on state variables relevant to objectives of conservation programs. They focused on malleefowl Leipoa ocellata, ground-dwelling Australian megapodes listed as vulnerable. They noted that although fox Vulpes vulpes baiting is the main management action used in malleefowl conservation throughout southern Australia, evidence of the effectiveness of this action is limited and currently debated. Walsh et al. (2012) then used data from 64 sites monitored for malleefowl and foxes over 23 years to assess key functional relationships relevant to fox control as a conservation action for malleefowl. In one set of analyses, Walsh et al. (2012) focused on two relationships: fox baiting investment versus fox presence, and fox presence versus malleefowl population size and rate of population change. Results led to the counterintuitive conclusion that increases in investments in fox control produced slight decreases in malleefowl population size and growth. In a second set of analyses, Walsh et al. (2012) directly assessed the relationship between investment in fox baiting and malleefowl population size and rate of population change. This set of analyses showed no significant relationship between investment in fox population control and malleefowl population growth. Both sets of analyses benefited from the incorporation of key environmental covariates hypothesized to influence these management relationships. Walsh et al. (2012) concluded that "in most situations, malleefowl conservation did not effectively benefit from fox baiting at current levels of investment." In this commentary, I discuss the work of Walsh et al. (2012) using the conceptual framework of structured decision making (SDM). In doing so, I accept their analytic results and associated conclusions as accurate and discuss basic ideas about evidence, conservation and limits to management.

Tripolar spinal cord stimulation for the treatment of abdominal pain associated with irritable bowel syndrome.

Science.gov (United States)

Rana, Maunak V; Knezevic, Nebojsa Nick

2013-01-01

The objective of this case report is to describe the use of transverse tripolar dorsal column stimulation in a patient with a history of irritable bowel syndrome (IBS) associated with abdominal pain resistant to conservative treatments. We report a 36-year-old man who presented to the pain clinic with an eight-year history of IBS (constipation predominant with occasional diarrheal episodes), with "crampy and sharp" abdominal pain. He also had nonradicular thoracic spine pain due to thoracic scoliosis. Both pains were affecting his ability to function as an attorney. Prior conservative therapy, including psychologic treatment, antidepressants, and opioids, was without any benefits. The use of a spinal cord stimulator (SCS) was discussed with the patient. The procedure was performed after Institutional Review Board approval. A tripolar SCS was implanted at the T8 level using one-eight contact and two-four contact percutaneous leads based on paresthesia reproduction of patient's areas of discomfort. This tripolar spinal cord stimulation provided relief of abdominal and thoracic pain, and better management of gastrointestinal symptoms. The patient was followed-up for one year, and his quality of life also was improved via the IBS-Severity Scoring System quality of life tool. The use of the tripolar SCS in this patient provided relief of abdominal and thoracic spine pain, regulated bowel habits, and improved the patient's quality of life. We believe that the use of SCS should be considered as a treatment option in patients with IBS when all conservative treatments failed. © 2012 International Neuromodulation Society.

Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

Science.gov (United States)

Bouska, Kristin L.; Lindner, Garth; Paukert, Craig P.; Jacobson, Robert B.

2016-01-01

Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly

Neurobiology of Depression and Irritable Bowel Syndrome Comorbidity

Directory of Open Access Journals (Sweden)

Ozlem Donat Eker

2009-08-01

casuses of excessive feeling of irritable bowel syndrome symptoms leading to the dysfunction in the cortical representation of bodily states and negative emotional experiences. Individual variations in the interaction of cytokines, corticotrophin releasing factor, neurokinins (substance P, neurokinin A and neurokinin B and monoamines (serotonin and norepinephrine, and neuroanatomic functions may answer the question of “why do some irritable bowel syndrome patients experience depression and some do not?”. Moreover, irritable bowel syndrome patients with comorbid depression and anxiety disorders are reported to be complaining more about their irritable bowel syndrome symptoms. Although several treatment strategies are considered by clinicians in the management of irritable bowel syndrome, it is suggested that antidepressant medications to have the priority in the treatment of irritable bowel syndrome with the comorbidity of depression. Selective serotonin re-uptake inhibitors are the drug of choice regarding their safety and side effects profile. Nevertheless, tricyclic antidepressants may also have beneficial effects in lower doses than needed to treat clinical depression. Hypnosis, supportive or cognitive behavioral therapies, dietary and defecation habits management are also suggested as beneficial. The recognition of irritable bowel syndrome by psychiatrists may enhance the success of treatment of depression with the comorbidity of irritable bowel syndrome, which disables the patient and frequently accompanies to major depression. In this review, evidence for depression and irritable bowel syndrome comorbidity, the possible underlying mechanisms of this comorbidity and current treatment approaches regarding proposed mechanisms will be discussed.

Energy conservation: its planning and management

International Nuclear Information System (INIS)

Nanda, K.S.; Patra, K.C.

1995-01-01

Energy conservation, its planning and management and the development of renewable energy systems of proven design are very worthy challenges for all. Energy education at various levels is most important particularly in the development of renewable energy technology. 2 refs., 3 tabs

Engaging recreational fishers in management and conservation: global case studies.

Science.gov (United States)

Granek, E F; Madin, E M P; Brown, M A; Figueira, W; Cameron, D S; Hogan, Z; Kristianson, G; de Villiers, P; Williams, J E; Post, J; Zahn, S; Arlinghaus, R

2008-10-01

Globally, the number of recreational fishers is sizeable and increasing in many countries. Associated with this trend is the potential for negative impacts on fish stocks through exploitation or management measures such as stocking and introduction of non-native fishes. Nevertheless, recreational fishers can be instrumental in successful fisheries conservation through active involvement in, or initiation of, conservation projects to reduce both direct and external stressors contributing to fishery declines. Understanding fishers' concerns for sustained access to the resource and developing methods for their meaningful participation can have positive impacts on conservation efforts. We examined a suite of case studies that demonstrate successful involvement of recreational fishers in conservation and management activities that span developed and developing countries, temperate and tropical regions, marine and freshwater systems, and open- and closed-access fisheries. To illustrate potential benefits and challenges of involving recreational fishers in fisheries management and conservation, we examined the socioeconomic and ecological contexts of each case study. We devised a conceptual framework for the engagement of recreational fishers that targets particular types of involvement (enforcement, advocacy, conservation, management design [type and location], research, and monitoring) on the basis of degree of stakeholder stewardship, scale of the fishery, and source of impacts (internal or external). These activities can be enhanced by incorporating local knowledge and traditions, taking advantage of leadership and regional networks, and creating collaborations among various stakeholder groups, scientists, and agencies to maximize the probability of recreational fisher involvement and project success.

Spinal cord anomalies in patients with anorectal malformations without severe sacral abnormalities or meningomyelocele: outcomes after expectant, conservative management.

Science.gov (United States)

Kyrklund, Kristiina; Pakarinen, Mikko P; Taskinen, Seppo; Kivisaari, Reetta; Rintala, Risto J

2016-12-01

OBJECTIVE The goal of this study was to determine the significance of spinal cord anomalies (SCAs) in patients with anorectal malformations (ARMs) by comparing the outcomes for bowel function, lower urinary tract symptoms (LUTS), and lower-limb neurological abnormalities to these outcomes in patients with similar ARMs and a normal spinal cord. METHODS The spinal cord MRI records of female patients treated for vestibular and perineal fistula (VF/PF) and male patients with rectourethral fistula (RUF) at a single center between 1983 and 2006 were reviewed. Bowel function and LUTS were assessed by questionnaire. Patients with extensive sacral anomalies or meningomyelocele were excluded. RESULTS Of 89 patients (median age 15 years, range 5-29 years), MRI was available in 90% (n = 80; 40 male patients with RUF), and 80% of patients returned the questionnaire (n = 64; 31 male patients with RUF). Spinal cord anomalies were found in 34%, comprising a filum terminale lipoma in 30%, low conus medullaris in 10%, and thoracolumbar syrinx in 6%. Bowel functional outcomes between patients with SCAs (n = 23) and those with a normal spinal cord (n = 41) were not significantly different for soiling (70% vs 63%), fecal accidents (43% vs 34%), and constipation (57% vs 39%; p = not significant for all). The LUTS, including urge (65% vs 54%), urge incontinence (39% vs 24%), stress incontinence (17% vs 22%), and straining (32% vs 29%) were also comparable between groups (p = not significant for all). No patients developed lower-limb neurological abnormalities. CONCLUSIONS The results suggest that the long-term functional outcomes for patients with SCAs who had VF/PF and RUF may not differ significantly from patients with the same type of ARMs and a normal spinal cord. The results favor a conservative approach to their management in the absence of abnormal neurological findings in the lower limbs.

Long-term efficacy and safety of otilonium bromide in the management of irritable bowel syndrome: a literature review

Directory of Open Access Journals (Sweden)

Triantafillidis JK

2014-04-01

Full Text Available John K Triantafillidis, George Malgarinos Inflammatory Bowel Disease Unit, IASO General Hospital, Athens, Greece Abstract: Irritable bowel syndrome (IBS is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The disease affects a large part of the world population. The clinical course is mostly characterized by a cyclic recurrence of symptoms. Therefore, IBS patients should receive, as an initial therapeutic approach, a short course of treatment, and long-term treatment should be reserved for those patients with recurrent symptoms. The available clinical trials show that significant improvement of the symptoms over placebo could be achieved with various drugs, although this improvement is frequently time dependent and with high relapse rates after the cessation of the treatment. In a proportion of patients, clinically obvious relapse could appear long after stopping the treatment. Some of the available pharmacologic agents, including otilonium bromide (OB, are able to significantly prolong the time to the appearance of relapse, compared with placebo. As a consequence, some authors suggest that a cyclic treatment could be of benefit. Antispasmodic drugs have been used for many years in an effort to control the symptoms of IBS. OB is a poorly absorbed spasmolytic drug, exerting significantly greater control of the symptoms of IBS compared with placebo. Recent data suggest that the drug could effectively be used for the long-term management of patients with IBS. The aim of this review is to provide the reader with an evidence-based overview of the efficacy and tolerability of OB in the long-term management of IBS patients, based on the results of the clinical trials published so far. Keywords: irritable bowel syndrome, IBS, treatment, otilonium bromide

Incidence, management, and course of cancer in patients with inflammatory bowel disease.

Science.gov (United States)

Algaba, Alicia; Guerra, Iván; Marín-Jiménez, Ignacio; Quintanilla, Elvira; López-Serrano, Pilar; García-Sánchez, María Concepción; Casis, Begoña; Taxonera, Carlos; Moral, Ignacio; Chaparro, María; Martín-Rodríguez, Daniel; Martín-Arranz, María Dolores; Manceñido, Noemí; Menchén, Luis; López-Sanromán, Antonio; Castaño, Ángel; Bermejo, Fernando

2015-04-01

Patients with inflammatory bowel disease [IBD] are at increased risk for developing some types of neoplasia. Our aims were to determin the risk for cancer in patients with IBD and to describe the relationship with immunosuppressive therapies and clinical management after tumor diagnosis. Retrospective, multicenter, observational, 5-year follow-up, cohort study. Relative risk [RR] of cancer in the IBD cohort and the background population, therapeutic strategies, and cancer evolution were analyzed. A total of 145 cancers were diagnosed in 133 of 9100 patients with IBD (global cumulative incidence 1.6% vs 2.4% in local population; RR = 0.67; 95% confidence interval [CI]: 0.57-0.78). Patients with IBD had a significantly increased RR of non-melanoma skin cancer [RR = 3.85; 2.53-5.80] and small bowel cancer [RR = 3.70; 1.23-11.13]. After cancer diagnosis, IBD treatment was maintained in 13 of 27 [48.1%] patients on thiopurines, in 2 of 3 on methotrexate [66.6%], none on anti-TNF-α monotherapy [n = 6] and 4 of 12 [33.3%] patients on combined therapy. Rate of death and cancer remission during follow-up did not differ [p > 0.05] between patients who maintained the treatment compared with patients who withdrew [5% vs 8% and 95% vs 74%, respectively]. An association between thiopurines [p = 0.20] or anti-TNF-α drugs [p = 0.77] and cancer was not found. Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure.

Science.gov (United States)

Keefer, Laurie; Kiebles, Jennifer L; Taft, Tiffany H

2011-02-01

Inflammatory bowel diseases (IBDs) require self-management skills that may be influenced by self-efficacy (SE). Self-efficacy represents an individual's perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD-specific SE that can be used in clinical and research contexts. One hundred and twenty-two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n=42) and a sample of online respondents (n=80). All participants (N=122) completed the IBD Self-Efficacy Scale (IBD-SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory-18 and the Rosenberg Self-Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey. The IBD-SES was initially constructed to identify 4 distinct theoretical domains of self-efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29-item IBD-SES has high internal consistency (r=0.96), high test-retest reliability (r=0.90), and demonstrates strong construct and concurrent validity with established measures. The IBD-SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD.

Fenced and Fragmented: Conservation Value of Managed Metapopulations

Science.gov (United States)

Miller, Susan M.; Harper, Cindy K.; Bloomer, Paulette; Hofmeyr, Jennifer; Funston, Paul J.

2015-01-01

Population fragmentation is threatening biodiversity worldwide. Species that once roamed vast areas are increasingly being conserved in small, isolated areas. Modern management approaches must adapt to ensure the continued survival and conservation value of these populations. In South Africa, a managed metapopulation approach has been adopted for several large carnivore species, all protected in isolated, relatively small, reserves that are fenced. As far as possible these approaches are based on natural metapopulation structures. In this network, over the past 25 years, African lions (Panthera leo) were reintroduced into 44 fenced reserves with little attention given to maintaining genetic diversity. To examine the situation, we investigated the current genetic provenance and diversity of these lions. We found that overall genetic diversity was similar to that in a large national park, and included a mixture of four different southern African evolutionarily significant units (ESUs). This mixing of ESUs, while not ideal, provides a unique opportunity to study the impact of mixing ESUs over the long term. We propose a strategic managed metapopulation plan to ensure the maintenance of genetic diversity and improve the long-term conservation value of these lions. This managed metapopulation approach could be applied to other species under similar ecological constraints around the globe. PMID:26699333

Integrating In-Situ and Ex-Situ Data Management Processes for Biodiversity Conservation

Directory of Open Access Journals (Sweden)

Karin R. Schwartz

2017-10-01

Full Text Available There is an increasing need for a “one plan approach” for conservation strategies that integrate in-situ and ex-situ management processes. Zoological institutions contribute directly to threatened species conservation through paradigms, such as reintroduction, head-starting, supplementation, or rescue/rehabilitation/release. This in-situ/ex-situ integration necessitates collaboration at all levels of conservation action including planning, implementation, monitoring and assessment to drive adaptive management processes. Each component is dependent on the availability and accuracy of data for evidence to facilitate evaluation and adaptive management processes. The Zoological Information Management System (ZIMS, managed by Species360, is a centralized web-based information system used in zoological institutions worldwide to pool life history, behavior and health data and facilitate animal husbandry, health, and breeding management processes. Currently used for few integrated conservation programs, ZIMS is an innovative tool that offers a new opportunity to link data management processes for animals that spend a part of their lives under human care and part in their natural environment and has great potential for use in managed wild populations.

Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

Directory of Open Access Journals (Sweden)

Zuhal Ozisler

2015-01-01

Full Text Available In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80% of the 55 patients before bowel program. Constipation (56%, 31/55 and incontinence (42%, 23/55 were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55 and after (73%, 40/55 bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

Position paper : Whole bowel irrigation

NARCIS (Netherlands)

2004-01-01

Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that

Improving quality of care in inflammatory bowel disease: what changes can be made today?

Science.gov (United States)

Panés, Julián; O'Connor, Marian; Peyrin-Biroulet, Laurent; Irving, Peter; Petersson, Joel; Colombel, Jean-Frédéric

2014-09-01

There are a number of gaps in our current quality of care for patients with inflammatory bowel diseases. This review proposes changes that could be made now to improve inflammatory bowel disease care. Evidence from the literature and clinical experience are presented that illustrate best practice for improving current quality of care of patients with inflammatory bowel diseases. Best care for inflammatory bowel disease patients will involve services provided by a multidisciplinary team, ideally delivered at a centre of excellence and founded on current guidelines. Dedicated telephone support lines, virtual clinics and networking may also provide models through which to deliver high-quality, expert integrated patient care. Improved physician-patient collaboration may improve treatment adherence, producing tangible improvements in disease outcomes, and may also allow patients to better understand the benefits and risks of a disease management plan. Coaching programmes and tools that improve patient self-management and empowerment are likely to be supported by payers if these can be shown to reduce long-term disability. Halting disease progression before there is widespread bowel damage and disability are ideal goals of inflammatory bowel disease management. Improving patient-physician communication and supporting patients in their understanding of the evidence base are vital for ensuring patient commitment and involvement in the long-term management of their condition. Furthermore, there is a need to create more centres of excellence and to develop inflammatory bowel disease networks to ensure a consistent level of care across different settings. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

When is irritable bowel syndrome not irritable bowel syndrome? Diagnosis and treatment of chronic functional abdominal pain.

Science.gov (United States)

Grover, Madhusudan

2012-08-01

Functional abdominal pain syndrome (FAPS) is a distinct chronic gastrointestinal (GI) pain disorder characterized by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods. The pain experience in FAPS is predominantly centrally driven as compared to other chronic painful GI conditions such as inflammatory bowel disease and chronic pancreatitis where peripherally acting factors play a major role in driving the pain. Psychosocial factors are often integrally associated with the disorder and can pose significant challenges to evaluation and treatment. Patients suffer from considerable loss of function, which can drive health care utilization. Treatment options are limited at best with most therapeutic regimens extrapolated from pain management of other functional GI disorders and chronic pain conditions. A comprehensive approach to management using a biopsychosocial construct and collaboration with pain specialists and psychiatry is most beneficial to the management of this disorder.

Outcome of Conservative Management of Burns: Critical Review ...

African Journals Online (AJOL)

Background: Management of burn continues to be a great challenge. Dressing and ... The state of depression was assessed using Beck classification of ... depression. Conclusion: Conservative management of burns is associated with more wound complications. Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 25-28 ...

Diagnosis and conservative management of female stress urinary incontinence

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Anil Krishna Dass

2013-05-01

Full Text Available Urinary incontinence affects 17–45% of women worldwide and stress urinary incontinence is responsible for 48% of all cases. Detailed history, physical examination and investigations are crucial to identify the diagnosis underlying the incontinence symptoms to select effective therapy. Although mid-urethral sling procedures are considered to be ‘gold standard’ treatment of SUI, conservative treatment with pelvic floor muscle training and lifestyle modification is still the first line of management. This article discusses the diagnosis and conservative management of female SUI.

Assessment of management effectiveness of Lekki conservation ...

African Journals Online (AJOL)

This study was carried out in the Lekki Conservation Centre (LCC), a private ... questionnaires for three categories of respondents – tourists, NCF and LCC ... awareness education and resource management are some of the strengths of LCC.

The localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

International Nuclear Information System (INIS)

Stevens, J.M.; Northover, J.M.A.; Raphael, M.J.; Slack, W.W.

1981-01-01

Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated. (author)

Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet

DEFF Research Database (Denmark)

Maagaard, Louise; Ankersen, Dorit Vedel; Callaerts-Vegh, Zsuzsanna

2016-01-01

AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS ...... deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients. CONCLUSION: These data suggest that a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients....

Inflammatory bowel disease and irritable bowel syndrome: similarities and differences.

Science.gov (United States)

Barbara, Giovanni; Cremon, Cesare; Stanghellini, Vincenzo

2014-07-01

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are classically viewed as dichotomous conditions. The former is perceived as a typical organic disease, and the latter is regarded as a disorder of gut function driven by mood. Recent research identified some shared contributing factors, which will be discussed here. Mounting evidence shows the importance in both IBD and IBS of genetic, microbiological, epithelial, and immunological factors. In some instances, these factors overlap in the two conditions as shown by: involvement of brain-gut axis dysfunction in IBD, implication of TNFSF gene in Crohn's disease and IBS, evidence of abnormal microbiota and its impact on host functions, identification of low-grade inflammation in subsets of IBS patients, and development of IBS symptoms in patients with IBD in remission. IBD and IBS remain separate conditions although there are some overlapping mechanisms. Both research and clinical management would benefit from considering a functional approach for certain manifestations of IBD and accepting an organic view in subsets of IBS patients.

How Stakeholder Co-management Reproduces Conservation Conflicts: Revealing Rationality Problems in Swedish Wolf Conservation

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Erica von Essen

2015-01-01

Full Text Available 'Stakeholder' has become the primary category of political actor in decision-making, not least within nature conservation. Drawing from Habermas' theory on communicative action, this article argues that there are democratic deficits to the stakeholder model that promote citizens to remain locked in predetermined, polarized positions. It contends that the stakeholder model must, hence, be scrutinized with respect to its potential role in perpetuating conservation conflicts in modernity. Using the case study of stakeholder-based game management delegations (GMDs in Sweden, our research identifies four barriers, which tie to the instrumental basis and liberal democratic legacy of the stakeholder approach: 1 strong sense of accountability; 2 overly purposive atmosphere; 3 overemphasis on decision as final outcome; and 4 perceived inability on the part of the delegates to influence science-led decision-making. The article suggests that these democratic deficits preclude the deliberation and contestation necessary to legitimate conservation policy. Indeed, stakeholder rationality causes citizens to become inert, instrumental agents who approach discussion with strategic rather than communicative rationality. We conclude that the deficits of the stakeholder model currently: 1 restrict democratic freedom for citizens; 2 engender a crisis of legitimacy of management; and 3 reproduce the conflict, which in Sweden relates to the conservation of wolves.

A single centre case series of gallstone sigmoid ileus management

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Nicholas Farkas

2017-01-01

Conclusions: This is the first case series highlighting the differing strategies and challenges faced by clinicians managing gallstone sigmoid ileus. Conservative measures (including manual evacuation, endoscopy, lithotripsy and surgery all play important roles in relieving large bowel obstruction. It is essential to tailor care to individual patients’ needs given the complexities of this potentially life threatening condition.

Conservative Management for Stable High Ankle Injuries in Professional Football Players.

Science.gov (United States)

Knapik, Derrick M; Trem, Anthony; Sheehan, Joseph; Salata, Michael J; Voos, James E

High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Clinical review. Level 3. When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

Managing post-therapy fatigue for cancer survivors using energy conservation training.

Science.gov (United States)

Yuen, Hon Keung; Mitcham, Maralynne; Morgan, Larissa

2006-01-01

This pilot study evaluated the effectiveness of energy conservation training to help post-therapy cancer survivors manage their fatigue. Twelve post-therapy cancer survivors were randomly assigned to an energy conservation training or usual care control (6 in each group). Participants in the intervention group received 1 to 2 hours of individual, face-to-face energy conservation training from an occupational therapist followed by once-a-week telephone monitoring sessions in the subsequent three weeks. Participants in the control group received standard care from their oncologist. Analysis of pre- and post-training data from the Piper Fatigue Scale (PFS) revealed significant reduction only in the sensory subscale of the PFS (Z = 2.21; p = 0.027) for the intervention group; but no significant reduction in the four subscale or total scores of the PFS for the control group. Findings demonstrate partial support for the effectiveness of energy conservation training in helping post-therapy cancer survivors manage their fatigue. Energy conservation training seems to be a viable strategy for managing cancer-related fatigue, though its efficacy is modest. Incorporating specific energy restoration strategies such as relaxation and meditation for future research may help advance the growing body of knowledge in symptom management for post-therapy cancer survivors.

Implementation of Quality Management System for Historical Building Conservation

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Zahari N.F.

2014-01-01

Full Text Available The main objectives of this study are twofold. Firstly, to identify the implementation of ISO 9001 procedures being used as references for conservation works and the development of Quality Management System (QMS guidelines. Data were solicited from three (3 conservation areas. The analysis involved of descriptive approach and statistical methods. The findings revealed that QMS is not structurally established, implemented and enforced as part of conservation practice in Malaysia. From the findings, the authors hope to give clear perception to the reader on current preservation practice and the existence of QMS with reference to ISO 9001 for future conservation mechanism.

Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging.

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Perandini, Alessio; Perandini, Simone; Montemezzi, Stefania; Bonin, Cecilia; Bellini, Gaia; Bergamini, Valentino

2018-02-01

Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection. The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%. MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study. © 2017 Japan Society of Obstetrics and Gynecology.

[Towards new therapeutic paradigms beyond symptom control in the management of inflammatory bowel diseases.

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Festa, Stefano; Zerboni, Giulia; Aratari, Annalisa; Ballanti, Riccardo; Papi, Claudio

2018-01-01

Inflammatory bowel diseases, Crohn's disease and ulcerative colitis are chronic relapsing conditions that may result in progressive bowel damage, high risk of complications, surgery and permanent disability. The conventional therapeutic approach for inflammatory bowel diseases is based mainly on symptom control. Unfortunately, a symptom-based therapeutic approach has little impact on major long-term disease outcomes. In other chronic disabling conditions such as diabetes, hypertension and rheumatoid arthritis, the development of new therapeutic approaches has led to better outcomes. In this context a "treat to target" strategy has been developed. This strategy is based on identification of high-risk patients, regular assessment of disease activity by means of objective measures, adjustment of treatment to reach the pre-defined target. A treat to target approach has recently been proposed for inflammatory bowel disease with the aim at modifying the natural history of the disease. In this review, the evidence and the limitations of the treat to target paradigm in inflammatory bowel disease are analyzed and discussed.

Short bowel syndrome

International Nuclear Information System (INIS)

Engels, L.G.J.B.

1983-01-01

This thesis describes some aspects of short bowel syndrome. When approximately 1 m or less small bowel is retained after extensive resection, a condition called short bowel syndrome is present. Since the advent of parenteral nutrition, the prognosis of patients with a very short bowel has dramatically improved. Patients with 40 to 100 cm remaining jejunum and/or ileum can generally be maintained with oral nutrition due to increased absorption of the small bowel remnant as result of intestinal adaptation. This study reports clinical, biochemical and nutritional aspects of short bowel patients on oral or parenteral nutrition, emphasizing data on absorption of various nutrients and on bone metabolism. Furthermore, some technical apsects concerning long-term parenteral nutrition are discussed. (Auth.)

South-South exchanges enhance resource management and biodiversity conservation at various scales

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William D Heyman

2011-01-01

Full Text Available International conservation organisations have invested considerable resources in fostering biodiversity conservation programs in the humid tropics, the most biologically diverse areas on earth. Recent approaches to conservation have centered on integrated conservation and development projects and participatory resource management programs, co-managed between governments and local communities. But these programs have had only mixed success and often suffer from insufficient quantity or quality of participation by local communities. We pose that participatory resource management is more likely to succeed when community members, 1 gain a global perspective on how their social, economic and environmental conditions compare with peer communities in other similar areas of the world, and thus better understand issues of relative scarcity and the benefits of sustainable resource management, and 2 engage as decision-makers at every stage of the conservation process up to reflective program evaluation. This paper examines the role of South-South exchanges as a tool to achieve these intermediate goals that ultimately foster more effective and participatory conservation and support sustainable local livelihoods. The data are extracted from the initiatives of the authors in two different environments- marine and coastal communities in Central America and the Caribbean, and lowland rainforest communities in the western Amazon of South America. We conclude that the exchanges are effective ways to build stakeholder comprehension about, and meaningful engagement in, resource management. South-South exchanges may also help build multi-local coalitions from various remote areas that together support biodiversity conservation at regional and global scales.

Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy.

Science.gov (United States)

Fanning, J; Yu-Brekke, S

1999-06-01

Postoperative traditional feeding protocols are not based on scientific studies, but rather on anecdotal evidence. We present the first prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy in an attempt to determine its effect on the length of hospital stay. Twenty consecutive patients undergoing radical hysterectomy were entered onto a prospective trial of aggressive postoperative bowel stimulation, which consisted of 30 cc milk of magnesia p.o. b.i.d. starting on postoperative day 1 and biscolic suppositories q.d. starting on day 2. A clear liquid diet was begun following flatus or bowel movement and patients were discharged 12 h after tolerating a clear liquid diet. Diet was slowly advanced at home. Median time to flatus was 3 days, bowel movement 3 days, and clear liquid diet 3 days. Median time to discharge was 4 days. No patients developed ileus or bowel obstructions and there were no readmissions for bowel complications. Our median time to discharge of 4 days represents a 50% reduction in hospital stay compared to our previous prospective study using traditional postoperative bowel management (8 days), which was statistically significant at P = 0.001. Aggressive bowel stimulation with milk of magnesia and biscolic suppositories resulted in early return of bowel function and early discharge with no noticeable complications. Copyright 1999 Academic Press.

Irritable bowel syndrome and its psychological management

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Ravikesh Tripathi

2015-01-01

Full Text Available Irritable Bowel Syndrome (IBS is a chronic and disabling gastrointestinal problem that affects psychosocial functioning as well as the quality of life. This case study reports the utility of cognitive behavior therapy as a psychological intervention procedure in a chronic case of IBS. The use of psychological intervention was found to result in a reduction of anxiety; amelioration of the symptoms associated with IBS and improved functioning.

Non-small-bowel abnormalities identified during small bowel capsule endoscopy

NARCIS (Netherlands)

Hoedemakers, Reinier; Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.

2014-01-01

AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed. METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as

Dyadic confirmatory factor analysis of the inflammatory bowel disease family responsibility questionnaire.

Science.gov (United States)

Greenley, Rachel Neff; Reed-Knight, Bonney; Blount, Ronald L; Wilson, Helen W

2013-09-01

Evaluate the factor structure of youth and maternal involvement ratings on the Inflammatory Bowel Disease Family Responsibility Questionnaire, a measure of family allocation of condition management responsibilities in pediatric inflammatory bowel disease. Participants included 251 youth aged 11-18 years with inflammatory bowel disease and their mothers. Item-level descriptive analyses, subscale internal consistency estimates, and confirmatory factor analyses of youth and maternal involvement were conducted using a dyadic data-analytic approach. Results supported the validity of 4 conceptually derived subscales including general health maintenance, social aspects, condition management tasks, and nutrition domains. Additionally, results indicated adequate support for the factor structure of a 21-item youth involvement measure and strong support for a 16-item maternal involvement measure. Additional empirical support for the validity of the Inflammatory Bowel Disease Family Responsibility Questionnaire was provided. Future research to replicate current findings and to examine the measure's clinical utility is warranted.

The role of computed tomography in the diagnosis and management of clinically occult post-traumatic small bowel perforation

International Nuclear Information System (INIS)

Ahmed, I.; Ahmed, N.; Bell, D.J.; Hughes, D.V.; Evans, G.H.; Howlett, D.C.

2009-01-01

Purpose: To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method: This review includes three patients who presented with mild abdominal symptoms following minor blunt abdominal trauma. Initial radiographs and laboratory investigations were unremarkable but their symptoms failed to resolve and contrast-enhanced CT was performed for further evaluation. Results: In each case the CT appearances were indicative of localised small bowel perforation, with no evidence of other visceral injury. In two patients pockets of free intraperitoneal air were present closely related to the second part of the duodenum suggesting injury at this site. In the third case, a thickened proximal jejunal loop was demonstrated with free air and fluid in the adjacent mesentery consistent with a focal perforation. These CT findings were subsequently confirmed at laparotomy. Conclusion: CT is an accurate diagnostic tool in the assessment of clinically and radiologically occult traumatic small bowel injury. The use of CT should be considered in patients who have unresolving abdominal symptoms even after apparently insignificant abdominal trauma.

Kirtland's Warbler Wildlife Management Area Comprehensive Conservation Plan

Data.gov (United States)

Department of the Interior — The Comprehensive Conservation Plan (CCP) for Kirtland’s Warbler Wildlife Management Area (WMA) was signed on September 10, 2009, completing a planning process that...

CONSERVATION MANAGEMENT AND LEGISLATION THE UK EXPERIENCE

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SIBLEY P. J.

2003-04-01

Full Text Available Underpinning the conservation management of Austropotamobius pallipes in the UK is the process of monitoring and reporting crayfish distribution. Should the current trend in the decline of A. pallipes continue, the species could be virtually extinct in mainland Britain within 30 years (SIBLEY, 2003. Conversely, if the increase in the distribution of non-indigenous crayfish species (NICS continues at its current rate, the distribution (by 10 km squares of these species could double within 15 years. These forward projections are based on a number of possibly unreliable assumptions; they illustrate however the magnitude of the challenge facing those concerned with the conservation of A. pallipes in the UK at this time. Recent work in crayfish conservation management in the UK has yielded guidance in several areas including monitoring, habitat enhancement and a re-introduction protocol for A. pallipes (KEMP and HILEY, 2003. Similarly, scientific research continues to inform our understanding of the movement and behaviour of NICS and explores new methods for the potential management of these species. In addition, the protection afforded to A. pallipes by current legislation is key to the long-term survival prospects of the species, albeit with a probable fragmented distribution, across the British Isles and continental Europe. Legal provisions in the UK derive in part from European instructions (e.g. EC Habitats and Species Directive and also from national legislation (e.g. Salmon and Freshwater Fisheries Act (1975 and the Wildlife and Countryside Act (1981. Also, a raft of “quasi-legislation” exists which requires responsible organisations in the UK to implement the white-clawed crayfish biodiversity action plan (BAP. Altogether these provisions constitute a considerable volume of legal protection for crayfish and provide the legal framework on which UK management policy and practice are based.

Fertility and obstetric outcome after conservative management of placenta accreta.

Science.gov (United States)

Provansal, Magali; Courbiere, Blandine; Agostini, Aubert; D'Ercole, Claude; Boubli, Léon; Bretelle, Florence

2010-05-01

To determine the fertility and obstetric outcomes after conservative management of placenta accreta. A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded. During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18-156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48-176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35-40 weeks). Four patients delivered prematurely. Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence.

Science.gov (United States)

Ng, Yvonne Ying-Ru; Ngu, James Chi-Yong; Wong, Andrew Siang-Yih

2018-01-01

Although adhesions account for more than 70% of small bowel obstruction (SBO), they are thought to be less likely aetiologies in patients without previous abdominal surgery. Expedient surgery has historically been advocated as prudent management in these patients. Emerging evidence appears to challenge such a dogmatic approach. A retrospective analysis was performed in all SBO patients with a virgin abdomen admitted between January 2012 and August 2014. Patients with obstruction secondary to abdominal wall hernias were excluded. Patient demographics, clinical presentation, management strategy and pathology involved were reviewed. A total of 72 patients were included in the study. The majority of patients were males (66.7%), with a median age of 58 years (range: 23-101). Abdominal pain (97%) and vomiting (86%) were the most common presentations while abdominal distention (60%) and constipation (25%) were reported less frequently. Adhesions accounted for the underlying cause in 44 (62%) patients. Other aetiologies included gallstone ileus (n = 5), phytobezoar (n = 5), intussusception (n = 4), internal herniation (n = 4), newly diagnosed small bowel tumour (n = 3), mesenteric volvulus (n = 3), stricture (n = 3) and Meckel's diverticulum (n = 1). Twenty-nine (40%) patients were successfully managed conservatively while the remaining 43 (60%) underwent surgery. The intraoperative findings were in concordance with the preoperative computed tomography scan in 76% of cases. Adhesions remain prevalent despite the absence of previous abdominal surgery. Non-operative management is feasible for SBO in a virgin abdomen. Computed tomography scan can be a useful adjunct in discerning patients who may be treated non-operatively by elucidating the underlying cause of obstruction. © 2016 Royal Australasian College of Surgeons.

Extensive small bowel intramural haematoma secondary to warfarin.

Science.gov (United States)

Limmer, Alexandra M; Clement, Zackariah

2017-03-01

Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in  1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was successfully managed non-operatively with fluid resuscitation, INR reversal, bowel rest and nasogastric decompression. The patient's presentation was atypical with a lack of classic symptoms such as abdominal pain. This highlights the importance of considering intramural haematoma as a differential diagnosis for gastrointestinal symptoms in anticoagulated patients.

Conservative management of neuromuscular scoliosis: personal experience and review of literature.

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Kotwicki, Tomasz; Jozwiak, Marek

2008-01-01

The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

Bowel function and quality of life after colostomy in individuals with spinal cord injury.

Science.gov (United States)

Bølling Hansen, Rikke; Staun, Michael; Kalhauge, Anna; Langholz, Ebbe; Biering-Sørensen, Fin

2016-05-01

To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). Cross-sectional descriptive study. Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet. Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. Questionnaires and measurement of gastrointestinal transit time (GITT). Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. Seventy-two percent significantly reduced their use of time on bowel emptying after the colostomy. All but one reported being content with the colostomy. Thirty-nine percent reported one or more problems related to the colostomy. Seventy-five percent had a GITT within normal range for able-bodied populations. When disregarding the physical component, QoL was not significantly lower in the total study group compared to a Danish norm group, but significantly lower when compared the subgroup of persons with tetraplegia. A colostomy reduces the time necessary for bowel management. The majority of individuals with SCI and a colostomy did not perceive bowel management as being a problem. The results indicate that colostomy is a favourable option for individuals with SCI, who spend long hours on bowel management and for whom non-invasive procedures did not improve the situation enough.

Managing inflammatory bowel disease in pregnancy: current perspectives

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Pinder M

2016-10-01

Full Text Available Matthew Pinder,1 Katie Lummis,1 Christian P Selinger1,2 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, 2University of Leeds, Leeds, UK Abstract: Inflammatory bowel disease (IBD affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes. Keywords: pregnancy, breast feeding, nursing, inflammatory bowel disease, Crohn’s disease, ulcerative colitis

Surgical aspects of radiation enteritis of the small bowel

Energy Technology Data Exchange (ETDEWEB)

Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

1984-02-01

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

Surgical aspects of radiation enteritis of the small bowel

International Nuclear Information System (INIS)

Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

1984-01-01

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation

Management of inflammatory bowel disease with Clostridium difficile infection.

Science.gov (United States)

D'Aoust, Julie; Battat, Robert; Bessissow, Talat

2017-07-21

To address the management of Clostridium difficile ( C. difficile ) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. A systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations. In those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not. Strong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.

Small Bowel Bleeding

Science.gov (United States)

... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

Large bowel resection

Science.gov (United States)

... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

Use of monitoring data to support conservation management and policy decisions in Micronesia.

Science.gov (United States)

Montambault, Jensen Reitz; Wongbusarakum, Supin; Leberer, Trina; Joseph, Eugene; Andrew, Wayne; Castro, Fran; Nevitt, Brooke; Golbuu, Yimnang; Oldiais, Noelle W; Groves, Craig R; Kostka, Willy; Houk, Peter

2015-10-01

Adaptive management implies a continuous knowledge-based decision-making process in conservation. Yet, the coupling of scientific monitoring and management frameworks remains rare in practice because formal and informal communication pathways are lacking. We examined 4 cases in Micronesia where conservation practitioners are using new knowledge in the form of monitoring data to advance marine conservation. These cases were drawn from projects in Micronesia Challenge jurisdictions that received funding for coupled monitoring-to-management frameworks and encompassed all segments of adaptive management. Monitoring in Helen Reef, Republic of Palau, was catalyzed by coral bleaching and revealed evidence of overfishing that led to increased enforcement and outreach. In Nimpal Channel, Yap, Federated States of Micronesia (FSM), monitoring the recovery of marine food resources after customary restrictions were put in place led to new, more effective enforcement approaches. Monitoring in Laolao Bay, Saipan, Commonwealth of the Northern Mariana Islands, was catalyzed by observable sediment loads from poor land-use practices and resulted in actions that reduced land-based threats, particularly littering and illegal burning, and revealed additional threats from overfishing. Pohnpei (FSM) began monitoring after observed declines in grouper spawning aggregations. This data led to adjusting marine conservation area boundaries and implementing market-based size class restrictions. Two themes emerged from these cases. First, in each case monitoring was conducted in a manner relevant to the social and ecological systems and integrated into the decision-making process. Second, conservation practitioners and scientists in these cases integrated culturally appropriate stakeholder engagement throughout all phases of the adaptive management cycle. More broadly, our study suggests, when describing adaptive management, providing more details on how monitoring and management activities are

Physiology can contribute to better understanding, management, and conservation of coral reef fishes.

Science.gov (United States)

Illing, Björn; Rummer, Jodie L

2017-01-01

Coral reef fishes, like many other marine organisms, are affected by anthropogenic stressors such as fishing and pollution and, owing to climate change, are experiencing increasing water temperatures and ocean acidification. Against the backdrop of these various stressors, a mechanistic understanding of processes governing individual organismal performance is the first step for identifying drivers of coral reef fish population dynamics. In fact, physiological measurements can help to reveal potential cause-and-effect relationships and enable physiologists to advise conservation management by upscaling results from cellular and individual organismal levels to population levels. Here, we highlight studies that include physiological measurements of coral reef fishes and those that give advice for their conservation. A literature search using combined physiological, conservation and coral reef fish key words resulted in ~1900 studies, of which only 99 matched predefined requirements. We observed that, over the last 20 years, the combination of physiological and conservation aspects in studies on coral reef fishes has received increased attention. Most of the selected studies made their physiological observations at the whole organism level and used their findings to give conservation advice on population dynamics, habitat use or the potential effects of climate change. The precision of the recommendations differed greatly and, not surprisingly, was least concrete when studies examined the effects of projected climate change scenarios. Although more and more physiological studies on coral reef fishes include conservation aspects, there is still a lack of concrete advice for conservation managers, with only very few published examples of physiological findings leading to improved management practices. We conclude with a call to action to foster better knowledge exchange between natural scientists and conservation managers to translate physiological findings more

Frequency of Different Psychiatric Disorders in Patients With Functional Bowel Disorders: A Short Report

Directory of Open Access Journals (Sweden)

Fakhraei

2015-06-01

Full Text Available Background Functional gastrointestinal (GI disorders are very common and many patients with such disorders are not satisfied with treatment outcomes. Psychological aspects of functional disorders need special attention that may play an important role in patient management. Objectives In this study, psychology evaluation was performed for a population of patients with functional bowel disorders. Patients and Methods One hundred patients with functional bowel disorders including 50 patients with irritable bowel syndrome (IBS referred to GI clinics were candidates for psychiatry evaluation; of those 60 patients completed the study. Psychiatric disorders were diagnosed using a structured clinical interview based on diagnostic and statistical manual of mental disorders IV (DSM IV. Results Of 60 patients with functional bowel disorders (including 39 IBS, 51 (85% were diagnosed with at least one psychiatry disorder. The most common disorders were dysthymia (25% and obsessive-compulsive disorder (20%. There was no significant difference between IBS patients and other functional bowel disorders regarding the prevalence of psychiatric disorders. Conclusions Psychiatric disorders are very prevalent among patients with functional bowel disorders. Prompt diagnosis and appropriate management of associated psychiatric disorders along with GI targeted treatments may lead to a better outcome in these patients.

Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery

Energy Technology Data Exchange (ETDEWEB)

Deshmukh, Swati D.; Shin, David S.; Willmann, Juergen K.; Rosenberg, Jarrett; Shin, Lewis; Jeffrey, R.B. [Stanford University, School of Medicine, Department of Radiology, Stanford, CA (United States)

2011-05-15

To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

Setting conservation management thresholds using a novel participatory modeling approach.

Science.gov (United States)

Addison, P F E; de Bie, K; Rumpff, L

2015-10-01

We devised a participatory modeling approach for setting management thresholds that show when management intervention is required to address undesirable ecosystem changes. This approach was designed to be used when management thresholds: must be set for environmental indicators in the face of multiple competing objectives; need to incorporate scientific understanding and value judgments; and will be set by participants with limited modeling experience. We applied our approach to a case study where management thresholds were set for a mat-forming brown alga, Hormosira banksii, in a protected area management context. Participants, including management staff and scientists, were involved in a workshop to test the approach, and set management thresholds to address the threat of trampling by visitors to an intertidal rocky reef. The approach involved trading off the environmental objective, to maintain the condition of intertidal reef communities, with social and economic objectives to ensure management intervention was cost-effective. Ecological scenarios, developed using scenario planning, were a key feature that provided the foundation for where to set management thresholds. The scenarios developed represented declines in percent cover of H. banksii that may occur under increased threatening processes. Participants defined 4 discrete management alternatives to address the threat of trampling and estimated the effect of these alternatives on the objectives under each ecological scenario. A weighted additive model was used to aggregate participants' consequence estimates. Model outputs (decision scores) clearly expressed uncertainty, which can be considered by decision makers and used to inform where to set management thresholds. This approach encourages a proactive form of conservation, where management thresholds and associated actions are defined a priori for ecological indicators, rather than reacting to unexpected ecosystem changes in the future. © 2015 The

Women's experiences of living with neurogenic bladder and bowel after spinal cord injury: life controlled by bladder and bowel.

Science.gov (United States)

Nevedal, Andrea; Kratz, Anna L; Tate, Denise G

2016-01-01

Neurogenic bladder and bowel (NBB) is a chronic condition hindering the functioning and quality of life (QOL) of people with spinal cord injury (SCI). NBB research has focused on men with SCI leaving unanswered questions about women's experiences of living with NBB. The purpose of this study was to identify and describe women's experiences of living with SCI and NBB. Secondary analysis of semi-structured interviews from a larger qualitative study of women with SCI (N = 50) was carried out. Transcripts were coded for bowel and bladder content. Pile-sorting techniques were used to identify emergent themes related to NBB. Meta-themes were categorized under the International Classification of Functioning, Disability and Health. Bladder and bowel topics were spontaneously discussed by 46 out of 50 study participants suggesting the salience of this issue for women with SCI. We identified 6 meta-themes: life controlled by bladder and bowel, bladder and bowel accidents, women's specific challenges, life course disruption, bladder and bowel medical management, and finding independence. Findings describe concerns, strategies, and the detrimental impact of NBB in the lives of women with SCI. Findings inform policy makers, health care and rehabilitation professionals to improve accessibility and quality of life for women with NBB. Women with spinal cord injury (SCI) reported gender specific challenges to living with neurogenic bladder and bowel (NBB). Interventions designed for women with SCI can address these problems and provide recommendations for prevention and treatment. Women described the detrimental impact of NBB on life course expectations, emotional, social, physical health, and quality of life domains. Psychosocial and educational programs can be developed to address these challenges and improve overall quality of life. Recommendations for special treatment and policy considerations are needed to maximize women's independence and health while living with NBB

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

Science.gov (United States)

Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

2016-10-01

The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

Science.gov (United States)

Irom, Keshorjit Singh; Khumallambam, Ibomcha Singh; Sinam, Rajendra Singh

2015-01-01

Introduction Emphysematous pyelophritis (EPN) is a serious condition with significant mortality. The prognosis of patients with EPN has changed over the years. Mortality has declined with prompt and aggressive medical management and minimally invasive strategies. Aim To identify the prognostic factors and assess the outcome of conservative management of emphysematous pyelonephritis. Settings and Design This was a retrospective study of 8 consecutive patients who were diagnosed with EPN in two medical institutes between July 2010 and June 2015. Materials and Methods Eight consecutive patients diagnosed with emphysematous pyelonephritis between July 2010 and June 2015 was studied retrospectively. On the basis of Computerised tomographic scan findings they were grouped into four classes (1 to 4) according the modified classification recommended by Huang and Tseng. The management was conservative (combination of percutaneous drainage and antibiotics), immediate nephrectomy or delayed nephrectomy (when conservative management failed). Demographic, clinical, biochemical and radiological characteristics were assessed and compared between survivors and nonsurvivors. Results Seven (87.5%) of a total of 8 patients had diabetes mellitus. Escherichia coli (71.4 %) was the most common offending pathogen identified in pus culture. With conservative management in 7 patients (combination of percutaneous drainage and antibiotics), treatment was successful in 57.14 % and with immediate nephrectomy (one patient), the success rate was 100%. The risk factors for mortality were thrombocytopenia, shock and altered sensorium at presentation. The mortality rate in class 1, 2 and 3 was 0%, 33.3% and 66.7%. None of the patient had class 4 EPN. Conclusion A combination of percutaneous drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis. PMID:26675196

Septic Shock after Conservative Management for Placenta Accreta

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Ying-Cheng Chiang

2006-03-01

Conclusion: At present, there is no consensus about the optimal treatment for placenta accreta. Conservative treatment appears to be an alternative in selected patients, but the complications such as sepsis should be carefully identified and appropriately managed.

Vicious circles in inflammatory bowel disease.

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Sonnenberg, Amnon; Collins, Judith F

2006-10-01

Inflammatory bowel disease can present with a bewildering array of disease manifestations whose overall impact on patient health is difficult to disentangle. The multitude of disease complications and therapeutic side effects result in conflicting ideas on how to best manage a patient. The aim of the study is to test the usefulness of influence diagrams in resolving conflicts centered on managing complex disease processes. The influences of a disease process and the ensuing medical interventions on the health of a patient with inflammatory bowel disease are modeled by an influence diagram. Patient health is the focal point of multiple influences affecting its overall strength. Any downstream influence represents the focal point of other preceding upstream influences. The mathematics underlying the influence diagram is similar to that of a decision tree. Its formalism allows one to consider additive and inhibitory influences and include in the same analysis qualitatively different types of parameters, such as diagnoses, complications, side effects, and therapeutic outcomes. Three exemplary cases are presented to illustrate the potential use of influence diagrams. In all three case scenarios, Crohn's disease resulted in disease manifestations that seemingly interfered with its own therapy. The presence of negative feedback loops rendered the management of each case particularly challenging. The analyses by influence diagrams revealed subtle interactions among the multiple influences and their joint contributions to the patient's overall health that would have been difficult to appreciate by verbal reasoning alone. Influence diagrams represent a decision tool that is particularly suited to improve decision-making in inflammatory bowel disease. They highlight key factors of a complex disease process and help to assess their quantitative interactions.

What Are the Targets of Inflammatory Bowel Disease Management.

Science.gov (United States)

Lega, Sara; Dubinsky, Marla C

2018-04-25

With recent evidence suggesting that keeping the inflammatory process under tight control prevents long-term disability, the aim of treatments in inflammatory bowel disease (IBD) has shifted from symptom control toward the resolution of bowel inflammation. Mucosal healing is currently recognized as the principal treatment target to be used in a "treat to target" paradigm, whereas histologic healing and normalization of biomarkers are being evaluated as potential future targets. Although symptom relief is no longer a sufficient target, patient experience with the disease is of unquestionable importance and should be assessed in the form of patient-reported outcomes, to be used as a co-primary target with an objective measure of disease activity. IBD in is a heterogeneous disease; thus besides defining common treatment targets, every effort should be made to deliver a personalized treatment plan based on the risk factors for disease progression and individual drug metabolism to improve treatment success.

Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome.

Science.gov (United States)

Pereira, Ester; Estanqueiro, Paula; Almeida, Susana; Ferreira, Ricardo; Tellechea, Oscar; Salgado, Manuel

2014-09-01

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Conservative Management of Placenta Accreta/Increta after Vaginal Birth

Science.gov (United States)

Peiffer, S.; Reinhard, J.; Reitter, A.; Louwen, F.

2012-01-01

Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14–100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus. PMID:25308979

Bowel Movement

Science.gov (United States)

A bowel movement is the last stop in the movement of food through your digestive tract. Your stool passes out of ... what you eat and drink. Sometimes a bowel movement isn't normal. Diarrhea happens when stool passes ...

Annual report to Congress on Federal Government Energy Management and Conservation Programs

Energy Technology Data Exchange (ETDEWEB)

1994-02-01

This report on Federal Energy Management for Fiscal year (FY) 1992 provides information on energy consumption in Federal buildings and operations and documents activities conducted by Federal agencies to meet the statutory requirements of Title V, Part 3, of the National Energy Conservation Policy Act (NECPA), as amended, 42 U.S.C. 8251-8261, and Title VIII of NECPA, 42 U.S.C. 8287-8287b. This report also describes the energy conservation and management activities of the Federal Government under the authorization of section 381 of the Energy Policy and Conservation Act (EPCA), as amended, 42 U.S.C. 6361. Implementation activities undertaken during FY 1992 by the Federal agencies under Executive Order 12759 on Federal Energy Management are also described in this report.

Dynamic bowel obstruction: aetiology, clinical presentation ...

African Journals Online (AJOL)

2005). This makes it essential that studies are made periodically in every region to define the local causes with the idea to do work on their prevention (Adhikari et al., 2010). This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction.

Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses.

Science.gov (United States)

Jansson, Nicolai

2016-11-01

To report the outcome of conservative management of unilateral fractures of the mandibular rami in horses. Retrospective case series. 24 client-owned horses with unilateral mandibular fractures METHODS: Medical records (January 2000-January 2014) of horses with unilateral mandibular ramus fractures were retrieved. Only conservatively managed horses with follow-up information were included. Follow-up information on clinical outcome was retrieved from the medical records (n=11) or obtained by telephone interviews with the owners or trainers (n=13). Twenty-three horses (96%) returned to their previous or intended use and had no clinically evident masticatory or fracture healing-related problems at the time of follow-up. The owner of 1 horse (4%) reported it had tooth loosening, feed impaction, and masticatory problems. Conservative management of unilateral fractures of the mandibular rami is a treatment option in horses. © Copyright 2016 by The American College of Veterinary Surgeons.

Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

Science.gov (United States)

Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

2005-03-01

Background  Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives  The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis�

Conservative Management of Azygous Vein Rupture in Blunt Thoracic Trauma

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Cian McDermott

2012-01-01

Full Text Available We report a case of successful conservative management of acute traumatic rupture of the azygous vein. A 48-year-old male was involved in a motor vehicle collision. Primary survey revealed acute right intrathoracic haemorrhage. He remained haemodynamically stable with rapid infusion of warmed crystalloid solution and blood. Computed tomographic imaging showed a contained haematoma of the azygous vein. The patient was managed conservatively in the intensive care. Azygous vein laceration resulting from blunt thoracic trauma is a rare condition that carries a universally poor prognosis unless the appropriate treatment is instituted. Clinical features include acute hypovolaemic shock, widened mediastinum on chest radiograph, and a right-sided haemothorax. Haemodynamic collapse necessitates immediate resuscitative thoracotomy. Interest in this injury stems from the severity of the clinical condition, difficulty in diagnosis, the onset of a rapidly deteriorating clinical course all of which can be promptly reversed by timely and appropriate treatment. Although it is a rare cause of intramediastinal haemorrhage, it is proposed that a ruptured azygous vein should be considered in every trauma case causing a right-sided haemothorax or widened mediastinum. All cases described in the literature to date involved operative management. We present a case of successful conservative management of this condition.

Community-managed conservation efforts at Tsingy Mahaloka ...

African Journals Online (AJOL)

... for habitat protection; (ii) create economic incentives and benefits for residents; and, ... KOFAMA, as the local organization to be responsible for management of the ... rising 80–100 metres above a flat coastal plain), a diverse endemic avifauna, ... et enfin une structure destinée à faciliter les efforts de conservation qui sont ...

Laparoscopic management of a small bowel obstruction secondary to Elipse intragastric balloon migration: A case report

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Saud Al-Subaie

Full Text Available Introduction: The Elipse™ intragastric balloon (IGB for weight loss is a swallowable capsule that is filled with 550 mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event. Presentation of case: A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO, and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient’s recovery was uneventful and she was discharged on postoperative day 4. Discussion: We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases. Conclusion: Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully. Keywords: Elipse, Intragastric balloon, Capsule, Obesity, Case report

Building on Two Decades of Ecosystem Management and Biodiversity Conservation under the Northwest Forest Plan, USA

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Dominick A. DellaSala

2015-09-01

Full Text Available The 1994 Northwest Forest Plan (NWFP shifted federal lands management from a focus on timber production to ecosystem management and biodiversity conservation. The plan established a network of conservation reserves and an ecosystem management strategy on ~10 million hectares from northern California to Washington State, USA, within the range of the federally threatened northern spotted owl (Strix occidentalis caurina. Several subsequent assessments—and 20 years of data from monitoring programs established under the plan—have demonstrated the effectiveness of this reserve network and ecosystem management approach in making progress toward attaining many of the plan’s conservation and ecosystem management goals. This paper (1 showcases the fundamental conservation biology and ecosystem management principles underpinning the NWFP as a case study for managers interested in large-landscape conservation; and (2 recommends improvements to the plan’s strategy in response to unprecedented climate change and land-use threats. Twenty years into plan implementation, however, the U.S. Forest Service and Bureau of Land Management, under pressure for increased timber harvest, are retreating from conservation measures. We believe that federal agencies should instead build on the NWFP to ensure continuing success in the Pacific Northwest. We urge federal land managers to (1 protect all remaining late-successional/old-growth forests; (2 identify climate refugia for at-risk species; (3 maintain or increase stream buffers and landscape connectivity; (4 decommission and repair failing roads to improve water quality; (5 reduce fire risk in fire-prone tree plantations; and (6 prevent logging after fires in areas of high conservation value. In many respects, the NWFP is instructive for managers considering similar large-scale conservation efforts.

Dynamic bowel obstruction: aetiology, clinical presentation ...

African Journals Online (AJOL)

This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation ...

Biochemical genetics in marine fisheries management and conservation

Digital Repository Service at National Institute of Oceanography (India)

Menezes, M.R.

- 403004 NBDBlDBTSponsored Training on Taxonomy, GOIdia turd Gme Bturking o/Coastal and Marine Bloresources, CIFE, Mumbal BIOCHEMICAL GENETICS IN MARINE FISHERIES MANAGEMENT AND CONSERVATION Maria R. Menezes Introduction . Species of fish, like most... population structure may have evolved and been maintained in species of fish ofeconomic interest has led to the concept of 'stock'. The stock concept dominates much of marine fisheries management, theory and practice because the identification of discrete...

Indicators for surgery in adhesive bowel obstruction.

Science.gov (United States)

Rajanikmanth, P V; Kate, V; Ananthakrishnan, N

2001-01-01

There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

Managing scuba divers to meet ecological goals for coral reef conservation.

Science.gov (United States)

Sorice, Michael G; Oh, Chi-Ok; Ditton, Robert B

2007-06-01

Marine protected areas increasingly are challenged to maintain or increase tourism benefits while adequately protecting resources. Although carrying capacity strategies can be used to cope with use-related impacts, there is little understanding of divers themselves, their management preferences, and how preferences relate to conservation goals. By using a stated preference choice modeling approach, we investigated the choices divers make in selecting diving trips to marine protected areas as defined by use level, access, level of supervision, fees, conservation education, and diving expectations. Logit models showed that divers preferred a more restrictive management scenario over the status quo. Divers favored reductions in the level of site use and increased levels of conservation education. Divers did not favor fees to access protected areas, having less access to the resource, or extensive supervision. Finally, divers were much more willing to accept increasingly restrictive management scenarios when they could expect to see increased marine life.

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

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Barbara Monard

2017-01-01

Full Text Available Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome.

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

Science.gov (United States)

Mottet, Nicolas; Ramanah, Rajeev; Riethmuller, Didier

2017-01-01

Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome. PMID:29230337

Bringing genetic diversity to the forefront of conservation policy and management

DEFF Research Database (Denmark)

Hoban, S.M.; Hauffe, H.C.; Pérez-Espona, S.

2013-01-01

In this essay we explore questions on how to increase the visibility and utility of genetic information for biodiversity managers and policy makers. This is discussed in the light of Aichi CBD Target 13, which for the first time impels signatories to minimise genetic erosion and safeguard genetic...... genetics. We then discuss the implications of these findings for academics involved in conservation genetics and suggest that a much closer partnership between academic conservation geneticists and conservation practitioners is necessary if the full potential of genetic tools in conservation...

Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

Energy Technology Data Exchange (ETDEWEB)

Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2004-12-01

About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

International Nuclear Information System (INIS)

Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F.

2004-01-01

About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

A new technique of laparoscopic intracorporeal anastomosis for transrectal bowel resection with transvaginal specimen extraction.

Science.gov (United States)

Faller, Emilie; Albornoz, Jaime; Messori, Pietro; Leroy, Joël; Wattiez, Arnaud

2013-01-01

To show a new technique of laparoscopic intracorporeal anastomosis for transrectal bowel resection with transvaginal specimen extraction, a technique particularly suited for treatment of bowel endometriosis. Step-by-step explanation of the technique using videos and pictures (educative video). Endometriosis may affect the bowel in 3% to 37% of all endometriosis cases. Bowel endometriosis affects young women, without any co-morbidities and in particular without any vascular disorders. In addition, affected patients often express a desire for childbearing. Radical excision is sometimes required because of the impossibility of conservative treatment such as shaving, mucosal skinning, or discoid resection. Bowel endometriosis should not be considered a cancer, and consequently maximal resection is not the objective. Rather, the goal would be to achieve functional benefit. As a result, resection must be as economic and cosmetic as possible. The laparoscopic approach has proved its superiority over the open technique, although mini-laparotomy is generally performed to prepare for the anastomosis. Total laparoscopic approach in patients with partial bowel stenosis, using the vagina for specimen extraction. This technique of intracorporeal anastomosis with transvaginal specimen extraction enables a smaller resection and avoidance of abdominal incision enlargement that may cause hernia, infection, or pain. When stenosis is partial, this technique seems particularly suited for treatment of bowel endometriosis requiring resection. If stenosis is complete, the anvil can be inserted above the lesion transvaginally. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

The Colorado Plateau V: research, environmental planning, and management for collaborative conservation

Science.gov (United States)

Villarreal, Miguel L.; van Riper, Carena J.; Johnson, Matthew J.; van Riper, Charles

2012-01-01

Roughly centered on the Four Corners region of the southwestern United States, the Colorado Plateau covers some 130,000 square miles of sparsely vegetated plateaus, mesas, canyons, arches, and cliffs in Arizona, Utah, Colorado, and New Mexico. With elevations ranging from 3,000 to 14,000 feet, the natural systems found within the plateau are dramatically varied, from desert to alpine conditions. This volume, the fifth from the University of Arizona Press and the tenth overall, focuses on adaptation of resource management and conservation to climate change and water scarcity, protecting biodiversity through restructured energy policies, ensuring wildlife habitat connectivity across barriers, building effective conservation networks, and exploring new opportunities for education and leadership in conservation science. An informative read for people interested in the conservation and natural history of the region, the book will also serve as a valuable reference for those people engaged in the management of cultural and biological resources of the Colorado Plateau, as well as scientists interested in methods and tools for land and resource management throughout the West.

Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management

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Ronald Ikechi

2017-04-01

Full Text Available Irritable bowel syndrome (IBS is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits. It generally presents as a complex of symptoms, including psychological dysfunction. Hypersensitivity to certain foods, especially foods that contain high amounts of fructose, plays a role in the pathophysiology of IBS. Elevated consumption of high-fructose corn syrup (HFCS has been discussed in this aspect. The treatment options for IBS are challenging and varied. In addition to dietary restrictions for HFCS-induced IBS, such as low-FODMAP (Fermentable Oligosaccharides, Disaccharide, Monosaccharides, and Polyols diets, existing drug therapies are administered based on the predominant symptoms and IBS-subtype. Patients with IBS are likely to suffer from issues, such as anxiety, depression, and post-traumatic-stress disorder. Biopsychosocial factors particularly socioeconomic status, sex, and race should, thus, be considered for diagnostic evaluation of patients with IBS.

Micro-Credit and Community Wildlife Management: Complementary Strategies to Improve Conservation Outcomes in Serengeti National Park, Tanzania

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Kaaya, Emmanuel; Chapman, Margaret

2017-09-01

Community wildlife management programs in African protected areas aim to deliver livelihood and social benefits to local communities in order to bolster support for their conservation objectives. Most of these benefits are delivered at the community level. However, many local people are also seeking more individual or household-level livelihood benefits from community wildlife management programs because it is at this level that many of the costs of protected area conservation are borne. Because community wildlife management delivers few benefits at this level, support for their conservation objectives amongst local people often declines. The study investigated the implications of this for reducing poaching in Serengeti National Park, Tanzania. Three community wildlife management initiatives undertaken by Park management were compared with regard to their capacity to deliver the individual and household-level benefits sought by local people: community conservation services, wildlife management areas and community conservation banks. Interviews were carried out with poachers and local people from four villages in the Western Serengeti including members of village conservation banks, as well as a number of key informants. The results suggest that community conservation banks could, as a complementary strategy to existing community wildlife management programs, potentially provide a more effective means of reducing poaching in African protected areas than community wildlife management programs alone.

Research priorities for conservation and natural resource management in Oceania's small-island developing states.

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Weeks, R; Adams, V M

2018-02-01

For conservation science to effectively inform management, research must focus on creating the scientific knowledge required to solve conservation problems. We identified research questions that, if answered, would increase the effectiveness of conservation and natural resource management practice and policy in Oceania's small-island developing states. We asked conservation professionals from academia, governmental, and nongovernmental organizations across the region to propose such questions and then identify which were of high priority in an online survey. We compared the high-priority questions with research questions identified globally and for other regions. Of 270 questions proposed by respondents, 38 were considered high priority, including: What are the highest priority areas for conservation in the face of increasing resource demand and climate change? How should marine protected areas be networked to account for connectivity and climate change? What are the most effective fisheries management policies that contribute to sustainable coral reef fisheries? High-priority questions related to the particular challenges of undertaking conservation on small-island developing states and the need for a research agenda that is responsive to the sociocultural context of Oceania. Research priorities for Oceania relative to elsewhere were broadly similar but differed in specific issues relevant to particular conservation contexts. These differences emphasize the importance of involving local practitioners in the identification of research priorities. Priorities were reasonably well aligned among sectoral groups. Only a few questions were widely considered answered, which may indicate a smaller-than-expected knowledge-action gap. We believe these questions can be used to strengthen research collaborations between scientists and practitioners working to further conservation and natural resource management in this region. © 2017 The Authors. Conservation Biology

Systematic review: interventions for abdominal pain management in inflammatory bowel disease.

Science.gov (United States)

Norton, C; Czuber-Dochan, W; Artom, M; Sweeney, L; Hart, A

2017-07-01

Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under-treated symptom. To systematically review evidence on interventions (excluding disease-modifying interventions) for abdominal pain management in IBD. Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) were searched (February 2016). Two researchers independently screened references and extracted data. Fifteen papers were included: 13 intervention studies and two cross-sectional surveys. A variety of psychological, dietary and pharmacological interventions were reported. Four of six studies reported pain reduction with psychological intervention including individualised and group-based relaxation, disease anxiety-related Cognitive Behavioural Therapy and stress management. Both psychologist-led and self-directed stress management in inactive Crohn's disease reduced pain compared with controls (symptom frequency reduction index=-26.7, -11.3 and 17.2 at 6-month follow-up, respectively). Two dietary interventions (alcoholic drinks with high sugar content and fermentable carbohydrate with prebiotic properties) had an effect on abdominal pain. Antibiotics (for patients with bacterial overgrowth) and transdermal nicotine patches reduced abdominal pain. Current and past cannabis users report it relieves pain. One controlled trial of cannabis reduced SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). These results must be treated with caution: data were derived from predominantly small uncontrolled studies of moderate to low quality. Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD. © 2017 John Wiley & Sons Ltd.

Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction

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Sinha, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)]. E-mail: rakesh.sinha@uhl-tr.nhs.uk; Verma, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)

2005-10-01

Large bowel obstruction may present as an emergency as high-grade colonic obstruction and can result in perforation. Perforated large bowel obstruction causes faecal peritonitis, which can result in high morbidity and mortality. Multidetector row computed tomography (MDCT) has the potential of providing an accurate diagnosis of large bowel obstruction. The rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of the various causes of large bowel obstruction with emphasis on important pathogenic factors, CT appearances and the use of multiplanar reformatted images in the diagnostic workup.

Management of Inflammatory Bowel Disease in the Elderly Patient: Challenges and Opportunities.

Science.gov (United States)

Ananthakrishnan, Ashwin N; Donaldson, Tamara; Lasch, Karen; Yajnik, Vijay

2017-06-01

The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn's disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older patients with IBD are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

Chondrichthyan Diversity, Conservation Status, and Management Challenges in Costa Rica

Directory of Open Access Journals (Sweden)

Mario Espinoza

2018-03-01

Full Text Available Understanding key aspects of the biology and ecology of chondrichthyan fishes (sharks, rays, and chimeras, as well as the range of threats affecting their populations is crucial given the rapid rate at which some species are declining. In the Eastern Tropical Pacific (ETP, the lack of knowledge, unreliable (or non-existent landing statistics, and limited enforcement of existing fisheries regulations has hindered management and conservation efforts for chondrichthyan species. This review evaluated our current understanding of Costa Rican chondrichthyans and their conservation status. Specifically, we (1 provide an updated checklist on the species richness, habitat use, and distribution patterns, (2 summarize the most relevant chondrichthyan studies (scientific publications, theses, and official technical reports, (3 identify knowledge gaps, (4 discuss fisheries-related threats, and (5 highlight the management challenges and research needs to effectively protect their populations. A total of 99 chondrichthyan species are formally recorded in Costa Rican waters, from which 15% are threatened with extinction and 41% are “Data Deficient” based on the IUCN (International Union for Conservation of Nature Red List. A total of 121 studies were published between 1891 and 2017; 82% in the Pacific (24% from Isla del Coco and only 18% from the Caribbean Sea. These results highlight the need to redirect research efforts on specific taxonomic groups and geographic regions (i.e., Caribbean. Based on our review, improving the quality and quantity of fisheries landing statistics, as well as determining the degree of overlap between chondrichthyans and Costa Rican fisheries remains a priority. We proposed an adaptive management framework for chondrichthyan fisheries in data-poor countries where management goals/targets are clearly defined. This framework could strengthen the conservation of chondrichthyan populations in Costa Rica and the region.

Short Bowel Syndrome, a Case of Intestinal Rehabilitation

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Dianna Ramírez Prada

2015-05-01

Full Text Available Case: The objective is to present the successful experience of multidisciplinary management of a patient with short bowel syndrome and intestinal failure with progression to intestinal adaptation. This is a newly born premature with intestinal atresia type IV with multiple intestinal atresia who evolved to intestinal failure and required managed with prolonged parenteral nutritional support, multiple antibiotic schemes, prebiotics, multivitamins, enteral nutrition with elemental formula to achieve their adaptation intestinal until lead to a normal diet. The evolution of these patients intestinal failure is a challenge for the health team, as it not only involves the surgical management of your condition if not basic nutritional support, fluid and electrolyte balance, hepatic dysfunction cholestasis associated infections etc. Discussion: Short bowel syndrome with progression to intestinal failure in children is a condition whose prevalence is increasing worldwide, thanks to advances in neonatal intensive care, neonatal surgery, and nutritional support of patients with conditions such as gastroschisis, omphalocele and necrotizing enterocolitis. Despite the limitations of our health system, it is possible to offer a multidisciplinary and integrated to lead to intestinal adaptation treatment.

A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

Science.gov (United States)

Pavlacky, David C; Lukacs, Paul M; Blakesley, Jennifer A; Skorkowsky, Robert C; Klute, David S; Hahn, Beth A; Dreitz, Victoria J; George, T Luke; Hanni, David J

2017-01-01

Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1) coordination across organizations and regions, 2) meaningful management and conservation objectives, and 3) rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR) program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17). We provide two examples for the Brewer's sparrow (Spizella breweri) in BCR 17 demonstrating the ability of the design to 1) determine hierarchical population responses to landscape change and 2) estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous statistical

A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

Directory of Open Access Journals (Sweden)

David C Pavlacky

Full Text Available Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1 coordination across organizations and regions, 2 meaningful management and conservation objectives, and 3 rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17. We provide two examples for the Brewer's sparrow (Spizella breweri in BCR 17 demonstrating the ability of the design to 1 determine hierarchical population responses to landscape change and 2 estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous

Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy

International Nuclear Information System (INIS)

Green, Sheryl; Stock, Richard; Greenstein, Adrian

1995-01-01

4 gastro-intestinal toxicity. Two patients (13%) developed small bowel obstruction at 2 and 4 months, respectively, post-irradiation which were managed conservatively. There were no long term complications in patients irradiated. CONCLUSION: Treatment results are comparable to those historically reported for non-inflammatory bowel disease related rectal cancer although the subset of high risk patients appeared to have a poorer outcome. In light of this finding and the ability of patients with inflammatory bowel disease to tolerate pelvic irradiation, high risk patients should be treated aggressively with chemotherapy and radiation therapy

Basic Energy Conservation and Management--Part 2: HVAC

Science.gov (United States)

Krueger, Glenn

2012-01-01

Reducing school district energy expenditures has become a universal goal, and new technologies have brought greater energy efficiencies to the school environment. In Part 1 of this two-part series, the author discussed the steps required to establish an energy conservation and management program with an emphasis on lighting. In this article, he…

Minimization of small bowel volume within treatment fields using customized small bowel displacement system (SBDS)

International Nuclear Information System (INIS)

Lim, D. H.; Huh, S. J.; Ahn, Y. C.; Kim, D. Y.; Wu, H. G.; Kim, M. K.; Choi, D. R.; Shin, K. H.

1997-01-01

Authors designed a customized Small Bowel Displacement System(SBDS) to displace the small bowel from the pelvic radiation fields and minimize treatment-related bowel morbidities. From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position. After opacifying the small bowel with Barium, the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. Using the SBDS, the mean small bowel area was reduced by 59% on PA and 51% on LAT films (P=0.0001). In six patients (6/55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only 15% (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used. (author)

Concentrating or scattering management in agricultural landscapes : Examining the effectiveness and efficiency of conservation measures

NARCIS (Netherlands)

Hammers, Martijn; Muskens, Gerard; Van Kats, Ruud J. M.; Teunissen, Wolf A.; Kleijn, David

A key issue in conservation is where and how much management should be implemented to obtain optimal biodiversity benefits. Cost-effective conservation requires knowledge on whether biodiversity benefits are higher when management is concentrated in a few core areas or scattered across the

Conservative fluid management prevents age-associated ventilator induced mortality.

Science.gov (United States)

Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

2016-08-01

Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in

Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

International Nuclear Information System (INIS)

Rosenbaum, Daniel G.; Conrad, Maire A.; Kelsen, Judith R.; Biko, David M.; Anupindi, Sudha A.; Ruchelli, Eduardo D.

2017-01-01

Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

Energy Technology Data Exchange (ETDEWEB)

Rosenbaum, Daniel G. [NewYork-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Conrad, Maire A.; Kelsen, Judith R. [The Children' s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA (United States); Biko, David M.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Ruchelli, Eduardo D. [The Children' s Hospital of Philadelphia, Division of Anatomic Pathology, Philadelphia, PA (United States)

2017-01-15

Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

Ecological Conservation, Ecotourism, and Sustainable Management: The Case of Penang National Park

Directory of Open Access Journals (Sweden)

Sara Kaffashi

2015-07-01

Full Text Available Penang National Park (PNP, as Malaysia’s smallest national park, is one of the few naturally forested areas left on Penang Island, in Peninsular Malaysia. The main objective was to analyse users’ preferences and willingness to pay to enhance improved management of PNP for the dual aim of conservation and recreation. Structural equation modelling (SEM was used to analyse the formation of attitudes towards different aspects of PNP. Results showed that implementing enforcements with rules and regulations and imposing permits and charges on certain activities were the most influential variables of PNPs’ perceptions. The results of a random parameter logit model (RPL demonstrated that visitors placed the highest value on having adequate information about PNP, and the second-highest value on improvements in the park’s ecological management. The welfare measure for improvement in management of PNP against status quo is estimated at about MYR 9. Results also showed that demand for better conservation and management of PNP is relatively price-inelastic. Simulations of the results showed, under a MYR10 admission fee, that improvement in management would have 96% of market share compared with status quo. This study concluded that visitor entrance fees can and ought to be introduced as a means of financing conservation initiatives and possibly preventing congestion.

Irritable Bowel Syndrome

Science.gov (United States)

... your belly area), constipation (when you can't poop), and diarrhea (when you poop too much). If you have irritable bowel syndrome, ... food particles are also known as stool, a bowel movement, or poop. Here's why an intestine gets "irritable." ...

The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management.

Science.gov (United States)

Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

2017-10-27

The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012-2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Cognitive behavioural therapy for the management of inflammatory bowel disease-fatigue with a nested qualitative element: study protocol for a randomised controlled trial.

Science.gov (United States)

Artom, Micol; Czuber-Dochan, Wladyslawa; Sturt, Jackie; Norton, Christine

2017-05-11

Fatigue is one of the most prevalent and burdensome symptoms for patients with inflammatory bowel disease (IBD). Although fatigue increases during periods of inflammation, for some patients it persists when disease is in remission. Compared to other long-term conditions where fatigue has been extensively researched, optimal management of fatigue in patients with IBD is unknown and fatigue has rarely been the primary outcome in intervention studies. To date, interventions for the management of IBD-fatigue are sparse, have short-term effects and have not been implemented within the existing health system. There is a need to integrate current best evidence across different conditions, patient experience and clinical expertise in order to develop interventions for IBD-fatigue management that are feasible and effective. Modifying an existing intervention for patients with multiple sclerosis, this study aims to assess the feasibility and initial estimates of efficacy of a cognitive behavioural therapy (CBT) intervention for the management of fatigue in patients with IBD. The study will be a two-arm pilot randomised controlled trial. Patients will be recruited from one outpatient IBD clinic and randomised individually to either: Group 1 (CBT manual for the management of fatigue, one 60-min session and seven 30-min telephone/Skype sessions with a therapist over an eight-week period); or Group 2 (fatigue information sheet to use without therapist help). Self-reported IBD-fatigue (Inflammatory Bowel Disease-Fatigue Scale) and IBD-quality of life (United Kingdom Inflammatory Bowel Disease Questionnaire) and self-reported disease activity will be collected at baseline, three, six and 12 months post randomisation. Illness perceptions, daytime sleepiness, anxiety and depression explanatory variables will be collected only at three months post randomisation. Clinical and sociodemographic data will be retrieved from the patients' medical notes. A nested qualitative study will

Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

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Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

2015-06-01

The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China

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Yi Qu

2018-04-01

Full Text Available Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups (p-values between groups < 0.05, which helped to refine management strategies formulated to best enhance ES across the study area. The proposed method allows conservation and management plans to easily adapt to a wide variety of quantitative ES target goals within urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

Conservative approach to the acute management of a large mesenteric cyst.

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Leung, Billy C; Sankey, Ruth; Fronza, Matteo; Maatouk, Mohamed

2017-09-16

Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

Ostomy Surgery of the Bowel

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... Digestive System & How it Works Zollinger-Ellison Syndrome Ostomy Surgery of the Bowel What is ostomy surgery of the bowel? Ostomy surgery of the ... of the body. Why does a person need ostomy surgery of the bowel? A person may need ...

Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"?

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Susanta Kumar Padhy

2015-01-01

Full Text Available Irritable bowel syndrome (IBS has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed.

Conservative management of fracture scaphoid

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Mittal V

2006-01-01

Full Text Available Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

Unusual causes of mechanical small bowel obstruction

International Nuclear Information System (INIS)

Shatnawi, Nawaf J.; Bani-Hani, Kamal E.

2005-01-01

We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause. (author)

Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer.

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Yin, Lishi; Fan, Ling; Tan, Renfu; Yang, Guangjing; Jiang, Fenglin; Zhang, Chao; Ma, Jun; Yan, Yang; Zou, Yanhong; Zhang, Yaowen; Wang, Yamei; Zhang, Guifang

2018-06-04

The purpose of this research is to identify the bowel symptoms and self-care strategies for rectal cancer survivors during the recovery process following low anterior resection surgery. A total of 100 participants were investigated under the structured interview guide based on the dimensions of "symptom management theory". 92% of participants reported changes in bowel habits, the most common being the frequent bowel movements and narrower stools, which we named it finger-shaped consistency stools. The 6 most frequently reported bowel symptoms were excessive flatus (93%), clustering (86%), urgency (77%), straining (62%), bowel frequency (57%) and anal pendant expansion (53%). Periodic bowel movements occurred in 19% participants. For a group of 79 participants at 6 to 24 months post-operation, 86.1% reported a significant improvement of bowel symptoms. Among 68 participants of this subgroup with significant improvements, 70.5% participants reported the length of time it took was at least 6 months. Self-care strategies adopted by participants included diet, bowel medications, practice management and exercise. It is necessary to educate patients on the symptoms experienced following low anterior resection surgery. Through the process of trial and error, participants have acquired self-care strategies. Healthcare professionals should learn knowledge of such strategies and help them build effective interventions.

Conservation markets for wildlife management with case studies from whaling.

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Gerber, Leah R; Costello, Christopher; Gaines, Steven D

2014-01-01

Although market-based incentives have helped resolve many environmental challenges, conservation markets still play a relatively minor role in wildlife management. Establishing property rights for environmental goods and allowing trade between resource extractors and resource conservationists may offer a path forward in conserving charismatic species like whales, wolves, turtles, and sharks. In this paper, we provide a conceptual model for implementing a conservation market for wildlife and evaluate how such a market could be applied to three case studies for whales (minke [Balaenoptera acutorostrata], bowhead [Balaena mysticetus], and gray [Eschrictius robustus]). We show that, if designed and operated properly, such a market could ensure persistence of imperiled populations, while simultaneously improving the welfare of resource harvesters.

Bowel preparation for CT colonography

International Nuclear Information System (INIS)

Neri, Emanuele; Lefere, Philippe; Gryspeerdt, Stefaan; Bemi, Pietro; Mantarro, Annalisa; Bartolozzi, Carlo

2013-01-01

Bowel preparation represents an essential part of CT colonography, as the accuracy of the exam is strongly related to the adequacy of colonic cleansing, and a poor bowel preparation may compromise the diagnostic quality even despite optimization of all other acquisition parameters. Residual stool and fluid in the large bowel may affect the interpretation of the exam and may increase the number of false positives and false negatives. In this regard, the majority of patients having undergone CT colonography state that bowel preparation is the most unpleasant part. Unfortunately, to date no definite consensus has been reached about the ideal bowel preparation technique, and there is great variability in preparation strategies across diagnostic centers. The purpose of this review article is to describe the development and evolution of bowel preparation techniques in order to choose the best approach for optimizing the diagnostic quality of CT colonography in each patient

Bowel preparation for CT colonography

Energy Technology Data Exchange (ETDEWEB)

Neri, Emanuele, E-mail: emanuele.neri@med.unipi.it [Diagnostic and Interventional Radiology, University of Pisa (Italy); Lefere, Philippe; Gryspeerdt, Stefaan [Department of Radiology, Stedelijk Ziekenhuis, Roeselare (Belgium); Bemi, Pietro; Mantarro, Annalisa; Bartolozzi, Carlo [Diagnostic and Interventional Radiology, University of Pisa (Italy)

2013-08-15

Bowel preparation represents an essential part of CT colonography, as the accuracy of the exam is strongly related to the adequacy of colonic cleansing, and a poor bowel preparation may compromise the diagnostic quality even despite optimization of all other acquisition parameters. Residual stool and fluid in the large bowel may affect the interpretation of the exam and may increase the number of false positives and false negatives. In this regard, the majority of patients having undergone CT colonography state that bowel preparation is the most unpleasant part. Unfortunately, to date no definite consensus has been reached about the ideal bowel preparation technique, and there is great variability in preparation strategies across diagnostic centers. The purpose of this review article is to describe the development and evolution of bowel preparation techniques in order to choose the best approach for optimizing the diagnostic quality of CT colonography in each patient.

Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease

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Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet; Weiss, Günter

2015-01-01

Abstract Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron. PMID:26061331

Where and how to manage: Optimal selection of conservation actions for multiple species.

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Astrid van Teeffelen

2008-01-01

Full Text Available Multiple alternative options are frequently available for the protection, maintenance or restoration of conservation areas. The choice of a particular management action can have large effects on the species occurring in the area, because different actions have different effects on different species. Together with the fact that conservation funds are limited and particular management actions are costly, it would be desirable to be able to identify where, and what kind of management should be applied to maximize conservation benefits. Currently available site-selection algorithms can identify the optimal set of sites for a reserve network. However, these algorithms have not been designed to answer what kind of action would be most beneficial at these sites when multiple alternative actions are available. We describe an algorithm capable of solving multi-species planning problems with multiple management options per site. The algorithm is based on benefit functions, which translate the effect of a management action on species representation levels into a value, in order to identify the most beneficial option. We test the performance of this algorithm with simulated data for different types of benefit functions and show that the algorithm’s solutions are optimal, or very near globally optimal, partially depending on the type of benefit function used. The good performance of the proposed algorithm suggests that it could be profitably used for large multi-action multi-species conservation planning problems.

41 CFR 102-74.155 - What energy conservation policy must Federal agencies follow in the management of facilities?

Science.gov (United States)

2010-07-01

... policy must Federal agencies follow in the management of facilities? 102-74.155 Section 102-74.155 Public... MANAGEMENT REGULATION REAL PROPERTY 74-FACILITY MANAGEMENT Facility Management Energy Conservation § 102-74.155 What energy conservation policy must Federal agencies follow in the management of facilities...

Assessing the components of adaptive capacity to improve conservation and management efforts under global change.

Science.gov (United States)

Nicotra, Adrienne B; Beever, Erik A; Robertson, Amanda L; Hofmann, Gretchen E; O'Leary, John

2015-10-01

Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions. © 2015 Society for

Adenocarcinoma of the small bowel

International Nuclear Information System (INIS)

Savli, M.; Jamar, B.

2007-01-01

Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

Adenocarcinoma of the small bowel

Energy Technology Data Exchange (ETDEWEB)

Savli, M; Jamar, B [Inst. of Clinical Radiology, Univ. Medical Centre, Ljubljana (Slovenia)

2007-06-15

Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

Protected River. A new concept for conservation management of fluvial systems in Colombia

International Nuclear Information System (INIS)

Andrade; German I

2011-01-01

Based upon the concept of Ecological Integrity, relevant geophysical, bio- ecological and social attributes for river systems area identified. It is argued that current conservation and environmental management instruments in Colombia, do not take into account the identified IE attributes simultaneously. The concept of Protected River, PR, is then presented, as a necessary complement for conservation strategies. The PR concept would be defined for the maintenance of the attributes of EI in some representative river systems, as a part of the biodiversity conservation objectives within the Convention of Biological Diversity. Some attributes and indicators, and thresholds of undesired change are discussed. A typology for PR is proposed, following the international protected area management categories.

Process of spontaneous resolution in the conservative management of congenital dacryocystocele

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Mimura M

2014-02-01

Full Text Available Masashi Mimura,1,2 Mari Ueki,1 Hidehiro Oku,1 Bunpei Sato,2 Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, Takatsuki, 2Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, JapanPurpose: To assess efficacy of the conservative management of patients with congenital dacryocystocele.Materials and methods: This was a retrospective case series involving six sides of five infants with a dacryocystocele treated at Osaka Kaisei Hospital, Osaka, Japan. The conservative management protocol consisted of the application of warm compresses and massage over the mass, with the addition of antibiotics when dacryocystitis developed. Patient age at the time of resolution, presence of retrograde outflow of contents of dacryocystoceles from the puncta, and development of dacryocystitis were recorded.Results: The dacryocystocele was unilateral in four patients and bilateral in one patient. A nasal cyst was present in four patients without respiratory distress. The median patient age at the time of the diagnosis was 7 days (range 2–10 days. Conservative management was selected in all patients, and the dacryocystocele was resolved in all patients at a median patient age of 14.5 days (range 11–105 days. Two sides developed dacryocystitis, which resolved in a few days with antibiotic treatment. In those two sides, rupture of the dacryocystoceles to the common canaliculus with retrograde discharge of the contents from the puncta before the dacryocystitis developed was noted. For the other four treated sides, no such discharge or development of dacryocystitis was observed.Conclusion: The findings of this study show that a dacryocystocele has a good chance of resolving spontaneously with conservative management and careful observation, and that rupture of the dacryocystocele to the common canaliculus might be an important precursor of dacryocystitis.Keywords: dacryocystitis, congenital lacrimal obstruction, remnant, precursor, retrograde

Spectrum of short bowel syndrome in adults

DEFF Research Database (Denmark)

Jeppesen, Palle B

2014-01-01

to diminished health-related quality of life because of its many physical and psychological effects on patients. SBS is associated with decreased survival; risk factors for SBS-related mortality include very short remnant small bowel, end-jejunal remnant anatomy, and arterial mesenteric infarction as primary...... severity and resection type; thus, each patient should be individually managed. This review discusses the spectrum of disease in patients with SBS and presents common complications encountered by these patients to highlight the importance of individualized management and treatment....

Management Approaches to Accomplish Contemporary Livestock Production-Conservation Objectives in Shortgrass Steppe

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Traditional rangeland management in the shortgrass steppe has emphasized livestock production with moderate stocking rates, but alternative approaches will be needed to meet production objectives under increasing demands for conservation-oriented management. We investigated the utility of very inten...

Hemorrhoids and anal fissures in inflammatory bowel disease.

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D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

2015-12-01

Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis.

Irritable bowel syndrome: the burden and unmet needs in Europe.

LENUS (Irish Health Repository)

Quigley, E M M

2012-02-03

Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.

Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

Science.gov (United States)

Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

2016-01-01

Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

Compression Dressing Using Dental Impression Compound for Conservative Management of Sialocele.

Science.gov (United States)

Kudva, Adarsh; Carriappa, K M; Kamath, Abhay; Chithra, A

2016-12-01

A Sialocele or salivary pseudocyst is due to extravasation of saliva into periglandular tissue due to disruption of gland parenchyma. Various techniques of management have been described in literature; both conservative and surgical management have been documented. We report a simple economical and efficient method to deal with sailocele presenting after neck dissection.

Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease.

Science.gov (United States)

Rosenbaum, Daniel G; Conrad, Maire A; Biko, David M; Ruchelli, Eduardo D; Kelsen, Judith R; Anupindi, Sudha A

2017-01-01

Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the

Understanding the threats posed by non-native species: public vs. conservation managers.

Directory of Open Access Journals (Sweden)

Rodolphe E Gozlan

Full Text Available Public perception is a key factor influencing current conservation policy. Therefore, it is important to determine the influence of the public, end-users and scientists on the prioritisation of conservation issues and the direct implications for policy makers. Here, we assessed public attitudes and the perception of conservation managers to five non-native species in the UK, with these supplemented by those of an ecosystem user, freshwater anglers. We found that threat perception was not influenced by the volume of scientific research or by the actual threats posed by the specific non-native species. Media interest also reflected public perception and vice versa. Anglers were most concerned with perceived threats to their recreational activities but their concerns did not correspond to the greatest demonstrated ecological threat. The perception of conservation managers was an amalgamation of public and angler opinions but was mismatched to quantified ecological risks of the species. As this suggests that invasive species management in the UK is vulnerable to a knowledge gap, researchers must consider the intrinsic characteristics of their study species to determine whether raising public perception will be effective. The case study of the topmouth gudgeon Pseudorasbora parva reveals that media pressure and political debate has greater capacity to ignite policy changes and impact studies on non-native species than scientific evidence alone.

Conservative management and health-related quality of life in end-stage renal disease: a systematic review.

Science.gov (United States)

Tsai, Hung-Bin; Chao, Chia-Ter; Chang, Ray-E; Hung, Kuan-Yu; COGENT Study Group

2017-06-26

Few studies have addressed health-related quality of life (QoL) in patients who chose conservative management over dialysis. This systematic review aims to better define the role of conservative management in improving health-related QoL in patients with end-stage renal disease (ESRD). Medline, Cochrane and EMBASE were searched for prospective or retrospective studies published until June 30, 2016, that examined QoL of ESRD patients. The primary outcome was health-related QoL. Four studies were included (405 patients received dialysis and 332 received conservative management). Two studies that used the Short Form-36 Survey (SF-36) showed that the dialysis group had higher physical component scores, but the conservative management group had similar, or better, mental component scores at the end of intervention. Another study using the SF-36 showed that the physical and mental component scores of the dialysis group did not significantly change after intervention. In the conservative management group, the physical component scores did not change, but the mental component scores increased significantly over time (0.12 ± 0.32, p management group. Although there are only a limited number of published articles, ESRD patients who receive conservative management may have improved mental health-related QoL when compared with those who receive dialysis.

Blowhole colostomy for the urgent management of distal large bowel obstruction.

Science.gov (United States)

Kasten, Kevin R; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Paquette, Ian M

2014-05-01

Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction. Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression. One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients. Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention. Copyright © 2014 Elsevier Inc. All rights reserved.

The use of GIS and modelling approaches in squirrel population management and conservation: A review

Science.gov (United States)

P. W. W. Lurz; J. L. Koprowski; D. J. A. Wood

2008-01-01

We review modelling approaches in relation to three key areas of sciurid ecology: management, disease risk assessments and conservation. Models enable us to explore different scenarios to develop effective management and conservation strategies. They may also assist in identifying and targeting research needs for tree and flying squirrels. However, there is a need to...

Systematic Planning and Ecosystem-Based Management as Strategies to Reconcile Mangrove Conservation with Resource Use

Directory of Open Access Journals (Sweden)

Rebecca Borges

2017-11-01

Full Text Available About 120 million people worldwide live within 10 km of large mangrove forests, and many of them directly depend on the goods and services provided by these ecosystems. However, it remains unclear how to synchronize ecological definitions and legal conservation strategies regarding mangroves, especially in developing countries, such as Brazil. The influence of human populations' socio-economic context in mangrove conservation policies, as well associated challenges in incorporating this influence, are underestimated or, often, largely ignored. Considering the recent threats emerging from changes in legislation and the lack of spatial and social-ecological integrated data to plan mangrove conservation in Brazil, this paper aims to answer the following questions: (1 What suitable measures could managers and other decision makers adopt for efficient mangrove conservation planning?; (2 What are the site-specific, social-ecological aspects that need to be taken into account when deciding on conservation and management strategies?; and (3 How could science contribute to the development of these measures? In order to achieve an ecosystem-based management approach, mangrove ecosystems should not be divided into sub-systems, but instead treated as an integrated system. Furthermore, interconnections with other coastal ecosystems must be assessed and taken into account. This is crucial for effective systematic conservation planning. Also, most of the particular social-ecological aspects in the different types of mangrove ecosystems along the Brazilian coast, and how those differences might be considered while planning for conservation, remain poorly understood. Based on similar drivers of change, geological features, and likely impacts of climate change, a macro-unit approach is proposed to group mangrove systems along the Brazilian coast and guide national policies. This paper draws parallels with management approaches worldwide to find common points and

Comparison of Water, Mannitol and Positive Oral Contrast for Evaluation of Bowel By Computed Tomography

Directory of Open Access Journals (Sweden)

Padhmanaban Elamparidhi

2017-10-01

Full Text Available Introduction: Small bowel remains a challenging anatomical site. Imaging approaches like CT-enterography helps in diagnosing non specific clinical presentations and imaging aids in appropriate management. Hence, bowel evaluation by CT requires a oral contrast agent for diagnosing the bowel pathology. Thus, quantitative and qualitative analysis of three oral contrast agents i.e., water, mannitol and positive contrast was done for identification of ideal intraluminal contrast agent. Aim: To assess the performance of mannitol as an endoluminal contrast agent as compared to water and positive contrast in the evaluation of bowel, to compare the distention of bowel with different oral contrasts and also to assess the usefulness of bowel distension in assessment of mural enhancement pattern of bowel. Materials and Methods: A comparative observational study was performed which consisted of 75 patients who were divided into three groups of 25 patients each. Patients in each group were given 1500 ml of oral contrast. Group I was given mannitol, Group II was given water and Group III was given positive contrast. Assessments of bowel distention at various levels and mural enhancement of bowel were studied. Chisquare test was used as test of significance for qualitative data. ANOVA (Analysis of Variance was the test of significance for quantitative data. Results: Bowel distention was excellent in mannitol compared to water and positive contrast. Wall enhancement and mural pattern was better appreciated with mannitol compared to other two contrast agents. Conclusion: Adequate bowel evaluation by CT requires an oral contrast agent which can cause maximal bowel distention, uniform intraluminal attenuation, increased contrast between intraluminal content and bowel wall with no artifacts and adverse effects. Mannitol has all the above characteristic and can be used as ideal neutral oral contrast agent.

Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease.

Science.gov (United States)

Peters, S L; Muir, J G; Gibson, P R

2015-06-01

Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD). To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD. A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed. Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials. Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required. © 2015 John Wiley & Sons Ltd.

Bowel injury following gynecological laparoscopic surgery.

African Journals Online (AJOL)

Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatment. ... cluding less post-operative pain, earlier return of normal bowel function, shorter hospital ... and presence of previous abdominal surgery increase the risk of bowel ...

Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis.

Science.gov (United States)

Seyer-Hansen, Mikkel; Egekvist, Anne; Forman, Axel; Riiskjaer, Mads

2018-01-01

Women with endometriosis often experience pain and infertility. Medical treatment interferes with the possibility of attaining pregnancy. For infertile women with endometriosis, surgery is a possible treatment, but with advanced disease there is an increased risk of serious complications. With only limited pain, women will often be referred for in vitro fertilization treatment instead. The disease is estrogen-dependent and during in vitro fertilization treatment the women could theoretically experience worsening of their symptoms. The study is a retrospective cohort study of 76 women with bowel endometriosis who were treated conservatively and underwent in vitro fertilization treatment. Nine (11.8%) of the women experienced severe worsening of their bowel-related symptoms, including two patients presenting with colon ileus. One additional woman had no previous diagnosis of endometriosis before she presented with subocclusion of the bowel during in vitro fertilization. In all cases the in vitro fertilization treatment was stopped. Our study revealed that bowel endometriosis increases the risk of complications during in vitro fertilization treatment. This is in contrast to several publications. However, our study population is different due to the fact that none of these women had previous operations for bowel endometriosis. In all, 88% of the women completed fertility treatment without need for surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Conservative management in ureteric hydronephrosis due to deep endometriosis: Could the levonorgestrel-intrauterine device be an option?

Science.gov (United States)

Simón, Elisa; Tejerizo, Álvaro; Muñoz, José Luis; Álvarez, Carmen; Marqueta, Laura; Jiménez, Jesús S

2017-07-01

Endometriosis can affect up to 10% of women of reproductive age, in a wide range of clinical presentations that vary from mild to severe or deep endometriosis. Deep endometriosis can affect the urinary tract in 1-5% to 15-25% cases. Even though deep endometriosis' surgeries are usually complex with higher rate of complications, conservative management is not always considered as an option because of its high failure rates. This paper describes two cases of deep endometriosis with ureteric involvement (hydronephrosis) treated conservatively with a double-pigtail stent plus a Levonorgestrel intrauterine device, after conservative surgery, who remained symptom free with no evidence of recurrence at 3 years follow-up, avoiding radical high-risk surgery. Impact statement Several treatments have been described for endometriosis. From a symptomatic perspective, conservative medical management has been proposed with a variable response. Concerning deep endometriosis (affecting the urinary or digestive tract), the definitive treatment has always been thought to be radical surgery. However, this can lead to several complications. To illustrate a possible more conservative approach this paper describes two cases of deep infiltrating endometriosis affecting the ureter, treated conservatively with a temporary pigtail ureter stent plus a Levonorgestrel intrauterine device. The management demonstrates that, in a selected population, conservative treatment solves the urinary disease avoiding the surgical complications and, what is more, improving patients' symptoms in a permanent way. Further prospective studies are needed to confirm whether the introduction of this management in clinical practice would reduce the need for surgery thereby, avoiding high-risk surgery and improving the success rate of conservative management.

Accuracy of abdominal auscultation for bowel obstruction

DEFF Research Database (Denmark)

Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas

2015-01-01

AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were process...

Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

Energy Technology Data Exchange (ETDEWEB)

Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen (Germany); Schneemann, Hubert [Institute of Pharmacy and Pharmaceutical Sciences, University Hospital Essen, Essen (Germany)

2004-03-01

The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

International Nuclear Information System (INIS)

Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C.; Schneemann, Hubert

2004-01-01

The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

Using landscape limnology to classify freshwater ecosystems for multi-ecosystem management and conservation

Science.gov (United States)

Soranno, Patricia A.; Cheruvelil, Kendra Spence; Webster, Katherine E.; Bremigan, Mary T.; Wagner, Tyler; Stow, Craig A.

2010-01-01

Governmental entities are responsible for managing and conserving large numbers of lake, river, and wetland ecosystems that can be addressed only rarely on a case-by-case basis. We present a system for predictive classification modeling, grounded in the theoretical foundation of landscape limnology, that creates a tractable number of ecosystem classes to which management actions may be tailored. We demonstrate our system by applying two types of predictive classification modeling approaches to develop nutrient criteria for eutrophication management in 1998 north temperate lakes. Our predictive classification system promotes the effective management of multiple ecosystems across broad geographic scales by explicitly connecting management and conservation goals to the classification modeling approach, considering multiple spatial scales as drivers of ecosystem dynamics, and acknowledging the hierarchical structure of freshwater ecosystems. Such a system is critical for adaptive management of complex mosaics of freshwater ecosystems and for balancing competing needs for ecosystem services in a changing world.

The functional outcome of blow-out fractures managed surgically and conservatively

DEFF Research Database (Denmark)

Felding, Ulrik Ascanius; Rasmussen, Janne; Toft, Peter Bjerre

2016-01-01

of diplopia and enophthalmus was determined by reviewing the medical records. Data from the patients' initial consultation and their 3-month follow-up were also collected. Of the 60 patients whose data could be analysed, 36 had been managed surgically and 24 conservatively. Of the patients managed surgically......, 25 had diplopia in peripheral gaze before surgery and 12 at 3-month follow-up. Nine had diplopia in primary gaze before surgery and none at 3-month follow-up. Five had enophthalmus before surgery and two at 3-month follow-up. Of the patients managed conservatively, eight had diplopia in peripheral...... gaze initially and seven at 3-month follow-up. Three had diplopia in primary gaze initially and one at 3-month follow-up. One had enophthalmus initially which was still present at 3-month follow-up. Primary gaze diplopia disappeared while secondary gaze diplopia was present in about a third of patients...

Small Bowel Review: Part I

Directory of Open Access Journals (Sweden)

ABR Thomson

2000-01-01

Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

Small Bowel Review: Part II

Directory of Open Access Journals (Sweden)

ABR Thomson

2001-01-01

Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 1500 papers were assessed. Some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

Review article: The clinical importance of growth in children with inflammatory bowel disease: is it important to the gastroenterologist?

NARCIS (Netherlands)

Taminiau, J. A.

2007-01-01

Growth in children with inflammatory bowel disease is often compromised. To explore the origins of growth retardation in paediatric inflammatory bowel disease and to consider management strategies. Relevant literature was identified and reviewed. A combination of the following factors results in

Load building versus conservation as demand-side management objectives

International Nuclear Information System (INIS)

Kexel, D.T.

1994-01-01

This paper examines the economics of load building versus conservation as demand-side management objectives. Economic criteria to be used in evaluating each type of program from the perspectives of all impacted parties are provided. The impact of DSM programs on electric rates is shown to be a key focal point of a thorough evaluation

Inflammatory bowel disease at the korle bu teaching hospital, accra.

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Nkrumah, Kn

2008-03-01

SummaryCase files of patients with Inflammatory Bowel Disease (IBD) managed by the author in the Medical Department over the period 1997 - 2004 have been reviewed to identify some features of the disease that may aid improved diagnosis and management. The findings indicate that IBD may not be rare in the country and that there is usually a long delay in establishing the diagnosis. It appears that, in Ghana, more males than females are affected and that most are fifty years of age or below. Malignant colonic change is uncommon but there is a high default rate among the patients. Five patients (29%) died. Cases managed in an Arab country, between 1987 and 1996, have been compared. In that group more female than male patients were affected but the commonest age group affected was similar. The diagnosis was similarly delayed but no deaths were recorded as opposed to the Ghana patients. Since Inflammatory Bowel Disease (IBD) is a potentially treatable condition medical practitioners need increased awareness to avoid undue delay in diagnosis.

Bowel vaginoplasty in children

Directory of Open Access Journals (Sweden)

Sarin Yogesh

2006-01-01

Full Text Available OBJECTIVES: To describe our experience with bowel vaginoplasty done in children. MATERIALS AND METHODS: This is a retrospective study of eight children aged 10 months to 8 years, who underwent bowel vaginoplasty over a period of 5 years (2000-2005. The indications of bowel vaginoplasty included anorectovestibular fistula (ARVF associated with Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome (n=6 and cloaca (n=2. The bowel segment used for vaginoplasty included colon (n=3, ileum (n=2 and duplicated rectum (n=1. In two patients of ARVF associated with uterovaginal agenesis, the distal- most part of ARVF was transected at the level of peritoneal reflection and left as neovagina, whereas the proximal bowel was pulled through at the proposed neo-anal site. All the patients were advised daily home dilatation of the neo vaginal orifice with Hegar′s dilators, for a period of six weeks. RESULTS: Bowel vaginoplasty was done in eight patients. None had any significant per-operative complication. Two patients had abdominal wound dehiscence, requiring secondary suturing. Two patients had mucosal prolapse of the neovagina, which required trimming. One patient died two months after discharge, because of meningitis. Out of the eight patients, seven are in regular follow-up. Six patients have neovagina, cosmetically acceptable to the parents; all have been radiologically proven to have adequate length. One patient had unacceptable perineal appearance with nipple-like vaginal orifice and scarred perineal wound, that merits a revision. None of the patients had vaginal stenosis and excessive mucus discharge, during follow-up visits. Although post surgical results are acceptable to the parents cosmetically, the sexual and psychological outcome is yet to be assessed. Conclusions: Bowel vaginoplasty is a safe and acceptable procedure to treat the pediatric patients of uterovaginal agenesis and cloaca.

Administrative Co-management: The Case of Special-Use Forest Conservation in Vietnam

NARCIS (Netherlands)

Nguyen, T.K.D.; Bush, S.R.; Mol, A.P.J.

2013-01-01

Special-use forests (SUFs) are nature protected areas in Vietnam used to conserve nature and its biodiversity. While the Vietnamese government has managed to increase the size and number of SUFs, biodiversity within these areas continues to decline. To improve protection of these SUFs, co-management

Accuracy of abdominal auscultation for bowel obstruction.

Science.gov (United States)

Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge

2015-09-14

To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

Impact of psychological stress on irritable bowel syndrome.

Science.gov (United States)

Qin, Hong-Yan; Cheng, Chung-Wah; Tang, Xu-Dong; Bian, Zhao-Xiang

2014-10-21

Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain. In the present review we discuss the potential role of psychological stress in the pathogenesis of IBS and provide comprehensive approaches in clinical treatment. Evidence from clinical and experimental studies showed that psychological stresses have marked impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alterations in central nervous system, peripheral neurons and gastrointestinal microbiota. Stress-induced alterations in neuro-endocrine-immune pathways acts on the gut-brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in IBS. IBS is a stress-sensitive disorder, therefore, the treatment of IBS should focus on managing stress and stress-induced responses. Now, non-pharmacological approaches and pharmacological strategies that target on stress-related alterations, such as antidepressants, antipsychotics, miscellaneous agents, 5-HT synthesis inhibitors, selective 5-HT reuptake inhibitors, and specific 5-HT receptor antagonists or agonists have shown a critical role in IBS management. A integrative approach for IBS management is a necessary.

Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China.

Science.gov (United States)

Qu, Yi; Lu, Ming

2018-01-01

Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES) and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP) methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km 2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups ( p -values between groups urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

Using in situ management to conserve biodiversity under climate change.

Science.gov (United States)

Greenwood, Owen; Mossman, Hannah L; Suggitt, Andrew J; Curtis, Robin J; Maclean, Ilya M D

2016-06-01

Successful conservation will increasingly depend on our ability to help species cope with climate change. While there has been much attention on accommodating or assisting range shifts, less has been given to the alternative strategy of helping species survive climate change through in situ management.Here we provide a synthesis of published evidence examining whether habitat management can be used to offset the adverse impacts on biodiversity of changes in temperature, water availability and sea-level rise. Our focus is on practical methods whereby the local environmental conditions experienced by organisms can be made more suitable.Many studies suggest that manipulating vegetation structure can alter the temperature and moisture conditions experienced by organisms, and several demonstrate that these altered conditions benefit species as regional climatic conditions become unsuitable. The effects of topography on local climatic conditions are even better understood, but the alteration of topography as a climate adaptation tool is not ingrained in conservation practice. Trials of topographic alteration in the field should therefore be a priority for future research.Coastal systems have the natural capacity to keep pace with climate change, but require sufficient sediment supplies and space for landward migration to do so. There is an extensive literature on managed realignment. While the underlying rationale is simple, successful implementation requires careful consideration of elevation and past land use. Even with careful management, restored habitats may not attain the physical and biological attributes of natural habitats. Synthesis and applications . The recent literature provides a compelling case that some of the adverse effects of climate change can be offset by appropriate management. However, much of the evidence for this is indirect and too few studies provide empirical tests of the long-term effectiveness of these management interventions. It is clear

Incentives for biodiversity conservation beyond the best management practices: are forestland owners interested

Science.gov (United States)

Jagannadha R. Matta; Janaki R. R. Alavalapati; D. Evan Mercer

2009-01-01

With the growing recognition of the role of environmental services rendered by private lands, landowner involvement has become a critical component of landscape-level strategies to conserve biodiversity. In this paper, we examine the willingness of private forest owners to participate in a conservation program that requires adopting management regimes beyond...

Dealing with Drought: Decoupling Climatic and Management-Related Drivers of Water Conservation Behavior

Science.gov (United States)

Hemati, A.; Rippy, M.; Grant, S. B.

2015-12-01

As global populations grow, cities in drought prone regions of the world such as California and South East Australia are faced with escalating water scarcity and water security challenges. The management approaches geared towards addressing these challenges are diverse. Given the myriad of possible approaches and the tendency to apply them in combination, successful management actions can be difficult to identify. Background climactic variability further complicates the story, making transfer of management lessons from one drought stressed region to another difficult. Here we use Melbourne, a city of 4.3 million people in South East Australia that recently faced and overcame a > 10 year "Millennium" drought, as a test case for evaluating the relative importance of various management-related and climactic factors in driving reductions in municipal water consumption (~60% in 12 years). Our analysis suggests that Melbourne's declining municipal consumption cannot be explained by potable substitution alone, as reductions in municipal consumption were not matched by increased use of alternative sources (e.g., urban rain or recycled water). Thus, water conservation behavior (not source switching) may be responsible for the majority of demand reduction in Melbourne. Interestingly, while voluntary or mandatory water restrictions appear to have substantially altered the rate of change of consumption near the end of Melbourne's Millennium drought (e.g., forcing a period of intense conservation), overall conservation behavior precedes these restrictions. This suggests that other rapidly implemented (and hither too unquantified) management approaches such as advertising or newspapers may have driven water conservation behavior early in the drought. Climatic factors, particularly precipitation may also have influenced conservation behavior; changes in precipitation were significantly positively correlated with changes in water consumption at a lag of 18 months. Similar

Evaluation of conservation-oriented management on grayish brown soil

Directory of Open Access Journals (Sweden)

Consuelo E. Hernández Rodríguez

2015-03-01

Full Text Available Conservation and improvement actions were taken to ensure the soil preservation in agricultural areas affected by erosion on a grayish brown soil of Sarduy farm in Cumanayagua, Cuba. The technology that was used included strip-till, crop rotation, live and/or dead barriers, channel terraces, contour farming and the addition of organic matter and biofertilizers. The implementation of the soil conservation-oriented management had an influence on the yield increase of 10.6% - 20.2%, on the decrease of the erosive processes with a retention of soils to 13.33 t.ha -1, on maintaining the soil pH and on the increment of the assimilable P2O5 contents and soil organic matter.

Bowel injury following gynecological laparoscopic surgery.

African Journals Online (AJOL)

nique did not reduce bowel injuries.6 Majority of gyne- .... showed (A-B) distended small bowel loops (yellow arrows) and an incarcerated bowel loop in one of the ... intolerance of oral intake, bloating, nausea, fever or diar- ..... Strategies in.

Studying citizen science through adaptive management and learning feedbacks as mechanisms for improving conservation.

Science.gov (United States)

Jordan, Rebecca; Gray, Steven; Sorensen, Amanda; Newman, Greg; Mellor, David; Newman, Greg; Hmelo-Silver, Cindy; LaDeau, Shannon; Biehler, Dawn; Crall, Alycia

2016-06-01

Citizen science has generated a growing interest among scientists and community groups, and citizen science programs have been created specifically for conservation. We examined collaborative science, a highly interactive form of citizen science, which we developed within a theoretically informed framework. In this essay, we focused on 2 aspects of our framework: social learning and adaptive management. Social learning, in contrast to individual-based learning, stresses collaborative and generative insight making and is well-suited for adaptive management. Adaptive-management integrates feedback loops that are informed by what is learned and is guided by iterative decision making. Participants engaged in citizen science are able to add to what they are learning through primary data collection, which can result in the real-time information that is often necessary for conservation. Our work is particularly timely because research publications consistently report a lack of established frameworks and evaluation plans to address the extent of conservation outcomes in citizen science. To illustrate how our framework supports conservation through citizen science, we examined how 2 programs enacted our collaborative science framework. Further, we inspected preliminary conservation outcomes of our case-study programs. These programs, despite their recent implementation, are demonstrating promise with regard to positive conservation outcomes. To date, they are independently earning funds to support research, earning buy-in from local partners to engage in experimentation, and, in the absence of leading scientists, are collecting data to test ideas. We argue that this success is due to citizen scientists being organized around local issues and engaging in iterative, collaborative, and adaptive learning. © 2016 Society for Conservation Biology.

Outcomes of a conservative approach to management in amoebic liver abscess

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S Kale

2017-01-01

Full Text Available Context: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA. Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases. Aims: To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure. Settings and Design: A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011-2014 in India. Materials and Methods: Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM. Results: Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67% patients were managed conservatively, while 11 (18.33% patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P 7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA. Conclusions: A conservative approach is effective in the management of

A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VS. EXTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES

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Sanjeev Kumar Kare

2016-12-01

Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.

Customer Quality of Patients with Inflammatory Bowel Disease In Tabriz, 1391

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Roya Hasanzadeh

2015-08-01

Full Text Available Background and objectives: Customer Quality is one of the most important dimensions of quality in health care which refers to service receiver's knowledge, attitude and skills that play effective role in treatment process. This study is aimed at assessing customer quality score in patients with Inflammatory Bowel Disease in Tabriz city in 2012. Material and Methods: This is a cross-sectional study which was conducted with the participation of 94 Inflammatory Bowel Disease patients who referred to Tabriz Imam Reza Hospital and Golgasht clinic. Customer Quality was measured using a questionnaire with 19 items which its validity was confirmed by 10 experts and its reliability was reviewed using Cronbach's alpha index (α =0.78.  Obtained data were analyzed using SPSS17.   Results: The results illustrated that average score of customer quality among patients with inflammatory bowel disease is 70.63 (±9.67. All the participants achieved stage 1 scores of Customer Quality in self-management but only 11.7% reported highest customer quality score and were able to continue their self-care in high pressure circumstances such as stress and financial problems. Also, there was a significant relation between customer quality score and patient’s education (P-value=0.05, so that by having higher education level, the customer quality score was increased as well. Conclusion: The results of this study indicate that customer quality status in assessed patients with Inflammatory Bowel Disease is partially acceptable, but major problems in some areas are evident and require more attention of health care managers and policy makers. ​

Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases.

Science.gov (United States)

Yamashita, Hideomi; Nakagawa, Keiichi; Tago, Masao; Igaki, Hiroshi; Shiraishi, Kenshirou; Nakamura, Naoki; Sasano, Nakashi; Yamakawa, Sen; Ohtomo, Kuni

2006-04-01

We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.

The contribution of agent-based simulations to conservation management on a Natura 2000 site.

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Dupont, Hélène; Gourmelon, Françoise; Rouan, Mathias; Le Viol, Isabelle; Kerbiriou, Christian

2016-03-01

The conservation of biodiversity today must include the participation and support of local stakeholders. Natura 2000 can be considered as a conservation system that, in its application in most EU countries, relies on the participation of local stakeholders. Our study proposes a scientific method for participatory modelling, with the aim of contributing to the conservation management of habitats and species at a Natura 2000 site (Crozon Peninsula, Bretagne, France) that is representative of in landuse changes in coastal areas. We make use of companion modelling and its associated tools (scenario-planning, GIS, multi-agent modelling and simulations) to consider possible futures through the co-construction of management scenarios and the understanding of their consequences on different indicators of biodiversity status (habitats, avifauna, flora). The maintenance of human activities as they have been carried out since the creation of the Natura 2000s zone allows the biodiversity values to remain stable. Extensive agricultural activities have been shown to be essential to this maintenance, whereas management sustained by the multiplication of conservation actions brings about variable results according to the indicators. None of the scenarios has a positive incidence on the set of indicators. However, an understanding of the modelling system and the results of the simulations allow for the refining of the selection of conservation actions in relation to the species to be preserved. Copyright © 2015 Elsevier Ltd. All rights reserved.

Integration of environmental flow assessment and freshwater conservation planning: a new era in catchment management

CSIR Research Space (South Africa)

Nel, JL

2011-03-01

Full Text Available Integrated water resources management offers an ideal platform for addressing the goals of freshwater conservation and climate change adaptation. Environmental flow assessment and systematic conservation planning have evolved separately...

The comparative analyses of selected aspects of conservation and management of Vietnam’s national parks

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Le Thanh An

2018-01-01

Full Text Available The national parks in Vietnam are protected areas in the national system of special-use forests created to protect natural resources and biodiversity. In order to improve the effectiveness of management of national parks, the study assesses some current aspects of conservation and management of natural resources with respect to management plans, financial sources, staff, cooperative activities, causes of limited management capacity and threats to natural resources. Out of the total of 30 national parks, six are under the responsibility of the Vietnam Administration of Forestry (VNFOREST and 24 national parks are managed by provincial authorities. It was found that most of the national parks have updated their management plans. Financial sources of funding for national parks mainly originated from the central and provincial budgets, with an average of 51% and 76% respectively. Fifty percent of national parks spent 40–60% of their total funding on conservation activities. About 85% of national parks’ staff had academic degrees, typically in the fields of forestry, agriculture and fisheries. Biodiversity conservation was considered a priority cooperative action in national parks with scientific institutes. Major causes of a limited management capacity of national parks included human population growth and pressure associated with resources use, lack of funding, limited human and institutional capacity and land use conflict/land grab. Illegal hunting, trapping, poaching and fishing, the illegal wildlife trade, illegal logging and firewood collecting appeared to be the most serious threats to the conservation and management of natural resources. In addition to these results, significant differences were found between the VNFOREST and provincial parks in terms of financial sources, staff and the threat of illegal logging and firewood collecting. The authors’ findings offer useful information for national park planners and managers, as well as

Alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization

International Nuclear Information System (INIS)

Ai Songtao; Wang Xiaolin; Gong Gaoquan; Chen Yi; Lin Genlai; Zhang Feng; Li Guoping; Liu Lingxiao

2005-01-01

Objective: To explore alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization and provide academic basis for assessing bowel viability and management. Methods: Twenty normal rabbits were selected and divided into three groups (2 mg group, n=10; 6 mg group, n=5; control group, n=5). Members of 2 mg group were embolized with PVA 2 mg, those of 6 mg group with PVA 6 mg, and the control group with normal saline 2 ml. After microcatherization embolization, myoelectric activity of the small bowel was recorded for 24 hr using chronically implanted electrodes in conscious rabbits. Results: In 2 mg group, the frequency and the amplitude of slow wave of proximal jejunum were significantly lower in post-embolization period than pre-embolization period [(17.83±0.55) cpm vs (11.59±0.23) cpm(P 0.05) and (0.1632±0.002) mV vs (0.1606±0.003) mV (P>0.05), respectively]. Conclusions: Embolization with PVA evokes significant and passive effect on basal electrical rhythm of small bowel. It could provide academic basis for assessing bowel viability to interventional embolization. (authors)

Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study.

Science.gov (United States)

Seo, Eun Hee; Kim, Tae Oh; Park, Min Jae; Joo, Hee Rin; Heo, Nae Yun; Park, Jongha; Park, Seung Ha; Yang, Sung Yeon; Moon, Young Soo

2012-03-01

Several factors influence bowel preparation quality. Recent studies have indicated that the time interval between bowel preparation and the start of colonoscopy is also important in determining bowel preparation quality. To evaluate the influence of the preparation-to-colonoscopy (PC) interval (the interval of time between the last polyethylene glycol dose ingestion and the start of the colonoscopy) on bowel preparation quality in the split-dose method for colonoscopy. Prospective observational study. University medical center. A total of 366 consecutive outpatients undergoing colonoscopy. Split-dose bowel preparation and colonoscopy. The quality of bowel preparation was assessed by using the Ottawa Bowel Preparation Scale according to the PC interval, and other factors that might influence bowel preparation quality were analyzed. Colonoscopies with a PC interval of 3 to 5 hours had the best bowel preparation quality score in the whole, right, mid, and rectosigmoid colon according to the Ottawa Bowel Preparation Scale. In multivariate analysis, the PC interval (odds ratio [OR] 1.85; 95% CI, 1.18-2.86), the amount of PEG ingested (OR 4.34; 95% CI, 1.08-16.66), and compliance with diet instructions (OR 2.22l 95% CI, 1.33-3.70) were significant contributors to satisfactory bowel preparation. Nonrandomized controlled, single-center trial. The optimal time interval between the last dose of the agent and the start of colonoscopy is one of the important factors to determine satisfactory bowel preparation quality in split-dose polyethylene glycol bowel preparation. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

MRI for chronic inflammatory bowel disease

International Nuclear Information System (INIS)

Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M.; Elsing, C.

2001-01-01

Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T 1 -weighted gradient echo and T 2 -weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.) [de

Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts.

Science.gov (United States)

Calabrese, Emma; Maaser, Christian; Zorzi, Francesca; Kannengiesser, Klaus; Hanauer, Stephen B; Bruining, David H; Iacucci, Marietta; Maconi, Giovanni; Novak, Kerri L; Panaccione, Remo; Strobel, Deike; Wilson, Stephanie R; Watanabe, Mamoru; Pallone, Francesco; Ghosh, Subrata

2016-05-01

Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use. Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English. The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent. Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.

Primary malignant small bowel tumor

Energy Technology Data Exchange (ETDEWEB)

Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk [Kosin College, Pusan (Korea, Republic of)

1990-07-15

Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings.

Primary malignant small bowel tumor

International Nuclear Information System (INIS)

Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk

1990-01-01

Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings

Biomarkers as Potential Treatment Targets in Inflammatory Bowel Disease: A Systematic Review

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Travis B Murdoch

2015-01-01

Full Text Available There is increasing interest in the concept of ‘treat-to-target’ in inflammatory bowel disease as a mechanism to standardize management and prevent complications. While clinical, radiographic and endoscopic treatment end points will figure prominently in this promising management paradigm, the role that noninvasive biomarkers will play is currently undefined. The goal of the present systematic review was to investigate the potential value of biomarkers as treatment targets in inflammatory bowel disease, with particular focus on those best studied: serum C-reactive protein (CRP and fecal calprotectin. In Crohn disease, elevated CRP levels at baseline predict response to anti-tumour necrosis factor agents, and normalization is usually associated with clinical and endoscopic remission. CRP and hemoglobin levels can be used to help predict clinical relapse in the context of withdrawal of therapy. Ultimately, the authors conclude that currently available biomarkers should not be used as treatment targets in inflammatory bowel disease because they have inadequate operational characteristics to make them safe surrogates for clinical, endoscopic and radiographic evaluation. However, CRP and fecal calprotectin are important adjunctive measures that help alert the clinician to pursue further investigation.

Transabdominal Ultrasonography of the Small Bowel

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Rudolf Kralik

2013-01-01

Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

Developing a conservation strategy to maximize persistence of an endangered freshwater mussel species while considering management effectiveness and cost

Science.gov (United States)

Smith, David R.; McRae, Sarah E.; Augspurger, Tom; Ratcliffe, Judith A.; Nichols, Robert B.; Eads, Chris B.; Savidge, Tim; Bogan, Arthur E.

2015-01-01

We used a structured decision-making process to develop conservation strategies to increase persistence of Dwarf Wedgemussel (Alasmidonta heterodon) in North Carolina, USA, while accounting for uncertainty in management effectiveness and considering costs. Alternative conservation strategies were portfolios of management actions that differed by location of management actions on the landscape. Objectives of the conservation strategy were to maximize species persistence, maintain genetic diversity, maximize public support, and minimize management costs. We compared 4 conservation strategies: 1) the ‘status quo’ strategy represented current management, 2) the ‘protect the best’ strategy focused on protecting the best populations in the Tar River basin, 3) the ‘expand the distribution’ strategy focused on management of extant populations and establishment of new populations in the Neuse River basin, and 4) the ‘hybrid’ strategy combined elements of each strategy to balance conservation in the Tar and Neuse River basins. A population model informed requirements for population management, and experts projected performance of alternative strategies over a 20-y period. The optimal strategy depended on the relative value placed on competing objectives, which can vary among stakeholders. The protect the best and hybrid strategies were optimal across a wide range of relative values with 2 exceptions: 1) if minimizing management cost was of overriding concern, then status quo was optimal, or 2) if maximizing population persistence in the Neuse River basin was emphasized, then expand the distribution strategy was optimal. The optimal strategy was robust to uncertainty in management effectiveness. Overall, the structured decision process can help identify the most promising strategies for endangered species conservation that maximize conservation benefit given the constraint of limited funding.

Assessing the components of adaptive capacity to improve conservation and management efforts under global change

Science.gov (United States)

Nicotra, Adrienne; Beever, Erik; Robertson, Amanda; Hofmann, Gretchen; O’Leary, John

2015-01-01

Natural-resource managers and other conservation practitioners are under unprecedented pressure to categorize and quantify the vulnerability of natural systems based on assessment of the exposure, sensitivity, and adaptive capacity of species to climate change. Despite the urgent need for these assessments, neither the theoretical basis of adaptive capacity nor the practical issues underlying its quantification has been articulated in a manner that is directly applicable to natural-resource management. Both are critical for researchers, managers, and other conservation practitioners to develop reliable strategies for assessing adaptive capacity. Drawing from principles of classical and contemporary research and examples from terrestrial, marine, plant, and animal systems, we examined broadly the theory behind the concept of adaptive capacity. We then considered how interdisciplinary, trait- and triage-based approaches encompassing the oft-overlooked interactions among components of adaptive capacity can be used to identify species and populations likely to have higher (or lower) adaptive capacity. We identified the challenges and value of such endeavors and argue for a concerted interdisciplinary research approach that combines ecology, ecological genetics, and eco-physiology to reflect the interacting components of adaptive capacity. We aimed to provide a basis for constructive discussion between natural-resource managers and researchers, discussions urgently needed to identify research directions that will deliver answers to real-world questions facing resource managers, other conservation practitioners, and policy makers. Directing research to both seek general patterns and identify ways to facilitate adaptive capacity of key species and populations within species, will enable conservation ecologists and resource managers to maximize returns on research and management investment and arrive at novel and dynamic management and policy decisions.

Functional bowel disease

DEFF Research Database (Denmark)

Rumessen, J J; Gudmand-Høyer, E

1988-01-01

Twenty-five patients with functional bowel disease were given fructose, sorbitol, fructose-sorbitol mixtures, and sucrose. The occurrence of malabsorption was evaluated by means of hydrogen breath tests and the gastrointestinal symptoms, if any, were recorded. One patient could not be evaluated...... because of lack of H2 production. Based on a cut-off level of 10 ppm rise of H2 concentration, malabsorption was apparent in 13 patients, in 7 of which the calculated absorption capacities were below 15 g. In contrast, in patients given 50 g of sucrose, malabsorption could not be detected. Ingestion...... with functional bowel disease. The findings may have direct influence on the dietary guidance given to a major group of patients with functional bowel disease and may make it possible to define separate entities in this disease complex....

Bowel Endometriosis Syndrome

DEFF Research Database (Denmark)

Riiskjær, M; Egekvist, A G; Hartwell, D

2017-01-01

STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect...... of medical and surgical treatment of women suffering from bowel endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems...... are mainly based on anatomical and surgical findings. STUDY DESIGN, SIZE, DURATION: The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. PARTICIPANTS/MATERIALS, SETTING AND METHODS...

Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.

Science.gov (United States)

Frohwein, S; Ververis, J J; Marshall, J J

1995-04-01

Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.

Small bowel obstruction secondary to migration of a fragment of lithobezoar: a case report.

LENUS (Irish Health Repository)

Medani, Mekki

2009-01-01

INTRODUCTION: Small bowel obstruction is a common world-wide condition that has a range of etiological factors. The management is largely dependent on the cause of the obstruction. Small bowel obstruction caused by foreign body ingestion is rare; many items have been reported as responsible, but there are no reports implicating polyurethane foam. CASE PRESENTATION: We report the case of a 44-year-old Irish male who presented following ingestion of polyurethane foam. He was asymptomatic on presentation but developed a small bowel obstruction shortly thereafter. CONCLUSION: Patients presenting following ingestion of polyurethane foam should be scheduled for elective laparotomy, gastrotomy, and retrieval of the cast on the next available theatre list - given that they are suitable for surgery.

Government conservation policies on Mexican coastal areas: is "top-down" management working?

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Héctor Nava

2011-12-01

Full Text Available Marine and terrestrial ecosystems are declining globally due to environmental degradation and poorly planned resource use. Traditionally, local government agencies have been responsible of the management of natural reserves to preserve biodiversity. Nonetheless, much of these approaches have failed, suggesting the development of more integrative strategies. In order to discuss the importance of a holistic approach in conservation initiatives, coastal and underwater landscape value and biological/environmental indicators of coral reef degradation were assessed using the study case of Zihuatanejo, Guerrero coastal area. This area shelters representative coral reef structures of the Eastern Pacific coast and its terrestrial biodiversity and archaeology enhance the high value of its coastal area. This study explored the landscape value of both terrestrial and marine ecosystems using the geomorphosite approach in two sites on the Zihuatanejo coastal area: Caleta de Chon and Manzanillo Beach. Sedimentation rate, water transparency, chlorophyll and total suspended solids were recorded underwater in each site for environmental characterization. 50 photo-quadrants on five transects were surveyed between 3-4m depth to record coverage (% of living corals, dead corals, algae, sand and rocks. The conservation status of coral reefs was assessed by the coral mortality index (MI. Landscape values showed that both terrestrial and marine ecosystems had important scientific and aesthetic values, being Manzanillo Beach the site with the highest potential for conservation initiatives (TtV=14.2. However, coral reefs face elevated sedimentation rates (up to 1.16kg/m2d and low water transparency (less of 5m generated by coastal land use changes that have increased soil erosion in the adjacent coastal area. High coverage of dead corals (23.6% and algae (up to 29% confirm the low values in conservation status of coral reefs (MI=0.5, reflecting a poorly-planned management

Pacific Canada's Rockfish Conservation Areas: using Ostrom's design principles to assess management effectiveness

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Darienne Lancaster

2015-09-01

Full Text Available International declines in marine biodiversity have lead to the creation of marine protected areas and fishery reserve systems. In Canada, 164 Rockfish Conservation Areas (RCAs were implemented between 2003 and 2007 and now cover 4847.2 km² of ocean. These reserves were created in response to widespread concern from fishers and nongovernmental organizations about inshore rockfish (genus Sebastes population declines. We used the design principles for effective common-pool resource management systems, originally developed by Elinor Ostrom, to assess the social and ecological effectiveness of these conservation areas more than 10 years after their initial implementation. We assessed the relative presence or absence of each design principle within current RCA management. We found that 2 of the 11 design principles were moderately present in the recreational fishery. All other design principles were lacking for the recreational sector. We found that 2 design principles were fully present and 5 were moderately present in the commercial sector. Four design principles were lacking in the commercial sector. Based on this analysis, we highlight 4 main areas for management improvement: (1 create an education and outreach campaign to explain RCA rules, regulations, boundaries, and the need for marine conservation; (2 increase monitoring of users and resources to discourage noncompliance and gather the necessary data to create social buy-in for marine conservation; (3 encourage informal nested governance through stakeholder organizations for education and self-regulation (e.g. fisher to fisher; and (4 most importantly, create a formal, decadal RCA review process to gather stakeholder input and make amendments to regulations and RCA boundaries. This information can be used to inform spatial management systems both in Canada and internationally. This analysis also contributes to a growing literature on effectively scaling up small-scale management techniques

WLCI researchers employ new approaches to help managers conserve deer migrations

Science.gov (United States)

Allen, Leslie A.; Kauffman, Matthew J.

2012-01-01

Elk, mule deer, pronghorn antelope, moose, and bighorn sheep are iconic animals of the American West. These hooved animals, known as ungulates, commonly travel 30–60 miles between seasonal ranges. These migrations between winter and summer ranges are vital for survival and reproduction. As habitat fragmentation continues, the conservation of ungulate migration routes has received considerable attention in the West and across the globe. For example, it is estimated that many ungulate migration routes in the Greater Yellowstone Ecosystem have already been lost. The traditional migration routes of Wyoming ungulates are threatened by unprecedented levels of energy development and by increasing levels of rural ranchette development (including fences, structures, and roads). In the past, migration corridors have been mapped based primarily on the expert opinions of state game managers, but long-term conservation of Wyoming's ungulate migration routes requires a better understanding of migration ecology and more sophisticated management tools. Wyoming Landscape Conservation Initiative (WLCI) researchers investigated the migration of a large mule deer herd across the Dad and Wild Horse winter ranges in southwest Wyoming, where 2,000 gas wells and 1,609 kilometers of pipelines and roads have been proposed for development.

Building Virtual Watersheds: A Global Opportunity to Strengthen Resource Management and Conservation

Science.gov (United States)

Benda, Lee; Miller, Daniel; Barquin, Jose; McCleary, Richard; Cai, TiJiu; Ji, Y.

2016-03-01

Modern land-use planning and conservation strategies at landscape to country scales worldwide require complete and accurate digital representations of river networks, encompassing all channels including the smallest headwaters. The digital river networks, integrated with widely available digital elevation models, also need to have analytical capabilities to support resource management and conservation, including attributing river segments with key stream and watershed data, characterizing topography to identify landforms, discretizing land uses at scales necessary to identify human-environment interactions, and connecting channels downstream and upstream, and to terrestrial environments. We investigate the completeness and analytical capabilities of national to regional scale digital river networks that are available in five countries: Canada, China, Russia, Spain, and United States using actual resource management and conservation projects involving 12 university, agency, and NGO organizations. In addition, we review one pan-European and one global digital river network. Based on our analysis, we conclude that the majority of the regional, national, and global scale digital river networks in our sample lack in network completeness, analytical capabilities or both. To address this limitation, we outline a general framework to build as complete as possible digital river networks and to integrate them with available digital elevation models to create robust analytical capabilities (e.g., virtual watersheds). We believe this presents a global opportunity for in-country agencies, or international players, to support creation of virtual watersheds to increase environmental problem solving, broaden access to the watershed sciences, and strengthen resource management and conservation in countries worldwide.

Is the disease course predictable in inflammatory bowel diseases?

Science.gov (United States)

Lakatos, Peter Laszlo; Kiss, Lajos S

2010-01-01

During the course of the disease, most patients with Crohn’s disease (CD) may eventually develop a stricturing or a perforating complication, and a significant number of patients with both CD and ulcerative colitis will undergo surgery. In recent years, research has focused on the determination of factors important in the prediction of disease course in inflammatory bowel diseases to improve stratification of patients, identify individual patient profiles, including clinical, laboratory and molecular markers, which hopefully will allow physicians to choose the most appropriate management in terms of therapy and intensity of follow-up. This review summarizes the available evidence on clinical, endoscopic variables and biomarkers in the prediction of short and long-term outcome in patients with inflammatory bowel diseases. PMID:20518079

Multidisciplinary conservative management in classical Volkmann's contracture: A case report

NARCIS (Netherlands)

Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.

1996-01-01

This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is

Lack of effectiveness of primary conservative management for infants with brachial plexus birth palsy.

Science.gov (United States)

Bialocerkowski, Andrea Emmi; Vladusic, Sharon; Moore, Rosemary Patricia

Brachial plexus birth palsy (BPBP) is the most common peripheral nerve injury in children (prevalence microsurgical repair of the brachial plexus, surgical management of secondary deformities or received other treatments traditionally delivered by surgeons, such as Botulinum toxin injections. The eligibility of each study identified from the database searches was evaluated against the inclusion criteria by two independent reviewers. These studies were then critically appraised for level of evidence using the National Health and Medical Research Council of Australia Hierarchy of Evidence and methodological quality using the Critical Review Form - Quantitative Studies. Data pertaining to the demographic characteristics of study participants, treatments received, main results and outcome measures used were also extracted. Where any disagreement between reviewers occurred, consensus was reached by discussion. Data from the recently published studies were narratively synthesised and then combined with the data gained from our previous systematic review to create a body of evidence on primary conservative management for BPBP infants. Four publications, representing three studies (one comparative study, two case series), were sourced. Methodological quality scores of these studies ranged from 6 to 12 (maximum =16). The current body of evidence (publications from 1992 to 2008) therefore comprises 11 studies, four using a comparative design and seven using a case series design. Six of the 11 studies were classified as being of "poor" methodological quality (score <8). Conservative management mainly consisted of exercise therapy, although splinting, massage and dynamic traction were also used. All studies lacked a clear definition of conservative management sufficient to allow replication of the treatment in a clinical setting. A variety of outcome measures were used, limiting comparability of the studies. Data from the three case studies suggests that conservative

Conservatively managed pineal apoplexy in an anticoagulated patient

International Nuclear Information System (INIS)

Werder, Gabriel M.; Razdan, Rahul S.; Gagliardi, Joseph A.; Chaddha, Shashi K.B.

2008-01-01

We present a case of pineal apoplexy in an anticoagulated and hypertensive 56-year-old Hispanic male. At presentation, the patient's international normalized ratio (INR) was 10.51 and his blood pressure was 200/130 mmHg. His presenting symptoms included acute onset of headache, chest pain, nausea, vomiting, vertigo, and visual disturbance. Neuroimaging demonstrated hemorrhage into a morphologically normal pineal gland. Under conservative management, the patient experienced gradual resolution of all symptoms excluding the disturbance of upward gaze

77 FR 16942 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

Science.gov (United States)

2012-03-23

... Multispecies Fishery Management Plan which was approved on March 8, 2012. This action amends the Northeast Multispecies Fishery Management Plan to explicitly define and facilitate the effective operation of state.... 110901552-20494-02] RIN 0648-BB34 Magnuson-Stevens Fishery Conservation and Management Act Provisions...

76 FR 56985 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

Science.gov (United States)

2011-09-15

... to estimate total haddock catch by the herring midwater trawl fleet in these herring management areas.... 110627355-1539-02] RIN 0648-BB08 Magnuson-Stevens Fishery Conservation and Management Act Provisions... the NE Multispecies Fishery Management Plan (FMP), which increases the haddock incidental catch cap...

Biodiversity conservation and indigenous land management in the era of self-determination.

Science.gov (United States)

Schmidt, Paige M; Peterson, Markus J

2009-12-01

Indigenous people inhabit approximately 85% of areas designated for biodiversity conservation worldwide. They also continue to struggle for recognition and preservation of cultural identities, lifestyles, and livelihoods--a struggle contingent on control and protection of traditional lands and associated natural resources (hereafter, self-determination). Indigenous lands and the biodiversity they support are increasingly threatened because of human population growth and per capita consumption. Application of the Endangered Species Act (ESA) to tribal lands in the United States provides a rich example of the articulation between biodiversity conservation and indigenous peoples' struggle for self-determination. We found a paradoxical relationship whereby tribal governments are simultaneously and contradictory sovereign nations; yet their communities depend on the U.S. government for protection through the federal-trust doctrine. The unique legal status of tribal lands, their importance for conserving federally protected species, and federal environmental regulations' failure to define applicability to tribal lands creates conflict between tribal sovereignty, self-determination, and constitutional authority. We reviewed Secretarial Order 3206, the U.S. policy on "American Indian tribal rights, federal-tribal trust responsibilities, and the ESA," and evaluated how it influences ESA implementation on tribal lands. We found improved biodiversity conservation and tribal self-determination requires revision of the fiduciary relationship between the federal government and the tribes to establish clear, legal definitions regarding land rights, applicability of environmental laws, and financial responsibilities. Such actions will allow provision of adequate funding and training to tribal leaders and resource managers, government agency personnel responsible for biodiversity conservation and land management, and environmental policy makers. Increased capacity, cooperation, and

Cross-cultural and psychological issues in irritable bowel syndrome.

Science.gov (United States)

Sahoo, Swapnajeet; Padhy, Susanta Kumar

2017-10-01

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders encountered by gastroenterologists worldwide. Of all the etiological factors that had been postulated to explain the pathophysiology of IBS, cultural and psychological factors are unique and difficult to understand. Culture plays an important role in coloring the presentation of IBS, and many a times, it has a significant role in several treatment aspects too. Psychological aspects like personality profiles, family relationships, societal myths, and abuse in any form are equally important in the management perspectives of IBS. In this brief review, we had tried to specifically focus on these aspects in IBS and have explained the evidences in favor of these factors. Knowledge about various cross-cultural aspects and psychological factors in patients with IBS is essential for taking an appropriate history and for undertaking a holistic approach for the management of the same. A collaborative team effort by psychiatrists and gastroenterologists could help in reducing the burden of this difficult to treat functional bowel disorder. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?

International Nuclear Information System (INIS)

Kinner, Sonja; Kuehle, Christiane A.; Ladd, Susanne C.; Barkhausen, Joerg; Herbig, Sebastian; Haag, Sebastian; Lauenstein, Thomas C.

2008-01-01

Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. (orig.)

75 FR 27182 - Energy Conservation Program: Web-Based Compliance and Certification Management System

Science.gov (United States)

2010-05-14

... Conservation Program: Web-Based Compliance and Certification Management System AGENCY: Office of Energy... following means: 1. Compliance and Certification Management System (CCMS)--via the Web portal: http... certification reports to the Department of Energy (DOE) through an electronic Web-based tool, the Compliance and...

Small bowel volvulus in the adult populace of the United States: results from a population-based study.

Science.gov (United States)

Coe, Taylor M; Chang, David C; Sicklick, Jason K

2015-08-01

Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. The Nationwide Inpatient Sample (1998 to 2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (International Classification of Diseases, 9th Edition [ICD-9] code 560.2 excluding gastric/colonic procedures) in patients greater than or equal to 18 years old. There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than nonoperative (65.21% vs 34.79%, P volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults. Copyright © 2015 Elsevier Inc. All rights reserved.

Maternal outcome after conservative management of abnormally invasive placenta

Directory of Open Access Journals (Sweden)

Hsiu-Wei Su

2017-06-01

Conclusion: In this small series, we observed a low successful uterine preservation rate and a high maternal complication rate. We recommend that primary cesarean hysterectomy should be used as the treatment of choice for mild to severe abnormally invasive placenta. Conservative management should be reserved for women with a strong fertility desire and women with extensive disease that precludes primary hysterectomy due to surgical difficulty.

The plight of Indian sea horses: Need for conservation and management

Digital Repository Service at National Institute of Oceanography (India)

Sreepada, R.A.; Desai, U.M.; Naik, S.

along the Indian coast in the last decade has been alarming. Conservation and management are currently limited by the absence of data on the abundance and distribution of seahorses species in the region. This paper highlights the plight of Indian...

Bringing genetic diversity to the forefront of conservation policy and management

Czech Academy of Sciences Publication Activity Database

Hoban, S. M.; Hauffe, H. C.; Pérez-Espona, S.; Arntzen, J. W.; Bertorelle, G.; Bryja, Josef; Frith, K.; Gaggiotti, O. E.; Galbusera, P.; Godoy, J. A.; Hoelzel, A. R.; Nichols, R. A.; Primmer, C. R.; Russo, I.-R.; Segelbacher, G.; Siegismund, H. R.; Sihvonen, M.; Vernesi, C.; Vila, C.; Bruford, M. W.

2013-01-01

Roč. 5, č. 2 (2013), s. 593-598 ISSN 1877-7252 Institutional support: RVO:68081766 Keywords : Conservation genetics * Aichi target 13 * ConGRESS * Biodiversity management * Biodiversity policy Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 1.136, year: 2013

Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction

Directory of Open Access Journals (Sweden)

Leppert W

2015-04-01

Full Text Available Wojciech Leppert Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland Abstract: Opioid-induced bowel dysfunction (OIBD comprises gastrointestinal (GI symptoms, including dry mouth, nausea, vomiting, gastric stasis, bloating, abdominal pain, and opioid-induced constipation, which significantly impair patients’ quality of life and may lead to undertreatment of pain. Traditional laxatives are often prescribed for OIBD symptoms, although they display limited efficacy and exert adverse effects. Other strategies include prokinetics and change of opioids or their administration route. However, these approaches do not address underlying causes of OIBD associated with opioid effects on mostly peripheral opioid receptors located in the GI tract. Targeted management of OIBD comprises purely peripherally acting opioid receptor antagonists and a combination of opioid receptor agonist and antagonist. Methylnaltrexone induces laxation in 50%–60% of patients with advanced diseases and OIBD who do not respond to traditional oral laxatives without inducing opioid withdrawal symptoms with similar response (45%–50% after an oral administration of naloxegol. A combination of prolonged-release oxycodone with prolonged-release naloxone (OXN in one tablet (a ratio of 2:1 provides analgesia with limited negative effect on the bowel function, as oxycodone displays high oral bioavailability and naloxone demonstrates local antagonist effect on opioid receptors in the GI tract and is totally inactivated in the liver. OXN in daily doses of up to 80 mg/40 mg provides equally effective analgesia with improved bowel function compared to oxycodone administered alone in patients with chronic non-malignant and cancer-related pain. OIBD is a common complication of long-term opioid therapy and may lead to quality of life deterioration and undertreatment of pain. Thus, a complex assessment and management that addresses underlying

Clinical peculiarities of antibiotic associated bowels impairment and its significance in irritable bowel syndrome appearance

Directory of Open Access Journals (Sweden)

І. O. Pasichna

2016-06-01

Full Text Available Aim: the main objective of this study was to investigate bowels impairment due to treatment with antibiotics, its incidence and clinical peculiarities; to evaluate its role in appearance of in irritable bowel syndrome. Material and Methods. We studied 110 patients (33 males and 77 females, age range 16-83 years, who received treatment with antibiotic. We evaluated the function of the intestine before treatment with antibiotic, then in 1 week, 3 months after treatment finish (1, 2, 3, 4 visits respectively. Control group included 20 healthy persons, who haven't had antibiotics administered during recent two years. Results. We revealed that the signs of bowel function impairment took place at the first visit in 18.2% of patients, at the second visit – in 60.0% of patients, at the third visit – in 45.5% of patients and at the fourth visit – in 41.1% of patients. At the second, third and fourth visits the signs of bowels function impairment were observed reliably more often then at the first visit (before antibiotic administration, p<0.001. At the second visit the signs bowels function disorders were the most prominent: abdominal pain – in 44.5%, distention – in 46.4%, diarrhea – in 29.1%, constipation – in 18.2%, presence of both (diarrhea and periodically constipation manifestations – in 2.7%; and extraintestinal manifestations (depression. depressed mood, sorrow, apathy, decreased stamina, sleep disturbances – in 29.1% of patients. Clinical manifestations of irritable bowel syndrome occured in 6 months of observation in 32.2% of patients. Conclusions. The signs of bowel function impairment were observed in 60.0% of patients after finishing treatment with antibiotic. This incidence is much higher than in control group (р<0.001. Bowel disorders mostly manifested as the changes in quantity and consistency of feaces, pain, abdominal distention and extraintestinal manifestations. In 32.2% of patients clinical manifestations of

Brief report: development of the inflammatory bowel disease family responsibility questionnaire.

Science.gov (United States)

Greenley, Rachel Neff; Doughty, Alyssa; Stephens, Mike; Kugathasan, Subra

2010-03-01

To present psychometric data on youth and parent versions of the Inflammatory Bowel Disease-Family Responsibility Questionnaire (IBD-FRQ), a measure of family involvement in IBD management. Fifty-eight adolescents with inflammatory bowel disease (IBD), along with 55 mothers and 26 fathers completed the IBD-FRQ, a demographics questionnaire, and a measure of family involvement in decision making in non-IBD domains. Medical information was obtained via chart review. Support for the internal consistency of the IBD-FRQ was obtained. Evidence of validity was documented via moderate to high intercorrelations among reporters. Youth involvement increased with youth age, while maternal and paternal involvement decreased with youth age. Across all reporters, maternal involvement was higher than paternal involvement. Preliminary analyses offer support for the measure's reliability and validity. The measure shows promise as a means of assessing family involvement in IBD condition management; however, further validation studies are needed.

Nutritive support in short Bowel syndrome (sbs

Directory of Open Access Journals (Sweden)

Simić Dušica

2003-01-01

Full Text Available Short bowel syndrome most commonly result after bowel resection for necrosis of the bowel. It may be caused by arterial or venous thrombosis, volvolus and in children, necrotizing enterocolitis. The other causes are Crohn,s disease intestinal atresia. The factors influencing the risk on short bowel syndrome are the remaining length of the small bowel, the age of onset, the length of the colon, the presence or absence of the ileo-coecal valve and the time after resection. Besides nutritional deficiencies there some other consequences of extensive resections of the small intestine (gastric acid hypersecretion, d-lactic acidosis, nephrolithiasis, cholelithiasis, which must be diagnosed, treated, and if possible, prevented. With current therapy most patients with short bowel have normal body mass index and good quality of life.

Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter

LENUS (Irish Health Repository)

Foran, AT

2018-04-01

Suprapubic catheter insertion and exchange is a common urological procedure, but it is not without risks and complications. While bowel perforation is a recognised complication at suprapubic catheter insertion, it is not commonly reported at suprapubic catheter exchange. We report our experience of recognition, diagnosis and subsequent successful management of the most important complication related to suprapubic catheters.

Conservatively managed pineal apoplexy in an anticoagulated patient

Energy Technology Data Exchange (ETDEWEB)

Werder, Gabriel M. [William Beaumont Hospital, Department of Radiology, 3600 West Thirteen Mile Road, Royal Oak, MI 48073 (United States); St Christopher Iba Mar Diop College of Medicine, Luton (United Kingdom)], E-mail: gabriel_werder@yahoo.com; Razdan, Rahul S.; Gagliardi, Joseph A.; Chaddha, Shashi K.B. [St Vincent' s Medical Center, Bridgeport, CT (United States)

2008-02-15

We present a case of pineal apoplexy in an anticoagulated and hypertensive 56-year-old Hispanic male. At presentation, the patient's international normalized ratio (INR) was 10.51 and his blood pressure was 200/130 mmHg. His presenting symptoms included acute onset of headache, chest pain, nausea, vomiting, vertigo, and visual disturbance. Neuroimaging demonstrated hemorrhage into a morphologically normal pineal gland. Under conservative management, the patient experienced gradual resolution of all symptoms excluding the disturbance of upward gaze.

Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

Science.gov (United States)

Yamashita, Shimpei; Kohjimoto, Yasuo; Hirabayashi, Yasuo; Iguchi, Takashi; Iba, Akinori; Higuchi, Masatoshi; Koike, Hiroyuki; Wakamiya, Takahito; Nishizawa, Satoshi; Hara, Isao

2017-11-16

It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival. Fifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival.

The ecosystem approach to fisheries: management at the dynamic interface between biodiversity conservation and sustainable use.

Science.gov (United States)

Jennings, Simon; Smith, Anthony D M; Fulton, Elizabeth A; Smith, David C

2014-08-01

The emergence of an ecosystem approach to fisheries (EAF) was characterized by the adoption of objectives for maintaining ecosystem health alongside those for fisheries. The EAF was expected to meet some aspirations for biodiversity conservation, but health was principally linked to sustainable use rather than lower levels of human impact. Consequently, while policies including EAF concepts identified objectives for fisheries management and biodiversity conservation, the wording often reflected unresolved societal and political debates about objectives and gave imprecise guidance on addressing inevitable trade-offs. Despite scientific progress in making trade-offs and consequences explicit, there remain substantial differences in interpretations of acceptable impact, responses to uncertainty and risk, and the use of management measures by groups accountable for fisheries management and biodiversity conservation. Within and among nations and regions, these differences are influenced by the contribution of fisheries, aquaculture, farming, and trade to food security, consumers' options, and other social, economic, and environmental factors. Notwithstanding, mutual understanding of the motivations and norms of fisheries management and biodiversity conservation groups is increasing, and interactions between these groups have likely supported more progress toward meeting their stated objectives than would have otherwise been achievable. © 2014 New York Academy of Sciences.

MIGRATION AND CONSERVATION: FRAMEWORKS, GAPS, AND SYNERGIES IN SCIENCE, LAW, AND MANAGEMENT.

Science.gov (United States)

Meretsky, Vicky J; Atwell, Jonathan W; Hyman, Jeffrey B

2011-01-01

Migratory animals provide unique spectacles of cultural, ecological, and economic importance. However, the process of migration is a source of risk for migratory species as human actions increasingly destroy and fragment habitat, create obstacles to migration, and increase mortality along the migration corridor. As a result, many migratory species are declining in numbers. In the United States, the Endangered Species Act provides some protection against extinction for such species, but no protection until numbers are severely reduced, and no guarantee of recovery to population levels associated with cultural, ecological, or economic significance. Although groups of species receive some protection from statutes such as the Migratory Bird Treaty Act and Marine Mammal Protection Act, there is no coordinated system for conservation of migratory species. In addition, information needed to protect migratory species is often lacking, limiting options for land and wildlife managers who seek to support these species. In this Article, we outline the existing scientific, legal, and management information and approaches to migratory species. Our objective is to assess present capacity to protect the species and the phenomenon of migration, and we argue that al three disciplines are necessary for effective conservation. We find significant capacity to support conservation in all three disciplines, but no organization around conservation of migration within any discipline or among the three disciplines. Areas of synergy exist among the disciplines but not as a result of any attempt for coordination. As a result, significant gaps in information and capacity exist that must be addressed if effective conservation of migratory species is to be undertaken. We suggest that all three disciplines cooperate to identify the most pressing research needs, so that these can become targets for relevant funding sources. We identify areas of current risk to migratory species that represent gaps

Medico-legal significance of service difficulties and clinical errors in the management of patients with inflammatory bowel diseases.

Science.gov (United States)

Farrukh, Affifa; Mayberry, John F

2015-03-01

There is a significant growth in medical litigation, and cases involving the care and management of patients with inflammatory bowel disease are becoming common. There is no central register of such cases, and the majority are settled before court proceedings. As a result, there is no specific case law related to such conditions, and secrecy usually surrounds the outcome with "no admission of guilt" by the defendant and a clause about non-disclosure and discussion linked to the financial compensation received by the claimant. This review discusses common areas of potential litigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Volvulus of the Small Bowel and Colon

Science.gov (United States)

Kapadia, Muneera R.

2017-01-01

Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection. PMID:28144211

Efficacy and safety of bisphosphonates in management of low bone density in inflammatory bowel disease

Science.gov (United States)

Yao, Liwei; Wang, Haiqing; Dong, Wenwei; Liu, Zhenxin; Mao, Haijiao

2017-01-01

Abstract This study aims to determine whether bisphosphonates are safe, as well as effective against bone mineral loss in inflammatory bowel disease (IBD). A computerized search of electronic databases from 1966 to 2016 was performed. Randomized controlled trials (RCTs) were included in this review to evaluate the role of bisphosphonates in the management of osteoporosis in IBD patients. A revised 7-point Jadad scale was used to evaluate the quality of each study. Overall, 13 RCTs and 923 patients met the inclusion criteria of this meta-analysis. The result showed that bisphosphonates decreased bone mass density (BMD) loss at the lumbar spine (P = 0.0002), reduced the risk of new fractures (P = 0.01), and retained the similar adverse events (P = 0.86). Bisphosphonates may provide protection and safety against bone mineral loss in IBD patients. PMID:28099343

Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

International Nuclear Information System (INIS)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I.; Badillo, Andrea T.

2017-01-01

Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

Energy Technology Data Exchange (ETDEWEB)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Medical System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Badillo, Andrea T. [Children' s National Medical System, Division of General and Thoracic Surgery, Washington, DC (United States)

2017-04-15

Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

Generation of priority research questions to inform conservation policy and management at a national level.

Science.gov (United States)

Rudd, Murray A; Beazley, Karen F; Cooke, Steven J; Fleishman, Erica; Lane, Daniel E; Mascia, Michael B; Roth, Robin; Tabor, Gary; Bakker, Jiselle A; Bellefontaine, Teresa; Berteaux, Dominique; Cantin, Bernard; Chaulk, Keith G; Cunningham, Kathryn; Dobell, Rod; Fast, Eleanor; Ferrara, Nadia; Findlay, C Scott; Hallstrom, Lars K; Hammond, Thomas; Hermanutz, Luise; Hutchings, Jeffrey A; Lindsay, Kathryn E; Marta, Tim J; Nguyen, Vivian M; Northey, Greg; Prior, Kent; Ramirez-Sanchez, Saudiel; Rice, Jake; Sleep, Darren J H; Szabo, Nora D; Trottier, Geneviève; Toussaint, Jean-Patrick; Veilleux, Jean-Philippe

2011-06-01

Integrating knowledge from across the natural and social sciences is necessary to effectively address societal tradeoffs between human use of biological diversity and its preservation. Collaborative processes can change the ways decision makers think about scientific evidence, enhance levels of mutual trust and credibility, and advance the conservation policy discourse. Canada has responsibility for a large fraction of some major ecosystems, such as boreal forests, Arctic tundra, wetlands, and temperate and Arctic oceans. Stressors to biological diversity within these ecosystems arise from activities of the country's resource-based economy, as well as external drivers of environmental change. Effective management is complicated by incongruence between ecological and political boundaries and conflicting perspectives on social and economic goals. Many knowledge gaps about stressors and their management might be reduced through targeted, timely research. We identify 40 questions that, if addressed or answered, would advance research that has a high probability of supporting development of effective policies and management strategies for species, ecosystems, and ecological processes in Canada. A total of 396 candidate questions drawn from natural and social science disciplines were contributed by individuals with diverse organizational affiliations. These were collaboratively winnowed to 40 by our team of collaborators. The questions emphasize understanding ecosystems, the effects and mitigation of climate change, coordinating governance and management efforts across multiple jurisdictions, and examining relations between conservation policy and the social and economic well-being of Aboriginal peoples. The questions we identified provide potential links between evidence from the conservation sciences and formulation of policies for conservation and resource management. Our collaborative process of communication and engagement between scientists and decision makers for

DNA in the conservation and management of African antelope

DEFF Research Database (Denmark)

Lorenzen, Eline

2016-01-01

tool in informed species conservation and sustainable wildlife management. The movement of antelope through translocations, reintroductions, and population augmentations is common practice in wildlife management. DNA-led species identification using genetic barcoding is an effective use of genetic data...... within forensics. DNA barcoding is a taxonomic method that uses a short genetic marker in an organism's DNA to identify it as belonging to a particular species....... databases, and represents a valuable reference database of antelope DNA diversity. For the evolution of antelope, sub-Saharan Africa is a region of particular intrigue. The geographic regions of sub-Saharan Africa represent unique evolutionary scenarios. Molecular data have become an increasingly important...

A conservative approach to pediatric mandibular fracture management: outcome and advantages.

Science.gov (United States)

Khatri, Amit; Kalra, Namita

2011-01-01

Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

Small bowel volvulus in children

International Nuclear Information System (INIS)

Siegel, M.J.; Shackelford, G.D.; McAlister, W.H.

1980-01-01

Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery. (orig.) [de

Mammal indicator species for protected areas and managed forests in a landscape conservation area in northern India

Science.gov (United States)

Pradeep K. Mathur; Harish Kumar; John F. Lehmkuhl; Anshuman Tripathi; Vishwas B. Sawarkar; Rupak. De

2010-01-01

There is a realization that managed forests and other natural areas in the landscape matrix can and must make significant contributions to biodiversity conservation. Often, however, there are no consistent baseline vegetation or wildlife data for assessing the status of biodiversity elements across protected and managed areas for conservation planning, nor is there a...

Groundwater resources: conservation and management: proceedings of the sixteenth national symposium on environment

International Nuclear Information System (INIS)

Puranik, V.D.; Ramachandran, T.V.; Saradhi, I.V.; Sahu, S.K.; Prathibha, P.

2008-01-01

The main theme of this volume is conservation and management of groundwater resources. The topics covered are groundwater for sustainable development, problems perspectives and challenges, monitoring and modeling of pollutants and their transport, waste management, environmental radioactivity and environmental awareness and biodiversity. Papers relevant to INIS are indexed separately

Conservation genomics of natural and managed populations: building a conceptual and practical framework.

Science.gov (United States)

Benestan, Laura Marilyn; Ferchaud, Anne-Laure; Hohenlohe, Paul A; Garner, Brittany A; Naylor, Gavin J P; Baums, Iliana Brigitta; Schwartz, Michael K; Kelley, Joanna L; Luikart, Gordon

2016-07-01

The boom of massive parallel sequencing (MPS) technology and its applications in conservation of natural and managed populations brings new opportunities and challenges to meet the scientific questions that can be addressed. Genomic conservation offers a wide range of approaches and analytical techniques, with their respective strengths and weaknesses that rely on several implicit assumptions. However, finding the most suitable approaches and analysis regarding our scientific question are often difficult and time-consuming. To address this gap, a recent workshop entitled 'ConGen 2015' was held at Montana University in order to bring together the knowledge accumulated in this field and to provide training in conceptual and practical aspects of data analysis applied to the field of conservation and evolutionary genomics. Here, we summarize the expertise yield by each instructor that has led us to consider the importance of keeping in mind the scientific question from sampling to management practices along with the selection of appropriate genomics tools and bioinformatics challenges. © 2016 John Wiley & Sons Ltd.

Understanding the local socio-political processes affecting conservation management outcomes in Corbett Tiger Reserve, India.

Science.gov (United States)

Rastogi, Archi; Hickey, Gordon M; Badola, Ruchi; Hussain, Syed Ainul

2014-05-01

Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

Understanding the Local Socio-political Processes Affecting Conservation Management Outcomes in Corbett Tiger Reserve, India

Science.gov (United States)

Rastogi, Archi; Hickey, Gordon M.; Badola, Ruchi; Hussain, Syed Ainul

2014-05-01

Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

Conservative Management of Placenta Accreta in a Multiparous Woman

OpenAIRE

Jennifer C. Hunt

2010-01-01

Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was ...

Pacemaker lead erosion simulating "Loch Ness Monster": conservative management.

Science.gov (United States)

Garg, Naveen; Moorthy, Nagaraja

2012-12-01

The majority of pacemaker pocket or lead erosions are due to either mechanical erosion by the bulky pulse generator or secondary to pacemaker pocket infection. We describe an unusual case of delayed pacemaker lead erosion causing extrusion of a portion of the pacing lead, with separate entry and exit points, with the gap filled with new skin formation, simulating the "Loch Ness Monster", which was successfully managed conservatively by surgical reinsertion.

Conservative management of anal and rectal cancer

International Nuclear Information System (INIS)

Gerard, J.P.; Romestaing, P.; Montbarbon, X.

1989-01-01

The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

Breaking through the crisis in marine conservation and management: insights from the philosophies of Ed Ricketts.

Science.gov (United States)

Sagarin, Raphael D; Crowder, Larry B

2009-02-01

Over the last decade, 2 major U.S. commissions on ocean policy and a wide range of independent sources have argued that ocean ecosystems are in a period of crisis and that current policies are inadequate to prevent further ecological damage. These sources have advocated ecosystem-based management as an approach to address conservation issues in the oceans, but managers remain uncertain as to how to implement ecosystem-based approaches in the real world. We argue that the philosophies of Edward F. Ricketts, a mid-20th-century marine ecologist, offer a framework and clear guidance for taking an ecosystem approach to marine conservation. Ricketts' philosophies, which were grounded in basic observations of natural history, espoused building a holistic picture of the natural world, including the influence of humans, through repeated observation. This approach, when applied to conservation, grounds management in what is observable in nature, encourages early action in the face of uncertainty, and supports an adaptive approach to management as new information becomes available. Ricketts' philosophy of "breaking through," which focuses on getting beyond crisis and conflict through honest debate of different parties' needs (rather than forcing compromise of differing positions), emphasizes the social dimension of natural resource management. New observational technologies, long-term ecological data sets, and especially advances in the social sciences made available since Ricketts' time greatly enhance the utility of Ricketts' philosophy of marine conservation.

A roadmap for knowledge exchange and mobilization research in conservation and natural resource management.

Science.gov (United States)

Nguyen, Vivian M; Young, Nathan; Cooke, Steven J

2017-08-01

Scholars across all disciplines have long been interested in how knowledge moves within and beyond their community of peers. Rapid environmental changes and calls for sustainable management practices mean the best knowledge possible is needed to inform decisions, policies, and practices to protect biodiversity and sustainably manage vulnerable natural resources. Although the conservation literature on knowledge exchange (KE) and knowledge mobilization (KM) has grown in recent years, much of it is based on context-specific case studies. This presents a challenge for learning cumulative lessons from KE and KM research and thus effectively using knowledge in conservation and natural resources management. Although continued research on the gap between knowledge and action is valuable, overarching conceptual frameworks are now needed to enable summaries and comparisons across diverse KE-KM research. We propose a knowledge-action framework that provides a conceptual roadmap for future research and practice in KE/KM with the aim of synthesizing lessons learned from contextual case studies and guiding the development and testing of hypotheses in this domain. Our knowledge-action framework has 3 elements that occur at multiple levels and scales: knowledge production (e.g., academia and government), knowledge mediation (e.g., knowledge networks, actors, relational dimension, and contextual dimension), and knowledge-based action (e.g., instrumental, symbolic, and conceptual). The framework integrates concepts from the sociology of science in particular, and serves as a guide to further comprehensive understanding of knowledge exchange and mobilization in conservation and sustainable natural resource management. © 2016 Society for Conservation Biology.

Infertility in men with inflammatory bowel disease

OpenAIRE

Shin, Takeshi; Okada, Hiroshi

2016-01-01

Inflammatory bowel disease (IBD) predominantly affects young adults. Fertility-related issues are therefore important in the management of patients with IBD. However, relatively modest attention has been paid to reproductive issues faced by men with IBD. To investigate the effects of IBD and its treatment on male fertility, we reviewed the current literature using a systematic search for published studies. A PubMed search were performed using the main search terms “IBD AND male infertility”, ...

Increased incidence of bowel cancer after non-surgical treatment of appendicitis.

Science.gov (United States)

Enblad, Malin; Birgisson, Helgi; Ekbom, Anders; Sandin, Fredrik; Graf, Wilhelm

2017-11-01

There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis. Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated. Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1). Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Physiologic effects of bowel preparation

DEFF Research Database (Denmark)

Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

2004-01-01

healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance...

Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease

Science.gov (United States)

Vikner, Malene Elbaek; Weiss, Günter

2018-01-01

Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD. PMID:29342861

The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management.

Science.gov (United States)

Brkljac, Milos; Kumar, Shyam; Kalloo, Dale; Hirehal, Kiran

2015-12-01

We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.

Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type

Science.gov (United States)

This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assem...

Scientifically defensible fish conservation and recovery plans: Addressing diffuse threats and developing rigorous adaptive management plans

Science.gov (United States)

Maas-Hebner, Kathleen G.; Schreck, Carl B.; Hughes, Robert M.; Yeakley, Alan; Molina, Nancy

2016-01-01

We discuss the importance of addressing diffuse threats to long-term species and habitat viability in fish conservation and recovery planning. In the Pacific Northwest, USA, salmonid management plans have typically focused on degraded freshwater habitat, dams, fish passage, harvest rates, and hatchery releases. However, such plans inadequately address threats related to human population and economic growth, intra- and interspecific competition, and changes in climate, ocean, and estuarine conditions. Based on reviews conducted on eight conservation and/or recovery plans, we found that though threats resulting from such changes are difficult to model and/or predict, they are especially important for wide-ranging diadromous species. Adaptive management is also a critical but often inadequately constructed component of those plans. Adaptive management should be designed to respond to evolving knowledge about the fish and their supporting ecosystems; if done properly, it should help improve conservation efforts by decreasing uncertainty regarding known and diffuse threats. We conclude with a general call for environmental managers and planners to reinvigorate the adaptive management process in future management plans, including more explicitly identifying critical uncertainties, implementing monitoring programs to reduce those uncertainties, and explicitly stating what management actions will occur when pre-identified trigger points are reached.

Bowel Diseases and Kidneys

Directory of Open Access Journals (Sweden)

A.E. Dorofeiev

2015-09-01

Full Text Available This review of contemporary publications analyzes the prevalence of combinations of bowel and renal diseases. Special attention is paid to the problem of correlation between bowel diseases and urolithiasis. We consider the possible pathogenic mechanisms of lesions, such as genetically determined violations of intestinal absorption and secretion, changes in the intestinal microbiota, systemic inflammatory response, water and electrolyte disturbances.

Cheap and nasty? The potential perils of using management costs to identify global conservation priorities.

Science.gov (United States)

McCreless, Erin; Visconti, Piero; Carwardine, Josie; Wilcox, Chris; Smith, Robert J

2013-01-01

The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity.

Cheap and Nasty? The Potential Perils of Using Management Costs to Identify Global Conservation Priorities

Science.gov (United States)

McCreless, Erin; Visconti, Piero; Carwardine, Josie; Wilcox, Chris; Smith, Robert J.

2013-01-01

The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity. PMID:24260502

Cheap and nasty? The potential perils of using management costs to identify global conservation priorities.

Directory of Open Access Journals (Sweden)

Erin McCreless

Full Text Available The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity.

Inflammatory pathways of importance for management of inflammatory bowel disease

DEFF Research Database (Denmark)

Pedersen, Jannie; Coskun, Mehmet; Soendergaard, Christoffer

2014-01-01

Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn's disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor......-inflammatory cytokines, antibodies targeting integrins, and small anti-adhesion molecules that block adhesion between leukocytes and the intestinal vascular endothelium, reducing their infiltration into the inflamed mucosa. In this review we have elucidated the major signaling pathways of clinical importance for IBD...

Multifunctional management of mountain forests - Compromises between the protection and conservation functions

Directory of Open Access Journals (Sweden)

Marc Fuhr, Nicolas Clouet, Thomas Cordonnier and Frédéric Berger

2011-03-01

Full Text Available How can the balance between protection against natural hazards and biodiversity conservation be determined at each stage in forest development? This study provides a number of answers in view of improving multifunctional management.

Genetic characterization of Western European noble crayfish populations (Astacus astacus) for advanced conservation management strategies

NARCIS (Netherlands)

Schrimpf, A.; Piscione, M.; Cammaerts, R.; Collas, M.; Herman, D.; Jung, A.; Ottburg, F.; Roessink, I.; Rollin, X.; Schulz, R.; Theissinger, K.

2017-01-01

One central goal of conservation biology is to conserve the genetic diversity of species in order to protect their adaptive potential. The main objective of this study was to identify management units (MUs) for the threatened noble crayfish (Astacus astacus) in Western Europe by utilizing

Evaluation of management and surgical outcomes in pregnancies complicated by acute cholecystitis.

Science.gov (United States)

El-Messidi, Amira; Alsarraj, Ghazi; Czuzoj-Shulman, Nicholas; Mishkin, Daniel S; Abenhaim, Haim Arie

2018-01-25

To evaluate the management of pregnancies complicated by acute cholecystitis (AC) and determine whether pregnant women are more likely to have medical and surgical complications. We carried out a population-based matched cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Pregnant women with AC were age matched to non-pregnant women with AC on a 1:5 ratio. Management and outcomes were compared using descriptive analysis and conditional logistic regression. There were 11,835 pregnant women admitted with AC who were age matched to 59,175 non-pregnant women. As compared to non-pregnant women, women with AC were more commonly managed conservatively, odds ratio (OR) 6.1 (5.8-6.4). As compared to non-pregnant women, pregnant women with AC more commonly developed sepsis [OR 1.4 (1.0-1.9)], developed venous thromboembolism [OR 8.7 (4.3-17.8)] and had bowel obstruction [OR 1.3 (1.1-1.6)]. Among pregnant women with AC, surgical management was associated with a small but significant increased risk of septic shock and bile leak. AC, in the context of pregnancy, is associated with an increased risk of adverse outcomes. Although the literature favors early surgical intervention, pregnancies with AC appear to be more commonly managed conservatively with overall comparable outcomes to surgically managed AC. Conservative management may have a role in select pregnant women with AC.

A conservative approach to pediatric mandibular fracture management: Outcome and advantages

Directory of Open Access Journals (Sweden)

Amit Khatri

2011-01-01

Full Text Available Pediatric mandibular fractures are rare and their treatment remains controversial. Management is extremely complicated in mixed dentition as it is inherently dynamic and unstable. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. This case report describes and evaluates the conservative technique of acrylic splint in the treatment of pediatric mandible fracture in a 12-year-old female child. The patient with isolated mandibular fracture was treated with acrylic splint and interdental wiring followed by evaluation of clinical and radiographic healing as well as the somatosensory status. Patient demonstrated clinical union to her pre-injury occlusion by three to four weeks. Panoramic finding supported the finding of clinical examination throughout the study. High osteogenic potential of the pediatric mandible allowed conservative management to be successful in this case.

Physiologic effects of bowel preparation

DEFF Research Database (Denmark)

Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

2004-01-01

PURPOSE: Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation. METHODS: In a prospective study, 12...

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

Energy Technology Data Exchange (ETDEWEB)

Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Wang, Hong-Hau [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Department of Radiology, Taipei (China); Fan, Hsiu-Lung [Tri-Service General Hospital, National Defense Medical Center, Division of General Surgery, Department of Surgery, Taipei (China); Chen, Ran-Chou [Taipei City Hospital, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China); Chang, Wei-Chou [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China)

2015-04-01

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

International Nuclear Information System (INIS)

Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung; Wang, Hong-Hau; Fan, Hsiu-Lung; Chen, Ran-Chou; Chang, Wei-Chou

2015-01-01

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention

International Nuclear Information System (INIS)

Ajaj, Waleed; Kuehle, Christiane; Nuefer, Michael; Goehde, Susanne C.; Lauenstein, Thomas C.; Goyen, Mathias; Schneemann, Hubert; Ruehm, Stefan G.

2005-01-01

To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol-barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol-barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol-LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol-barium sulphate solution as an alternative for 1500-ml sorbitol-LBG solution for optimal bowel distension. (orig.)

Environmental impact assessment - A management tool for conservation of large marine ecosystems

Digital Repository Service at National Institute of Oceanography (India)

Nair, V.R.

and conservation of natural resources. The problem has become crucial and the only alternative is the implementation of Environment Impact Assessment (EIA) to evolve environmental management strategies for optimum use of a given coastal area without disturbing...

Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

2010-01-15

The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels.

Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

International Nuclear Information System (INIS)

Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang

2010-01-01

The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels

Positives and pathologies of natural resource management on private land-conservation areas.

Science.gov (United States)

Clements, Hayley S; Cumming, Graeme S

2017-06-01

In managed natural resource systems, such as fisheries and rangelands, there is a recognized trade-off between managing for short-term benefits and managing for longer term resilience. Management actions that stabilize ecological attributes or processes can improve productivity in the supply of ecosystem goods and services in the short term but erode system resilience at longer time scales. For example, fire suppression in rangelands can increase grass biomass initially but ultimately result in an undesirable, shrub-dominated system. Analyses of this phenomenon have focused largely on how management actions influence slow-changing biophysical system attributes (such as vegetation composition). Data on the frequency of management actions that reduce natural ecological variation on 66 private land-conservation areas (PLCAs) in South Africa were used to investigate how management actions are influenced by manager decision-making approaches, a largely ignored part of the problem. The pathology of natural resource management was evident on some PLCAs: increased focus on revenue-generation in decision making resulted in an increased frequency of actions to stabilize short-term variation in large mammal populations, which led to increased revenues from ecotourism or hunting. On many PLCAs, these management actions corresponded with a reduced focus on ecological monitoring and an increase in overstocking of game (i.e., ungulate species) and stocking of extralimitals (i.e., game species outside their historical range). Positives in natural resource management also existed. Some managers monitored slower changing ecological attributes, which resulted in less-intensive management, fewer extralimital species, and lower stocking rates. Our unique, empirical investigation of monitoring-management relationships illustrates that management decisions informed by revenue monitoring versus ecological monitoring can have opposing consequences for natural resource productivity and

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT

Directory of Open Access Journals (Sweden)

Beatriz Sebastián Sánchez

Full Text Available The current goal of treatment in irritable bowel syndrome (IBS focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome. Cognitive behavioral therapy (CBT is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than attention placebo control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT).

Science.gov (United States)

Sebastián Sánchez, Beatriz; Gil Roales-Nieto, Jesús; Ferreira, Nuno Bravo; Gil Luciano, Bárbara; Sebastián Domingo, Juan José

2017-09-01

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

Citizen science can improve conservation science, natural resource management, and environmental protection

Science.gov (United States)

McKinley, Duncan C.; Miller-Rushing, Abe J.; Ballard, Heidi L.; Bonney, Rick; Brown, Hutch; Cook-Patton, Susan; Evans, Daniel M.; French, Rebecca A.; Parrish, Julia; Phillips, Tina B.; Ryan, Sean F.; Shanley, Lea A.; Shirk, Jennifer L.; Stepenuck, Kristine F.; Weltzin, Jake F.; Wiggins, Andrea; Boyle, Owen D.; Briggs, Russell D.; Chapin, Stuart F.; Hewitt, David A.; Preuss, Peter W.; Soukup, Michael A.

2017-01-01

Citizen science has advanced science for hundreds of years, contributed to many peer-reviewed articles, and informed land management decisions and policies across the United States. Over the last 10 years, citizen science has grown immensely in the United States and many other countries. Here, we show how citizen science is a powerful tool for tackling many of the challenges faced in the field of conservation biology. We describe the two interwoven paths by which citizen science can improve conservation efforts, natural resource management, and environmental protection. The first path includes building scientific knowledge, while the other path involves informing policy and encouraging public action. We explore how citizen science is currently used and describe the investments needed to create a citizen science program. We find that:Citizen science already contributes substantially to many domains of science, including conservation, natural resource, and environmental science. Citizen science informs natural resource management, environmental protection, and policymaking and fosters public input and engagement.Many types of projects can benefit from citizen science, but one must be careful to match the needs for science and public involvement with the right type of citizen science project and the right method of public participation.Citizen science is a rigorous process of scientific discovery, indistinguishable from conventional science apart from the participation of volunteers. When properly designed, carried out, and evaluated, citizen science can provide sound science, efficiently generate high-quality data, and help solve problems.

CONSERVATIVE THERAPY VERSUS EPIDURAL STEROID INFILTRATION IN MANAGEMENT OF CHRONIC LOW BACK ACHE

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Vivian Roshan D

2015-11-01

Full Text Available BACKGROUND: Sciatica due to lumbar intervertebral disc herniation is one of the most common causes of radicular pain in an adult working population. This study aims at studying the effectiveness of conservative management of lumbar disc herniation as an alternative to surgical measures. METHODS: A prospective study of 100 patients with lumbar disc herniations who were treated conservatively were followed up at intervals of 1 month, 6 months and 1 year. Patients planned for conservative treatment were treated with pharmacological therapy, rest and physiotherapy. Those planned for epidural steroid injections were administered a single dose of steroid one level higher than the lesion in the epidural space. The collected data was analyzed by Chi square. RESULTS: Our results showed that in both genders, epidural steroid infiltration yielded better results than conservative treatment. Occupation had no discernible effect on the magnitude of disc herniation. People with sedentary lifestyle recovered better with epidural steroid infiltration as compared to the heavy physical labor group. Irrespective of disc bulge, protrusion or extrusion, the epidural steroid injection group showed significant improvement in symptoms as compared to conservative treatment. Smokers tended to show delay in the recovery as compared with the non-smoker group. The amount of disc herniation is not directly proportional to the outcome of treatment. CONCLUSIONS: Epidural steroid infiltration showed significant improvement in symptoms of lumbar intervertebral disc herniation thereby avoiding disc surgery. Conservative management for atleast 4 to 6 weeks can be recommended followed by epidural steroid in those patients without improvement. Cessation of smoking should be an integral part of the treatment.

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery

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Silvia Canonico

2013-01-01

Full Text Available Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture and internal (Bakri balloon uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.

Review article: the gut microbiome in inflammatory bowel disease-avenues for microbial management.

Science.gov (United States)

McIlroy, J; Ianiro, G; Mukhopadhya, I; Hansen, R; Hold, G L

2018-01-01

The concept of an altered collective gut microbiota rather than identification of a single culprit is possibly the most significant development in inflammatory bowel disease research. We have entered the "omics" era, which now allows us to undertake large-scale/high-throughput microbiota analysis which may well define how we approach diagnosis and treatment of inflammatory bowel disease (IBD) in the future, with a strong steer towards personalised therapeutics. To assess current epidemiological, experimental and clinical evidence of the current status of knowledge relating to the gut microbiome, and its role in IBD, with emphasis on reviewing the evidence relating to microbial therapeutics and future microbiome modulating therapeutics. A Medline search including items 'intestinal microbiota/microbiome', 'inflammatory bowel disease', 'ulcerative colitis', 'Crohn's disease', 'faecal microbial transplantation', 'dietary manipulation' was performed. Disease remission and relapse are associated with microbial changes in both mucosal and luminal samples. In particular, a loss of species richness in Crohn's disease has been widely observed. Existing therapeutic approaches broadly fall into 3 categories, namely: accession, reduction or indirect modulation of the microbiome. In terms of microbial therapeutics, faecal microbial transplantation appears to hold the most promise; however, differences in study design/methodology mean it is currently challenging to elegantly translate results into clinical practice. Existing approaches to modulate the gut microbiome are relatively unrefined. Looking forward, the future of microbiome-modulating therapeutics looks bright with several novel strategies/technologies on the horizon. Taken collectively, it is clear that ignoring the microbiome in IBD is not an option. © 2017 John Wiley & Sons Ltd.

76 FR 43745 - Magnuson-Stevens Fishery Conservation and Management Act (MSA) Provisions; Fisheries of the...

Science.gov (United States)

2011-07-21

... during the course of the FY. Management uncertainty for the LAGC IFQ fleet is considered very low because... incorporate ACT into the LAGC IFQ fleet allocation, but chose not to apply any management uncertainty buffer... Atmospheric Administration 50 CFR Part 648 Magnuson-Stevens Fishery Conservation and Management Act (MSA...

Effectiveness and Morbidity Associated With Reirradiation in Conservative Salvage Management of Recurrent Soft-Tissue Sarcoma

International Nuclear Information System (INIS)

Indelicato, Daniel J.; Meadows, Kenyon; Gibbs, Charles P.; Morris, Christopher G.; Scarborough, Mark T.; Zlotecki, Robert A.

2009-01-01

Purpose: The management of isolated local recurrence of soft-tissue sarcoma is therapeutically complex, and functional conservative management is preferable to radical or amputative salvage surgery. This study reviews University of Florida experience using conservative resection and reirradiation to manage isolated local recurrences of soft-tissue sarcoma. Methods and Materials: Between 1976 and 2005, a total of 14 patients who underwent primary conservative resection and irradiation developed isolated local recurrence and were managed with salvage conservative resection and reirradiation. Of the patients treated, 3 had tumors of the distal extremity, 8 had tumors of the proximal extremity, and 3 had tumors of the trunk. At the time of recurrence, 64% of tumors were greater than 5 cm and 79% were high grade. In combination with gross total resection, 13 of 14 patients received external beam radiotherapy with or without brachytherapy, and 1 patient was treated with brachytherapy alone. Two patients received chemotherapy. Results: The median follow-up was 30 months, and no living patients were lost during follow-up. From retreatment, the 5-year actuarial overall survival, cause-specific survival, and local control rates were 40%, 40%, and 18% respectively. There was a 50% incidence of serious complication requiring either reoperation or leading to permanent functional impairment. Of the 14 patients, only 1 has remained disease free and without significant complications. No treatment factors, including achieving wide surgical margins or delivering higher radiation dosages, seemed to confer an advantage in local control. Conclusions: Salvage therapy for management of locally recurrent soft-tissue sarcoma is challenging, and the effects of reoperation and reirradiation can be severe

An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings

International Nuclear Information System (INIS)

Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul

2013-01-01

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Rotation grazing as a conservation management tool : Vegetation changes after six years of application in a salt marsh ecosystem

NARCIS (Netherlands)

Lagendijk, D. D. Georgette; Howison, Ruth A.; Esselink, Peter; Ubels, Richard; Smit, Christian

2017-01-01

Grazing is commonly used in conservation to promote biodiversity, but the search for a grazing management regime that optimises biodiversity is still ongoing. Rotation grazing, where grazing is followed by a relatively long period of non-grazing, is a relative new tool in conservation management,

Velocity of climate change algorithms for guiding conservation and management.

Science.gov (United States)

Hamann, Andreas; Roberts, David R; Barber, Quinn E; Carroll, Carlos; Nielsen, Scott E

2015-02-01

The velocity of climate change is an elegant analytical concept that can be used to evaluate the exposure of organisms to climate change. In essence, one divides the rate of climate change by the rate of spatial climate variability to obtain a speed at which species must migrate over the surface of the earth to maintain constant climate conditions. However, to apply the algorithm for conservation and management purposes, additional information is needed to improve realism at local scales. For example, destination information is needed to ensure that vectors describing speed and direction of required migration do not point toward a climatic cul-de-sac by pointing beyond mountain tops. Here, we present an analytical approach that conforms to standard velocity algorithms if climate equivalents are nearby. Otherwise, the algorithm extends the search for climate refugia, which can be expanded to search for multivariate climate matches. With source and destination information available, forward and backward velocities can be calculated allowing useful inferences about conservation of species (present-to-future velocities) and management of species populations (future-to-present velocities). © 2014 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

Development of a soil conservation standard and guidelines for OHV recreation management in California

Science.gov (United States)

Bedrossian, T.L.; Reynolds, S.D.

2007-01-01

In 2004, the California State Parks (CSP) agency contracted with the California Geological Survey (CGS) to update the 1991 Soil Conservation Guide-lines/Standards for Off-Highway Vehicle (OHV) Recreation Management. Per state legislation, the 1991 standards were updated to establish a generic and measurable standard at least sufficient to allow restoration of OHV areas and trails. Given the rapid increase in OHV use in California, the updated Soil Conservation Standard and Guidelines for OHV Recreation Management also allowed for sustainability of trail systems and recreation opportunities. A key part of the update was interaction with stakeholders, agencies, and other interest groups through public workshops and a Consulting Agency Review Committee composed of representatives from the U.S. Natural Resources Conservation Service, U.S. Forest Service, U.S. Bureau of Land Management, U.S. Geological Survey, California Department of Conservation, and CSP. CGS also assessed proposed revisions in three representative OHV areas to ensure that the updated Standard and Guidelines provided sufficient flexibility to allow their application to all sites state-wide, ecosystems with multiple geology and soils types, and a variety of vehicle uses. While geology was not the only basis for the guideline revisions, it was a major factor. CGS staff also had the breadth of knowledge and experience in engineering geology, hydrogeology, road and trail construction, erosion control, and OHV riding necessary to coordinate and develop the multidisciplinary and multi-stakeholder effort.

Globalisation of inflammatory bowel disease: perspectives from the evolution of inflammatory bowel disease in the UK and China.

Science.gov (United States)

Kaplan, Gilaad G; Ng, Siew C

2016-12-01

The UK and China provide unique historical perspectives on the evolution of the incidence of inflammatory bowel disease, which might provide insight into its pathogenesis. Historical records from the UK document the emergence of ulcerative colitis during the mid-1800s, which was later followed by the recognition of Crohn's disease in 1932. During the second half of the 20th century, the incidence of inflammatory bowel disease rose dramatically in high-income countries. Globalisation at the turn of the 21st century led to rapid economic development of newly industrialised countries such as China. In China, the modernisation of society was accompanied by the recognition of a sharp rise in the incidence of inflammatory bowel disease. The prevalence of inflammatory bowel disease is expected to continue to rise in high-income countries and is also likely to accelerate in the developing world. An understanding of the shared and different environmental determinants underpinning the pathogenesis of inflammatory bowel disease in western and eastern countries is essential to implement interventions that will blunt the rising global burden of inflammatory bowel disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

Segmental absence of intestinal musculature with metachronous bowel perforations in an infant

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Noboru Oyachi

2018-03-01

Full Text Available Segmental absence of intestinal musculature is a rare condition. A female patient was born at 39 weeks gestational age with birth weight of 2,900 g. The patient was prenatally diagnosed as having segmental bowel distension in the fetal stage. She manifested bilious emesis with abdominal distension at day 1. Although excretion of viscous meconium was observed by gastrografin enema, gastrointestinal perforation developed. Emergency laparotomy and peritoneal drainage was required at that time and further laparotomy was performed on day 15. Multiple perforations were recognized discontinuously from the jejunum to the transverse colon, and jejunostomy was constructed. Additional bowel perforations occurred and re-exploration was required at day 43. We found newly formed small perforations in the proximal jejunum, ileum and the transverse colon and a tube jejunostomy and a colostomy were established. The patient required prolonged TPN management, which induced correlated cholestasis and liver failure, and died at day 143. Pathologic findings showed partial hypoplasia of the intrinsic muscle layer in the small intestine and diagnosed as segmental absence of intestinal musculature. Her disorder was unusual in its presentation, which included prenatal bowel dilatation, metachronous superimposed bowel perforation, and extensive discrete lesions from the jejunum to the transverse colon.

Help Desk Answers: Surgery vs conservative management for AC joint repair: How do the 2 compare?

Science.gov (United States)

Matchin, Bruce; Yee, Bruce; Mott, Timothy

2016-04-01

When not considering the grade of acromioclavicular (AC) joint dislocation, both conservative and surgical management lead to positive outcomes, although surgically managed patients require more time out of work.

Stem Cells in the Intestine: Possible Roles in Pathogenesis of Irritable Bowel Syndrome.

Science.gov (United States)

Ratanasirintrawoot, Sutheera; Israsena, Nipan

2016-07-30

Irritable bowel syndrome is one of the most common functional gastrointestinal (GI) disorders that significantly impair quality of life in patients. Current available treatments are still not effective and the pathophysiology of this condition remains unclearly defined. Recently, research on intestinal stem cells has greatly advanced our understanding of various GI disorders. Alterations in conserved stem cell regulatory pathways such as Notch, Wnt, and bone morphogenic protein/TGF- β have been well documented in diseases such as inflammatory bowel diseases and cancer. Interaction between intestinal stem cells and various signals from their environment is important for the control of stem cell self-renewal, regulation of number and function of specific intestinal cell types, and maintenance of the mucosal barrier. Besides their roles in stem cell regulation, these signals are also known to have potent effects on immune cells, enteric nervous system and secretory cells in the gut, and may be responsible for various aspects of pathogenesis of functional GI disorders, including visceral hypersensitivity, altered gut motility and low grade gut inflammation. In this article, we briefly summarize the components of these signaling pathways, how they can be modified by extrinsic factors and novel treatments, and provide evidenced support of their roles in the inflammation processes. Furthermore, we propose how changes in these signals may contribute to the symptom development and pathogenesis of irritable bowel syndrome.

The prevalence of inflammatory bowel diseases, microscopic colitis, and colorectal cancer in patients with irritable bowel syndrome

Directory of Open Access Journals (Sweden)

Magdy El-Salhy

2011-07-01

Full Text Available The diagnosis of irritable bowel syndrome (IBS is symptom-based and experts have developed diagnostic criteria for IBS. Distinguishing inflammatory bowel diseases (IBD from IBS, especially with mild disease activity, can be difficult. Another concern is microscopic colitis (MC. MC and IBS have similar symptoms and a normal endoscopic appearance. Our study investigated the prevalence of patients with IBD, MC, and colorectal cancer among 968 patients that fulfill the Rome III criteria for IBS. Among these patients, four were found with IBD (0.4% and seven with MC (0.7%. Among the IBD patients, three suffered from Crohn’s disease, affecting the terminal ileum, and one with ulcerative rectosigmoiditis. Of the seven patients with MC, two had collagenous colitis and five had lymphocytic colitis. Two IBS diarrhea-predominant patients had adenocarcin­oma in the sigmoid colon. These patients were a female aged 58 years and a male aged 56 years. We concluded from our study and earl­ier studies that symptom-based diagnosis of IBS may lead to missing a number of other gastrointestinal disorders that require quite different management than that for IBS.

Management of irritable bowel syndrome in primary care: feasibility randomised controlled trial of mebeverine, methylcellulose, placebo and a patient self-management cognitive behavioural therapy website. (MIBS trial

Directory of Open Access Journals (Sweden)

Yardley Lucy

2010-11-01

Full Text Available Abstract Background IBS affects 10-22% of the UK population. Abdominal pain, bloating and altered bowel habit affect quality of life, social functioning and time off work. Current GP treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many suffer ongoing symptoms. A recent Cochrane review highlighted the lack of research evidence for IBS drugs. Neither GPs, nor patients have good evidence to inform prescribing decisions. However, IBS drugs are widely used: In 2005 the NHS costs were nearly £10 million for mebeverine and over £8 million for fibre-based bulking agents. CBT and self-management can be helpful, but poor availability in the NHS restricts their use. We have developed a web-based CBT self-management programme, Regul8, based on an existing evidence based self-management manual and in partnership with patients. This could increase access with minimal increased costs. Methods/Design The aim is to undertake a feasibility factorial RCT to assess the effectiveness of the commonly prescribed medications in UK general practice for IBS: mebeverine (anti-spasmodic and methylcellulose (bulking-agent and Regul8, the CBT based self-management website. 135 patients aged 16 to 60 years with IBS symptoms fulfilling Rome III criteria, recruited via GP practices, will be randomised to 1 of 3 levels of the drug condition: mebeverine, methylcellulose or placebo for 6 weeks and to 1 of 3 levels of the website condition, Regul8 with a nurse telephone session and email support, Regul8 with minimal email support, or no website, thus creating 9 groups. Outcomes: Irritable bowel symptom severity scale and IBS-QOL will be measured at baseline, 6 and 12 weeks as the primary outcomes. An intention to treat analysis will be undertaken by ANCOVA for a factorial trial. Discussion This pilot will provide valuable information for a larger trial. Determining the effectiveness of commonly used drug treatments will help

Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management.

Science.gov (United States)

Yamamoto, T; Keighley, M R

2000-08-01

Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.

Costs of conservative management of early-stage prostate cancer compared to radical prostatectomy–a claims data analysis

Directory of Open Access Journals (Sweden)

Alina Brandes

2016-11-01

Full Text Available Abstract Background Due to widespread PSA testing incidence rates of localized prostate cancer increase but curative treatment is often not required. Overtreatment imposes a substantial economic burden on health care systems. We compared the direct medical costs of conservative management and radical therapy for the management of early-stage prostate cancer in routine care. Methods An observational study design is chosen based on claims data of a German statutory health insurance fund for the years 2008–2011. Three hundred fifty-three age-matched men diagnosed with prostate cancer and treated with conservative management and radical prostatectomy, are included. Individuals with diagnoses of metastases or treatment of advanced prostate cancer are excluded. In an excess cost approach direct medical costs are considered from an insured community perspective for in- and outpatient care, pharmaceuticals, physiotherapy, and assistive technologies. Generalized linear models adjust for comorbidity by Charlson comorbidity score and recycled predictions method calculates per capita costs per treatment strategy. Results After follow-up of 2.5 years per capita costs of conservative management are €6611 lower than costs of prostatectomy ([−9734;−3547], p < 0.0001. Complications increase costs of assistive technologies by 30% (p = 0.0182, but do not influence any other costs. Results are robust to cost outliers and incidence of prostate cancer diagnosis. The short time horizon does not allow assessing long-term consequences of conservative management. Conclusions At a time horizon of 2.5 years, conservative management is preferable to radical prostatectomy in terms of costs. Claims data analysis is limited in the selection of comparable treatment groups, as clinical information is scarce and bias due to non-randomization can only be partly mitigated by matching and confounder adjustment.

Bowel function and quality of life after colostomy in individuals with spinal cord injury

DEFF Research Database (Denmark)

Bølling Hansen, Rikke; Staun, Michael; Kalhauge, Anna

2016-01-01

OBJECTIVE: To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN: Cross-sectional descriptive study. SETTING: Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet....... PARTICIPANTS: Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. INTERVENTIONS: Questionnaires...... and measurement of gastrointestinal transit time (GITT). OUTCOME MEASURES: Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. RESULTS: Seventy-two percent significantly reduced their use of time on bowel...

Evaluating outcomes of management targeting the recovery of a migratory songbird of conservation concern

Science.gov (United States)

Streby, Henry M.; Kramer, Gunnar R.; Peterson, Sean M.; Andersen, David

2018-01-01

Assessing outcomes of habitat management is critical for informing and adapting conservation plans. From 2013 – 2019, a multi-stage management initiative aims to create >25,000 ha of shrubland and early-successional vegetation to benefit Golden-winged Warblers (Vermivora chrysoptera) in managed forested landscapes of the western Great Lakes region. We studied a dense breeding population of Golden-winged Warblers at Rice Lake National Wildlife Refuge (NWR) in Minnesota, USA, where shrubs and young trees were sheared during the winter of 2014-2015 in a single treatment supported in part by the American Bird Conservancy (ABC) and in part by other funding source(s) to benefit Golden-winged Warblers and other species associated with young forest [e.g., American Woodcock (Scalopax minor)] and as part of maintenance of early successional forest cover on the refuge.

Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition.

Science.gov (United States)

Fishman, Laurie N; Barendse, Renée M; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

2010-12-01

Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the Children's Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.

Are we working towards global research priorities for management and conservation of sea turtles?

Science.gov (United States)

Rees, A.F.; Alfaro-Shigueto, J.; Barata, P.C.R.; Bjorndal, K.A.; Bolten, A.B.; Bourjea, J.; Broderick, A.C.; Campbell, L.M.; Cardona, L.; Carreras, C.; Casale, P.; Ceriani, S.A.; Dutton, P.H.; Eguchi, T.; Formia, A.; Fuentes, M.M.P.B.; Fuller, W.J.; Girondot, M.; Godfrey, M.H.; Hamann, M.; Hart, Kristen M.; Hays, G.C.; Hochscheid, S.; Kaska, Y.; Jensen, M.P.; Mangel, J.C.; Mortimer, J.A.; Naro-Maciel, E.; Ng, C.K.Y.; Nichols, W.J.; Phillott, A.D.; Reina, R.D.; Revuelta, O.; Schofield, G.; Seminoff, J.A.; Shanker, K.; Tomás, J.; van de Merwe, J.P.; Van Houtan, K.S.; Vander Zanden, H.B.; Wallace, B.P.; Wedemeyer-Strombel, K.R.; Work, Thierry M.; Godley, B.J.

2016-01-01

In 2010, an international group of 35 sea turtle researchers refined an initial list of more than 200 research questions into 20 metaquestions that were considered key for management and conservation of sea turtles. These were classified under 5 categories: reproductive biology, biogeography, population ecology, threats and conservation strategies. To obtain a picture of how research is being focused towards these key questions, we undertook a systematic review of the peer-reviewed literature (2014 and 2015) attributing papers to the original 20 questions. In total, we reviewed 605 articles in full and from these 355 (59%) were judged to substantively address the 20 key questions, with others focusing on basic science and monitoring. Progress to answering the 20 questions was not uniform, and there were biases regarding focal turtle species, geographic scope and publication outlet. Whilst it offers some meaningful indications as to effort, quantifying peer-reviewed literature output is obviously not the only, and possibly not the best, metric for understanding progress towards informing key conservation and management goals. Along with the literature review, an international group based on the original project consortium was assigned to critically summarise recent progress towards answering each of the 20 questions. We found that significant research is being expended towards global priorities for management and conservation of sea turtles. Although highly variable, there has been significant progress in all the key questions identified in 2010. Undertaking this critical review has highlighted that it may be timely to undertake one or more new prioritizing exercises. For this to have maximal benefit we make a range of recommendations for its execution. These include a far greater engagement with social sciences, widening the pool of contributors and focussing the questions, perhaps disaggregating ecology and conservation.

Ecosystem management and the conservation of caribou habitat in British Columbia

Directory of Open Access Journals (Sweden)

Dale R. Seip

1998-03-01

Full Text Available Woodland caribou (Rangifer tarandus caribou in British Columbia inhabit a wide variety of forest ecosystems. Numerous research projects have provided information that has been used to develop caribou habitat management recommendations for different areas. Recently, the province has implemented guidelines to protect biodiversity that are based on an ecosystem management strategy of mimicking natural forest conditions. There is a great deal of similarity between caribou management recommendations and biodiversity recommendations within different forest types. In mountain caribou habitat, both approaches recommend maintaining a landscape dominated by old and mature forests, uneven-aged management, small cutblocks, and maintaining mature forest connectivity. In northern caribou habitat, both approaches recommend maintaining some older stands on the landscape (but less than for mountain caribou, even-aged management, and a mosaic of large harvest units and leave areas. The ecosystem management recommendations provide a useful foundation for caribou habitat conservation. More detailed information on caribou and other management objectives can then be used to fine-tune those recommendations.

Tourism, poaching and wildlife conservation: what can integrated conservation and development projects accomplish?

Energy Technology Data Exchange (ETDEWEB)

Johannesen, Anne Borge; Skonhoft, Anders [Department of Economics, Norwegian University of Science and Technology, N-7491 Trondheim, Dragvoll (Norway)

2005-10-15

Integrated conservation and development projects (ICDPs) have frequently been established in Africa to improve wildlife conservation and the welfare of local communities. However, their effectiveness has been hampered by conflicts and illegal harvesting. This paper focuses on the strategic interaction between the manager of a protected area and a group of local people. The park manager benefits from wildlife through tourism and hunting. The local people benefit through hunting, but also bear the wildlife damage. ICDPs relying on money transfers to the local people from the park manager may or may not promote wildlife conservation. In addition, the welfare of the local people are ambiguous. (author) [Wildlife; Conservation; Conflicts; Local welfare].

Conclusions: The Future of Shark Management and Conservation in the Northeast Pacific Ocean.

Science.gov (United States)

Lowry, Dayv

Human interactions with sharks in the Northeast Pacific Ocean (NEP) have occurred for millennia but were largely limited to nearshore encounters as target and nontarget catch in fisheries. The arrival of Spanish explorers in the mid-1500s, followed by subsequent waves of explorers and colonizers from Europe and Russia, did little to change this relationship, until the mid-1800s. As technological advances conferred the ability to exploit marine fish further offshore and in deeper water, substantial fisheries developed and many of these encountered, and sometimes directly targeted, sharks. As these fisheries rose and fell with market demands and fluctuations in the abundance of target species, the collective consciousness of the nations fishing this region came to realize that adequate management plans with clear policy guidance rooted in conservation were crucial to sustaining both biodiversity and abundance of marine resources. With explicitly defined management regions governed by scientifically informed bodies that consider both societal and ecological needs, systems have been in place to manage and conserve marine species, including sharks, for over four decades now in the NEP. While policy evolution has largely limited directed fishing pressure as a threat for most shark species, bycatch is still a concern. Additionally, habitat degradation and destruction, ocean acidification, and global climate change are anticipated to fundamentally alter the ecosystems sharks are an integral part of in coming decades and centuries. Adequate conservation and management of sharks in the NEP, and around the world, moving into this period of uncertainty will rely upon comprehensive, integrated management of the ecosystem rooted in international coordination and cooperation. Far from being an unattainable goal, steps are being made each day to 'move the needle' in this direction-for the benefit of all. © 2017 Elsevier Ltd All rights reserved.

Prospects and future of conservative management of beta thalassemia major in a developing country

International Nuclear Information System (INIS)

Rahman, M.; Lodhi, Y.

2004-01-01

Objective: To assess the efficacy, prospects and future of conservative management of beta thalassemia major patients in a developing country. Design: Patients registered at IHBTS were studied over a period of three years. They consented to being managed on moderate transfusion regimen, aiming to maintain a pre-transfusion haemoglobin(Hgb) level of 9.0 plus minus 1.0 g per dL. We studied their transfusion requirements, status for transfusion transmitted infections (TTls), serum ferritin levels and complications developing as a result of iron overload. Subjects: Initially all registered patients were included in this study. Sporadic patients as well as dropouts occurring due to any reason, (patients concurrently seeking treatment at other centres as well, or complying poorly to advised chelation therapy) were excluded from the study. The data presented here conforms to a cohort of 60 regular patients who adhered best to our selection criteria. Main Outcome Measures: 1) The study highlights the deficiencies and problems of conservative management for beta thalassemia major. 2) The major impact of our study is the message that conservative management in a poor country, like ours, is a no-win situation. 3) There is an urgent need to immediately start a prevention programme. Results: In the younger patients, blood consumption even on the moderate transfusion regimen is 120ml/kg/year, however with ascending age the consumption increases to 240ml/kg/year. A substantive number of the patients are either Hep C (35%) or Hep B (1.7%) positive. There are no HIV positive patients. Serum ferritin levels vary widely and could not be controlled due to poor compliance to chelation. 50% of the patients developed one or other complications of iron overload. The cost of treatment depending on the quality of care, is tremendous and beyond the reach of the common man. Conclusions: Conservative management may be the best alternative and at times the only hope for patients in our country

Muscarinic acetylcholine receptor expression in aganglionic bowel.

Science.gov (United States)

Oue, T; Yoneda, A; Shima, H; Puri, P

2000-01-01

In Hirschsprung's disease (HD) there exists an overabundance of acetylcholine (ACh), which in turn stimulates excessive production of the enzyme acetylcholinesterase. Muscarinic ACh receptors (mAChRs) play an important role in smooth-muscle contraction. Recent studies have indicated five different subtypes of mAChRs encoded by five different genes, ml to m5. The purpose of this study was to investigate the expression of each mAChR subtype in aganglionic (AG) colon to further understand the pathophysiology of HD. Entire colon resected at the time of pull-through operation for HD was obtained from 14 patients. Specimens obtained at autopsy from 8 age-matched patients without gastrointestinal disease acted as controls. Frozen sections were used for indirect immunohistochemistry as well as in-situ hybridization. Immunohistochemistry was performed using specific antiserum against each mAChR subtype and in-situ hybridization was performed using specific oligonucleotide probes against ml to m5 subtypes. Messenger RNA (mRNA) was extracted from normoganglionic (NG) and AG bowel of HD patients and normal control bowel. Reverse transcription-polymerase chain reaction was performed to evaluate mRNA levels of each mAChR subtype. To adjust the levels of mRNA expression, a housekeeping gene G3PDH, known to be expressed normally, was used as an internal control. Strong m2 and m3 immunoreactivity was observed in the mucosal layer, smooth-muscle layers, and myenteric plexus of NG bowel, whereas ml immunoreactivity was only detected in the mucosal layer. The most striking finding was the abundance of m3-immunoreactive fibers in muscle layers of NG bowel while there was a total lack of m3 fibers in smooth-muscle of AG bowel. Intense mRNA signals encoding m2 and m3 and to a lesser degree ml were detected in NG bowel, and these signals were weak in AG bowel. Immunoreactivity and mRNA expression of m4 and m5 was not detected in NG or AG bowel. The lack of m3-immunoreactive fibers in the

Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

Science.gov (United States)

Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel

2013-01-01

nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

Conservation Easements and Management by Family Forest Owners: A Propensity Score Matching Approach with Multi-Imputations of Survey Data

Science.gov (United States)

Nianfu Song; Francisco X. Aguilar; Brett J. Butler

2014-01-01

Increasingly, private landowners are participating in conservation easement programs, but their effects on land management remain to be addressed. Data from the USDA Forest Service National Woodland Owner Survey for the US Northern Region were used to investigate how conservation easement participation is associated with selected past and future forest management...

Inflammatory bowel diseases: principles of nutritional therapy

Directory of Open Access Journals (Sweden)

Campos Fábio Guilherme

2002-01-01

Full Text Available Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants still need further evaluation through prospective and randomized trials.

Multidetector CT findings of bowel Transection in blunt abdominal trauma

International Nuclear Information System (INIS)

Cho, Hyun Suk; Woo, Ji Young; Hong, Hye Suk; Park, Mee Hyun; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji Young; Ha, Hong Il

2013-01-01

Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

Multislice CT enteroclysis in the diagnosis of bowel endometriosis

International Nuclear Information System (INIS)

Biscaldi, Ennio; Rollandi, Gian A.; Ferrero, Simone; Ragni, Nicola; Remorgida, Valentino; Fulcheri, Ezio

2007-01-01

This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions. (orig.)

Multislice CT enteroclysis in the diagnosis of bowel endometriosis

Energy Technology Data Exchange (ETDEWEB)

Biscaldi, Ennio; Rollandi, Gian A. [' ' Duchesse of Galliera' ' -Hospital, Genoa (Italy). Dept. of Radiology; Ferrero, Simone; Ragni, Nicola; Remorgida, Valentino [San Martino Hospital and Genoa Univ. (Italy). Dept. of Obstretics and Gynaecology; Fulcheri, Ezio [San Martino Hospital and Genoa Univ. (Italy). Unit of Anatomy and Histopathology

2007-01-15

This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions. (orig.)

Small Bowel Transplantation: Current Clinical Status

Directory of Open Access Journals (Sweden)

David Sigalet

1991-01-01

Full Text Available With recent refinements in immunosuppression techniques, the first successful reports of small bowel transplantation in humans have now been made, increasing interest in bowel transplantation among clinicians and patients alike. This article reviews recent developments in understanding of the functional capabilities and requirements for effective immune suppression in bowel transplantation. Both experimental and clinical experience with transplantation are discussed, as are the areas which appear to offer the most promise for future developments. Finally guidelines for consideration of patient selection for this procedure are reviewed.

Small-bowel permeability in collagenous colitis

DEFF Research Database (Denmark)

Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

2006-01-01

Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies......, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal permeability....

Conservation Reserve Program (CRP) contributions to wildlife habitat, management issues, challenges and policy choices--an annotated bibliography

Science.gov (United States)

Allen, Arthur W.; Vandever, Mark W.

2012-01-01

The following bibliography presents brief summaries of documents relevant to Conservation Reserve Program relations to wildlife habitat, habitat management in agriculturally dominated landscapes, and conservation policies potentially affecting wildlife habitats in agricultural ecosystems. Because the literature summaries furnished provide only sweeping overviews, users are urged to obtain and evaluate those papers appearing useful to obtain a more complete understanding of study findings and their implications to conservation in agricultural ecosystems. The bibliography contains references to reports that reach beyond topics that directly relate to the Conservation Reserve Program. Sections addressing grassland management and landowner surveys/opinions, for example, furnish information useful for enhancing development and administration of conservation policies affecting lands beyond those enrolled in conservation programs. Some sections of the bibliography (for example, agricultural conservation policy, economics, soils) are far from inclusive of all relevant material written on the subject. Hopefully, these sections will serve as fundamental introductions to related issues. In a few instances, references may be presented in more than one section of the bibliography. For example, individual papers specifically addressing both non-game and game birds are included in respective sections of the bibliography. Duplication of citations and associated notes has, however, been kept to a minimum.

Assessing Cognitive behavioural Therapy in Irritable Bowel (ACTIB): protocol for a randomised controlled trial of clinical-effectiveness and cost-effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome in adults.

Science.gov (United States)

Everitt, Hazel; Landau, Sabine; Little, Paul; Bishop, Felicity L; McCrone, Paul; O'Reilly, Gilly; Coleman, Nicholas; Logan, Robert; Chalder, Trudie; Moss-Morris, Rona

2015-07-15

Irritable bowel syndrome (IBS) affects 10-22% of the UK population, with England's annual National Health Service (NHS) costs amounting to more than £200 million. Abdominal pain, bloating and altered bowel habit affect quality of life, social functioning and time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive behaviour therapy (CBT) and self-management can be helpful, but availability is limited. To determine the clinical- and cost-effectiveness of therapist delivered cognitive behavioural therapy (TCBT) and web-based CBT self-management (WBCBT) in IBS, 495 participants with refractory IBS will be randomised to TCBT plus treatment as usual (TAU); WBCBT plus TAU; or TAU alone. The two CBT programmes have similar content. However, TCBT consists of six, 60 min telephone CBT sessions with a therapist over 9 weeks, at home, and two 'booster' 1 hour follow-up phone calls at 4 and 8 months (8 h therapist contact time). WBCBT consists of access to a previously developed and piloted WBCBT management programme (Regul8) and three 30 min therapist telephone sessions over 9 weeks, at home, and two 'booster' 30 min follow-up phone calls at 4 and 8 months (2½ h therapist contact time). Clinical effectiveness will be assessed by examining the difference between arms in the IBS Symptom Severity Score (IBS SSS) and Work and Social Adjustment Scale (WASAS) at 12 months from randomisation. Cost-effectiveness will combine measures of resource use with the IBS SSS at 12 months and quality-adjusted life years. This trial has full ethical approval. It will be disseminated via peer reviewed publications and conference presentations. The results will enable clinicians, patients and health service planners to make informed decisions regarding the management of IBS with CBT. ISRCTN44427879. Published by the BMJ Publishing Group Limited. For permission to

SOIL AND WATER CONSERVATION MANAGEMENT THROUGH ...

African Journals Online (AJOL)

Osondu

socio-cultural, economic system constraints for the implementation and maintenance of conservation .... Purpose of natural resource conservation is therefore ... the soil and water resources through traditional and ..... “Integrated Natural.

1980 survey and evaluation of utility conservation, load management, and solar end-use projects. Volume 3: utility load management projects. Final report

Energy Technology Data Exchange (ETDEWEB)

1982-01-01

The results of the 1980 survey of electric utility-sponsored energy conservation, load management, and end-use solar energy conversion projects are described. The work is an expansion of a previous survey and evaluation and has been jointly sponsored by EPRI and DOE through the Oak Ridge National Laboratory. There are three volumes and a summary document. Each volume presents the results of an extensive survey to determine electric utility involvement in customer-side projects related to the particular technology (i.e., conservation, solar, or load management), selected descriptions of utility projects and results, and first-level technical and economic evaluations.

Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination

International Nuclear Information System (INIS)

Chou, S.; Skehan, S.J.; Brown, A.L.; Rawlinson, J.; Somers, S.

2000-01-01

AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

75 FR 24549 - Merchant Marine Act and Magnuson-Stevens Fishery Conservation and Management Act (Magnuson...

Science.gov (United States)

2010-05-05

... Management Act (Magnuson-Stevens Act) Provisions; Fishing Vessel, Fishing Facility and Individual Fishing... Fisheries Finance Program (FFP or the Program) provides long-term financing to the commercial fishing and...) lending program, 16 U.S.C. 1855(i)(1). The Magnuson-Stevens Fishery Conservation and Management...

Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease

DEFF Research Database (Denmark)

Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke B; Rezanavaz-Gheshlagh, Bijan

2015-01-01

-52%, 83-94% and 76-92% for DWI, respectively. The κ values for bowel wall thickening, DWI, and mural hyperenhancement were detected with fair agreement (κ = 0.26-0.39) at both MRI examinations, whereas only bowel wall thickening in MRFT were detected with moderate agreement (κ = 0.47) Conclusion. Plain......OBJECTIVE: To compare prospectively the diagnostic accuracy of magnetic resonance imaging (MRI) without use of contrast medium orally or intravenously (plain MRI) with magnetic resonance follow-through (MRFT) in patients with inflammatory bowel disease (IBD). MATERIAL AND METHODS: Plain MRI...

Evidence Based Conservative Management of Patello-femoral Syndrome

Directory of Open Access Journals (Sweden)

E. Carlos Rodriguez-Merchan

2014-03-01

Full Text Available Background:   Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.    

Profile of rifaximin and its potential in the treatment of irritable bowel syndrome

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Iorio N

2015-06-01

Full Text Available Natalya Iorio, Zubair Malik, Ron Schey Section of Gastroenterology, Department of Medicine, Temple University Hospital, Philadelphia, PA, USA Abstract: Irritable bowel syndrome (IBS is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain and abnormal bowel patterns. Alteration in gut flora, visceral hypersensitivity, and abnormal bowel motility are among numerous factors in the complex pathophysiology of IBS. Antibiotics have been used adjunctively to treat IBS for many years but are associated with various systemic side effects. Rifaximin is a nonabsorbable, broad-spectrum antimicrobial that inhibits bacterial RNA synthesis by binding the β-subunit of microbial RNA polymerase. It targets the gastrointestinal tract and works by reducing the quantity of gas-producing bacteria and altering the predominant species of bacteria present. In vivo animal studies suggest additional beneficial mechanisms of rifaximin, including reducing mucosal inflammation and visceral hypersensitivity. Clinical studies have demonstrated that rifaximin improves symptoms associated with IBS, such as bloating, flatulence, stool consistency, and abdominal pain, and has a side-effect profile similar to placebo. Although additional investigation into optimal dosing, treatment duration, and potential resistance is required, rifaximin presents as a safe and beneficial addition to the current management options for IBS. Keywords: irritable bowel syndrome, rifaximin, small intestinal bacterial overgrowth, mucosal inflammation

Practical implementation of optimal management strategies in conservation programmes: a mate selection method

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Fernández, J.

2001-12-01

Full Text Available The maintenance of genetic diversity is, from a genetic point of view, a key objective of conservation programmes. The selection of individuals contributing offspring and the decision of the mating scheme are the steps on which managers can control genetic diversity, specially on ‘ex situ’ programmes. Previous studies have shown that the optimal management strategy is to look for the parents’ contributions that yield minimum group coancestry (overall probability of identity by descent in the population and, then, to arrange mating couples following minimum pairwise coancestry. However, physiological constraints make it necessary to account for mating restrictions when deciding the contributions and, therefore, these should be implemented in a single step along with the mating plan. In the present paper, a single-step method is proposed to optimise the management of a conservation programme when restrictions on the mating scheme exist. The performance of the method is tested by computer simulation. The strategy turns out to be as efficient as the two-step method, regarding both the genetic diversity preserved and the fitness of the population.

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope.

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Ching, Siok Siong; Tan, Yih Kai

2012-09-07

To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann(®) Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen

Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease.

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Mackner, Laura M; Ruff, Jessica M; Vannatta, Kathryn

2014-10-01

Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD. Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above. Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support. Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

Usefulness of bowel sound auscultation: a prospective evaluation.

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Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

2014-01-01

Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened

77 FR 62537 - Notice of Waste Management Permit Application Received Under the Antarctic Conservation Act of 1978

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2012-10-15

... NATIONAL SCIENCE FOUNDATION Notice of Waste Management Permit Application Received Under the Antarctic Conservation Act of 1978 AGENCY: National Science Foundation. ACTION: Notice of a Waste Management... the National Science Foundation (NSF) has received a waste management permit application for Mike...

Surgical perspectives on inflammatory bowel disease

African Journals Online (AJOL)

VikasC

Xia B, Crusius JBA, Meuwissen SGM, Pena AS. Inflammatory bowel disease: Definition, epidemiology, etiologic aspects, and immunologic studies. World J. Gastroentero 1998;4:44658. 2. Fry DR, Mahmood N, Maron DJ, Ross HM, Rombeau. J. Inflammatory bowel disease in Towsend: Sabiston. Textbook of Surgery.

Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Green, Sheryl; Stock, Richard; Greenstein, Adrian

1995-07-01

compared to 0% for patients with N1 - N3 disease (P < 0.0001). An analysis of high risk patients (30) with T3-T4 or N1 - N3 disease revealed at 5 years on OS of 9%, a DFS of 10%, a PC rate of 26% and FFDF of 20%. In this subset of patients, there was a trend toward improved pelvic control in patients receiving radiation therapy (14) with a 5 year PC of 60% compared to a rate of 23% for those patients not irradiated (16) (p=0.59). Acute complications (grade 3 or >) were noted in 3 patients (20%) receiving radiation therapy and these included two cases of grade 3 skin reactions and one case of grade 4 gastro-intestinal toxicity. Two patients (13%) developed small bowel obstruction at 2 and 4 months, respectively, post-irradiation which were managed conservatively. There were no long term complications in patients irradiated. CONCLUSION: Treatment results are comparable to those historically reported for non-inflammatory bowel disease related rectal cancer although the subset of high risk patients appeared to have a poorer outcome. In light of this finding and the ability of patients with inflammatory bowel disease to tolerate pelvic irradiation, high risk patients should be treated aggressively with chemotherapy and radiation therapy.

Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma.

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Ho, Thomas W; Koh, Dean C

2007-05-01

Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0-10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5-100) days. Ten patients (22%) had postoperative complications, and there was one death. Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate

Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease

DEFF Research Database (Denmark)

Carlsen, Katrine; Houen, Gunnar; Jakobsen, Christian

2017-01-01

BACKGROUND: To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. METHODS: Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after...... their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk...... after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program. RESULTS: There were 29 patients with IBD in the eHealth...

Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease: A Systematic Review.

Science.gov (United States)

Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet; Weiss, Günter

2015-06-01

Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron.

Nonoperative management of pancreatic injuries in pediatric patients

International Nuclear Information System (INIS)

Cigdem, M.K.; Senturk, S.; Onen, A.; Siga, M.; Akay, H.; Otcu, S.

2011-01-01

Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst. (author)