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Unusual manifestation of Erdheim-Chester disease
Antony Pan, Terence Doyle, Martin Schlup, Ralf Lubcke, Michael Schultz
BMC Gastroenterology , 2011, DOI: 10.1186/1471-230x-11-77
Abstract: This case report describes the case of a 69-year-old man who presented otherwise well to the gastroenterology department with unspecific abdominal symptoms, nausea, vomiting and weight loss. ECD involving the gastrointestinal tract was confirmed clinically, radiologically and histologically.Gastroenterological manifestation of ECD is rare but should be considered in the differential diagnosis in patients presenting with evidence of multi-organ disease and typical radiological features of Erdheim-Chester disease elsewhere.Erdheim-Chester Disease (ECD) is a rare multisystem histiocytosis characterized by the xanthomatous or xanthogranulomatous infiltration of tissues with histiocytes, surrounded by fibrosis. The disease can affect multiple organs systems, but gastrointestinal involvement, is exceedingly rare. We describe here the case of a 69-year old man with ECD who presented to the gastroenterology department with unspecific abdominal symptoms, nausea, vomiting and weight loss.A previously fit and well 69-year-old man was admitted to the gastroenterology department with a short one month history of lethargy, decreased appetite, persistent vomiting, significant weight loss of six kilograms over 1 month and a dry cough. He denied abdominal pain, haematemesis, dysphagia and a change in bowel habit and described no cardiac, respiratory, neurological symptoms or bone pain. His past medical history includes appendectomy and total hip joint replacement. At the time of admission, he was not on any regular medication.Physical examination revealed that he was febrile (38.8C°) and appeared cachexic but with no peripheral stigmata of chronic liver disease. His abdominal examination revealed hepatomegaly but no other organomegaly, per rectal examination was unremarkable. His cardiopulmonary examinations were unremarkable apart from bilateral pitting edema up to his ankles. Peripheral blood analysis revealed an anaemia of chronic disease with hemoglobin of 108 g/L (norm - male 1
The role of aspirin in post-polypectomy bleeding – a retrospective survey
Pan Antony,Schlup Martin,Lubcke Ralf,Chou Annie
BMC Gastroenterology , 2012, DOI: 10.1186/1471-230x-12-138
Abstract: Background Bleeding following colonoscopic polypectomy is a common complication and has been reported to occur in up to 6.1% of patients. Several risk factors have been discussed but their overall contribution to post-polypectomy bleeding remains controversial. The aim of the study was to determine the rate of post polypectomy bleeding and to analyse the role of potential risk factors especially the role of aspirin. Methods We conducted a retrospective cohort study of all patients who underwent polypectomy at Dunedin Hospital, New Zealand between January 2007 and June 2009. Results During the study period, 514 patients underwent colonoscopy with polypectomy and a total of 1502 polyps were removed. From further analysis we excluded 21 patients; 15 patients had surgery immediately after colonoscopy for the diagnosis of colorectal carcinoma and 6 patients presented with symptoms of an acute lower gastrointestinal bleed prior to colonoscopy. Of the remaining 493 patients, 11 patients (2.2%) presented with post-polypectomy bleeding within 30 days of the investigation of which 8 were on aspirin. In total 145 patients were taking aspirin prior to colonoscopy and 348 patients were not taking aspirin. The use of aspirin was associated with an increased prevalence of post-polypectomy bleeding (OR=6.72, 95% C.I. 1.76 to 25.7). Interestingly, the use of non-steroidal anti-inflammatory drugs (NSAIDs) was not associated with risk of bleeding after polypectomy (OR=2.82, 95% C.I, 0.34 to 23.3). Conclusion Our study confirmed a significantly increased risk of lower gastrointestinal bleeding following polypectomy in patients taking aspirin. We would recommend approaching the patient on aspirin coming forward for a colonoscopy with potential polypectomy with caution.
Trends of Abundance of Salton Sea Fish: A Reversible Collapse or a Permanent Condition?  [PDF]
Ralf Riedel
Natural Resources (NR) , 2016, DOI: 10.4236/nr.2016.710045
Abstract: The Salton Sea is a closed-basin, 980 km2 salt lake in the Sonoran Desert of southern California. Three marine species, bairdiella (Bairdiella icistia), orangemouth corvina (Cynoscion xanthulus), and sargo (Anisotremus davidsoni), established from introductions of over 34 species beginning in 1929. During the late 1960s and early 1970s, a hybrid tilapia (Oreochromis mossambicus × O. urolepis hornorum) invaded the Salton Sea and became dominant by number and weight. Recent surveys show a precipitous decline of all four species above starting sometime between 2001 and 2002. Declines were more evident in nearshore than in estuarine habitats. Corvina has probably declined the soonest, followed by Gulf croaker. Tilapia declines were followed by more recent increases in population numbers. The tilapia rebound observed are probably only sustainable if a curb in Salton Sea salinity levels is realized. The marine species will likely need restocking to reach historic levels, if the salinity of the lake is managed at 40 gL1 or below. Restoration alternatives for the Salton Sea must take into consideration estuarine areas as essential fish habitats and fish refuge against high salinities.
Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported  [PDF]
Ralf-Bodo Troebs
Open Journal of Pediatrics (OJPed) , 2014, DOI: 10.4236/ojped.2014.43027
Abstract: Background: The aim of this study was to elucidate the preoperative clinical and biochemical profile of infants with IHPS to optimize infusion therapy. Patients and Method: We retrospectively analyzed data from 56 infants who were operated for IHPS. Our study includes growth and laboratory data prior to the initiation of therapy. Results: Median duration of propulsive vomiting was 4 d; the median age was 37 d (18 - 108), and the median body weight was 3840 g (2760 -5900). Metabolic alkalosis (MAlk) with a pH of 7.45 ± 0.06 and an stHCO3- of 28.7 ± 4.5 mmol/l was found. In a subgroup of the infants, negative base excess (BE) was observed. The sodium concentration was normal or reduced (mean/median of 137 mmol/l). There was a strong negative correlation between stHCO3- and K+. The carbon dioxide partial pressure tended to increase (5.72 ± 0.84 kPa). Calculations of osmolality revealed a normal osmolarity. Hypoglycemia did not occur. The creatinine clearance according to the Schwartz formula remained at a normal level (85.3 ± 24.3 ml/min/1.73 m2). Discussion: The presented case series is characterized by a short duration of preoperative vomiting. MAlk can be classified as a chloride deficiency syndrome. It is accompanied by normo- or hyponatremic dehydration with normal osmolality. Partial respiratory compensation occurred. A normal creatinine clearance indicated good glomerular renal function. Conclusion: The presented study supports the use of an isotonic infusion fluid with a low glucose concentration for preoperative infusion therapy.
Solar versus Non-Solar Urine Diversion Dehydration Toilets—Evaluation of Temperatures inside the Vaults of Different UDDT Systems  [PDF]
Constanze Windberg, Ralf Otterpohl
Journal of Environmental Protection (JEP) , 2016, DOI: 10.4236/jep.2016.79109
Abstract: The Urine Diverting Dehydration Toilet (UDDT) is one of a wide range of technologies Ecological Sanitation (Ecosan) offers. A commonly used type is the so called solar UDDT, constructed with inclined vault doors or panels which are usually made from black iron sheets to increase the temperature inside the vaults and therefore would facilitate dehydration and hygienisation. The study aims to give recommendations on the most appropriate system by comparing solar and non-solar UDDT systems. Existing building standards for UDDTs were reviewed, 133 UDDT sites visited and a comparative temperature study of the temperature inside the vaults of different UDDT systems carried out. The temperature study needed to assess if solar UDDTs would actually succeed in raising the temperature inside the vault. Programmed temperature loggers were placed in the vaults of solar and non-solar UDDTs. The review of building standards showed that the system recommended most is the solar UDDT. The field visits identified a number of problems related to the construction of solar UDDTs. The temperature study showed that solar UDDTs do not necessarily increase the temperature inside the vault significantly and therefore are not speeding up dehydration and pathogen destruction. The study hence concludes that before a solar UDDT system is chosen the climatic conditions have to be assessed carefully. The recommended standard design should be a non-solar UDDT system. It is hoped that the study will facilitate a move towards the construction of non-solar UDDTs.
Adaptive Pitch Transposition: Smart Auditory Spectral Shifts in Cochlear Implants  [PDF]
Kevin Struwe, Ralf Salomon
Engineering (ENG) , 2017, DOI: 10.4236/eng.2017.99045
Abstract: Patients with severe hearing loss have the option to get a cochlear implant device to regain their hearing. Yet, the implantation process is not always optimal, which in some cases results in a shallow insertion depth or an accidental insertion into the wrong cochlear duct. As a consequence, the patients' pitch discrimination ability is suboptimal, leading to an even more decreased vowel identification, which is vital for speech recognition. This paper presents a technical approach to solve this problem: the adaptive pitch transposition module modifies the frequency content in a fashion so that the pitch is fixed to an optimal value. To determine this value, a patient-individual best pitch is determined experimentally by evaluating speech recognition at different pitches. This best pitch is subsequently called the comfort pitch. As a result of the considerations a technical implementation is presented in principle. A system comprised of pitch detection, pitch transposition and an arbitrary chosen comfort pitch is described in depth. It has been implemented prototypically in Matlab/Octave and tested with an example audio file. The system?itself is designed as a preprocessing stage preceding cochlear implant processing.
Implications of an Aging Population on Pension Systems and Financial Markets  [PDF]
Tristan Nguyen, Ralf Stüzle
Theoretical Economics Letters (TEL) , 2012, DOI: 10.4236/tel.2012.22026
Abstract: In this paper, we introduce a macroeconomic model of overlapping generations to analyze the impacts of the demographic changes as well as the interactions between pension system, bond and stock markets. Furthermore, we examine how the pension system influences the distribution of wealth, consumption and saving within generations. In the context of this model, we show a drastic decline of capital market returns due to an aging population. Moreover, we examine the impacts demographic changes can have on individuals’ welfare for an existing pay-as-you-go pension scheme. Raising the pensionable age combined with a decrease of the contributions seems to be the best policy. On the other hand, increases in contributions as a result of demographic changes show the highest welfare losses. Taken into account the recent pension reforms in Germany, raising the retirement age or a faster transition from a pay-as-you-go pension system to a capital funded one would make sense. But it is questionable whether such a policy will be enforceable with an aging electorate.
Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study  [PDF]
Mike Ralf Langenbach, Stefan Sauerland
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.41005

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene\"\", Covidien, France), and a polyester mesh (Parietex\"\", Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

Stapled Trans-Anal Rectal Resection (STARR) for Obstructive Defecation Syndrome—Functional Outcome and Quality of Life after Two Years  [PDF]
Mike Ralf Langenbach, Alexandre Berengolts
International Journal of Clinical Medicine (IJCM) , 2016, DOI: 10.4236/ijcm.2016.73022
Abstract: Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR® TRANSTAR™ device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.
Duodenal Atresia-Tandler’s “Epithelial Plug Stage” Revisited  [PDF]
Ralf-Bodo Tr?bs
Open Journal of Pediatrics (OJPed) , 2019, DOI: 10.4236/ojped.2019.91010
Abstract: Background: Duodenal atresia is the most common type of intestinal atresia. Pathogenesis of duodenal atresia can be explained by an embryological theory that involves persistent physiologic epithelial occlusion (“epithelial plug”), first published in 1900. Tandlers developmental arrest theory has been accepted by the majority of recognized modern textbooks to date. The aim of the presented study is to re-evaluate the relevance of Tandler’s observations. Method: Tandler’s paper was reviewed retrospectively and discussed from the point of view of subsequent research. Results and Discussion: Local epithelial proliferation, vacuolization failure and mesenchyme ingrowth may continuously serve as a partly convincing but incomplete embryologic model to explain membranous duodenal atresia. Tandler’s theory has some weak points regarding the epithelial-mesenchymal interaction, the predisposition of the post-ampullary region, the association of duodenal atresia with other malformations and trisomy 21, and familial occurrence. Shrinkage artifacts, misinterpretation of a three-dimensional problem investigated with a two-dimensional tool (light microscope), animal studies, and the lack of apoptosis call the real existence of a solid stage in early duodenal embryology into question. Conclusion: More sophisticated morphologic, genetic and molecular-biological investigations revealed new insights regarding endoderm to mesoderm signaling as an important key to the pathogenesis of duodenal atresia.
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