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An Unusual Case of Stercoral Perforation in a Patient with 86?cm of Small Bowel
Alfin Okullo,Ghiyath Alsnih,Titus Kwok
Case Reports in Surgery , 2013, DOI: 10.1155/2013/317250
Abstract: A 77-year-old male who previously had extensive enterectomy due to ischaemic gut with loss of all but 86?cm of jejunum in addition to a right hemicolectomy presented to the emergency department (ED) with abdominal pain and constipation of 12-day duration. Abdominal imaging with X-ray and CT revealed pneumoperitoneum in addition to a grossly redundant and faecally loaded colon. At laparotomy, rectal perforation was found. In view of the patient’s advanced age, comorbidities, and the absence of intraperitoneal faecal contamination, manual disimpaction followed by wedge resection and primary closure of the perforation was done. On postop day 11, a perforation in the sigmoid colon with free subdiaphragmatic gas was picked up on CT after a work up for abdominal tenderness. In the absence of peritonism and other signs of deterioration, conservative management was chosen with subsequent uneventful recovery for the patient. 1. Introduction A patient with 86?cm of small bowel is expected to have short bowel syndrome (SBS). It is quite unusual for such a patient to present with constipation so severe that it causes stercoral perforation. We present a rare case of one such patient. 2. Case Report A 77-year-old male presented to the (ED) with generalized abdominal pain and constipation of about 12-day duration. He was still passing wind and denied any nausea or vomiting. His previous surgical history consisted of an extensive enterectomy 17 years ago for ischaemic gut, whereupon all but 86?cm of his jejunum was resected in addition to a right hemicolectomy. A jejunal-transverse colon anastomosis was done. Back then, his postop recovery was notable for a quick resolution of his diarrhea while on a low-fibre diet without any antimotility drugs and a return to his premorbid, chronically constipated state within about 2 months of the surgery. He thereafter required daily lactulose whose dose he had increased from 20 to 30 mls to no avail over the past 12 days. He was never on any medicines used to treat short bowel syndrome. A review of his regular medications was negative for any that would contribute to his chronic constipation prior to and after the bowel resection 17 years ago. At this presentation, his vital signs and blood tests were all normal except for an INR of 6.6. A chest X-ray revealed free subdiaphragmatic gas (Figure 1), while a plain erect abdominal X-ray showed gross faecal loading. Figure 1: CXR demonstrating air under the diaphragm on presentation. A CT abdomen and pelvis with oral and intravenous contrast demonstrated gross faecal loading in the
Practices, Norms and Recognition
Titus Stahl
Human Affairs , 2007, DOI: 10.2478/v10023-007-0002-0
Abstract: The problem of the social foundations of normativity can be illuminated by discussing the narrower question whether rule-following is necessarily a social matter. The problems with individualistic theories of rule-following seem to make such a conclusion unavoidable. Social theories of rule-following, however, seem to only push back one level the dilemma of having to choose either an infinite regress of interpretations or a collapse into non-normative descriptions. The most plausible of these models, Haugeland's conformism, can avoid these objections if it is supplemented with an ontologically reasonable concept of the collective attitude of a group. Groups of individuals who are bound to shared norms by recognizing each other as equipped with a standard authority of criticism have the necessary properties for ascribing to those groups such collective attitudes. Given such a weak notion of a collective attitude, there is hope for a plausible collectivist theory of rule-following.
Le plurilinguisme en Ouganda : Regards croisés dans les espaces régionaux
Titus Ogavu
Synergies Afrique des Grands Lacs , 2013,
Abstract: Dans la Communauté Economique des Pays des Grands-Lacs (CEPGL) et de la Communauté de l’Afrique de l’Est (CAE) comme dans le monde entier, le plurilinguisme est une nécessité. Alors que le plurilinguisme global se réfère à l’emploi de plusieurs langues internationales dans une communauté donnée, en Afrique, les autorités des pays favorisent l’usage des langues locales et transfrontalières pour la communication endotribale aussi bien qu’exotribale puisque la plupart des dialectes se parlent au-delà des démarcations ethniques, en Ouganda, par exemple. Au sein de la CEPLG et la CAE, l’anglais et le fran ais sont respectivement les langues de communication internationale selon l’histoire linguistique des pays membres. Par ailleurs, les politiques linguistiques des pays manifestent le relativisme du plurilinguisme en encourageant l’enseignement et l’utilisation du kiswahili afin de forger l’intégration régionale. Ce défi met certains promoteurs des langues internationales dans les régions concernées dans un embarras de choix des langues à favoriser afin d’assurer le plurilinguisme.
The Perfections of God in the Theology of Karl Barth: A Consideration of the Formal Structure
Eric Titus
Kairos : Evangelical Journal of Theology , 2010,
Abstract: This treatment of the perfections of God in the theology of Karl Barth serves as an introduction and summary of Barth’s thinking on this topic as found in Church Dogmatics II.1. The focus of the article is weighted to the formal side of Barth’s construction while not ignoring material considerations. As such, the author considers Barth’s understanding of God as the One who loves in freedom, general characteristics of Barth’s understanding of divine perfections, and more specifically the dialectical dyadic paradigm used by Barth in his construction.
Titus Hjelm
REVER : Revista de Estudos da Religi?o , 2005,
Abstract: Religion, as a collective phenomenon, cannot be conceived of without taking communication into account. Nevertheless, the sense of the communicative element in religion has been mostly implicit or completely lacking in religious studies. This paper explores some of the recent openings in the study of religion and communication, focusing on religion and the media in the modern world. The paper closes by delineating some future prospects for the field.
Some notes on the concealment of the classical philosopher
Titus Techera
Sfera Politicii , 2012,
Abstract: Review of: Paul Johnson, Socrates: A man for our times
A History of Anglicanism in the Caribbean and The Bahamas
Titus, Noel
College Forum , 1986,
Abstract: A history of growth and development of the Anglican Church in the Caribbean from its beginning in the 17th century to present day.
Comments on "Spin-dependent tunneling through a symmetric semiconductor barrier: The Dresselhaus effect"
Titus Sandu
Physics , 2010, DOI: 10.1103/PhysRevB.76.197301
Abstract: In a recent paper [Phys. Rev. B 72, 153314 (2005)], the $k^{3}$-Dresselhaus term in the contacts and the full form of the current operator are considered for spin-dependent tunneling through a symmetric barrier. The authors found that the full form of the current operator has a much larger influence on the spin polarization than it was initially thought. In this Comment we will show that their treatment of the other problem, the $k^{3}$-Dresselhaus term in the contacts, is incorrect. Their proposed solution in the contacts simply does not obey the Schr\"{o}dinger equation. In this context we also comment on the definition and the suitability of spin polarization in contacts with spin-orbit coupling.
Dynamics of a quantum oscillator strongly and off-resonantly coupled with a two-level system
Titus Sandu
Physics , 2009, DOI: 10.1016/j.physleta.2009.05.040
Abstract: Beyond the rotating-wave approximation, the dynamics of a quantum oscillator interacting strongly and off-resonantly with a two-level system exhibit beatings, whose period equals the revival time of the two-level system. On a longer time scale, the quantum oscillator shows collapses, revivals and fractional revivals, which are encountered in oscillator observables like the mean number of oscillator quanta and in the two-level inversion population. Also the scattered oscillator field shows doublets with symmetrically displaced peaks.
Optical matrix elements in tight-binding models with overlap
Titus Sandu
Physics , 2005, DOI: 10.1103/PhysRevB.72.125105
Abstract: We investigate the effect of orbital overlap on optical matrix elements in empirical tight-binding models. Empirical tight-binding models assume an orthogonal basis of (atomiclike) states and a diagonal coordinate operator which neglects the intra-atomic part. It is shown that, starting with an atomic basis which is not orthogonal, the orthogonalization process induces intra-atomic matrix elements of the coordinate operator and extends the range of the effective Hamiltonian. We analyze simple tight-binding models and show that non-orthogonality plays an important role in optical matrix elements. In addition, the procedure gives formal justification to the nearest-neighbor spin-orbit interaction introduced by Boykin [Phys. Rev \textbf{B} 57, 1620 (1998)] in order to describe the Dresselahaus term which is neglected in empirical tight-binding models.
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