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Introduction of oil and gas extraction wastewaters (OGWs) to surface water leads to elevated halide levels from geogenic bromide and iodide, as well as enhanced formation of brominated and iodinated disinfection byproducts (DBPs) when treated. OGWs contain high levels of chemical additives used to optimize extraction activities, such as surfactants, which have the potential to serve as organic DBP precursors in OGW-impacted water sources. We report the first identification of olefin sulfonate surfactant-derived DBPs from laboratory-disinfected gas extraction wastewater. Over 300 sulfur-containing DBPs, with 43 unique molecular formulas, were found by high-resolution mass spectrometry, following bench-scale chlor(am)ination. DBPs consisted of mostly brominated species, including bromohydrin sulfonates, dihalo-bromosulfonates, and bromosultone sulfonates, with chlorinated/iodinated analogues formed to a lesser extent. Disinfection of a commercial C12-olefin sulfonate surfactant mixture revealed dodecene sulfonate as a likely precursor for most detected DBPs; disulfur-containing DBPs, like bromosultone sulfonate and bromohydrin disulfonate, originated from olefin disulfonate species, present as side-products of olefin sulfonate production. Disinfection of wastewaters increased mammalian cytotoxicity several orders of magnitude, with chloraminated water being more toxic. This finding is important to OGW-impacted source waters because drinking water plants with high-bromide source waters may switch to chloramination to meet DBP regulations.
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Desinfetantes , Água Potável , Poluentes Químicos da Água , Purificação da Água , Animais , Desinfetantes/análise , Desinfecção , Halogenação , Espectrometria de Massas , Enxofre , Tensoativos , Águas Residuárias , Poluentes Químicos da Água/análiseRESUMO
OBJECTIVE: The aim of the study was to examine the association of Caesarean section (CS) with inflammatory bowel disease (IBD) in Nova Scotian children. METHODS: The study consisted of 2 retrospective cohorts in the Canadian province of Nova Scotia: all births between 1988 and 2014 (nâ=â262,729) linked with a clinical registry of all children diagnosed with IBD at the IWK Health Centre, Halifax (Clinical Cohort) and all births from 1989 to 1993 (nâ=â42,999) linked with provincial administrative health data (Administrative Cohort). The primary outcome was a diagnosis of IBD; the outcome in the Administrative Cohort was ascertained using a previously validated algorithm. Information on the exposures and confounding variables was obtained from the Nova Scotia Atlee Perinatal Database. The association between CS and time to diagnosis of IBD was examined using survival analysis. RESULTS: The population incidence of IBD in the Clinical and Administrative Cohort were 13.0 and 20.6, respectively, per 100,000 person-years; 23% and 19% of children were born by CS in the 2 cohorts. There was no association of CS with IBD in the 2 cohorts. CONCLUSIONS: Findings from 2 population-based cohorts in Atlantic Canada did not provide any evidence for an association between CS and IBD in childhood and young adulthood.
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Cesárea , Doenças Inflamatórias Intestinais , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/etiologia , Nova Escócia/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
Pyrochlore iridates (Na,Ca)2-xIr2O6·H2O are acid-stable electrocatalysts that are candidates for use in electrolysers and fuel cells. Ir LIII-edge X-ray absorption fine structure spectroscopy in 1 M H2SO4 at oxygen evolution conditions suggests the involvement of the electrons from the conduction band of the metallic particles, rather than just surface iridium reacting.
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We report the first time-synchronized protocol stack running on a crystal-free device. We use an early prototype of the Single-Chip micro Mote, SCµM, a single-chip 2×3 mm 2 mote-on-a-chip, which features an ARM Cortex-M0 micro-controller and an IEEE802.15.4 radio. This prototype consists of an FPGA version of the micro-controller, connected to the SCµM chip which implements the radio front-end. We port OpenWSN, a reference implementation of a synchronized protocol stack, onto SCµM. The challenge is that SCµM has only on-chip oscillators, with no absolute time reference such as a crystal. We use two calibration steps - receiving packets via the on-chip optical receiver and RF transceiver - to initially calibrate the oscillators on SCµM so that it can send frames to an off-the-shelf IEEE802.15.4 radio. We then use a digital trimming compensation algorithm based on tick skipping to turn a 567 ppm apparent drift into a 10 ppm drift. This allows us to run a full-featured standards-compliant 6TiSCH network between one SCµM and one OpenMote. This is a step towards realizing the smart dust vision of ultra-small and cheap ubiquitous wireless devices.
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Organophosphorus (OP) nerve agents continue to be a threat at home and abroad during the war against terrorism. Human exposure to nerve agents such as VX results in a cascade of toxic effects relative to the exposure level including ocular miosis, excessive secretions, convulsions, seizures, and death. The primary mechanism behind these overt symptoms is the disruption of cholinergic pathways. While much is known about the primary toxicity mechanisms of nerve agents, there remains a paucity of information regarding impacts on other pathways and systemic effects. These are important for establishing a comprehensive understanding of the toxic mechanisms of OP nerve agents. To identify novel proteins that interact with VX, and that may give insight into these other mechanisms, we used activity-based protein profiling (ABPP) employing a novel VX-probe on lysates from rat heart, liver, kidney, diaphragm, and brain tissue. By making use of a biotin linked VX-probe, proteins covalently bound by the probe were isolated and enriched using streptavidin beads. The proteins were then digested, labeled with isobarically distinct tandem mass tag (TMT) labels, and analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS). Quantitative analysis identified 132 bound proteins, with many proteins found in multiple tissues. As with previously published ABPP OP work, monoacylglycerol lipase associated proteins and fatty acid amide hydrolase (FAAH) were shown to be targets of VX. In addition to these two and other predicted neurotransmitter-related proteins, a number of proteins involved with energy metabolism were identified. Four of these enzymes, mitochondrial isocitrate dehydrogenase 2 (IDH2), isocitrate dehydrogenase 3 (IDH3), malate dehydrogenase (MDH), and succinyl CoA (SCS) ligase, were assayed for VX inhibition. Only IDH2 NADP+ activity was shown to be inhibited directly. This result is consistent with other work reporting animals exposed to OP compounds exhibit reduced IDH activity. Though clearly a secondary mechanism for toxicity, this is the first time VX has been shown to directly interfere with energy metabolism. Taken together, the ABPP work described here suggests the discovery of novel protein-agent interactions, which could be useful for the development of novel diagnostics or potential adjuvant therapeutics.
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Agentes Neurotóxicos/química , Compostos Organotiofosforados/química , Proteínas/química , Amidoidrolases/química , Amidoidrolases/metabolismo , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Cromatografia Líquida de Alta Pressão , Coração/efeitos dos fármacos , Isocitrato Desidrogenase/química , Isocitrato Desidrogenase/metabolismo , Rim/efeitos dos fármacos , Rim/metabolismo , Fígado/efeitos dos fármacos , Fígado/metabolismo , Malato Desidrogenase/química , Malato Desidrogenase/metabolismo , Masculino , Agentes Neurotóxicos/toxicidade , Compostos Organotiofosforados/toxicidade , Peptídeos/análise , Isoformas de Proteínas/química , Isoformas de Proteínas/metabolismo , Proteínas/metabolismo , Ratos , Ratos Sprague-Dawley , Espectrometria de Massas em TandemRESUMO
Sexually mature male and female Gottingen minipigs were exposed to various concentrations of GB and GF vapor via whole-body inhalation exposures or to liquid GB or GF via intravenous or subcutaneous injections. Vapor inhalation exposures were for 10, 60 or 180 min. Maximum likelihood estimation was used to calculate the median effect levels for severe effects (ECT50 and ED50) and lethality (LCT50 and LD50). Ordinal regression was used to model the concentration × time profile of the agent toxicity. Contrary to that predicted by Haber's rule, LCT50 values increased as the duration of the exposures increased for both nerve agents. The toxic load exponents (n) were calculated to be 1.38 and 1.28 for GB and GF vapor exposures, respectively. LCT50 values for 10-, 60- and 180-min exposures to vapor GB in male minipigs were 73, 106 and 182 mg min/m(3), respectively. LCT50 values for 10-, 60 - and 180-min exposures to vapor GB in female minipigs were 87, 127 and 174 mg min/m(3), respectively. LCT50 values for 10-, 60- and 180-min exposures to vapor GF in male minipigs were 218, 287 and 403 mg min/m(3), respectively. LCT50 values for 10-, 60- and 180-min exposures in female minipigs were 183, 282 and 365 mg min/m(3), respectively. For GB vapor exposures, there was a tenuous gender difference which did not exist for vapor GF exposures. Surprisingly, GF was 2-3 times less potent than GB via the inhalation route of exposure regardless of exposure duration. Additionally GF was found to be less potent than GB by intravenous and subcutaneous routes.
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Substâncias para a Guerra Química/toxicidade , Inibidores da Colinesterase/toxicidade , Exposição por Inalação/efeitos adversos , Compostos Organofosforados/toxicidade , Sarina/toxicidade , Animais , Colinesterases/sangue , Interpretação Estatística de Dados , Relação Dose-Resposta a Droga , Feminino , Injeções Intravenosas , Injeções Subcutâneas , Dose Letal Mediana , Masculino , Sus scrofa , Suínos , Porco Miniatura , Fatores de TempoRESUMO
Laparoscopic repair of perforated duodenal ulcers has proven superior results to open procedures though uptake has been poor. We describe the 'three arches' technique as a means of reducing technical difficulty and improving operative efficiency. Our case series of patients undergoing this technique for perforated peptic ulcer disease demonstrates comparable results to other methods of repair.
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Úlcera Duodenal , Laparoscopia , Úlcera Péptica Perfurada , Humanos , Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Úlcera Péptica Perfurada/cirurgia , Laparoscopia/métodos , Resultado do TratamentoRESUMO
UNLABELLED: The prevalence of chronic hepatitis C virus (HCV) infection among incarcerated individuals in the United States is estimated to be between 12% and 31%. HCV treatment during incarceration is an attractive option because of improved access to health care and directly observed therapy. We compared incarcerated and nonincarcerated HCV-infected patients evaluated for treatment at a single academic center between January 1, 2002 and December 31, 2007. During this period, 521 nonincarcerated and 388 incarcerated patients were evaluated for HCV treatment. Three hundred and nineteen (61.2%) nonincarcerated patients and 234 (60.3%) incarcerated patients underwent treatment with pegylated interferon and ribavirin. Incarcerated patients were more likely to be male, African-American race, and have a history of alcohol or intravenous drug use. Treated incarcerated patients were less likely to have genotype 1 virus and were less likely to have undergone previous treatment. There was a similar prevalence of coinfection with human immunodeficiency virus (HIV) in both groups. A sustained viral response (SVR) was achieved in 97 (42.9%) incarcerated patients, compared to 115 (38.0%) nonincarcerated patients (P = 0.304). Both groups had a similar proportion of patients that completed a full treatment course. Stepwise logistic regression was conducted, and the final model included full treatment course, non-genotype 1 virus, younger age at treatment start, and negative HIV status. Incarceration status was not a significant predictor when added to this model (P = 0.075). CONCLUSION: In a cohort of HCV-infected patients managed in an academic medical center ambulatory clinic, incarcerated patients were as likely to be treated for HCV and as likely to achieve an SVR as nonincarcerated patients.
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Antivirais/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Prisioneiros/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Análise de Variância , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Incidência , Interferon-alfa/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polietilenoglicóis/uso terapêutico , Valor Preditivo dos Testes , Proteínas Recombinantes/uso terapêutico , Características de Residência , Estudos Retrospectivos , Ribavirina/uso terapêutico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/virologia , Resultado do Tratamento , Adulto JovemRESUMO
Hydraulic fracturing (HF) events consume high volumes of water over a short time. When groundwater is the source, the additional pumping by rig/frack supply wells (RFSWs) may impose costs on owners of other sector wells (OSWs) by lowering the hydraulic head. The Carrizo-Wilcox aquifer in south Texas is the main source of water for HF of the Eagle Ford Shale (EFS) Play. The objectives are to assess the impacts of groundwater pumping for HF supply on: (1) hydraulic heads in OSWs located nearby an RFSW and (2) volumetric fluxes between layers of the regional aquifer system compared to a baseline model without the effect of RFSW pumping. The study area spans the footprint of the EFS Play in Texas and extends from 2011 to 2020. The pumping schedules of 2500 RFSWs were estimated from reported pumped water volumes to supply 22,500 HF events. Median annual drawdowns in OSWs ranged from 0.2 to 6.6 m, whereas 95th percentile annual drawdowns exceeded 20 m. The magnitudes of drawdown increased from 2011 to 2020. Of the four layers that comprise the Carrizo-Wilcox aquifer, the upper Wilcox was the most intensively pumped for HF supply. During the peak HF year of 2014, the net flux to the upper Wilcox was 292 Mm3 compared to the baseline net flux for the same year of 278 Mm3 -a relative gain of 14 Mm3 . Pumping for HF supply has the potential to negatively impact nearby OSWs by capturing water from adjacent aquifer layers.
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Oil and gas production generates large amounts of brine wastewater called "produced water" with various geogenic and synthetic contaminants. These brines are generally used in hydraulic fracturing operations to stimulate production. They are characterized by elevated halide levels, particularly geogenic bromide and iodide. Such salt concentrations in produced water may be as high as thousands of mg/L of bromide and tens of mg/L of iodide. Large volumes of produced water are stored, transported, reused in production operations, and ultimately disposed of by deep well injection into saline aquifers. Improper disposal may potentially contaminate shallow freshwater aquifers and impact drinking water sources. Because conventional produced water treatment typically does not remove halides, produced water contamination of groundwater aquifers may cause the formation of brominated and iodinated disinfection by-products (I-DBPs) at municipal water treatment plants. These compounds are of interest because of their higher toxicity relative to their chlorinated counterparts. This study reports a comprehensive analysis of 69 regulated and priority unregulated DBPs in simulated drinking waters fortified with 1 % (v/v) oil and gas wastewater. Impacted waters produced 1.3×-5× higher levels of total DBPs compared to river water after chlorination and chloramination. Individual DBP levels ranged from (<0.1-122 µg/L). Overall, chlorinated waters formed highest levels, including trihalomethanes that would exceed the U.S. EPA regulatory limit of 80 µg/L. Chloraminated waters had more I-DBP formation and highest levels of haloacetamides (23 µg/L) in impacted water. Calculated cytotoxicity and genotoxicity were higher for impacted waters treated with chlorine and chloramine than corresponding treated river waters. Chloraminated impacted waters had the highest calculated cytotoxicity, likely due to higher levels of more toxic I-DBPs and haloacetamides. These findings demonstrate that oil and gas wastewater if discharged to surface waters could adversely impact downstream drinking water supplies and potentially affect public health.
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Desinfetantes , Água Potável , Fraturamento Hidráulico , Poluentes Químicos da Água , Purificação da Água , Desinfecção , Água Potável/análise , Desinfetantes/análise , Águas Residuárias , Iodetos/análise , Brometos/análise , Poluentes Químicos da Água/análise , HalogenaçãoRESUMO
The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. Surgical reconstruction is the gold standard treatment for ACL ruptures, but 20-50% of patients develop post-traumatic osteoarthritis (PTOA). ACL rupture is thus a well-recognized etiology of PTOA; however, little is known about the initial relationship between ligamentous injury and subsequent PTOA. The goals of this project were to: (1) develop both partial and full models of mid-substance ACL rupture in male and female mice using non-invasive mechanical methods by means of tibial displacement; and (2) to characterize early PTOA changes in the full ACL rupture model. A custom material testing system was utilized to induce either partial or full ACL rupture by means of tibial displacement at 1.6 or 2.0 mm, respectively. Mice were euthanized either (i) immediately post-injury to determine rupture success rates or (ii) 14 days post-injury to evaluate early PTOA progression following full ACL rupture. Our models demonstrated high efficacy in inciting either full or partial ACL rupture in male and female mice within the mid-substance of the ACL. These tools can be utilized for preclinical testing of potential therapeutics and to further our understanding of PTOA following ACL rupture.
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Lesões do Ligamento Cruzado Anterior , Osteoartrite , Camundongos , Masculino , Feminino , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior , Articulação do Joelho , Tíbia , Ruptura/complicaçõesRESUMO
BACKGROUND: This paper describes the evolution, structure, operation and some outcomes of the Brazilian Laboratory Indicators Program created by the Brazilian Society of Clinical Pathology/Laboratory Medicine (Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, or SBPC/ML), in partnership with ControlLab, a Brazilian Company that provides services for proficiency testing, internal control, calibration, and training indicators for clinical laboratories. METHODS: This web-based program is confidential for all participants. It contains 61 indicators categorized into three groups. Program operation and data analysis methods are described and indicators are reported in box plot format, with grouping varying in accordance with the profiles of the participating laboratories. Three indicators were selected as examples of program effectiveness in 2011: hemolysis, blood re-collection and productivity. RESULTS: Participants profile, examples of three indicators for the year 2011 (hemolysis, blood re-collection and productivity) and exploratory research conducted in 2012 on the implementation of the program are presented. Data related to laboratories participating in the program from 2006 to 2011 were collected and graphically represented. CONCLUSIONS: The Brazilian Laboratory Indicators Program brings important benefits for participants, contributing to the improvement of existing health systems in Brazil.
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Técnicas de Laboratório Clínico/normas , Benchmarking , Coleta de Amostras Sanguíneas , Brasil , Hemólise , HumanosRESUMO
Gallbladder volvulus is a rare entity. It has been attributed to an elongated gallbladder mesentery, predisposing the gallbladder to twisting, obstructing the cystic duct and vessels, thus leading to ischemia and gangrene. Preoperative diagnosis can be elusive, but radiological features across multiple modalities have been described in the literature. We report a case of gallbladder volvulus in which the gallbladder appeared to be left-sided based on imaging, and present the radiological findings in keeping with a volvulus. Unlike cholecystitis, the treatment for volvulus is prompt detorsion and cholecystectomy; thus, accurate and timely diagnosis is paramount.
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BACKGROUND: Postoperative pancreatic fistula (POPF) remains a significant complication of pancreatic resection with recent evidence showing a strong association between post-operative pancreatitis and subsequent development of POPF. Incidence and severity of pancreatitis following endoscopic therapy has been effectively reduced with indomethacin prophylaxis, however further agents require evaluation. We present a systematic literature review and meta-analysis of the prophylactic treatment with corticosteroids or n-acetyl cysteine (NAC) of induced pancreatitis in rodent models. METHODS: A systematic literature search was conducted using Pubmed, Medline, Embase and Cochrane library to identify eligible randomized control trials (RCT) involving animal models that examined NAC or corticosteroids. The primary outcome was the subsequent effect on serum amylase and IL-6 and the histopathological markers of severity such as pancreatic oedema and necrosis. RESULTS: Four RCTs (n = 178) met inclusion criteria examining NAC and eight RCTs (n = 546) examining corticosteroid agents (dexamethasone, hydrocortisone, methylprednisolone). Prophylactic administration of all corticosteroid agents showed a net effect in favour of reducing markers of severity of pancreatitis. NAC showed a significant reduction in severity of amylase and necrosis. CONCLUSION: The RCTs examined suggest that prophylactic administration of corticosteroid agents and NAC can reduce the severity of pancreatitis as indicated by histopathologic markers, serum amylase and IL-6 levels.
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Interleucina-6 , Pancreatite , Amilases , Animais , Humanos , Necrose/complicações , Pancreatite/etiologia , Pancreatite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Despite advances in achieving low mortality rates with pancreaticoduodenectomy (PD), morbidity remains high. A key contributor to this morbidity is delayed gastric emptying (DGE) occurring with an incidence of up to 30%. The utility of a Braun enteroenterostomy (BE) appears promising to reducing the incidence of DGE, but current research is not definitive. METHODS AND ANALYSIS: This project will be designed as a prospective multicentre randomised controlled blinded study to assess how BE effects the rate of DGE after PD in the setting of malignancy, within Australia-with blinding of patients, outcome assessors and data analysts. Patients will be randomly assigned to PD with Billroth II reconstruction with BE versus PD with Billroth II reconstruction without BE. The primary outcome is the incidence of DGE as defined by the International Study Group of Pancreatic Surgery. Secondary outcomes will include length of hospital stay, postoperative pancreatic fistula incidence, development of major complications (Clavien-Dindo≥3 a), quality of life and 90-day mortality.The study will be powered at 80% to detect a reduction in DGE rate from 30% to 15%, requiring a total of 264 study participants. An interim analysis will be performed once a total of 104 study participants have been recruited at which point the study will be able to detect reduction in DGE from 30% to 10% with 80% power. Statistical analysis will be done with intention-to-treat principles. The proportion of patients suffering DGE will be compared between treatment arms using a χ2 test, with p values used to represent statistical significance. ETHICS AND DISSEMINATION: The study has been ethically approved by the Hunter New England Human Research Ethics Committee (2021/ETH11939), with results disseminated through presentation and publication. TRIAL REGISTRATION NUMBER: CTRN12622000048785.
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Gastroparesia , Pancreaticoduodenectomia , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Gastroparesia/etiologia , Gastroparesia/prevenção & controle , Gastroparesia/epidemiologia , Estudos Prospectivos , Qualidade de Vida , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Esvaziamento Gástrico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como AssuntoRESUMO
As electric vehicles become more widely used, there is a higher demand for lithium-ion batteries (LIBs) and hence a greater incentive to find better ways to recycle these at their end-of-life (EOL). This work focuses on the process of reclamation and re-use of cathode material from LIBs. Black mass containing mixed LiMn2O4 and Ni0.8Co0.15Al0.05O2 from a Nissan Leaf pouch cell are recovered via two different recycling routes, shredding or disassembly. The waste material stream purity is compared for both processes, less aluminium and copper impurities are present in the disassembled waste stream. The reclaimed black mass is further treated to reclaim the transition metals in a salt solution, Ni, Mn, Co ratios are adjusted in order to synthesize an upcycled cathode, LiNi0.6Mn0.2Co0.2O2 via a co-precipitation method. The two reclamation processes (disassembly and shredding) are evaluated based on the purity of the reclaimed material, the performance of the remanufactured cell, and the energy required for the complete process. The electrochemical performance of recycled material is comparable to that of as-manufactured cathode material, indicating no detrimental effect of purified recycled transition metal content. This research represents an important step toward scalable approaches to the recycling of EOL cathode material in LIBs.
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Limited work has been done to characterize the stricturing pediatric eosinophilic esophagitis (EoE) phenotype. We aimed to determine, in pediatric EoE: the local incidence, the frequency of esophageal stricturing, and the safety of mechanical dilations. Methods: We retrospectively identified all new cases of EoE at our center from 2015 to 2018 using esophageal biopsy reports, EoE clinic lists, and a local OR database of esophageal dilatations. Electronic medical records (EMRs) were reviewed to confirm EoE diagnosis. Clinical data were captured from the outpatient EMR and gastroscopy/pathology reports. Scope adverse event data were captured from multiple sources. The 2016 census data were used to calculate incidence rates. Results: One hundred eighty-five new cases of EoE were diagnosed during the study period. For patients <15 years old living in Edmonton, the incidence over the 4 years was 11.1 cases per 100,000 person years. Eight of 185 (4%) patients had endoscopically confirmed esophageal strictures, 4 of which required mechanical dilation. Eleven of 185 (5.9%) patients had more subtle signs of esophageal narrowing, but no focal strictures. No perforations or episodes of significant bleeding were reported. Pain was reported after 15% of all scopes, including 50% of the 28 scopes with focal strictures. No unexpected admissions or emergency department visits occurred within 72 hours of a gastroscope with esophageal narrowing. Conclusions: Edmonton zone has one of the highest incidences of pediatric EoE reported. In this cohort, 4% had focal esophageal strictures, and 6% had more subtle narrowing. Mechanical dilation of esophageal strictures was associated with no significant adverse events.
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A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.