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Our understanding of diverticular disease has evolved significantly during the last 25 years, and as such, a reexamination is in order. We performed a literature search for the years 1960-2017 of PubMed, Medline, and Google Scholar for updates regarding the epidemiology, risk factors, and therapies for traditional diverticulitis as well as the recently described subtypes of diverticular disease, segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Although the prevalence of diverticulosis is still extremely common in the general population, the literature suggests that the incidence of diverticulitis is much less than previously believed and occurrences do not necessarily increase with age. In addition, the commonly held beliefs that low-fiber diets alone contribute to the development of diverticulosis and diverticulitis have not been verified; however, the combination of a low-fiber diet and a high red meat/high-fat diet is a risk factor for diverticulitis. Surgery continues to be the treatment for severe complications of diverticulitis, but new literature suggests that it has a poor utility in preventing a recurrence of diverticulitis in the long term; therefore, elective surgery after two episodes of diverticulitis is no longer the standard.

Background: Chronic postoperative pain has been reported in as many as 62.9% of patients after inguinal herniorrhaphy. Moderate to severe neuropathic pain requiring intervention develops in 2.2% to 11.9% of patients as a result of ileoinguinal and genitofemoral nerve entrapment. Cryoanalgesic ablation has been successful in treating chronic pain from craniofacial neuralgia, facet joint syndrome, and malignant pain syndromes. We report our experience using cryoanalgesic ablation for chronic ileoinguinal and genitofemoral neuralgia after inguinal herniorrhaphy. Methods: Ten patients with ileoinguinal, genitofemoral, or combined neuralgia underwent 12 cryoanalgesic ablations between April 1996 and June 2001. These patients were referred from a multidisciplinary pain clinic, and focused low-volume nerve blocks were used to map nerve involvement preoperatively. After surgical exposure, nerves and surrounding tissues were cooled to ?70°C for 3 min using the Lloyd Neurostat. Patients were seen 2 weeks postoperatively and offered monthly follow-up assessments. Results: Nine men and one woman, ages 20 to 54 (mean, 42.6 years) were treated during 58 months, with a mean follow-up period of 8.2 months, for ileoinguinal (n = 4), genitofemoral (n = 1), and combined (n = 5) neuralgia. Patients reported one to five prior herniorrhaphies (mean, 1.8), experienced neuropathic pain 0 to 14 years (mean, 6.3 years), and underwent up to 3 (mean, 1.3) ablative pain procedures before referral. After cryotherapy, patients reported overall pain reduction of 0% to 100% (mean, 77.5%; median, 100%); 80% reported decreased analgesic use, and 90% reported increased physical capacity. Two patients underwent additional cryotherapy, one for incomplete relief and one for recurrent pain, both with 100% efficacy. Wound infection (n = 1) was the only complication. Conclusions: Cryoanalgesic ablation successfully eliminates ileoinguinal and genitofemoral neuralgia in most patients, and should be considered early in the treatment of patients with postherniorrhaphy neuropathic pain.

Geoscientists of the 21st century must continue to learn throughout their careers to maintain a contemporary understanding of their discipline and their role in the ever‐changing E&P market. To satisfy this requirement, we envision continuing education built around distance learning made possible by low‐cost multimedia PCs and high‐speed Internet connections. “By the time they are 30, most scientists are trapped in their own expertise.”—Francis Crick So let's transform the traditional CE, for Continuing Education, to ec for electronic communication (and also to mean “everyone contributes”—writers, presenters, instructors, professors, service providers, and learners themselves). In 1900, a bachelor's degree in an established discipline meant employment until retirement without significantly adding further knowledge. Today, knowledge expands so rapidly that a college degree's half-life is a few years. Consequently, as Peter Senge noted in The Fifth Discipline , companies and institutions must reinvent themselves as learning organizations. Over the last 20 years, computers have driven a continuous evolution on how geoscientists approach data and the whole subject of interpretation. Moreover, the new data-rich, low-risk E&P environment forces us to access large amounts of diverse information, apply novel processes, and assemble integrated pictures of the subsurface. To meet these demands, the CE needs of geoscientists range from basic instruction to advanced topics in several disciplines. This relates to basic-training the work force, adapting it to evolving practices, and retooling the highly skilled geoscientist when he or she moves between assignments, provinces, and companies. Available media for CE include conventional classroom instruction, correspondence courses, and interactive computer-based training (CBT). In all methods, hands-on exercises and “practice” of techniques are critical to learning. Also, evaluation of comprehension is important. Digital and Web-based versions of these methods are developing in the “e” world, occasionally with unique solutions. Classroom instruction remains an efficient means of knowledge transfer, …

A 34-year-old woman with a history of asthma and oral contraceptive use died suddenly. Autopsy examination showed chronic pulmonary emboli with an acute pulmonary saddle embolus. An underlying congenital thrombophilic disorder was considered. Molecular studies on DNA isolated from blood using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis revealed coagulation factor V Leiden mutation. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C (APC) resistance is discussed.This article presents a case report of a 34-year-old woman with a known medical history of asthma and oral contraceptive use who died suddenly from a massive pulmonary embolus. This woman had no underlying malignancy, trauma, recent surgery, or other predisposing factors putting her at risk of venous thromboembolism except for her use of oral contraceptives. Upon autopsy, a large saddle embolus was found occluding the main pulmonary arteries with bilateral extension into the smaller arteries. An acute pulmonary embolus obliterating the lumen of the main pulmonary artery was found during the microscopic examination. Molecular studies of blood DNA using polymerase chain reaction and restriction fragment length polymorphism revealed a coagulation factor V Leiden mutation. Female carriers of factor V Leiden mutation who take oral contraceptives have a more than 30-fold increased risk of developing deep venous thrombosis. This case demonstrates that the woman had an underlying predisposition that was further potentiated by oral contraceptive use. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C resistance is discussed.

The long-term outcomes of selective organ preservation in operable, locally advanced head and neck cancers in two sequential chemoradiotherapy (CRT) protocols (HN-53, HN-67) are reported. A total of 65 patients were treated with CRT consisting of carboplatin (AUC = 1/week) and paclitaxel (60 or 40 mg/m2/week) with radiation (1.8 Gy/day). After 5 weeks of CRT, if primary site biopsies were pathologically negative, then completion CRT to 67–72 Gy was done with neck dissection in node-positive cases. Alternatively, a positive rebiopsy required primary site resection and neck dissection followed by radiotherapy boost as deemed necessary. Pathologic complete responses occurred in 71% patients who then completed CRT; the remaining 29% patients underwent primary site surgery. The 5-year and median overall survival were 47% and 57 months with no statistically significant differences between the two groups. Overall long-term failure rates were: 6% local, 6% regional, and 32% distant. This strategy of selective organ preservation was effective in 71% patients with CRT, whereas salvage surgery was required in the remainder. Long-term survival was equivalent in both treatment groups.

Previously irradiated recurrent rectal cancer is a formidable patient threat with limited treatment options. Isolated pelvic perfusion (IPP) by the balloon-occlusion technique provides high-dose regional chemotherapy that may facilitate resection if appropriate or palliate pain and fungating tumor mass in the symptomatic patient. We currently report our results in 49 recurrent rectal cancer patients (26 had neoadjuvant IPP with intent to resect and 23 had IPP for palliation).IPP was done for 1 hour with paclitaxel 30 mg/m(2), 5 fluorouracil 1500 mg/m(2), cisplatin/oxaliplatin 60-130 mg/m(2), and mitomycin C 10 to 15 mg/m(2) (the latter three achieving pelvic-to-systemic drug ratios of 6-9:1).Neoadjuvant perfusion in 26 patients achieved a response in 14 patients (made resectable). Seven had R0 resections (clear margins), six by abdominal sacral resection (ABSR), and one by an extended APR. Of seven other patients, one had a complete pathologic response negating planned resection, one had50% tumor regression in pelvis (but developed distant metastases), and three refused ABSR. Planned ABSR in two patients was aborted because of complicating cardiovascular issues. A variety of medical and cancer issues precluded resection in the remaining 12 of these 26 neoadjuvant patients. Within the neoadjuvant group, median survival was 24 months in the responding (made resectable) group (14 patients) and it was 8 months in the non-resectable group (12 patients), p = 0.0001. In the responding (made resectable) group, seven patients had R0 resections (median survival 26 months) and seven patients were not resected (median survival 18 months), p = 0.0198. In the IPP group for palliation, 17 of 23 patients (74%) had significant relief of pain, and other tumor-related symptoms (mean survival 11 months).Isolated pelvic perfusion using a simplified balloon-occlusion technique has promise in palliation of or augmenting resectability of advanced rectal malignancy in patients not amenable to treatment with conventional modalities.

Background: Circumferential mucosectomy with stapled proctopexy (CMSP) was first introduced in 1993 as a less painful and highly effective alternative to traditional operative hemorrhoidectomy. Although CMSP has many advantages over traditional hemorrhoidectomy, some authorities and insurers continue to regard it as an inpatient procedure and others have been slow to adopt this progressive technique. This study documents the safe and effective outpatient nature of this procedure. Methods: From December 2001 through August 2002, 33 patients with mucosal prolapse and prolapsing internal hemorrhoids were treated using circumferential mucosectomy with stapled proctopexy as outpatients at an ambulatory surgery center. Fourteen (42%) patients were treated using local anesthesia with intravenous sedation, 18 (55%) chose spinal anesthesia, and general anesthesia was used in one patient. Patients were evaluated postoperatively by telephone at 1 and 2 weeks, and seen in clinic at 4 weeks. Results: One patient (3%) required an emergency department visit for minor postoperative bleeding. None of our elderly patients required emergency department evaluation and none reported significant complications. Four patients (13%) required urinary catheter placement prior to discharge from the surgery center due to urinary retention. One patient (3%) developed an uncomplicated urinary tract infection, which resolved with antibiotic treatment. Two patients were seen earlier than 4 weeks at the surgeon’s request; one was immunocompromised from chemotherapy for metastatic carcinoid, and one reported persistent pain during initial telephone follow-up. No complications were identified in either patient, and no additional complications have been noted to date. Conclusions: CMSP is a safe, effective, time-efficient procedure for patients with mucosal prolapse and prolapsing hemorrhoids that can be performed safely in the ambulatory surgery center setting. Age is not a limiting factor in selecting patients for this safe outpatient procedure.

2. applying a recursive inversion method to independently generate estimates of acoustic impedance from NI and Poisson ratio from PR; and 3. utilizing a crossplot method to simultaneously display and as a color-coded section portraying variations in lithology, porosity and pore fluid. This approach overcomes limitations in stack seismic inversion to discriminate porosity from lithology. It also extends application of AVO to sands with exceeding shale

In this case study, the authors estimate the bulk densities which would be measured by the density log in a well. They base this estimate on the sonic log, a derived lithology log and velocity-density trend curves. Two published methods based on Gardner et al.`s (1974) relationship and an alternate approach that utilizes an areal trend analysis are evaluated. In comparison with the observed density, the Gardner`s relationship underpredicts the shale density and overpredicts the sand density. A modification of Gardner`s equation (Castagna et al., 1993), which utilizes different coefficients for each lithology, produces a better estimate. However, the results vary from well to well. A local data base within their study area provides an empirical calibration to improve upon the Gardner-type relationships for this area. Approximately 1,000 square miles with 50 wells make up their study area in offshore Louisiana, centered on South Marsh island Block 106. These logs constitute a local data base for determining trends in velocity and density for a two component lithology of sand and shale. The authors identify a linear relationship between the density and logarithm of velocity for both sand and shale. Mixing the sand and shale relationships based on their volume lithologicmore » fractions, they arrive at their density estimate. In comparison to the modified Gardner`s method, a comparable to better estimate of the densities is obtained. Furthermore, the linear relationship allows for easy fine-tuning of the local density prediction. If a portion of the well has a density log, they can calibrate the relationships for the remainder of the well. These results show a remarkable fit to the density curve, with errors of less than 2%. When discrepancies are evident, the predicted curve can be used to edit other logs or to indicate the presence of gas.« less

3759 Background: Recurrence after initial resection of rectal cancer often presents with local regional disease and distant metastases. Aggressive monitoring and surgical intervention is controvers...

SEG once again contributed to the success of the International Science and Engineering Fair, the “World Series” of scientific achievement at the high school level. This year's event took place in Mississippi Beach, Mississippi, 9–15 May. There were 826 participants fmm 21 countries, and SEG was among 60 professional organizations to donate cash awards, scholarships, publications and other gifts to the finalists.

The SEG Research Committee held its 1989 summer workshop on recording and processing vector wave field data August 13–17, 1989, in Snowbird, Utah. The workshop title proved puzzling to some, so a word of explanation may be in order. Seismic wave motion, although commonly treated as a scalar quantity, is a vector quantity because particle motions are properly represented as vectors. Three‐component detectors, but not single‐component, can faithfully record the vector motion. A vector wave field is the spatial distribution of such propagating vector waves in a rock volume. Seven half‐day workshop sessions addressed six questions.

Even sophisticated seismic data processing does not usually result in an unambiguous geologic picture: we need to interpret seismic data because information of exploration interest (such as horizon depth, lithological type and saturant) is not readily available. So, given seismic data, their limitations, plus available well and subsurface control, the goal is to determine what lithologies and saturants are represented. This type of inference or inverse problem usually works at the limits of seismic resolution, thus ambiguities and nonuniqueness arise. Vertical seismic profiling (VSP) can provide a direct relationship between surface seismic data and well information. This relationship may help remove ambiguities in the interpretation and nonuniqueness in the inverse process. The VSP is also expected to give additional and complementary seismic values to be used in data processing (e.g., interval velocity, zero‐phase reflectivity).

For much of its existence, vertical seismic profiling was an appealing idea on the fringe of petroleum exploration. It had a definite theoretical fascination but was trapped by “catch 22” circumstances. The critical experimental evidence needed to establish its value could only be gathered in boreholes, but few operators were willing to shut down production, losing money and risking serious well damage in the process, to test a concept which so little field data to support it.