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OBJECTIVE. In 2013, a multidisciplinary group at our Veterans Administration hospital collaborated to improve the diagnosis and treatment of patients with acute cholecystitis (AC) at our facility. ...

Situs permukiman Kampung kuno Kao terletak di pedalaman Halmahera Utara, berdiri di atas tanah yang relatif basah diapit oleh sungai Aer Kalak, Ake Ngoali, dan Ake Jodo dan dikelilingi oleh hutan sagu dan rawa. Kondisi permukiman di situs ini membuatnya memiliki keterbatasan ruang hunian, namun orang-orang yang menghuni Kampung kuno Kao bermukim di wilayah ini dalam jangka waktu yang relatif panjang, yaitu antara 100-200 tahun, dan bahkan tercatat dalam rekam sejarah bahwa wilayah Kao dahulu menjadi penyuplai makanan pokok Ternate. Penelitian ini bersifat deduktif, yaitu menyusun sebuah hipotesa yang kemudian diuji di lapangan. Metode pengumpulan data dalam penelitian ini menggunakan metode observasi lapangan dan ekskavasi arkeologi. Ragam data arkeologi baik artefak maupun tradisi lisan yang diperoleh di lapangan kemudian dianalisa dengan merujuk pada sumber referensi yang relevan. Hasil penelitian menunjukkan bahwa Situs Kao merupakan permukiman yang cukup maju dan memiliki peran cukup penting sebagai wilayah pusat Islamisasi di Halmahera. Orang-orang di Kampung kuno Kao tinggal dalam waktu lama di satu lokasi didukung oleh sumber air dan potensi tanah-tanah pertanian menjadikan wilayah Kao sebagai bagian dari jaringan perdagangan yang ramai. Kao menjadi bagian dari strategi dalam penyebaran Islam ke wilayah-wilayah pedalaman lainnya, juga daerah-daerah pesisir di Halmahera Utara.The Kao Ancient Village settlement site is located in the hinterland of North Halmahera, standing on relatively wet ground flanked by the river Aer Kalak, Ake Ngoali, and Ake Jodo and surrounded by sago and swamp forests. The settlement conditions on the site make it limited for residential space, but a community of Kao people settled in this area for a relatively long period of time between 100-200 years and even recorded in history that Kao region is the main food supplier for Ternate in the past. This research conducted surface surveys and limited excavations, then mapped the areas of artifactual findings, and identified patterns of spatial use by analyzing surface features and artifact scatters. Variety of archeological data both artifacts and oral traditions are then analyzed guided by relevant reference sources. The results show that Kao Site is an advanced settlement and has a significant role as the center of Islamicization in Halmahera. The Kao people settled for a long time in one location supported by water sources and the potential of farming lands making the Kao area a part of bustling trade networks. Kao became part of a strategy in spreading Islam to other inland areas, as well as coastal areas in North Halmahera.

Xanthogranulomatous pyelonephritis (XGPN) is a rare, chronic disease characterized by the destruction of renal parenchyma and replacement with granulomatous tissue and is associated with long-term obstructive uropathy, chronic renal parenchymal infection, and nephrolithiasis. A 57-year-old patient with XGPN was unable to undergo total nephrectomy. Renal artery embolization (RAE) was performed post subtotal nephrectomy as adjunct therapy to prevent urine formation and decrease the risk of post-operative infection. Our case report demonstrates that RAE can be performed safely and effectively without evident complications and underscores the utility of cone-beam computed tomography in cases of altered post-surgical anatomy. To the author’s knowledge, this is the second case in the literature demonstrating perioperative management of XGPN with RAE.

To inform radiologic technologists about which imaging modalities and examinations are best suited for evaluating specific anatomical structures in patients who have sustained a traumatic injury.Two scholarly research databases were searched to identify articles focused on trauma imaging of the head, cervical spine, thorax, abdomen, and pelvis. Articles focused on trauma diagnosis were excluded. Thirty-two articles were selected for analysis.Physical examination and plain-film radiographs typically are used to assess nasal bone fracures. Computed tomography (CT) can be used to assess zygomaticomaxillary complex, mandibular, and temporal bone fractures. Traumatic brain injuries are difficult to assess, and broad classifications are used. Depending on the severity of cervical spine trauma, plain-film radiographs or CT imaging is adequate, with magnetic resonance imaging used as a means for further evaluation. Trauma to the thorax typically is assessed with radiography and CT, and CT is recommended for assesment of abdominal and pelvic trauma.The literature was consistent regarding which examinations to perform to best evaluate suspected injuries to the chest, abdomen, and pelvis. The need for, and correct use of, imaging in evaluating trauma to the head and cervical spine is more controversial. Despite the need for additional research, emergency department care providers should be familiar with the structures most commonly injured during trauma and the role of medical imaging for diagnosis.

Die vorliegende Übersichtsarbeit befasst sich mit der Abklärung und medikamentösen Behandlung von Schmerzen bei Tumorpatienten. Die verschiedenen diagnostischen und therapeutischen Schritte werden detailliert dargestellt und die Besonderheiten beim Einsatz von Opiaten erläutert.

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised clinical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and performance status, previous weight loss, sex and age on patient-rated QL was analysed over six chemotherapy cycles in 124-130 patients (according to available QL data) with more than 400 questionnaires. Fatigue/malaise, personal functioning, emotional and general well-being were prospectively selected as QL indicators. Predefined summary measures (average QL score over chemotherapy cycles, 'minimum', 'maximum' and 'final' improvement) were analysed separately by scale in various patient groups. General linear models adjusted for treatment arm and response were used to confirm the univariate findings. Within the overall sample, the average QL scores over six cycles were predicted by initial prognostic factors. Patients with poor prognostic factors reported worse QL. Within a limited sample (with baseline QL), patients with poor prognostic factors reported worse QL at baseline and greater improvement under treatment. Graphical comparison of QL patterns over cycles showed permanent discrimination by levels of prognostic factors. The impact of initial prognostic factors was consistently confirmed in the three analyses. Levels of performance status and weight loss best discriminated QL. Initial tumour stage, performance status and previous weight loss can predict QL in small-cell lung cancer during chemotherapy, even after controlling for response to treatment. Our results may contribute to clinical decision-making with regard to the intensity of chemotherapy and QL outcome, especially in patients with extensive disease.

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised clinical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and performance status, previous weight loss, sex and age on patient-rated QL was analysed over six chemotherapy cycles in 124-130 patients (according to available QL data) with more than 400 questionnaires. Fatigue/malaise, personal functioning, emotional and general well-being were prospectively selected as QL indicators. Predefined summary measures (average QL score over chemotherapy cycles, 'minimum', 'maximum' and 'final' improvement) were analysed separately by scale in various patient groups. General linear models adjusted for treatment arm and response were used to confirm the univariate findings. Within the overall sample, the average QL scores over six cycles were predicted by initial prognostic factors. Patients with poor prognostic factors reported worse QL. Within a limited sample (with baseline QL), patients with poor prognostic factors reported worse QL at baseline and greater improvement under treatment. Graphical comparison of QL patterns over cycles showed permanent discrimination by levels of prognostic factors. The impact of initial prognostic factors was consistently confirmed in the three analyses. Levels of performance status and weight loss best discriminated QL. Initial tumour stage, performance status and previous weight loss can predict QL in small-cell lung cancer during chemotherapy, even after controlling for response to treatment. Our results may contribute to clinical decision-making with regard to the intensity of chemotherapy and QL outcome, especially in patients with extensive disease.

We report that the Rhesus (Rh)-negative phenotype is more prevalent in patients with small-cell lung cancer (SCLC) than in the normal Caucasian population (SCLC: 25% Rh-negative vs. 15% expected, p less than 0.0001). This finding has been validated for a Central and a Northern European population (Switzerland and UK). In contrast, the Rh-negative phenotype is no more frequent in non-small-cell lung cancer patients or in heavy smokers with coronary heart disease than in the general population. There was a normal distribution of the ABO blood group phenotype in all patients studied. Whilst the significance of this observation is unclear, we hypothesize that a genetic predisposition to the development of SCLC may be linked to a hitherto unidentified gene on chromosome 1p near the Rh locus. Our observation may perhaps allow further progress to be made in understanding genetic mechanisms of SCLC carcinogenesis.