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  • Key words: Bile duct stones — Laparoscopic cholecystectomy — Endoscopic sphincterotomy — High-risk patient — Elderly  (1)
  • competitive learning  (1)
  • gastroesophageal reflux  (1)
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  • 1
    ISSN: 1432-2218
    Keywords: Key words: Bile duct stones — Laparoscopic cholecystectomy — Endoscopic sphincterotomy — High-risk patient — Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The best approach to bile duct stones in high-risk patients is controversial. We showed in a randomized trial that open surgery had a morbi-mortality similar to that of endoscopic sphincterotomy alone (ES) and less late biliary complications. The aim of this study was to evaluate a minimally invasive approach to duct stones in high-risk patients compared with open surgery or ES alone. Methods: Sixty high-risk patients (mean age 80 years) suspected of duct stones were treated by ES + laparoscopic cholecystectomy (LC). High-risk factors were: age 〉 70 years, Goldman cardiac index 〉 13, chronic pulmonary disease, liver cirrhosis, neurologic deficit, and severe obesity. Results: ERCP success was 87%. Duct stones were found in 75%. LC succeeded in 92%. Post-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compared with open surgery or ES alone, ES + LC had a similar morbi-mortality, but shorter postop stay (p 〈 0.001). Late symptoms appeared in 20% after ES alone vs 4% after open surgery or ES plus LC (p 〈 0.04). Conclusions: Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Neural processing letters 12 (2000), S. 199-213 
    ISSN: 1573-773X
    Keywords: temporal inhibition ; competitive learning ; self-organizing maps ; learning vector quantization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science
    Notes: Abstract A model is presented for a neural network with competitive learning that demonstrates the self-organizing capabilities arising from the inclusion of a simple temporal inhibition mechanism within the neural units. This mechanism consists of the inhibition, for a certain time, of the neuron that generates an action potential; such a process is termed Post_Fire inhibition. The neural inhibition period, or degree of inhibition, and the way it is varied during the learning process, represents a decisive factor in the behaviour of the network, in addition to constituting the main basis for the exploitation of the model. Specifically, we show how Post_Fire inhibition is a simple mechanism that promotes the participation of and cooperation between the units comprising the network; it produces self-organized neural responses that reveal spatio–temporal characteristics of input data. Analysis of the inherent properties of the Post_Fire inhibition and the examples presented show its potential for applications such as vector quantization, clustering, pattern recognition, feature extraction and object segmentation. Finally, it should be noted that the Post_Fire inhibition mechanism is treated here as an efficient abstraction of biologically plausible mechanisms, which simplifies its implementation.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2568
    Keywords: esophagus ; gastroesophageal reflux ; pH-metry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty-four-hour intraesophageal pH monitoring is presently considered the most reliable diagnostic test for gastroesophageal reflux. Prolonged esophageal pH measurements can be obtained in hospitalized patients with a stationary technique and in ambulant outpatients by means of a portable device; however, there have been no studies that have examined whether the two approaches provide a similar diagnostic accuracy. We performed a prospective study to compare stationary and ambulatory pH-metry in the diagnosis of gastroesophageal reflux. Seventy-seven control subjects and 178 patients with proven gastroesophageal reflux disease were randomized to either ambulant or static pH-metry, which was performed with standard pH electrodes, sensors, and recorders. Reflux events (intraesophageal pH〈4.0) analyzed were: number of episodes; total, upright, and supine reflux time; number of episodes lasting 〉5 min; and duration of the longest episode. A composite score of all reflux events according to DeMeester was also calculated. The limits of normality were defined as the 95th percentiles of the control groups. Both controls and patients assigned to either pH monitoring method were comparable. Of 255 studies attempted, 243 (95%) were completed successfully. The results showed similar median values of reflux events for the two control groups and for the two patients groups. Percent total reflux time provided a good separation between normal and abnormal reflux, with a sensitivity of 0.92 for static pH-metry and 0.68 for the ambulant procedure (respective 95th percentiles, 3.4 and 4.6). The lower sensitivity of ambulatory pH-metry compared to the stationary method could not be attributed to the higher normal limit in the former; circumstantial evidence suggests that dietary restrictions by the patients to minimize symptoms during home monitoring were probably responsible of this relatively high false negative rate. In conclusion, the results confirm the accuracy of stationary pH monitoring in the diagnosis of gastroesophageal reflux and show that the ambulatory procedure is less reliable; its sensitivity could probably be improved by strict dietary standardization.
    Type of Medium: Electronic Resource
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