As lateral internal sphincterotomy, pneumatic balloon dilatation grants a high anal fissure-healing rate but with a statistically significant reduction in postoperative anal incontinence.
Gastric diverticula are rare and uncommon conditions. Most gastric diverticula are asymptomatic. When symptoms arise, they are most commonly upper abdominal pain, nausea and emesis, while dyspepsia and vomiting are less common. Occasionally, patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation. The diagnosis may be difficult, as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula. The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. Although some authors support conservative therapy with antacids, this provides only temporary symptom relief since it is not able to resolve the underlying pathology. Surgical resection is the mainstay of treatment when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy, with over two-thirds of patients remaining symptom-free after surgery, while laparoscopic resection, combined with intraoperative endoscopy, is a safe and feasible approach with excellent outcomes. Here, we present two cases of uncommon large symptomatic gastric diverticula with a discussion of the cornerstones in management and report a minimally invasive solution, with a brief review of the literature.
1 --Global Earthing Systems (GESs), created by the interconnection of local Earthing Systems (ESs), should guarantee the absence of dangerous touch voltages. According to international Standards, one of the reasons for this safety characteristic of GESs is that MV and LV grounding systems form a quasi-equipotential area.Typical examples of GESs are in city centers, thanks to the high number of interconnected grounding systems in the area. For this reason, in addition to ground-grids, also other metallic parts with different primary functions shall be considered: for example, water and gas pipes, tramway tracks and building foundations can modify the electric potential distribution in the area.In this paper, a model based on the Maxwell's sub-areas method (MaSM) is used to evaluate how buried metallic parts, not intentionally connected to ground-grids, modify the electric potential on the soil surface.Firstly, the MaSM model is validated with experimental measurements on a simple electrodes configuration. The measured voltages are compared with the MaSM results and with the results obtained with a FEM model simulated with COMSOL Multiphysics.Then the simulations are carried out on a realistic urban test case.
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