Walled-off pancreatic necrosis and a pancreatic abscess are the most severe complications of acute pancreatitis. Surgery in such critically ill patients is often associated with significant morbidity and mortality within the first few weeks after the onset of symptoms. Minimal invasive approaches with high success and low mortality rates are therefore of considerable interest. Endoscopic therapy has the potential to offer safe and effective alternative treatment. We report here on 3 consecutive patients with infected walled-off pancreatic necrosis and 1 patient with a pancreatic abscess who underwent direct endoscopic necrosectomy 19-21 d after the onset of acute pancreatitis. The infected pancreatic necrosis or abscess was punctured transluminally with a cystostome and, after balloon dilatation, a non-covered self-expanding biliary metal stent was placed into the necrotic cavity. Following stent deployment, a nasobiliary pigtail catheter was placed into the cavity to ensure continuous irrigation. After 5-7 d, the metal stent was removed endoscopically and the necrotic cavity was entered with a therapeutic gastroscope. Endoscopic debridement was performed via the simultaneous application of a high-flow water-jet system; using a flush knife, a Dormia basket, and hot biopsy forceps. The transluminal endotherapy was repeated 2-5 times daily during the next 10 d. Supportive care included parenteral antibiotics and jejunal feeding. All patients improved dramatically and with resolution of their septic conditions; 3 patients were completely cured without any further complications or the need for surgery. One patient died from a complication of prolonged ventilation severe bilateral pneumonia, not related to the endoscopic procedure. No procedure related complications were observed. Transluminal endoscopic necrosectomy with temporary application of a self-expanding metal stent and a high-flow water-jet system shows promise for enhancing the potential of this endoscopic approach in patients with walled-off pancreatic necrosis and/or a pancreatic abscess.
In selected, high-risk, SOD patients, early, prophylactic pancreas stent insertion followed by needle-knife fistulotomy seems a safe and effective procedure with no or only minimal risk of post-ERCP pancreatitis. However, prospective, randomized studies are awaited to lend to support to our approach.
Continuous visceral pain (biliary pain) caused by local inflammatory/sensitizing processes or a CNS malfunction could lead to significant hypersensitivity of the peripheral nociceptive nerve fibers in SOD patients. Postcholecystectomy pain may be explained by persistent hyperexcitability of the nociceptive neurons in the CNS with or without objective motility disorders of the SO.
Surveillance is often used as a tool in resilience strategies towards the threat posed by terrorist attacks and other serious crime. “Resilience” is a contested term with varying and ambiguous meaning in governmental, business and social discourses, and it is not clear how it relates to other terms that characterise processes or states of being. Resilience is often assumed to have positive connotations, but critics view it with great suspicion, regarding it as a neo-liberal governmental strategy. However, we argue that surveillance, introduced in the name of greater security, may itself erode social freedoms and public goods such as privacy, paradoxically requiring societal resilience, whether precautionary or in mitigation of the harms it causes to the public goods of free societies. This article develops new models and extends existing ones to describe resilience processes unfolding over time and in anticipation of, or in reaction to, adversities of different kinds and severity, and explores resilience both on the plane of abstract analysis and in the context of societal responses to mass surveillance. The article thus focuses upon surveillance as a special field for conceptual analysis and modelling of situations, and for evaluating contemporary developments in “surveillance societies”.
The ability of data protection authorities (DPAs) to gain and deploy sufficient knowledge of new technological developments in their regulation of personal-information practices is an important consideration now and for the future. However, DPAs' capacity to keep abreast of these developments has been questionable, and improvements in this are a matter of concern, especially given DPAs' task requirements under the European Union's (EU) General Data Protection Regulation (GDPR). This article reports the findings of a recent survey of EU DPAs that explore the problems they have in comprehending new technologies and how they are dealing with them.
The ability of data protection authorities (DPAs) to gain and deploy sufficient knowledge of new technological developments in their regulation of personal-information practices is an important consideration now and for the future. However, DPAs' capacity to keep abreast of these developments has been questionable, and improvements in this are a matter of concern, especially given DPAs' task requirements under the European Union's (EU) General Data Protection Regulation (GDPR). This article reports the findings of a recent survey of EU DPAs that explore the problems they have in comprehending new technologies and how they are dealing with them.
The so-called "Right to Be Forgotten or Erasure" (RTBF), article 17 of the proposed General Data Protection Regulation, provides individuals with a means to oppose the often persistent digital memory of the Web. Because digital information technologies affect the accessibility of information over time and time plays a fundamental role in biological forgetting, 'time' is a factor that should play a pivotal role in the RTBF. This chapter explores the roles that 'time' plays and could play in decisions regarding the retention or erasure of data. Two roles are identified:(1) 'time' as the marker of a discrete moment where the grounds for retention no longer hold and 'forgetting' of the data should follow and (2) 'time' as a factor P. Korenhof ( )
Purpose -The purpose of the paper is to provide an overview of the legal implications which may be relevant to the ethical aspects of emerging technologies, to explore the existing situation in the area of legal regulation at EU level, and to formulate recommendations for the lawmakers. Design/methodology/approach -The analysis is based on the premise that the law is supposed to invoke moral principles. Speculative findings are formulated on the basis of analyzing specific emerging technologies; empirical findings are based on a research conducted in the whole legal corpus of the EU. Findings -In the area of network-based technologies the already existing and elaborated legal frameworks can be used in an extended manner; artificial intelligence-based technologies call for alterations in several branches of law; while interface technologies show the difficulty and complexity of regulating interdisciplinary fields. The legal implications of emerging technologies have attracted only a minimal legislative attention in the competent bodies of the EU. Originality/value -The paper provides a systemic approach towards transmitting ethical norms to the application of emerging technologies through legal regulation, and formulates detailed recommendations in various areas of such technologies.
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