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Bouveret syndrome masquerading as a gastric mass-unmasked with endoscopic luminal laser lithotripsy:A case report

World Journal of Clinical Cases 2020年第22期8卷 5701-5706页

作者： swetha Parvataneni harshit s khara David L Diehl Department of Internal Medicine Geisinger Lewistown HospitalLewistownPA 17044United States Department of Gastroenterology and Hepatology Advanced EndoscopyGeisinger Health systemDanvillePA 17822United States Department of Gastroenterology and Nutrition Geisinger Medical CenterDanvillePA 17822United States

BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of *** condition is most often reported in *** diagnosis can be challenging and is often missed due to atypical presentations,which occasionally mimic gastric outlet obstruction symptoms such as nausea,vomiting,loss of appetite and *** symptoms vary with stone *** stones are managed with a surgical approach,but this carries increased morbidity and *** the past decade,the endoscopic approach has emerged as an alternative mode of treatment,but it is generally unsuccessful in the management of larger-sized stones.A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 *** we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction,who was successfully managed in a single session using a complete endoscopic approach with laser *** sUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain,vomiting,decreased appetite and weight *** abdominal computed tomography showed a 4.5 cm×4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet *** showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal *** nets and baskets were used in an attempt to remove the stone,but this approach was *** her advanced age,poor physical condition and underlying comorbidities,she was deemed to be high-risk for ***,a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the ***-procedure,the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her *** was subsequently discharged home

关键词： Gastric outlet obstruction Bouveret syndrome Laser lithotripsy Holmium laser lithotripsy Holmium and neodymium yttrium aluminum garnet lasers Case report

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Esophageal stent fracture:case report and review of the literature

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World Journal of Gastroenterology 2014年第10期20卷 2715-2720页

作者： harshit s khara David L Diehl seth A Gross Department of Gastroenterology and Nutrition Geisinger Medical Center Danville PA 17822 United States Division of Gastroenterology NYU School of Medicine NYU Langone Medical Center New York NY 10028United States

Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal *** expanding metal stents(sEMs)are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions;however they have known complications of stent migration,stent occlusion,tumor ingrowth,stricture formation,reflux,bleeding and perforation amongst others.A rare and infrequently reported complication of sEMs is stent fracture and subsequent migration of the broken *** have only been a handful of published case reports describing this *** this report we describe a case of a spontaneously fractured nitinol esophageal sEMs,and review the available literature on the unusual occurrence of sEMs fracture placed for benign or malignant obstruction in the *** fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esopha-geal *** usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated *** recognition and prompt management may be able to prevent further problems.

关键词： Esophagus self-expanding metal stent stent complic

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Language development from theory to practice khara L. Pence, Laura M. Justice.

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2008年

作者： khara L. Pence Laura M. Justice.

来源：畅想之星图书光盘版（南... 评论

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An inventory model under development cost-dependent imperfect production and reliability-dependent demand

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Journal of Management Analytics 2017年第3期4卷 258-275页

作者： Barun khara Jayanta Kumar Dey shyamal Kumar Mondal Department of Applied Mathematics with Oceanology and Computer Programming Vidyasagar UniversityMidnaporeWBIndia Department of Mathematics Mahishadal Raj CollgePurba MedinipurWBIndia

This paper considers a model that deals with an imperfect production process where both perfect and imperfect quality items are ***,demand depends on selling price and reliability of the *** manufacturing company expects to produce perfect quality *** due to the long-run process,several kinds of problem such as labor,machinery,and technology *** a result,the manufacturing system becomes out-of-control state and consequently produces both perfect and imperfect quality *** items are ready to sell but imperfect items are reworked at a cost to become *** cost,reliability of the product and reliability parameter of the manufacturing system can be improved by introducing the development cost and also by improving the quality of the raw material of the production *** such circumstances,a profit function has been developed to find the optimum values of reliability parameter of the manufacturing system,reliability of the product and duration of production such that a manufacturer gets a maximum ***,the model has been illustrated with some numerical examples exploring the sensitivity analysis with respect to some parameters.

关键词： imperfect production production time reliability parameter reliability of product

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Owner-Intruder contests with correlated resource values

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International Journal of Biomathematics 2021年第4期14卷 121-129页

作者： Polina A.Bukina Mehtab s.khara Haider H.Nadhem Patrick L.Woolley Jan Rychtár Dewey Taylor Department of Biology Virginia Commonwealth University RichmondVA 23284-2012USA Department of Mathematics and Applied Mathematics Virginia Commonwealth University Richmond VA 23284-2014USA

We study a conflict of two individuals over a valuable *** construct a sequential game where the first individual,the Owner,decides whether to defend the resource and the other individual,the Intruder,decides whether to attack and try to steal the *** know the value of the resource to *** provides the individuals an estimate of the value of the resource to the *** build a mathematical model that allows us to quantify and vary the accuracy of this *** study how the outcomes of the game depend on the *** show that,in our setting,the accuracy does not matter to the Intruder but it does to the *** resources of a large value,the Owner benefits from a smaller ***,for resources of a small value,the Owner benefits from a bigger accuracy.

关键词： Kleptoparasitism Owner-Intruder resource valuation game theory incom-plete information

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一看就懂的摄影书

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作者： (美)khara·Plicanic

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新世纪福音战士

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作者： (日)khara·GAINAX原

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对防治马丁香茅叶斑病的六种杀菌剂的室内评价

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世界热带农业信息 1986年第4期 43-45页

作者： H. s. khara 黄圣明

1976年7月在印度卢迪亚纳的旁遮普农业大学,观察到马丁香茅(Cybopogon martini)的一种严重叶斑病,并造成香茅油严重减产。经英国皇家真菌研究所鉴定,其病原为弯孢菌(Curvularia lunata)。在PDA培养基上进行病原菌的单孢分离,并用Koh氏... 详细信息

1976年7月在印度卢迪亚纳的旁遮普农业大学,观察到马丁香茅(Cybopogon martini)的一种严重叶斑病,并造成香茅油严重减产。经英国皇家真菌研究所鉴定,其病原为弯孢菌(Curvularia lunata)。在PDA培养基上进行病原菌的单孢分离,并用Koh氏法证明了其致病性。本研究通过培养基加毒法和抑制孢子萌发法,评价了常用的六种杀菌剂对该病原菌的抑制效果。

关键词：抑制效果病原菌香茅叶斑病马丁

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Language development from theory to practice

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2012年

作者： khara L. Pence Turnbull Laura M. Justice.

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超富营养化对河流生态系统营养盐吸收功能的影响

超富营养化对河流生态系统营养盐吸收功能的影响

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中国环境科学学会2021年科学技术年会

作者：姚婧梅黄屿玥智悦高杰王芳杨巍林敦梅韦冰 khara Grieger 韩乐重庆大学三峡库区生态环境教育部重点实验室重庆大学环境与生态学院北卡罗来纳州立大学应用生态学院

极端富营养化被称为超富营养化,通过干扰重要的生态功能而对淡水生态系统产生重大影响,而目前超富营养化对河流生态系统功能的影响及其潜在的生态效应尚不清楚,阻碍了该类严重污染水体的管理和恢复。本研究以重庆金佛山自然保护区境内... 详细信息

极端富营养化被称为超富营养化,通过干扰重要的生态功能而对淡水生态系统产生重大影响,而目前超富营养化对河流生态系统功能的影响及其潜在的生态效应尚不清楚,阻碍了该类严重污染水体的管理和恢复。本研究以重庆金佛山自然保护区境内的一条森林源头溪流和重庆市主城的清水溪分别作为对照河流和超富营养化河流的代表,评估了超富营养化对营养盐吸收功能的影响,并对与该功能相关的生物群落,包括微生物和大型底栖无脊椎动物群落的多样性进行调查。本研究基于营养螺旋模型,通过原位示踪实验测量氮(N)和磷(P)的吸收率。研究结果发现:超富营养化河流促进P的吸收(为对照河流的85倍)和降低N的吸收(为对照河流的0.13倍)。本研究能够为全面理解超富营养化条件下生物和生态因素之间的相互作用提供一定理论依据。

关键词：营养盐吸收超富营养化大型无脊椎动物微生物溪流

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