Vomiting is almost always present. Dullness.?Shifting dullness may be present in the flanks but a diagnosis should be possible without this sign. The pulse rate.?A rising pulse rate is an indication for laparotomy. Auscultation.?The value of auscultation cannot be overestimated. There arc two important signs. Twenty years ago Claybrook (1914) pointed out that, in cases of ruptured intestine fol...

A two days-old newborn female patient with Down Syndrome was admitted to our hospital with complaint of vomiting. Physical examination was unremarkable except for the typical physical appearance of Down Syndrome. An abdominal radiography showed the double-bubble sign, characteristic for duodenal obstruction, and the patient was operated with prediagnosis of duodenal atresia. However, during the...

The child presented to us on day 2 of life with complaints of bilious vomiting. An abdominal X-ray showed a double-bubble sign and a diagnosis of duodenal atresia was made. Duodenodoudenostomy with a feeding jejunostomy using an infant feeding tube was done. Post operatively, breast milk was accidentally connected to the intravenous cannula instead of the jejunostomy tube on day 5 and the baby ...

Given a smooth compact Riemannian n–manifold (M, g), we consider the equation ∆gu+ hu = |u| ∗−2−ε u, where h is a C–function on M , the exponent 2∗ := 2n/ (n− 2) is the critical Sobolev exponent, and ε is a small positive real parameter such that ε→ 0. We prove the existence of blowing-up families of sign-changing solutions which develop bubble towers at some point where the function h is great...

While automation helps to increase load-shifting, the combination of with time-of-use (TOU) or critical-peak prices (CPP) may lead rebound peaks at beginning low-tariff periods which exceed original peak. Using a discrete choice experiment representative sample 696 Swiss consumers, we find that tariff menu including (i) flat price direct load control (DLC) and (ii) without could avoid this prob...

Dynamic species' ranges, those that are either invasive or shifting in response to environmental change, are the focus of much recent interest in ecology, evolution, and genetics. Understanding how range expansions can shape evolutionary trajectories requires the consideration of nonneutral variability and genetic architecture, yet the majority of empirical and theoretical work to date has expl...

This paper proposes two parallelized radix-4 scalable Montgomery multiplier implementations. The designs do not require precomputed hard multiples of the operands, but instead uses Booth encoding to compute products. The designs use a novel method for propagating the sign bits for negative partial products. The first design right shifts operands to reduce critical path length when using Booth e...

the word parī (fairy) is the remaining of the avestan word pairīkā that derived from the indo- european root *per- 'to bear, to create', then it can be defined as 'fertile, creative'. pairīkā, in the ancient time were the admirable, beautiful and always young goddesses of birth and fertility that they were denoting to mankind fertility, birth and life with their presence. after zarathuštra made...