Bouveret Syndrome: When There Are No Options
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Division of Gastroenterology, McMaster University, Hamilton, Ontario Corrrespondence: Dr Harith Baharith, McMaster University, Division of Gastroenterology, 1280 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 289-700-2244, fax 905-648-1906, e-mail harith.baharith@medportal.ca Received for publication November 10, 2014. Accepted December 5, 2014 CASE PRESENTATION An 85-year-old female nursing home resident presented with a medical history of dementia, stroke, hypertension, gastroesophageal reflux disease and cholethiasis. The patient was referred because of four episodes of coffee-ground emesis and symptoms of right upper quadrant abdominal pain, with no issues with bowel movements. There was limited other information available due to the underlying history of dementia. The patient’s vital signs were stable. Physical examination revealed normal cardiorespiratory parameters. The abdominal examination revealed a tender right upper quadrant, with no palpable mass and the presence of bowel sounds. Laboratory investigations revealed a white blood cell count of 18.4×109/L (normal 4.0×109/L to 11.0×109/L), alkaline phosphatase level of 131 U/L (normal 40 U/L to 120 U/L) and gamma-glutamyl transferase level of 116 U/L (normal <37 U/L). The remaining laboratory investigations were unremarkable. An abdominal x-ray revealed a large, rounded, lamellated calcification in the epigastric region measuring approximately 4.5 cm × 3.3 cm (Figure 1). The patient underwent a computed tomography scan, which revealed gastric outlet obstruction secondary to an impacted gallstone within the duodenum, a cholecystoduodenal fistula and a collpased gallbladder, with thickening of the gallbladder wall and air within the gallbladder (Figure 2). The patient was initially managed with intravenous fluids, nasogastric tube, antiemetics and antibiotics. An urgent endoscopy was arranged by gastroenterology, revealing a stone impacted in the duodenal cap (Figure 3). Attempts to push or bypass the stone were unsuccessful, followed by attempts at retrieval with snare, basket, pronged grasper and Roth net, all of which were also unsuccessful. Additional attempts by another gastroenterologist and surgeon using endoscopic therapy to disimpact the stone were unsuccessful. The surgeon then suggested operative management for the patient; however, due to the patient’s deteriorating medical condition, the palliative team involved in her care and the family elected to proceed with palliation instead of surgery. After a three-week hospital stay, the patient was transferred to a hospice care facility where she died within one week.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it