This module is designed to teach the fundamentals of clean intermittent urinary catheterization for the disabled child, particularly in the school setting. The text includes information on proper hand washing techniques, the supplies needed, suggested settings, and the preparations required before and after the catheter is inserted into the…
Lewis, Mary Bell; Moseley, James L.
The techniques for superselective catheterization of hepatic artery are described. The catheters have five major configurations in various sizes: (1) simple curve, (2) reverse curve, (3) double curve, (4) modified double curve, and (5) hepatic and splenic curves. Since the celiac artery may be directed caudad, horizontally, or cephalad, the techniques vary accordingly. The basic approach of the system described is to tailor the catheter to fit the vascular anatomy. These various techniques have produced a 95% success rate in the hepatic artery catheterization of 1000 patients.
Chuang, V.P. (Univ. of Texas, Houston); Soo, C.S.; Carrasco, C.H.; Wallace, S.
The emergence of the Göttingen minipig in research of topics such as neuroscience, toxicology, diabetes, obesity, and experimental surgery reflects the close resemblance of these animals to human anatomy and physiology 1-6.The size of the Göttingen minipig permits the use of surgical equipment and advanced imaging modalities similar to those used in humans 6-8. The aim of this instructional video is to increase the awareness on the value of minipigs in biomedical research, by demonstrating how to perform tracheal intubation, transurethral bladder catheterization, femoral artery and vein catheterization, as well as transcardial perfusion. Endotracheal Intubation should be performed whenever a minipig undergoes general anesthesia, because it maintains a patent airway, permits assisted ventilation and protects the airways from aspirates. Transurethral bladder catheterization can provide useful information about about hydration state as well as renal and cardiovascular function during long surgical procedures. Furthermore, urinary catheterization can prevent contamination of delicate medico-technical equipment and painful bladder extension which may harm the animal and unnecessarily influence the experiment due to increased vagal tone and altered physiological parameters. Arterial and venous catheterization is useful for obtaining repeated blood samples and monitoring various physiological parameters. Catheterization of femoral vessels is preferable to catheterization of the neck vessels for ease of access, when performing experiments involving frame-based stereotaxic neurosurgery and brain imaging. When performing vessel catheterization in survival studies, strict aseptic technique must be employed to avoid infections6. Transcardial perfusion is the most effective fixation method, and yields preeminent results when preparing minipig organs for histology and histochemistry2,9. For more information about anesthesia, surgery and experimental techniques in swine in general we refer to Swindle 2007. Supplementary information about premedication and induction of anesthesia, assisted ventilation, analgesia, pre- and postoperative care of Göttingen minipigs are available via the internet at http://www.minipigs.com10. For extensive information about porcine anatomy we refer to Nickel et al. Vol. 1-511.
Ettrup, Kaare S.; Glud, Andreas N.; Orlowski, Dariusz; Fitting, Lise M.; Meier, Kaare; Soerensen, Jens Christian; Bjarkam, Carsten R.; Alstrup, Aage K. Olsen
To minimize procedural and fluoroscopic times and avoid the risks of vascular injury and pneumothorax, some investigators have advocated elimination of routine placement of a coronary sinus (CS) catheter during electrophysiological procedures. We hypothesized that expedient and reproducible CS catheterization could be performed with minimal patient risk by utilizing a femoral vein approach. Fifty consecutive patients referred for radiofrequency ablative procedures underwent attempted CS catheterization using a 6-French steerable, quadripolar catheter via a femoral vein. Procedures were performed utilizing single-plane fluoroscopy without contrast angiographic aid by operators experienced in the technique. Successful catheterization was defined by the attainment, in < 15 minutes, of a stable catheter position with the distal electrode at or beyond the lateral margin of the heart. Successful catheterization of the CS was achieved in 47 (94%) patients. Selective pacing of the left atrium without patient discomfort was possible in all, eliminating the need for a right atrial pacing catheter. The median time to successful catheterization was 1.4 minutes (range 0.3-14.7). Only six patients required > 5 minutes. The median fluoroscopic time required was 1.2 minutes (range 0.3-12.7). No clinical variable was predictive of catheterization failure or time to successful catheterization. No complications were observed as a result of this technique. This prospective evaluation demonstrates that catheterization of the CS via a femoral vein approach is highly successful, expedient, and safe. The ability to selectively pace the left atrium may eliminate the requirement for a right atrial catheter. PMID:7838781
Kleman, J M; Pinski, S L; Sterba, R; Kidwell, G A; Trohman, R G
Selective catheterization and angiography of brachiocephalic vessels in the elderly may be difficult because of tortuosity and unfolding of the thoracic aorta. Use of a special guide wire contributed to the successful performance of safe femorocerebral angiography with the Simmons sidewinder catheter in the 47 of 48 elderly patients in whom it was performed. All 47 had patent left subclavian arteries. PMID:2916048
Mewissen, M W; Zavitz, W R; Lipchik, E O
A new "transductal" technique of aortic arch and left ventricular angiography in patients with patent ductus arteriosus (PDA) is described by introducing the catheter to the aortic arch from the pulmonary artery via the PDA. Over a 4-year period, 44 infants and children with complicated PDA underwent cardiac catheterization with this technique at our institution. Twenty-five of the 30 in the group with PDA alone and 12 of 14 in the group with associated cardiac defects had successful aortic arch catheterization and angiography, an 84% success rate. No complications were encountered during the procedure. The technique offers a safe alternative to retrograde arterial catheterization in patients with PDA who have other associated lesions. PMID:6831557
Mardini, M K; Rao, P S
A new technique for transseptal left heart catheterization utilizing the Transseptal Introducer Set® in 520 patients is described in detail. The age range of these patients was 3 months to 40 years with 30% of the patients less than 2 years old and 28% less than 10 kilograms in weight. The safety and advantages of the technique are emphasized. The
Charles E. Mullins
It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.
Sammour, Mohammed T.; Ajjaj, Abdulbari Bin
Primary pancreatic hydatid cysts are rare and its percutaneous treatment and catheterization technique has, to the best of our knowledge, not been published in literature. A 33-year-old male patient who presented with abdominal pain was evaluated by ultrasonography (US) and computed tomography examinations. Both examinations revealed a cyst in the neck of the pancreas. After the administration of albendazole chemoprophylaxis, the patient underwent diagnostic puncture showing high pressure spring water which harbored the scoleces and was treated percutaneously by the catheterization technique. In this technique, first the cyst was punctured, the fluid content aspirated, the radiocontrast material injected to see possible fistulisation, and then re-aspirated. The 20% hypertonic saline solution was injected and re-aspiration was performed to the best of our abilities, followed by the insertion of a catheter for drainage of the remaining non-aspiratable fluid content. At follow-up examination, the cyst was not visible on US after 6 months. There was no evidence of cyst recurrence or dissemination after 18 months at serologic and imaging follow-up.
Karaman, Bulent; Ustunsoz, Bahri; Ugurel, Mehmet Sahin
Hernioscopy is laparoscopy traversing a hernial sac used in the course of traditional treatment for groin hernia and it may be both diagnostic or therapeutic. The technique involves dissecting the hernial sac followed by incision, and the creation of a pouch into which a trocar is passed to permit laparoscopy. Once detected an abdominal lesion can also be treated laparoscopically: adhesiotomy, debridement, biopsy etc. The indications to this technique are: strangulated hernia after reduction of the intestinal loop; contralateral diagnosis of inguinal hernia in infants; hernias accompanied by abdominal pain or subocclusive syndromes. For surgeons who adopt the traditional approach to the treatment of groin hernias this technique represents an unexpected addition to their armoury. PMID:9189817
INDICATIONS Urethral catheterization may be performed for diagnostic or therapeutic purposes. Therapeutically, catheters may be placed to decompress the bladder in patients with acute or chronic urinary retention as a result of conditions such as infravesicular obstruction of the urinary tract or neurogenic bladder. Catheterization and subse- quent irrigation may be required in patients with gross hematuria to remove blood
Todd W. Thomsen; Gary S. Setnik
Augmentation cystoplasty (AC) has traditionally been used in the treatment of the low capacity, poorly compliant or refractory overactive bladder (OAB). The use of intravesical botulinum toxin and sacral neuromodulation in detrusor overactivity has reduced the number of AC performed for this indication. However, AC remains important in the pediatric and renal transplant setting and still remains a viable option for refractory OAB. Advances in surgical technique have seen the development of both laparoscopic and robotic augmentation cystoplasty. A variety of intestinal segments can be used although ileocystoplasty remains the most common performed procedure. Early complications include thromboembolism and mortality, whereas long-term problems include metabolic disturbance, bacteriuria, urinary tract stones, incontinence, perforation, the need for intermittent self-catheterization and carcinoma. This article examines the contemporary indications, published results and possible future directions for augmentation cystoplasty.
Veeratterapillay, Rajan; Thorpe, Andrew C.; Harding, Chris
Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization. PMID:21542441
Newman, Diane K; Willson, Margaret M
Intermittent catheterization (IC) is a widely used technique for emptying the bladder, first recorded in 1000?bce. This article describes the normal anatomy and physiology of bladder filling and emptying, and discusses the reasons why emptying may be incomplete. Incomplete emptying usually has a neurogenic or obstructive cause, leading to symptoms such as frequency, urge incontinence and urinary tract infection. IC may be carried out for several reasons: as an acute intervention for transitory problems with bladder emptying; to enable the instillation of drugs into the bladder; or as a long-term intervention where there is a regular post-void residual volume of more than 100?ml. Ideally, the patient intermittently catheterizes his/her own bladder, but a relative or healthcare professional may carry out this task. Some patients have specific requirements and problems, and case studies are presented to illustrate how these problems may be resolved. PMID:18946390
Wilson, Mary Cr
Neurogenic lower urinary tract dysfunction (NLUTD) is commonly encountered in rehabilitation settings, and is caused by a variety of pathologies. The management of spinal cord injury (SCI) has been the model of reference for the management of other pathologies with NLUTD. The introduction of intermittent catheterization (IC) led to decline in renal related mortality in SCI patients and allowed an improvement of quality of life (QoL) in all neurogenic patients with NLUTD. IC could be sterile, aseptic or clean. Sterile intermittent catheterization (SIC) is the preferred method of bladder drainage in emergency medicine units and during spinal shock in SCI patients, but it is costly and time-consuming. Catheterizations performed in institutions, such as rehabilitation hospitals and nursing homes, are done aseptically. Clean intermittent catheterization (CIC), i.e. self-catheterization (CISC) or third party catheterization, represents the "gold standard" method for bladder emptying in all neuropathic patients with NLUTD: the technique is safe and effective and results in improved kidney and upper urinary tract status, lessening of vesico-ureteral reflux and amelioration of urinary continence. CISC is mandatory in patients with NLUTD secondary to detrusor areflexia/hypocontractility and in patients suffering from neurogenic detrusor overactivity with detrusor external sphincter dyssynergia and high post void residual of urine, often in combination with antimuscarinics/bladder relaxants. The review summarizes the most important aspects of IC and CISC. Attention was focused on the history of urethral catheterization, aims, materials, advantages, indications, and present-day techniques of CISC, emphasizing the importance of teaching in order to perform correctly the catheterization technique. PMID:22222962
Di Benedetto, P
Infraclavicular subclavian venepuncture in the oedematous burned patient is often difficult because of increased depth of the vein. In addition, proper patient positioning is not easily achieved because of extensive burns, generalised oedema and bulky dressings. To overcome these difficulties, a modified technique of infraclavicular subclavian venepuncture has been developed. The introducer needle is bent to create a mild curvature.
Bien-Keem Tan; Chin-Ho Wong; Robert Ng; Martin H. S. Huang; Seng-Teik Lee
Clean intermittent self-catheterization is an established option in bladder management of spinal cord injury patients. Several early and a small number of long-term studies have reported good preventive or therapeutic effects on hydronephrosis, vesicourethral reflux, urinary tract infection and incontinence. Most reports describe the use of small catheters and liberal use of jelly but urethral complications, such as strictures and
Lena Waller; Olof Jonsson; Lars Norlen; Lars. Sullivan
The authors herein report the feasibility of suprachoroidal buckling (SCB) procedure as a new approach for treating different forms of retinal detachment (RD) by creating suprachoroidal indentation (buckling effect). With this technique, specially designed devices, i.e. a catheter or cannula, are guided in the suprachoroidal space to reach the target area. Then, a suprachoroidal filler (long lasting hyaluronic acid) is injected to indent the choroid creating SCB, thereby closing retinal tears and supporting the overlying retina. This procedure was performed to treat both myopic tractional maculopathy (MTM), including myopic macular holes, as well as peripheral retinal breaks. SCB may be used alone or in conjunction with vitrectomy. In myopic patients, restoration of retinal layers was achieved in all eyes with myopic foveoschisis. Most eyes with macular hole detachments demonstrated closure of the holes. All peripheral retinal breaks were adequately buckled and closed in a single procedure. The buckling effect was long enough in duration to seal the tears and promote adequate chorioretinal scarring. The procedure was safe and relatively simple in terms of reaching the treatment area and injecting the filler. SCB adds to our surgical options for treating selected cases of peripheral retinal tears and rhegmatogenous RD, and avoids potential problems of episcleral buckles. Moreover it may avoid vitrectomy in selected cases of rhegmatogenous RD. PMID:24653830
El Rayes, Ehab N; Elborgy, Ebrahim
The authors herein report the feasibility of suprachoroidal buckling (SCB) procedure as a new approach for treating different forms of retinal detachment (RD) by creating suprachoroidal indentation (buckling effect). With this technique, specially designed devices, i.e. a catheter or cannula, are guided in the suprachoroidal space to reach the target area. Then, a suprachoroidal filler (long lasting hyaluronic acid) is injected to indent the choroid creating SCB, thereby closing retinal tears and supporting the overlying retina. This procedure was performed to treat both myopic tractional maculopathy (MTM), including myopic macular holes, as well as peripheral retinal breaks. SCB may be used alone or in conjunction with vitrectomy. In myopic patients, restoration of retinal layers was achieved in all eyes with myopic foveoschisis. Most eyes with macular hole detachments demonstrated closure of the holes. All peripheral retinal breaks were adequately buckled and closed in a single procedure. The buckling effect was long enough in duration to seal the tears and promote adequate chorioretinal scarring. The procedure was safe and relatively simple in terms of reaching the treatment area and injecting the filler. SCB adds to our surgical options for treating selected cases of peripheral retinal tears and rhegmatogenous RD, and avoids potential problems of episcleral buckles. Moreover it may avoid vitrectomy in selected cases of rhegmatogenous RD.
El Rayes, Ehab N; Elborgy, Ebrahim
... Institution: NIH Library User Name Password Sign In Cardiology Patient Page Radial Artery Catheterization Nicholas R. Balaji , ... Correspondence to Pinak B. Shah, MD, Director, Interventional Cardiology Training Program, Brigham and Women's Hospital, 75 Francis ...
The purpose of this study was to present the indications, technique, and results for subtalar arthroscopy in 50 consecutive patients. In each case, ankle arthroscopy was performed concomitantly to assess the exact source of the patient's pain. Surgical indications included chronic pain, swelling, buckling, and\\/or locking that failed conservative treatment. Arthroscopy of the ankle and subtalar joints were performed using
With the technological progress, the role of the cardiac catheterization has dramatically changed, moving from diagnostic to therapeutic and becoming adjuvant to surgical procedures. In various congenital heart defects, it allows to postpone the need for surgery or even cancel the surgical indication being less invasive and as powerful as surgery. It is thanks to many technological advances, in particular with the development of devices with memory alloy, that the catheterization makes such great strides today, and the miniaturization of the prosthetic material makes it possible to push back more and more the limits of feasibility which remain related to the smallness of the vascular accesses at the newborn age. The future of this discipline lies in the hybrid procedures, where a true teamwork between the surgeons and the pediatric cardiologists makes it possible to bring the best therapeutic strategy for patients with congenital heart defects. PMID:22041595
Van Aerschot, I; Boudjemline, Y
The radiotherapy department at Salah Azaïz institute had started, in March 2000, a new sophisticated technique of irradiation consisting in total body irradiation (TBI). TBI is used in many preparative regimens before bone marrow transplantation in the treatment of haematological malignancies. TBI aims to destroy immunocompetent tissues in order to avoid graft rejection and to eradicate residual tumor cells. In this article, we review different TBI techniques and its main indications. We also describe the acute and late effects of TBI. PMID:16370205
Kochbati, Lotfi; Besbes, Mounir; Frikha, Hatem; Sellami, Dalila; Gargouri, Walid; Ben Ammar, Chiraz Nasr; Ben Aissia, Ridha; Benna, Farouk; Damak, Hedi; Maalej, Mongi
Because there are no definitive guidelines for performing right heart catheterizations or controlled clinical trials demonstrating medical benefit, the value and necessity of performing routine right heart catheterizations for coronary artery disease have been questioned. This Texas Medical Foundation Health Care Quality Improvement Program project was designed to ensure medical necessity and proper documentation of right heart catheterization when performed as part of a bilateral procedure. Medicare claims data were used to identify Texas facilities where rates of bilateral catheterizations suggested that right heart catheterizations were being performed routinely. Five facilities were found to have rates of bilateral procedures exceeding 70%. Suggested guidelines for performing right heart catheterizations were prepared by the Texas Medical Association Committee on Cardiovascular Diseases. These guidelines, together with the facility's data on its rate of right heart catheterizations, were presented by the Texas Medical Foundation to the staff of each facility. They were asked to examine their individual facility's procedures for ensuring medical necessity and to develop and implement process improvement plans. Medicare claims data were analyzed to determine the rates of bilateral catheterizations before and after the plans were instituted. The statewide rate of bilateral procedures decreased from 27.2% to 21.3% (p < 0.005). Rate reductions for 4 facilities implementing improvement plans were statistically significant (p < 0.001): at the 1st facility, the rate decreased from 74.3% to 25.0%; at the 2nd, from 85.0% to 21.0%; at the 3rd, from 76.7% to 17.7%; and at the 4th facility, from 85.4% to 42.9%. The rate for the facility not implementing an improvement plan increased from 86.4% to 89.1%. Reductions in rates of bilateral procedures at the 4 facilities suggest that many procedures previously performed were routine and not medically indicated. Presentation of data and practice guidelines to facilities may have contributed to their ability to improve processes.
Bing, M L; Abel, R L; Lee, L J; McCauley, C
Clean intermittent self-catheterization is the recommended mode of voiding in patients with urinary retention. CISC is a non-sterile catheterization, done by the patient himself to insure complete emptying of the bladder several times per day. Its prescription rests on well-established recommendations with a sufficient frequency of self-catheterization (minimum 4), collected volumes less than 400 mL and a diuresis higher than 1.5 L. Clean intermittent self-catheterization allows a reduction in complications of infection, protects the upper urinary tract and provides urinary continence for the patient. Asymptomatic bacteriuria is very frequent in patients treated with intermittent catheterization and does not justify antibiotic therapy. Only symptomatic urinary tract infections have to be treated by a short course of antibiotics. Patient education and personalized medical follow-up must ensure adapted management dependant on this voiding mode and its risk factors. A guideline is provided to prescribe clean intermittent self-catheterization with its indications, its advantages and complications, its medical surveillance and treatment of urinary tract infection. This procedure should be well-known to general practitioners who are responsible for the follow up of these patients. PMID:19152777
Bonniaud, Véronique; Leroy, Joël; Kleinclauss, François; Look, Pierre-Yves; Bévalot, Julien; Parratte, Bernard
In this article, we discuss the surgical technique of finger replantation in detail, distinguishing particularities of technique in cases of thumb amputation, children fingertip replantation, ring finger avulsion, and very distal replantations. We emphasize the principles of bone shortening, the spare part concept, the special importance of nerve sutures and the use of vein graft in case of avulsion or crushing. However, even if finger replantation is now a routine procedure, a clear distinction should be made between revascularization and functional success. The indications for finger replantation are then detailed in the second part of this paper. The absolute indications for replantation are thumb, multiple fingers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Fingertip amputations distal to the insertion of the Flexor digitorum superficialis (FDS) are also a good indication. Other cases are more controversial because of the poor functional outcome, especially for the index finger, which is often functionally excluded. PMID:24075814
Barbary, S; Dap, F; Dautel, G
A series of nursing care variances related to the procedure of catheterizing male patients stimulated an evidence-based practice project designed to define best practice for the technique of inserting male catheters. Results indicate current nursing knowledge may be inadequate. PMID:12830746
Daneshgari, Firouz; Krugman, Mary; Bahn, Alissa; Lee, Robert S
Tracheostomy is a common procedure performed in critically ill patients requiring prolonged mechanical ventilation for acute respiratory failure and for airway issues. The ideal timing (early vs late) and techniques (percutaneous dilatational, other new percutaneous techniques, open surgical) for tracheostomy have been topics of considerable debate. In this review, we address general issues regarding tracheostomy (epidemiology, indications, and outcomes) and specifically review the literature regarding appropriate timing of tracheostomy tube placement. Based on evidence from 2 recent large randomized trials, it is reasonable to wait at least 10 d to be certain that a patient has an ongoing need for mechanical ventilation before consideration of tracheostomy. Percutaneous tracheostomy with flexible bronchoscopy guidance is recommended, and optimal percutaneous techniques, indications, and contraindications and results in high-risk patients (coagulopathy, thrombocytopenia, obesity) are reviewed. Additional issues related to tracheostomy diagnosis-related groups, charges, and procedural costs are reviewed. New advances regarding tracheostomy include the use of real-time ultrasound guidance for percutaneous tracheostomy in high-risk patients. New tracheostomy tubes (tapered with low-profile cuffs that fit better on the tapered dilators, longer percutaneous tracheostomy tubes) are discussed for optimal use with percutaneous dilatational tracheostomy. Two new percutaneous techniques, a balloon inflation technique (Dolphin) and the PercuTwist procedure, are reviewed. The efficacy of tracheostomy teams and tracheostomy hospital services with standardized protocols for tracheostomy insertion and care has been associated with improved outcomes. Finally, the UK National Tracheostomy Safety Project developed standardized resources for education of both health care providers and patients, including emergency algorithms for tracheostomy incidents, and serves as an excellent educational resource in this important area. PMID:24891198
Cheung, Nora H; Napolitano, Lena M
Hip arthroscopy is one of the most rapidly evolving arthroscopy techniques. It combines the benefits of a minimally invasive procedure and a short rehabilitation period. Improved instrumentation and technical skills have advanced our ability to accurately diagnose and treat various conditions. The role of this procedure continues to evolve with new indications that might change the outcome of degenerative joint disease of the hip joint. Hip arthroscopy is indicated for both traumatic and atraumatic intra and extra-articular conditions. Femoroacetabular impingement (FAI) is increasingly recognized as a disorder that can lead to progressive articular chondral and labral injury. A variety of arthroscopic techniques allows the treatment of labral and acetabular rim pathology as well as peripheral compartment femoral head-neck abnormalities. It is now recognized that labral tears that were traditionally treated with simple debridement are often associated with underlying FAI. Hip arthroscopy is also being used for surgery to the structures surrounding the hip as snapping hip syndromes, greater trochanteric pain syndrome, and arthroscopic repair of abductor tendon tears. Better understanding of the arthroscopic anatomy, improved operative techniques, lowered complication rate and objective outcome measuring tools will further define the optimal role of hip arthroscopy and improve its outcome. PMID:22675858
Rath, Ehud; Tsvieli, Oren; Levy, Ofer
Conversion of retrograde into antegrade catheterization is accomplished through the use of a sidewinder catheter with a reformed loop that is subsequently lost during advancement of the catheter tip. This technique was used to perform eight percutaneous dilatations (PTD) in seven patients (one had bilateral disease). Other applications for antegrade catheterization are considered. PMID:6883399
Shenoy, S S
Early detection of malignancies within the gastrointestinal tract is essential to improve the prognosis and outcome of affected patients. However, conventional white light endoscopy has a miss rate of up to 25% for gastrointestinal pathology, specifically in the context of small and flat lesions within the colon. Chromoendoscopy and other advanced imaging techniques aim at facilitating the visualization and detection of neoplastic lesions and have been applied throughout the gastrointestinal tract. Chromoendoscopy, particularly in combination with magnifying endoscopy has significantly improved means to detect neoplastic lesions in the gastrointestinal mucosa, particularly in ulcerative colitis and Crohn’s colitis. In addition, chromoendoscopy is beneficial in the upper gastrointestinal tract, especially when evaluating Barrett’s oesophagus (BO) for the presence of dysplasia. Furthermore, it also improves characterization, differentiation and diagnosis of endoscopically detected suspicious lesions, and helps to delineate the extent of neoplastic lesions that may be amenable to endoscopic resection. This review discusses the dyes, indications and advanced endoscopic imaging methods used in various chromoendoscopic techniques, and presents a critical overview of the existing evidence supporting their use in current practice with a particular emphasis on the role in inflammatory bowel disease and BO.
Endoscopic papillectomy (EP) is currently accepted as a viable alternative therapy to surgery in sporadic ampullary adenoma and has been reported to have high success and low recurrence rates. At present, the indications for EP are not yet fully established. The accepted criteria for EP include size (up to 5 cm), no evidence of intraductal growth, and no evidence of malignancy on endoscopic findings (ulceration, friability, and spontaneous bleeding). Endoscopic ultrasound (EUS) is the imaging modality of choice for local T staging in ampullary neoplasms. Data reported in the literature have revealed that linear EUS is superior to helical computed tomography in the preoperative assessment of tumor size, detection of regional nodal metastases and detection of major vascular invasion. Endoscopic ampullectomy is performed using a standard duodenoscope in a similar manner to snare polypectomy of a mucosal lesion. There is no standardization of the equipment or technique and broad EP methods are described. Endoscopic ampullectomy is considered a ‘‘high-risk’’ procedure due to complications. Complications of endoscopic papillectomy can be classified as early (pancreatitis, bleeding, perforation, and cholangitis) and late (papillary stenosis) complications. The appropriate use of stenting after ampullectomy may prevent post-procedural pancreatitis and papillary stenosis. Tumor recurrence of benign lesions occurs in up to 20% of patients and depends on tumor size, final histology, presence of intraductal tumor, coexisting familial adenomatous polyposis (FAP), and the expertise of the endoscopist. Recurrent lesions are usually benign and most can be retreated endoscopically.
De Palma, Giovanni D
In our university cardiac center, the incidence of a cohort of children with acute neurologic complications resulting from cardiac catheterization performed for acyanotic or cyanotic congenital heart disease is 0.38% (14 children of a total of 3,648 catheterization procedures). Neurologic complications consisted of convulsion (n = 10), stroke (n = 6), intracranial hemorrhage (n = 2), extrapyramidal features (n =
Xiao-Yan Liu; Virginia Wong; Maurice Leung
Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.
Willette, Paul A.; Coffield, Scott
Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Oncoplastic reconstruction may begin at the time of BCS (immediate), weeks (delayed-immediate) or months to years afterwards (delayed). With immediate reconstruction, the surgical process is smooth, since both procedures can be associated in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The oncoplastic techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/masthopexy. Regardless of the fact that there is no consensus concerning the best approach, the criteria are determined by the surgeon’s experience and the size of the defect in relation to the size of the remaining breast. On the basis of our 15-year experience, it is possible to identify trends in types of breast defects and to develop an algorithm for immediate BCS reconstruction on the basis of the initial breast volume, the extent/location of glandular tissue ressection and the remaining available breast tissue. The main advantages of the technique utilized should include reproducibility, low interference with the oncologic treatment and long-term results. Surgical planning should include the patients’s preferences, and chiefly addressing individual reconstructive requirements, enabling each patient to receive an individual “custom-made” reconstruction.
Montag, Eduardo; Gemperli, Rolf
Renal artery stenosis is a prevalent condition that has been implicated in the pathogenesis of renovascular hypertension, chronic kidney disease, and cardiac disturbance syndromes. The most common causes of renal artery stenosis are atherosclerosis and fibromuscular dysplasia. Endovascular revascularization of renal artery stenosis is controversial, but may have significant benefits for treatment of renovascular symptoms in carefully selected patients. In this review, we evaluate the literature and discuss indications for endovascular revascularization of renal artery stenosis. Technical aspects of renal artery stenting are addressed, including methods to avoid procedural complications and use of embolic protection devices. The role of drug eluting stents is examined, as are approaches to the detection and treatment of in-stent restenosis. PMID:23492602
Erwin, P A; Shishehbor, M H
The purpose of this study was to investigate a Doppler guided catheterization system as an adjunctive or alternative methodology to overcome the disadvantages of left heart catheterization and angiography. These disadvantages include the biological effects of radiation and the toxic and volume effects of iodine contrast. Doppler retrograde guidance uses a 20 MHz circular pulsed Doppler crystal incorporated into the tip of a triple lumen multipurpose catheter and is advanced retrogradely using the directional flow information provided by the Doppler waveform. The velocity detection limits are either 1 m/second or 4 m/second depending upon the instrumentation. In a physiologic flow model of the human aortic arch, multiple data points revealed a positive wave form when flow was traveling toward the catheter tip indicating proper alignment for retrograde advancement. There was a negative wave form when flow was traveling away from the catheter tip if the catheter was in a branch or bent upon itself indicating improper catheter tip position for retrograde advancement. In a series of six dogs, the catheter was able to be accurately advanced from the femoral artery to the left ventricular chamber under Doppler signal guidance without the use of x-ray. The potential applications of a Doppler guided retrograde catheterization system include decreasing time requirements and allowing safer catheter guidance in patients with atherosclerotic vascular disease and suspected aortic dissection. The Doppler system may allow left ventricular pressure monitoring in the intensive care unit without the need for x-ray and it may allow left sided contrast echocardiography. With pulse velocity detection limits of 4 m/second, this system may allow catheter direction and passage into the aortic root and left ventricle in patients with aortic stenosis. A modification of the Doppler catheter may include transponder technology which would allow precise catheter tip localization once the catheter tip is placed in the aortic root. Such technology may conceivably assist in allowing selective coronary catheterization. These studies have demonstrated that Doppler guided retrograde catheterization provides an accurate method to catheterization the aortic root and left ventricular chamber without x-ray. In humans, it may prove useful in a variety of settings including the development of invasive ultrasonic diagnostic and therapeutic technology.
Frazin, Leon J.; Vonesh, Michael J.; Chandran, Krishnan B.; Khasho, Fouad; Lanza, George M.; Talano, James V.; McPherson, David D.
Arteriographic examination of the coronary, cerebral, and peripheral circulatory systems is the ultimate diagnostic technique for the identification and quantification of atherosclerotic occlusive disease. In the past, hospitalization has been required for this invasive procedure. Recently, however, the concept of outpatient catheterization and arteriography has become a reality. To investigate the integrity, safety, and cost-effectiveness of our outpatient invasive procedures laboratory, we analyzed our experience with 254 cardiac catheterizations and 174 peripheral arteriograms performed during a 20-month period. There were no deaths or major complications. Minor complications (11%) included bleeding from the cutdown site, nausea, numbness, and allergic reactions. Two patients with arrhythmias required cardioversion. Nine patients (2%) were transferred to the hospital for observation or immediate surgery due to the nature of their atherosclerotic lesions. This study reveals (1) the technical quality, safety, indications, and contraindications for outpatient catheterization and arteriography; (2) the enthusiastic patient acceptance of outpatient invasive diagnostic studies; (3) the economic impact of these procedures on escalating health-care costs; and (4) the potential for outpatient catheterization and arteriography on a broad scale.
Diethrich, Edward B.; Kinard, Sam A.; Pierce, Stephen A.; Koopot, Ravi
Background The Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia, glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be considered a treatment option (when other treatments result inadequate). Patiants and methods Ten patients between the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular Distraction Osteogenesis (MDO). All patients underwent fibroscopic examination of the upper airway and a radiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for surgery included frequent apneic episodes with severe desaturation (70%). Gavage therapy was employed in all patients since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral mandibular distraction: two cases with an external multivector distraction device, six cases with an internal non-resorbable device and two cases with an internal resorbable device. In one case, the patient with Goldenhar's Syndrome, the procedure was repeated. Results The resolution of symptoms was obtained in all patients, and, when present, tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger patient (5 months old) the tracheotomy was removed 7 days postoperatively. In the Goldenhar's syndrome case (2 years old) a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia. Patients were discharged when the endpoint was obtained: symptoms and signs of airway obstruction were resolved, PAS and maxillomandibular relationship improved, and tracheotomy, when present, removed. During the follow-up, no injury to the inferior alveolar nerve was noted and scarring was significant in only the two cases treated with external devices. Conclusion Mandibular Distraction Osteogenesis is a good solution in solving respiratory distress when other procedures are failed in paediatric patients with severe micrognatia.
Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease, has become a therapeutic modality for many conditions. Balloon dilatation can now open stenotic valves and vessels, coils and umbrellas can now close unwanted communications, and emboli can be withdrawn without surgical intervention. Images
Waldman, J. D.; Swensson, R. E.
Myocardial perfusion single photon emission-computed tomography (MPS) has been one of the most important and common non-invasive diagnostic cardiac test. Gated MPS provides simultaneous assessment of myocardial perfusion and function with only one study. With appropriate attention to the MPS techniques, appropriate clinical utilization and effective reporting, gated MPS will remain a useful diagnostic test for many years to come. The aim of this article is to review the basic techniques of MPS, a simplified systematic approach for study interpretation, current clinical indications and reporting. After reading this article the reader should develop an understanding of the techniques, interpretation, current clinical indications and reporting of MPS studies.
The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to conventional PK. This review article describes the indications, different techniques, clinical outcomes and complications of deep anterior LK.
Karimian, Farid; Feizi, Sepehr
Combined cardiac catheterization for uncomplicated ischemic heart disease in a medicare population 1 1 The analyses upon which this publication is based were performed under contract number 500-96-P708, entitled, “Utilization and Quality Peer Review Organization for the Commonwealth of Pennsylvania,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The authors assume full responsibility for the accuracy and completeness of ideas presented
PURPOSE: Experts recommend left heart catheterization alone to evaluate uncomplicated ischemic heart disease, reserving right heart catheterization for specific indications. Yet some centers routinely perform combined cardiac catheterization (left heart catheterization and right heart catheterization together).SUBJECTS AND METHODS: Using 1992–1993 Pennsylvania Medicare claims for cardiac catheterizations (n = 41,180), we examined rates of combined cardiac catheterization for patients with uncomplicated
Christine Laine; Laura Venditti; Russell Localio; Leona Wickenheiser; D. Lynn Morris
Objectives. The aim of this study was to determine the relative risks of pediatric diagnostic, interventional and electrophysiologic catheterizations.Background. The role of the pediatric catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis.Methods. A study of 4,952 consecutive pediatric catheterization procedures was undertaken.Results. Patient ages ranged from
Renato Vitiello; Brian W McCrindle; David Nykanen; Robert M Freedom; Lee N Benson
The commonly used approach for rat hepatic artery catheterization is via the gastroduodenal artery, which is ligated after the procedure. A new method of rat hepatic artery catheterization via the left common carotid artery (LCCA) is described. The LCCA is repaired after catheterization. The catheterization procedures included the following: (1) opening the rat's abdominal cavity and exposing the portion of abdominal aorta at the level of the celiac trunk; (2) separating and exposing the LCCA; inserting a microguidewire and microcatheter set into the LCCA via an incision; after placement into the descending aorta, the microguidewire and microcatheter are maneuvered into the hepatic artery under direct vision; (3) after transcatheter therapy, the catheter is withdrawn and the incision at the LCCA is repaired. This technique was employed on 60 male Sprague-Dawley rats with diethylnitrosamine-induced liver cancer, using a 3F microguidewire and microcatheter set. Selective hepatic artery catheterization was successfully performed in 57 rats. One rat died during the operation and five rats died within 7 days after the procedure. It is envisaged that as experience increases, the catheterization success rate will increase and the death rate will decrease. A new approach for selective hepatic artery catheterization via the LCCA in rats is introduced, which makes repeat catheterization of this artery possible and allows large embolization particles to be delivered by using a 3F catheter.
Li Xiao [West China Hospital, Sichuan University, Department of Radiology (China); Wang Yixiang, J. [AstraZeneca R and D (United Kingdom); Zhou Xiangping [West China Hospital, Sichuan University, Department of Radiology (China)], E-mail: email@example.com; Guan Yongsong; Tang Chengwei [West China Hospital, Sichuan University, Department of Gastroenterology (China)
1. Rainbow trout were anesthetized with MS-222 (Sandoz) or methylpentynol and catheterized. Urine was collected at selected intervals up to 48 hr. 2. Effects of MS-222 anesthesia on urine flow and composition were isolated from the stress of catheterization by re-anesthetizing the fish 18 to 20 hr post catheterization. 3. Urine output patterns were similar following MS-222 or methylpentynol anesthesia and catheterization. Highest urine flows were measured 4 to 8 hr post treatment. The highest urine output after re-anesthetization with MS-222 was observed 2 to 4 hr post-anesthesia. 4. Highest concentrations of Na2+, K+, Ca2+, Cl- and inorganic PO4 in the urine were measured in the first 2 hr after anesthesia and catheterization. 5. Flow rates and chemical composition of urine indicate that "normal" renal function is re-established 12 to 24 hr post-treatment.
Hunn, J. B.; Willford, W. A.
In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors' experience. Details about surgical technique are provided, together with tips to avoid and manage complications.
D'Arpa, Salvatore; Toia, Francesca; Pirrello, Roberto; Moschella, Francesco; Cordova, Adriana
This article describes the indications and techniques related to the use of barbed sutures in facial aesthetic plastic surgery. The principle applications for barbed sutures in facial aesthetic plastic surgery are those involving lifts of the brow, midface, and the lower face and neck. Usually all three areas require surgical maneuvers to create a harmonious rejuvenation. Regardless of where in the face bidirectional barbed sutures are planned, five essential steps are needed: (1) making the incision or incisions, (2) dissecting soft tissue, (3) proximal anchoring, (4) deploying threads, and (5) molding soft tissue. PMID:18558239
Paul, Malcolm D
Early diagnosis, better imaging, and advanced treatment of cancer patients extend survival and increase the incidence of symptomatic spine metastases. The treatment algorithm for spine metastases has shifted to a more aggressive approach in recent years. Spine stereotactic radiosurgery (SRS) is a relatively new tool utilizing advanced imaging systems, planning software, image-guided localization, and intensity-modulated dose delivery. Radiosurgery of spine metastases yields high rates of pain- and tumor control, and offers both the patients and the treating physicians an effective noninvasive alternative. This review presents the indications and outcomes for SRS and describes current techniques. PMID:24725288
Harel, Ran; Zach, Leor
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.
Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T
Presentation of indication, technique and results of transarterial uterine artery embolization (UAE) for the treatment of symptomatic myomas. Technical requirements are presented like DSA, catheters, superselective catheterisation and the different embolization materials as polyvinylalcohol (PVA) or microspheres, as well as the follow-up after UAE. The technical success rate of UAE is documented to range between 98 to 100 % and myomatous symptomatology disappears in 85 to 94 % of the cases. A reduction in the size of the myomata after UAE is observed between 48 to 70 %. A resolution of the hemorrhage disappears in 80 to 96 % of the cases immediately. Particulate embolization of the uterine artery is a new minimally invasive therapy in the management of symptomatic leiomyomas with a high efficiency and low rate of major complications. Further studies may prove the longterm results after UAE, the influence on fertility and possible late complications. PMID:12886470
Vogl, T J; Jacobi, V; Gätje, R; Siebzehnrübl, E; Zangos, S
Thoracic ultrasonography can be used for diagnostic purposes as well as a guide for diagnostic and therapeutic interventions. When the lesion or fluid collection has been located and the patient properly positioned, the angle of the needle is identified with respect to the transducer. The insertion tract should transgress the smallest possible area of aerated parenchyma. The needle can be introduced with a free-hand technique or with the aid of a needle guide. Correct planning of the procedure reduces intervention time and decreases the risk of complications. The main indications are superficial masses that require biopsy, pleural and parenchymal lesions formerly biopsied with CT or fluoroscopic guidance, and fluid collections that need to be drained. Ultrasound, thanks to its widespread use, simple execution, and low costs, represents a safe, manageable guide for thoracic interventions.
Almolla, J.; Balconi, G.
Sometimes, in order to properly restore teeth, surgical intervention in the form of a crown-lengthening procedure is required. Crown lengthening is a periodontal resective procedure, aimed at removing supporting periodontal structures to gain sound tooth structure above the alveolar crest level. Periodontal health is of paramount importance for all teeth, both sound and restored. For the restorative dentist to utilize crown lengthening, it is important to understand the concept of biologic width, indications, techniques and other principles. This article reviews these basic concepts of clinical crown lengthening and presents four clinical cases utilizing crown lengthening as an integral part of treatments, to restore teeth and their surrounding tissues to health. PMID:15615335
Yeh, Simon; Andreana, Sebastiano
The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery. PMID:20188267
Carofino, Brad C; Mazzocca, Augustus D
Laparoscopic jejunostomy (LJ) represents a new way of enteral nutrition (EN) for surgical malnourished patients. LJ is an alternative form of therapy, with restricted indications to the few cases when classical way for EN (nosogastroenteral tube feeding, PEG/PEJ, surgical gastrostomy), are contraindicated or can not be used, and the patient is unable to eat. This technique is also preferred to the open surgical jejunostomy. The paper describes our LJ technique, indications and contraindications. We used JL in two surgical severely malnourished patients, within 11 and 14 days, before the elective, open, curative operations. In this period the patients where exclusively nourished with special feeding solutions through the LJ catheter. The main pathologic lesions were: extrinsec antral obstruction from a perforated transverse colon carcinoma in the omental pouch, in the first case, and proximal inflammatory stenosis of efferent loop, after gastric resection with Billroth II anastomosis for duodenal ulcer, in the second case. LJ gives the opportunity for the exploration of the whole abdominal cavity, and for the direct imaging of the pathological lesions. With EN being delivered before the open, elective operations, we get an amelioration of serum albumin values, and we have no morbidity related to the LJ or open, curative operation. EN was administrated after open surgery in the same way, and in the first case, during chemotherapy. LJ is an efficient, miniinvasive way for EN, in selected surgical severe malnourished patients with proximal digestive obstructions, especially oncologic ones, the aim being an amelioration of the nutritional status and a reduction of postoperative morbidity. A continuous study on a larger number of cases is imperative necessary. PMID:14997843
Nicolau, A E; Beuran, M; Veste, V; Grecu, Irina; Vasilescu, Cleopatra; Grin?escu, Ioana
The use of the skin roll technique as an indicator of spinal joint dysfunction (fixations) has not previously been subjected to validity testing. This study was undertaken to determine the degree of correlation between the skin roll technique and spinal joint dysfunction in the thoracic spine. Twenty-five (25) subjects reported tenderness to a paraspinal skin roll along the first ten thoracic vertebrae. At the tender areas elicited during the skin roll, a pressure algometer was used to determine the subject’s pressure pain threshold. Static joint challenging as described by Maigne was utilized by an independent examiner to identify levels of spinal joint dysfunction in the first ten thoracic vertebrae in the same subjects. A moderate, but highly significant correlation (Kappa = 0.48, p ? .001) was found relating a tender point on skin roll to a spinal joint dysfunction within one vertebrae above or below the level of the tender point. Pressure algometer readings revealed a highly statistically significant (p ? 0.0005) decrease in pain threshold tolerance at the level of a tender skin roll as compared to control (non-tender) points. These findings suggest a moderate level of support for the validity of the notion that spinal dysfunction is characterized by loss of joint motion and contiguous paraspinal tenderness.
Taylor, Perry; Tole, Gerald; Vernon, Howard
Clean intermittent self-catheterization is often proposed to patients with bladder emptying disorders. It is based on clinical conditions but motor, visual, cognitive and sensory patient's skills have also to be taken into account. PMID:19963185
The results of central venous catheterization for total parenteral nutrition were prospectively evaluated in 200 consecutive patients. All catheters were fabricated of polyurethane tubing inserted by the Seldinger technique. Two hundred sixty-three lines were inserted in 200 patients for a total of 4103 days. Major complications occurred in 2.3% patients. Twenty-four per cent of catheters were associated with suspected sepsis; of these, 52% were removed directly and 48% were changed over a guidewire. The total catheter sepsis rate was 5.7%. The incidence of sepsis correlated with the number of attempts to insert the line and with positive skin cultures. These data indicate that: use of the Seldinger technique to insert nonthrombogenic flexible catheters results in lower technical morbidity; the incidence of established infection is much lower than the incidence of suspected sepsis; guidewire change may be performed without risk to the patient or interruption of therapy; sepsis rates can be decreased by reducing the number of attempts to catheterize the subclavian vein; and sepsis rates correlate with positive skin cultures at the insertion site.
Sitzmann, J V; Townsend, T R; Siler, M C; Bartlett, J G
The clean intermittent self catheterization is an effective and safe technique for the treatment and prevention of urinary tract disease that result from spinal cord injuries. Although it has been described as of 1972, there is still resistance from health professionals for its utilization. The present study presents a report about the method used for training and encouraging of the patients towards using the technique, in a project of clinical and voluntary nursing care, performed in at a philanthropic association in the city of Curitiba. Our objective was to disseminate the experience that was learnt, to encourage professionals who assist people with spinal cord injuries towards recommending this technique. PMID:21445522
Assis, Gisela Maria; e Faro, Ana Cristina Mancussi
This descriptive, prospective cohort study aimed to analyze the process of central venous catheterization in neonatal intensive care and pediatric units; describe the variables related to study characterization, including admission unit, age, and sex; and to investigate related variables, such as catheter type, reason for insertion, number of lumens, insertion site, type of professional who performed the procedure, medication therapy infused, reason for withdrawal, length of time catheter was in situ, and mechanical and infectious complications. Data collection was performed with 82 charts in the intensive care units (ICUs) of the Instituto Fernandes Figueira. In the majority of cases, the indications for catheter insertion were prolonged drug infusion and total parenteral nutrition. Removal was predominantly required due to mechanical and infectious complications. This study assessed the process of central venous catheterization with the aim of improving care provided to the neonatal and pediatric patients. PMID:24310674
Gomes, Aline Verônica de Oliveira; Nascimento, Maria Aparecida de Luca
The authors review the percutaneous techniques: automated (Nucleotome) manual, with and without motorization ("shavers") with and without discoscopy. These techniques are indicated in less than 15% of cases of disc herniations; but, if the proper indications are respected, a rate of success between 75 and 85% can be expected. The guidelines of the indications are the following: contained disc herniation (longitudinal ligament not ruptured), subacute clinical course, no lateral spinal stenosis, age under 45.... Although the percutaneous techniques are simple and safe, they must be always preceded by a medical treatment during at least 6 weeks. The pre-operative imaging is of paramount value to assess the wholeness of posterior longitudinal ligament: computerized discography (C.T.-scan+discography), M.R.I., disco-manometry.... The authors advocate for percutaneous discectomy versus chemonucleolysis, but surgical approach by micro-technique remains indicated in most cases of lumbar herniated discs, especially in cases of ruptured discs (extruded or uncontained herniations), acute clinical course, spinal canal stenosis, age more than 45, or particular anatomical situations (such as deep-seated lumbosacral space or post-operative fibrosis). PMID:8247214
Privat, J M
The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT. PMID:16213340
Torgay, A; Pirat, A; Candan, S; Zeyneloglu, P; Arslan, G; Haberal, M
Background Cardiac catheterization may cause retinal embolization, a risk factor for cerebrovascular emboli and stroke. We describe the incidence of clinically silent and apparent retinal emboli following diagnostic and interventional coronary catheterization and associated risk factors. Methods Three hundred selected patients attending a tertiary referral center for diagnostic and therapeutic cardiac catheterization were studied. Retinal examination and examination of the visual field and acuity were done before and after catheterization by a retinal specialist. Results There were 5 case of retinal embolus before catheterization, and 19 patients (incidence 6.3%) developed new retinal arteriolar emboli after catheterization. Only 1 patient developed clinically apparent changes in vision. Two conventional risk factors (age and hypertension) were significantly associated with new retinal emboli. The risk of retinal emboli was also significantly associated with operator expertise. Conclusions Retinal embolism was found after coronary catheterization in 6.3% of our patients. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of coronary catheterization. Age and hypertension are independent predictors of retinal embolism. Trial Registration NCT01157338
This article (1) briefly reviews the topographical and surgical anatomy of the Asian upper eyelid, (2) provides guidelines for preoperative assessment and postoperative management for upper Asian blepharoplasty, (3) describes the senior author's surgical technique for external incisional approach to upper eyelid crease formation, and (4) discusses potential pitfalls and complications. PMID:23426749
Chen, William Pai-Dei; Park, John D J
ABSTRACT Methods are presented for estimating an index of relative abundance,from trawl survey catch per tow data. The estimated variance of the index takes into account the within survey variability in catch and possible yearly changes in catchability. Applying the techniques to a series of surveys for yellowtail flounder, Limandaferrugin.ea,off the northeast coast of the United States yields an abundance
The treatment of complex radial head fractures remains a challenge for the orthopedic surgeon. Novel implants and improved\\u000a surgical techniques have made reconstruction of the radial head with open reduction and internal fixation possible in most\\u000a cases. However, extremely comminuted radial head fractures with associated instabilities still require replacement of the\\u000a radial head with a prosthesis to allow rehabilitation with
Jan E. Madsen; Gunnar Flugsrud
Spina bifida (SB) is a neural tube defect that causes many physical and mental disabilities. Bowel and bladder incontinence is the disability seen most often in these students that requires the school nurse's attention. Clean intermittent catheterization (CIC) provides the student with SB a vehicle to reach a satisfactory level of continence,…
Katrancha, Elizabeth D.
\\u000a Background Laparoscopic sleeve gastrectomy (LSG) has been introduced as a multipurpose restrictive procedure for obese patients. Variations\\u000a of the surgical technique would be important for the late results.\\u000a \\u000a \\u000a \\u000a Methods 50 patients submitted to LSG from January 2005 to December 2006 were studied. Mean age was 38.2 years, preoperative weight\\u000a was 103.4?±?14.1 kg (78 to 146 kg), and preoperative BMI was 37.9?±?3.4 (32.9 to 46.8).
Italo Braghetto; Owen Korn; Héctor Valladares; Luís Gutiérrez; Attila Csendes; Aníbal Debandi; Jaime Castillo; Alberto Rodríguez; Ana Maria Burgos; Luís Brunet
Esthetic analysis of the face in some patients presenting a dental Class II can reveal the need for maxillo-mandibular advancement surgery. In these cases, mandibular advancement alone would provide a result which was satisfactory from the occlusal viewpoint but esthetically displeasing. Using bi-maxillary advancement, the impact of nasal volume is reduced and the nasolabial relationship is corrected. The sub-mandibular length is increased, thus creating a better-defined cervico-mental angle. This treatment technique involving a prior mandibular procedure has the advantage of restoring patients' dental occlusion while optimizing their facial esthetics. PMID:24813103
Olivi, Pierre; Garcia, Claude
The indicator diffusion method was used for studies of the blood-brain barrier in rats and (131I)iodoantipyrine (IAP) was used as a highly diffusable model test substance. Interlaminar (Taylor) diffusion and effects of red cell carriage were studied with 57Co-diethylene-triaminepentaacetic acid (DTPA), 125I-human serum albumin, and 46Sc-microspheres (15 microns diameter). Vascular shunting from the pterygopalatine artery (PPA) into the torcula sinus
Y. Sawada; C. S. Patlak; R. G. Blasberg
Urinary incontinence, difficulty voiding and recurrent urinary tract infections are common in general practice. In patients with multiple sclerosis, spina bifida, intervertebral disc lesions, spinal injuries or tumours, the symptoms may be associated with a high residual volume of urine owing to a neuropathic bladder. Similar complaints may occur in elderly people or in women with gynaecological problems owing to atonic urinary retention. Provided that a significant residual volume of urine is found on abdominal examination, ultrasound, x-ray or catheterization, both groups of patients may be helped by intermittent self catheterization. Intermittent self catheterization is a safe and simple technique. By catheterizing themselves between four and six times daily patients can gain control over their bladders. Abandoning indwelling catheters or bulky external appliances does much for a patient's morale and self esteem. In addition, since the bladder is being drained effectively, urinary tract infections cease to be a problem and the kidneys are safeguarded. Severe disability is not a contraindication since patients in wheelchairs have mastered the technique despite paraplegia, an anaesthetic perineum, spinal deformity, intention tremor, mental handicap, old age or blindness. Patients should be referred to urologists for a trial of intermittent self catheterization. If unsuccessful or unacceptable it can be abandoned with no long term consequences. If it is effective the benefits may be considerable.
Oakeshott, P; Hunt, G M
Transradial (TR) cardiac catheterization is effective and offers lower rates of vascular complications and bleeding compared with transfemoral cardiac catheterization. We sought to describe the safety and feasibility of TR cardiac catheterization in liver transplant candidates (LTCs). We retrospectively reviewed 1,071 consecutive cases of TR cardiac catheterization in 1,045 patients from May 2008 to December 2011 at a single institution. The primary end point was radial approach failure. Ten percent of TR cases (n = 107) were performed in LTCs and 90% (n = 964) were performed in non-LTCs. The LTC group had lower rates of cardiovascular diseases and cardiovascular risk factors. The LTC group had a significantly lower platelet count (75,000 vs 237,000/mm(3), p <0.01), higher international normalized ratio (1.7 vs 1.1, p <0.01), and lower mean arterial pressure (78 vs 89 mm Hg, p <0.01). The mean Model for End-Stage Liver Disease score was 21 in LTCs. Percutaneous coronary interventions were performed in 4% of LTCs and 15% of non-LTCs (p <0.01). The radial approach failure rate was 10% in LTCs and 7% in non-LTCs (p = 0.15). In conclusion, radial approach failure was similar between the LTC and non-LTC groups. Despite significant differences in platelet count and international normalized ratio, there was no difference in the incidence of adverse events between the groups, suggesting that TR cardiac catheterization is safe and effective in LTCs. PMID:24698460
Huded, Chetan P; Blair, John E; Sweis, Ranya N; Flaherty, James D
Microsurgical epididymal sperm aspiration (MESA) refers to retrieval of sperm-containing fluid from optimal areas of the epididymis that are selected and sampled using high-power optical magnification provided by an operating microscope. Retrieved sperm are subsequently used for intracytoplasmic sperm injection (ICSI) to induce fertilization and pregnancy. MESA is considered by many experts to be the gold standard technique for sperm retrieval in men with obstructive azoospermia given its high yield of quality sperm, excellent reported fertilization and pregnancy rates, and low risk of complications. However, MESA must be performed in an operating room, requires microsurgical skills and is only useful for reproduction using ICSI. Herein we present an overview of the evaluation of candidate patients for MESA, the technical performance of the procedure and the outcomes that have been reported. PMID:23160264
Bernie, Aaron M; Ramasamy, Ranjith; Stember, Doron S; Stahl, Peter J
Extensive defects of the ear require satisfactory cosmetic reconstruction to enable the patient to achieve full social integration. Although surgical procedures are the gold standard for reconstruction of the ear, in some cases they cannot be performed because of extended scars, threatening tumor, or congenital tissue abnormalities. Prosthetic reconstruction of the auricle is an established and reliable alternative technique to autologous surgical reconstructions. Since studies performed by Brånemark, osseointegrated implants have been widely used to provide a reliable and stable anchorage for a prosthesis (prosthesis anchored to bone). To allow good osseointegration of the titanium screw implants, two stages are necessary. After careful preparation for the surgical procedure (local and general examination, computed tomography scan, skin preparation), screws are implanted into bone, which are then covered by a skin flap. During the second stage, the skin is incised, and penetrating fixtures are attached to the screw implants, which allow fixation of the prosthesis. This procedure is reliable and reproducible, with good to excellent results and stability over time. PMID:23115532
Giot, Jean-Philippe; Labbé, Daniel; Soubeyrand, Eric; Pacini, Régine; Guillou-Jamard, Marie-Reine; Compère, Jean-François; Bénateau, Hervé
We report a case of probable contrast-induced neurotoxicity that followed a technically challenging cardiac catheterization in a 69-year-old woman. The procedure had involved the administration of a large cumulative dose of an iodinated, nonionic contrast medium into the innominate artery: twelve hours following the catheterization, the patient developed a seizure followed by a left hemiplegia, and an initial computed tomography (CT) scan showed sulcal effacement in the right cerebral hemisphere due to cerebral swelling. The patient's clinical symptoms resolved within 24 hours, and magnetic resonance imaging at 32 hours showed resolution of swelling. Contrast-induced neurotoxicity should be found in the differential diagnosis of acute neurological deficits occurring after radiological procedures involving iodinated contrast media, whether ionic or nonionic.
Law, Susan; Panichpisal, Kessarin; Demede, Melaku; John, Sabu; Marmur, Jonathan D.; Nath, Jaya; Baird, Alison E.
The authors report 4 observations of severe involvement induced by sub-clavian catheterization: - 2 catheter-embolisms; - 1 venous thrombosis and one hydrothoraxx. One embolism and the hydrothorax were caused by a faulty puncturing. The thrombosis was the result of a relative stenosis of the vein induced by a loop of the catheter in the Pirogoff confluent. Next, the authors develop the facts given by the literature bearing upon each one of these complications. PMID:2064
Michel, L; Vandeperre, J; Lantin, A
Clean intermittent self-catheterization (CISC) is considered the method of choice for treating urinary retention as of neurologic origin. Also, in multiple sclerosis (MS) the method is widely applied. Proper application needs sufficient hand function, possibility for proper positioning, sufficient sensation, cognitive function and as always the choice of the optimal material. The overall results are good. Specifically for MS patients more than average attention has to be given to training and follow-up in case of cognitive function impairment. Complications are acceptable with urinary tract infection having the highest incidence. MS being a progressive disease treatment possibly needs to be changed during follow-up. PMID:24951384
Wyndaele, J J
Introduction Ultrasound guidance has emerged as an adjunct for central vein catheterization in both adults and children. However, the use of ultrasound guidance for radial arterial catheterization has not been well established. We conducted a systematic review and meta-analysis to evaluate the efficacy of ultrasound guidance for radial artery catheterization. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) comparing ultrasound guidance with other techniques (palpation or Doppler) in adult or pediatric patients requiring radial artery catheterization were included. The primary outcome was first-attempt success. Results Seven RCTs enrolling 546 patients met the inclusion criteria, and all the selected trials were considered as at high risk of bias. Ultrasound-guided radial artery catheterization was associated with an increased first-attempt success (relative risk (RR) 1.55, 95% confidence interval (CI) 1.02 to 2.35). There was significant heterogeneity among the studies (I2?=?74%). Ultrasound-guided radial artery catheterization in small children and infants also provided an increased chance for first-attempt success (RR 1.94, 95% CI 1.31 to 2.88). Ultrasound guidance further significantly reduced mean attempts to success (weighted mean difference (WMD) ?1.13, 95% CI ?1.58 to ?0.69), mean time to success (WMD ?72.97 seconds, 95% CI ?134.41 to ?11.52), and incidence of the complication of hematoma (RR 0.17, 95% CI 0.07 to 0.41). Conclusions Ultrasound guidance is an effective and safe technique for radial artery catheterization, even in small children and infants. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
Perfusion assessed in the cardiac catheterization laboratory predicts outcomes after myocardial infarction. The aim of this study was to investigate a novel method of assessing perfusion using digital subtraction angiography to generate a time-density curve (TDC) of myocardial blush, incorporating epicardial and myocardial perfusion. Seven pigs underwent temporary occlusion of the left anterior descending coronary artery for 60 minutes. Angiography was performed in the same projections before, during, and after occlusion. Perfusion parameters were obtained from the TDC and compared with Thrombolysis In Myocardial Infarction (TIMI) frame count and myocardial perfusion grade. In addition, safety and feasibility were tested in 8 patients after primary percutaneous coronary intervention. The contrast density differential between the proximal artery and the myocardium derived from the TDC correlated well with TIMI myocardial perfusion grade (R = 0.54, p <0.001). The arterial transit time derived from the TDC correlated with TIMI frame count (R = 0.435, p = 0.011). Using a cutoff of 2.4, the density/time ratio, a ratio of density differential to transit time, had sensitivity and specificity of 100% for coronary arterial occlusion. The positive and negative predictive values were 100%. The generation of a TDC was safe and feasible in 7 patients after acute myocardial infarctions, but the correlation between TDC-derived parameters and TIMI parameters did not reach statistical significance. In conclusion, this novel method of digital subtraction angiography with rapid, automated, quantitative assessment of myocardial perfusion in the cardiac catheterization laboratory correlates well with established angiographic measures of perfusion. Further studies to assess the prognostic value of this technique are warranted. PMID:18929697
Boyle, Andrew J; Schuleri, Karl H; Lienard, Jean; Vaillant, Regis; Chan, Michael Y; Zimmet, Jeffrey M; Mazhari, Ramesh; Centola, Marco; Feigenbaum, Gary; Dib, Joud; Kapur, Navin K; Hare, Joshua M; Resar, Jon R
The manual is intended to provide technical assistance to South Carolina local education agencies (LEAs)in regard to provision of catheterization services to students with disabilities in the school system. The first section defines catheterization and briefly discusses the basic need for this specialized health care service. Recent relevant…
Signal processing techniques have been developed for extracting quantitative indicators of the performance of extruders processing soft-solid pastes from the data recorded by pressure transducers located near the extrusion die. Such techniques have been applied previously to isothermal ram and screw devices using retrospective methods. This article reports on the scope for application of retrospective algorithms, ideally suited to ram
Bruce D. Russell; D. Ian Wilson; Joan Lasenby; Stuart Blackburn
\\u000a Tethering with maternal and fetal catheterization is a preparation that gives researchers direct access to the physiological\\u000a status of both mother and fetus without the need for anesthesia or restraint. The technique involves the use of a flexible\\u000a hollow metal cable that attaches at one end to a nylon jacket worn by the female and at the other end to
Matthew Francis Stuart Xavier Novak; Stuart Xavier
Nowadays, abdominal catheterizations are mainly guided by 2D fluoroscopic imaging from one view, which complicates this task due to missing depth information, vessel invisibility, and patient motion. We propose a new technique for 3D navigation of guide wires based on single-plane 2D fluoroscopic views and a previously extracted 3D model of the vasculature. In order to relate the guide wire,
Martin Groher; Frederik Bender; Ali Khamene; Wolfgang Wein; Tim Hauke Heibel; Nassir Navab
Bladder stones account for 5% of all urinary stone disease and can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, or ureteral stent. In this case study, the authors present a patient with bladder stones associated with pubic hairs introduced during a monthly indwelling Foley catheter change. Clinicians have an important role in instructing patients on the use of proper technique and hygiene practices during urethral catheterization to minimize the potential for urinary complications. PMID:24354112
Perz, Sarah; Ellimoottil, Chandy; Rao, Manoj; Bresler, Larissa
We report a case of iatrogenic claudication as a result of a misplaced percutaneous arterial closure device (PACD) used to obtain hemostasis after cardiac catheterization. The patient presented one week after his procedure with complaints suggestive of right lower extremity claudication. Computed tomographic angiography demonstrated a near total occlusion of the right common femoral artery from a PACD implemented during the cardiac catheterization. The use of PACD’s to obtain rapid hemostasis is estimated to occur in half of all cardiac catheterizations. Ischemic complications as a result of these devices must be considered when evaluating post procedural patients with extremity complaints.
Hermann, Luke; Chow, Evelyn; Duvall, W. Lane
We report a case of iatrogenic claudication as a result of a misplaced percutaneous arterial closure device (PACD) used to obtain hemostasis after cardiac catheterization. The patient presented one week after his procedure with complaints suggestive of right lower extremity claudication. Computed tomographic angiography demonstrated a near total occlusion of the right common femoral artery from a PACD implemented during the cardiac catheterization. The use of PACD's to obtain rapid hemostasis is estimated to occur in half of all cardiac catheterizations. Ischemic complications as a result of these devices must be considered when evaluating post procedural patients with extremity complaints. PMID:21293776
Hermann, Luke; Chow, Evelyn; Duvall, W Lane
The diagnosis of pheochromocytoma rests primarily on determination of the 24-hour urinary excretion of catecholamines and their metabolites. In most cases nephrotomography and selective arteriography or venography, or both, are sufficient to localize the tumour. Selective venous catheterization and the assay of plasma catecholamines should be considered for pheochromocytoma localization in: (a) patients in whom standard techniques fail to localize the tumour; (b) patients who exhibit idiosyncratic reactions to the angiographic contrast materials; (c) young patients or patients with familial pheochromocytoma, including those with multiple neurofibromatosis or multiple endocrine adenomatosis, type 2; (d) patients with recurrent, malignant, or suspected multicentric or extra-adrenal tumours; and (e) patients excreting only norepinephrine in the urine. The validity of the results is particularly dependent on the skill with which venous catheterization is carried out.
Davies, R. A.; Patt, N. L.; Sole, M. J.
Three cases of complete heart block complicating retrograde left heart catheterization are presented. In two of the three cases, electrophysiologic study documented block below the AV (atrial ventricular) node. In the third recurrent complete heart block was fatal. It appears that complete heart block complicating retrograde left sided cardiac catheterization is not simply a pericatheterization event; rather, it appears that there is high risk of recurrent complete heart block and that electrophysiologic study is mandatory. PMID:2354514
Feit, A; Kipperman, R; Ursell, S; Reddy, C V
Inferior epigastric artery injury after cardiac catheterization and percutaneous coronary intervention is sporadically reported in the literature, yet it is a serious complication that can lead to life-threatening retroperitoneal hemorrhage and poor clinical outcomes after percutaneous coronary intervention. We present two cases of inferior epigastric artery injury from inadvertent puncture during cardiac catheterization and a discussion in the management and prevention of this potentially fatal complication. PMID:21538784
Sanchez, Carlos E; Helmy, Tarek
Estimation of left ventricular filling pressure and cardiac index is important in the management of patients requiring right heart catheterization. Doppler echocardiography can provide a noninvasive measure of these parameters, but its accuracy in individual measurements, predicting hemodynamic subgroups, and in tracking serial changes in critically ill patients remains to be elucidated. Left ventricular filling pressure and cardiac index were assessed in 49 critically ill patients requiring right heart catheterization and Doppler echocardiographic studies. Two or more serial studies were performed in 18 of these subjects. Patients were placed into 1 of 4 hemodynamic subgroups for each technique based on the acquired hemodynamic parameters. Left ventricular filling pressure and cardiac index by Doppler echocardiography and right heart catheterization were similar (21 +/- 8 vs 20 +/- 8 mm Hg; 3.0 +/- 1.2 vs 2.9 +/- 1.2 L/min/m2, respectively) and correlated well with each other (left ventricular filling pressure, r = 0.88; cardiac index, r = 0.92). The Doppler technique accurately placed 73 of 76 studies into the correct hemodynamic subgroup. The noninvasive technique also reliably tracked serial hemodynamic measurements. We conclude that Doppler echocardiography accurately assesses left heart hemodynamics in critically ill patients. Since this technique can be readily acquired, it can be ideal for the rapid assessment of hemodynamic parameters in critically ill patients, especially when right heart catheterization is delayed or is problematic. PMID:7639166
Dabaghi, S F; Rokey, R; Rivera, J M; Saliba, W I; Majid, P A
Background: With the decrease of life-threatening obstructive upper airway infections and the ongoing improvement of intensive care medicine, the role of tracheostomy in children has been changing considerably, until now. The aim of this study was to establish data regarding indications, complications, and techniques of pediatric tracheostomy, which would reflect the current state of science. Methods: The authors analyzed the
B. Kremer; A. I. Botos-Kremer; H. E. Eckel
Objective To test the implementation of a novel structured panel process in the evaluation of quality indicators. Data Source National panel of 64 clinicians rating usefulness of indicator applications in 2008–2009. Study Design Hybrid panel combined Delphi Group and Nominal Group (NG) techniques to evaluate 81 indicator applications. Principal Findings The Delphi Group and NG rated 56 percent of indicator applications similarly. Group assignment (Delphi versus Nominal) was not significantly associated with mean ratings, but specialty and research interests of panelists, and indicator factors such as denominator level and proposed use were. Rating distributions narrowed significantly in 20.8 percent of applications between review rounds. Conclusions The hybrid panel process facilitated information exchange and tightened rating distributions. Future assessments of this method might include a control panel.
Davies, Sheryl; Romano, Patrick S; Schmidt, Eric M; Schultz, Ellen; Geppert, Jeffrey J; McDonald, Kathryn M
The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.
Patel, Rakesh P., E-mail: firstname.lastname@example.org [Northwick Park Hospital, Department of Vascular Radiology (United Kingdom); Katsargyris, Athanasios, E-mail: email@example.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany)] [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany); Adam, Donald J., E-mail: firstname.lastname@example.org [Heartlands Hospital, Department of Vascular Surgery (United Kingdom); Hardman, John A., E-mail: email@example.com [Royal United Hospital Bath, Department of Vascular Radiology (United Kingdom)
Acellular dermal matrices are integrally involved in the majority of expander-implant reconstructions and complex hernia repairs today, and they are now making their way into secondary aesthetic breast surgery. The number of revisional breast surgery cases has continued to increase as the materials and repair techniques have improved. The aesthetic outcome bar is constantly being raised, and the complexity of patient deformities often requires additional tissues to achieve a successful repair. The most common complications in breast augmentation are reviewed, along with indications and some current repair techniques, general principles, and specific caveats to help plastic surgeons deal with these complex and challenging patient problems utilizing acellular dermal matrices. PMID:23096964
Ageing haemophilia patients are increasingly confronted with ischaemic heart disease (IHD). Treatment is complex because of the delicate equilibrium between bleeding and thrombosis. In 2009, we developed an institutional guideline on how to treat IHD in this patient population. The aim of this study was to evaluate feasibility and safety of this guideline. Haemophilia patients who underwent coronary angiography or percutaneous coronary intervention between January 2009 and June 2012 were included in the current case series. Nine diagnostic or therapeutic cardiac catheterizations were performed in six haemophilia patients. One patient with moderate haemophilia B was included, whereas the other patients had mild haemophilia A. In six of nine procedures, access to the circulation was gained via the radial artery. Only bare-metal stents were implanted, after which dual antiplatelet treatment was given for at least 4 weeks. During cardiac catheterization/intervention and dual antiplatelet treatment, clotting factor levels were corrected. No thrombotic or clinically relevant bleeding complications occurred. In one patient, a low-titre inhibitor recurred 10 months after catheterization. In-stent restenosis was diagnosed in one patient. This case series indicates that treatment according to the guideline is feasible and safe. Furthermore, based on the case series and developments in new guidelines for non-haemophilic patients with IHD, some adjustments on the 2009 guideline are proposed. PMID:23496171
Tuinenburg, A; Damen, S A J; Ypma, P F; Mauser-Bunschoten, E P; Voskuil, M; Schutgens, R E G
A chronically catheterized 14-y-old male rhesus macaque (Macaca mulatta) was reported for recurrent scrotal swelling. The scrotum was enlarged and warm to touch, and associated skin was noted to be lichenified on physical examination. The penis could not be extruded due to preputial swelling. Results from the following diagnostic tests were all unremarkable or within normal limits: scrotal aspirate, hematology, serum biochemistries, urinalysis, and radiography of the thorax, scrotum, and abdomen. Ultrasonography of lower extremities identified thrombi in bilateral iliac veins and left femoral vein. Collateral circulation surrounding the left femoral vein permitted some compensatory venous return. The left femoral vein of this animal had been catheterized approximately 2 mo before initial presentation. A coagulation panel revealed a positive D-dimer test, indicative of elevated levels of fibrin degradation products due to active thrombus breakdown. Enoxaparin sodium, a low-molecular-weight heparin for human use, was administered at 20 mg subcutaneously once daily for 10 d to treat occlusive venous thrombi. After enoxaparin treatment, the edema was greatly decreased. To achieve complete resolution, a second course of enoxaparin was administered 2 months after the first. Ultrasonography of the pelvic vasculature 6 mo after completion of therapy showed marked thrombus resolution, allowing for bilateral patency in the iliac and femoral veins. Follow-up evaluation revealed that D-dimer values were negative as well. This case demonstrates the novel application of the human medication enoxaparin to treat clinical signs of deep vein thrombosis in a chronically catheterized rhesus macaque.
Wathen, Asheley B; Myers, Daniel D; Zajkowski, Paul; Flory, Graham; Hankenson, F Claire
Clean intermittent self-catheterization (CISC) has been used successfully for many years to promote socially acceptable and functional continence practice. The impact on health services, quality of life, and associated costs has also been documented. The use of CISC as a routine technique has been widely implemented in the Hunter Area Health Service, NSW, Australia. The positive outcomes resulting from the routine use of CISC has included reduction in length of stay and numbers of admissions for patients with urinary retention, reduction in nursing time, and decreased infection rates. The technique has been well received by patients who report a positive impact on their quality of life. PMID:11993240
Watts, Wendy; Lloyd, Gillian; Brown, Wendy M; Clarke, Stephen; Wilson, Amanda J
Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 ± 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs ? 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs ? 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD. PMID:24259011
Gokalp, Selman; Guler Eroglu, Ayse; Saltik, Levent; Koca, Bulent
Catheterization of the male urethra might cause harm and discomfort for the patient. Computer-based simulator training might improve the skills of students as well as professional nurses. This study aims to study the feasibility of a new portable computer-based male urethral catheterization simulator, Urecath (Melerit Urecath Vision). The simulator consists of three software modules: teaching (explains the different procedures in the catheterization), learning (game settings with practice and self-assessments tests), and simulator module that is connected to a box with a model of a penis where syringes and the urinary catheter can be inserted. Registered nurses (n=23), nurse assistants (n=14), nurse students (n=12), and a nurse assistant student (n=1) participated in a simulation session and answered 30 questions about the feasibility of the simulator. The participants appreciated the different modules, particularly the teaching and learning modules. The simulator module was appreciated for its cross-sectional views and feedback but was found to lack a tactile component; there was too little and no varying resistance when inserting the catheter. The participants perceived the present prototype of Urecath as a valuable education tool. The male urethral catheterization simulator prototype Urecath has advantages in its present shape but to be an alternative to existing training options for practicing male urethral catheterization, it should be complemented with a tactile mode and degrees of difficulty. PMID:19443272
Jöud, Anna; Sandholm, Anders; Alseby, Lola; Petersson, Göran; Nilsson, Gunilla
Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined. PMID:24843847
Domb, Benjamin; LaReau, Justin; Redmond, John M
Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined.
Domb, Benjamin; LaReau, Justin; Redmond, John M.
Although only a small portion of all lower-extremity amputations in the United States are of traumatic origin, almost half of all living amputees have sustained traumatic amputations. This particular epidemiology is explained by the younger age, and thus longer life expectancy, of traumatic amputees. In this group especially, restoration and lifelong maintenance of ambulation and mobility is essential. The authors present the case of a bilateral traumatic lower-leg amputee whose management included a Pirogoff amputation. Although this amputation technique is not widely used, the authors believe it greatly facilitated stump and soft tissue management in this case and allowed for improved mobility. The indication for and technique of Pirogoff amputation are described, and a brief overview of amputation techniques in the foot is provided. [Orthopedics. 2014; 37(6):397-401.]. PMID:24972429
Ipaktchi, Kyros; Seidl, Adam; Banegas, Rodrigo; Hak, David; Mauffrey, Cyril
Video-assisted thoracoscopic surgery (VATS) lobectomy is a less invasive procedure when compared with the traditional thoracotomy. With the development of operative techniques, VATS lobectomy has become a definite procedure for stage I and some stage II a lung cancer. However, it is still controversial due to operative difficulty whether it is feasible to perform thoracoscopic surgery in anatomic pulmonary segmentectomy, bronchial sleeve lobectomy, bronchial and arterial sleeve lobectomy, large tumor (> 5 cm), pneumonectomy and resection of Pancoast tumor. Some difficulties in performing thoracoscopic lobectomy such as: pleural cavity adhesions or atresia, local invasion, interlobar fissure dysplasia, bleeding, as well as "troublesome hilum", were once thought to be indication for conversion to thoracotomy. We proposed a new concept of thoracoscopic lung resection: "single-direction thoracoscopic lobectomy", which has been proved to be simple, safe, and effective and has been widely accepted in our country. In practice, we are still proceeding with further exploration, technical optimization and expanding its application in more complicated lung surgery. For instance, we have developed strategies of "fast recovery" and "mini-invasive diagnosis and synchronous treatment of lung cancer" and a series of stylized techniques such as thoracoscopic adhesiolysis, bloodless technique, suction-compressing angiorrhaphy technique, presumptive control of the main pulmonary artery, hollow-out method in thoracoscopic lobectomy. With accumulative experience utilizing these innovative techniques, we believe that thoracoscopic lobectomy would become the mainstream for surgical management of pulmonary diseases. PMID:23600221
Liu, Lun-Xu; Liu, Cheng-Wu; Yang, Jun-Jie
Experimental scattering results using a microwave analog technique are described. Artificially constructed axially symmetric spheres with a graphite-like fine-layered composite structure and anisotropic refractive indices were employed to aid high-precision measurements of forward scattering under stable conditions (temperature, physical dimensions, electronic conditions) and to facilitate studies of the extinction and polarization of light by graphite particles in interstellar space. A theoretical approximation utilizing Mie theory for spheres with suitable orientation-dependent refractive indices is applied to account for changes in the complex forward-scattering amplitudes and phase in response to target orientation. The methods are extended to the full range of scattering angles, from the forward direction continuously to about 165 deg and at 180 deg. Agreement between experiment and prediction is close when the symmetry axis is parallel to the polarization.
Wang, R. T.; Greenberg, J. M.
The complications associated with central venous catheterization are common and well known. Common malplacement locations have been described in the literature. We report the case of a direct puncture of the pulmonary artery during a subclavian central venous catheterization.
Moriceau, Jerome; Compere, Vincent; Bigo, Marc; Dureuil, Bertrand
The fluid mechanics of blood flow in a catheterized curved artery with stenosis is studied through a mathematical analysis. Blood is modelled as an incompressible Newtonian fluid and the flow is assumed to be steady and laminar. An approximate analytic solution to the problem is obtained through a double series perturbation analysis for the case of small curvature and mild
R. K. Dash; G. Jayaraman; K. N. Mehta
Summary We describe three cases of transvenous embolization of arteriovenous fistulas of the cavernous sinus, achieved through the facial vein approach. The facial vein was catheterized from a jugular vein access. This cervical approach offered good stability to the guiding catheter that permitted us to negotiate difficult curves of the facial vein and to recanalize venous thrombosis in one case.
Karygiannis, M.N.; Szatmary, Z.; Claudino, P.A.; Houdart, E.
Simulation training and a prompt hierarchy were found to facilitate acquisition of clean intermittent self-catheterization skills by a four-year-old male with myelomeningocele. The child was first taught to perform catheterization on a doll, then on himself. Skills were clustered into three tasks of diapering, cleansing, and catheterization.…
Robertson, Jo; And Others
The Martius pedicle adipose flap can be used as an interposition flap during complex vaginal operations. It is a simple, rapid technique allowing raising of a well vascularized adipose flap with a mean length of 8 to 12 cm. It can be used in certain forms of vaginal repair, such as high supratrigonal vesicovaginal fistula, after bladder perforation, for obstructed urethra after colposuspension, after urethral destruction following prolonged bladder catheterization in a neurological patient, during repair of a complex urethral diverticulum or during transvaginal insertion of an artificial sphincter. After describing the flap raising operative technique, the various operative indications are presented. PMID:9116729
Chassagne, S; Haab, F; Zimmern, P
The role played currently by the different ancillary diagnostic techniques in the diagnosis of adult epithelial renal tumors continues to be debated. It has also become clear that in some instances light microscopic appearance alone cannot be used to classify these neoplasms into specific categories with the degree of precision required for therapeutic purposes. Renal cell carcinoma (RCC) subtypes may share common histologic characteristics but exhibit different biological behavior and response to therapy which clearly indicates the crucial role that advanced pathologic speciation plays in the current assessment of these neoplasms. Although immunohistochemistry is widely used for the purpose of categorizing renal tumors because of its widespread availability, the immunoprofiles of the various types of renal neoplasms overlap significantly, making definitive diagnostic determinations difficult and challenging at times. This manuscript will address how ancillary diagnostic techniques can be incorporated into the routine evaluation of neoplastic renal masses to improve classification. Both cytology and surgical specimens will be addressed, as fine needle aspiration (FNA) is being used with preference in many cases in the diagnosis of renal masses. Surgical and cytopathologists must intelligently select the ancillary diagnostic technique/s that will provide the information needed to solve the differential diagnosis under consideration in a given case. However, in some cases >1 of these techniques should be used to make an accurate diagnosis with the aim of arriving at an unequivocal diagnosis. The identification of specific signaling pathways that are defective in certain types of renal neoplasms has made possible the design of target-specific therapies that are directed towards the aberrant pathways associated with the defective proteins found in these tumors. This makes the exact classification of these neoplasms and the detection of these aberrant proteins targeted for treatment an absolute requirement for the application of these molecular-based therapeutic interventions. The role that the pathologic assessment plays in the classification of renal tumors becomes more important than ever to take advantage of this and similar new molecular-oriented therapies. PMID:24162266
Herrera, Guillermo A; Turbat-Herrera, Elba A
During the time period 1977-2007 postoperative radiotherapy in DBCG has varied considerably with regard to techniques and indications together with changes in the extent of surgery and adjuvant systemic therapy. The radiation treatment has been developed on the basis of clinical, radiophysical and radiobiological principles, encompassing also practical problems such as available equipment in the different centres and at times lack of sufficient machine capacity. The paper focus especially on the comprehensive work done prior to the DBCG 82 b&c studies, in order to optimize radiotherapy in all aspects prior to the evaluation of the efficacy of this treatment modality. The results from these trials did succeed in clear evidence that radiotherapy has an important role in the multidisciplinary treatment of early breast cancer. In parallel to these studies a new and challenging use of radiotherapy after breast conserving surgery was evaluated in the DBCG TM 82 protocol. The experience obtained with different techniques in this study formed the basis for the current principles of radiotherapy after lumpectomy. Reduction of radiation related morbidity has been a major issue for the DBCG radiotherapy group, and in this aspect several studies, including quality control visits, have been carried out to make the relevant modifications and to evaluate deviations from the guidelines between the centres. The background for the changes in radiotherapy is described for each of the programme periods as well as future perspectives which will include further refinements of the target and adjustments of dose and fractionation in selected patients. PMID:18465332
Overgaard, Marie; Christensen, Jens Juul
Deep venous reflux (DVR) is defined as a reflux affecting the deep venous system. DVR essentially arises from two aetiologies, primary deep valve incompetence (PDVI) and post-thrombotic syndrome (PTS), and it is correlated with severe chronic venous insufficiency. DVR correction aims at reducing the increased ambulatory venous pressure, which results from reflux in deep veins in orthodynamic conditions. The results of DVR surgery are not easy to assess, as it is mostly associated with surgery for insufficiency in the superficial venous system and/or perforators. In cases of primary insufficiency, valvuloplasty, the operation of choice, is credited at 5 years follow-up with a 70% success rate in terms of clinical outcome and improved haemodynamic performance. In PTS, a meta-analysis of transpositions and transplants at more than 5 years estimates successful clinical outcome and improved haemodynamic performance at 50%. The Maleti neovalve construction technique has achieved better results. Indications for DVR surgery are based on clinical, haemodynamic and imaging data. Aetiology is a decisive factor in the choice of the technique. PMID:21454106
Maleti, O; Perrin, M
Selective pulmonary uptake of many natural and synthetic substances has been demonstrated by physiologists and pharmacologists using isolated perfused lung preparations or invasive techniques. It is difficult, however, to relate these laboratory studies to disease processes and to the study of problems encountered in a clinical environment. Our goal was to develop a noninvasive method for studying the pulmonary uptake of tracer substances using available radiotracers, gamma cameras, and computers that would give information similar, if not identical, to that from the invasive laboratory methods, and that could be applied in a clinical setting. The multiple-indicator dilution technique, modified for external counting, is well suited for such studies of pulmonary uptake of tracer substances. In this study, Tc-99m micro sulfur colloid (Tc-99m micro SC) was used as an intravascular reference tracer, N-isopropyl-p-(/sup 123/I)iodoamphetamine (I-123 IMP) as a cellular test tracer amine, and In-111 DTPA as an extracellular tracer. Calculated first-pass lung uptakes of I-123 IMP and In-111 DTPA were 0.92 +/- 0.04 and 0.17 +/- 0.04, respectively, relative to the reference tracer. Using this approach, the first-pass pulmonary extraction of a variety of radiolabeled test tracers can be measured in a clinical environment in a variety of physiologic settings.
Rahimian, J.; Glass, E.C.; Touya, J.J.; Akber, S.F.; Graham, L.S.; Bennett, L.R.
The major issues concerning cardiac catherization services are examined. Following an introductory section, focus is on the following: the heart and abnormalities of the heart; methods for cardiac diagnosis and evaluation; the indications for coronary dia...
Unicompartmental femoro-tibial osteoarthritis usually affects the medial compartment of the knee, but in 10%, the lateral compartment is primarily involved. Femoral osteotomy is attractive to avoid TKA in younger patients with low-grade unicompartmental osteoarthritis and a valgus deformity. However, only limited functional results can be expected for patients with Ahlback grade 2 or greater osteoarthritis. Moreover, because of previous skin incisions and hardware removal, TKA after femoral osteotomy remains a complex procedure with poor functional results. Unicompartmental knee arthroplasty for both the medial and the lateral compartments has been performed since the 1970s. In a patient with involvement of only one compartment, a medial or a lateral UKA can provide a quicker recovery and enhanced function when compared to TKA. In addition, it preserves bone stock and can be "easily" revised by a TKA. Technical improvements, combined with strict patient selection, have resulted in ten year survivorships greater than 90%. However, lateral UKA is technically more challenging than medial UKA due to the lower number of indications, as well as the functional anatomy of the lateral compartment. The goals of this article are to present up-to-date information concerning indications, patients' selection, surgical technique and results of lateral compartment UKA. PMID:24337799
Ollivier, Matthieu; Abdel, Matthew P; Parratte, Sébastien; Argenson, Jean-Noël
There are scant audiovisual materials and few monographs relating to equipment, description, and usage in catheter technique and catheter care. Often residents, interns, nurses, and paraprofessionals have sketchy information about the practical aspects of the subject. This paper is intended to give such practical information.
Becker, Leslie E.
The cornual and intramural scarring associated with quinacrine-induced female sterilization has been presumed to make this method irreversible. However, this article presents the cases of two women from Calcutta, India, with successful reversal achieved through transcervical catheterization with recanalization under fluoroscopic guidance. The first woman, age 28 years, had been sterilized five years earlier by three treatments with 252 mg of quinacrine; the second, age 22 years, had been sterilized two years before reversal request with two quinacrine doses. Recanalization of the proximal right tube was achieved in both cases through use of two or three catheterization systems in sequential order; attempts to repair the left tube resulted only in venous intravasation. The gritty sensation during guide-wire recanalization was consistent with fibrosis in the intramural portion of the fallopian tube. The availability of this technique may increase the acceptability of quinacrine sterilization, especially in countries such as Egypt and Indonesia where national family planning programs require that sterilization techniques are reversible. PMID:7703582
Thurmond, A S; Jones, M K; Mullick, B; Kessel, E
There are few assessments of patterns of medicolegal cases involving cardiac catheterizations. This descriptive study reviews the patterns of liability and medical outcomes involving cardiac catheterization litigation from the LexisNexis Academic database and the Physician Insurers Association of America registry. From 1985 to 2009, the Physician Insurers Association of America registry documented 1,361 closed coronary angiography claims. The cardiovascular disease specialty was involved in 699 with other specialties involved in the remaining cases. Of the 1,361 closed claims, 301 (22%) resulted in payments to the plaintiff (average indemnity of $230,987). The most common alleged error was for improper performance (35.4%; average indemnity of $255,542). The alleged error with the highest average indemnity of $270,916 was errors in diagnosis. Not performing an indicated procedure had the highest ratio of paid to closed claims (41%) with an average indemnity of $246,988. In regard to the severity of injury, death was the most common outcome (44%). The highest ratio of paid to total closed claims (43%) was for grave injuries (highest average indemnity of $555,625). Of the 116 LexisNexis cases, litigation against physicians occurred in 90.5% of cases with judgments in favor of the patients in 29.5%. When death was the outcome (31% of cases), physicians were highly likely to be sued (97%) and the judgment was more likely in the plaintiffs' favor (44%). In conclusion, in litigation related to cardiac catheterizations, most cases are due to medical malpractice and physicians are sued in a high percentage of cases. Cardiologists should recognize these patterns of litigation as these may impact and improve processes of care. PMID:24012022
Kim, Candice; Vidovich, Mladen I
AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. METHODS: Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS: Seventeen patients (81%) were classified as GMFCS level IV, and 4 (19%) patients were classified as GMFCS level V. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers’ migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P < 0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P < 0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head. CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.
Canavese, Federico; Rousset, Marie; Samba, Antoine; de Coulon, Geraldo
Patient performance of clean intermittent self-catheterization is a crucial component of the management of incomplete bladder emptying, which can arise from a variety of conditions. This allows patients to have more control over their bladder emptying, and avoids the inconveniences that come with an indwelling urethral catheter. There are, however, barriers that patients face when performing this task which may ultimately limit adherence. In this article, these barriers are discussed in more detail with potential solutions to counter them. PMID:24611001
Seth, Jai H; Haslam, Collette; Panicker, Jalesh N
We describe the unique properties of low-molecular-weight heparins and review studies of the use of these agents in the catheterization laboratory for percutaneous coronary intervention. Recent data regarding bedside monitoring of low-molecular-weight heparin activity are also discussed, as are ongoing and future studies that should be of assistance to clinicians as they consider expanding the use of this newer form of antithrombotic therapy.
Kadakia, Rajan A.; Baimeedi, Shravantika R.; Ferguson, James J.
Arterial catheterization is the second most common invasive procedure performed in the intensive care unit. Despite the ubiquity\\u000a of the procedure, complications including failure to place the catheter occur. While many clinicians are familiar with the\\u000a use of ultrasound (US) guidance to decrease complication rates of central venous catheter insertion, fewer are familiar with\\u000a the use of ultrasound to guide
Ariel L. Shiloh; Lewis A. Eisen
Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs) and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula) was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%). Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.
Saraf, Rashmi; Shrivastava, Manish; Kumar, Nishant; Limaye, Uday
Botulinum toxin (BT) therapy is used in neurology to treat muscle hyperactivity disorders including dystonia, spasticity, cerebral palsy, hemifacial spasms and re-innervation synkinesias as well as exocrine gland hyperactivity disorders. To increase its therapeutic effect and to decrease adverse effects in adjacent tissues, exact BT placement is important. Ultrasonography (US) allows non-invasive, real-time imaging of muscular and glandular tissues and their surrounding structures. It can visualize, guide, and standardize the entire procedure of BT application. Small randomized studies suggest that US-guidance can improve therapeutic efficacy and reduce adverse effects of BT therapy when compared to conventional placement. US-guidance should be used in forearm muscles when functionality is important, and in selected leg muscles. It may be used for targeting distinct neck muscles in cervical dystonia. It is helpful for targeting the salivary glands. Here we review the technique, indications and future developments of US-guidance for BT injection in neurological disorders. PMID:25046267
Walter, Uwe; Dressler, Dirk
Oxygen consumption (VO(2) ) is an important part of hemodynamics using the direct Fick principle in children undergoing cardiac catheterization. Accurate measurement of VO(2) is vital. Obviously, any error in the measurement of VO(2) will translate directly into an equivalent percentage under- or overestimation of blood flows and vascular resistances. It remains common practice to estimate VO(2) values from published predictive equations. Among these, the LaFarge equation is the most commonly used equation and gives the closest estimation with the least bias and limits of agreement. However, considerable errors are introduced by the LaFarge equation, particularly in children younger than 3 years of age. Respiratory mass spectrometry remains the "state-of-the-art" method, allowing highly sensitive, rapid and simultaneous measurement of multiple gas fractions. The AMIS 2000 quadrupole respiratory mass spectrometer system has been adapted to measure VO(2) in children under mechanical ventilation with pediatric ventilators during cardiac catheterization. The small sampling rate, fast response time and long tubes make the equipment a unique and powerful tool for bedside continuous measurement of VO(2) in cardiac catheterization for both clinical and research purposes. PMID:22488802
In this study, the authors describe a simple, nontraumatic procedure for ultrasound-guided placement and maintenance ofjugular and cephalic vein catheterization. The ultrasound scans were performed with a GE Logiq 400 machine connected to a multifrequency (7-11 MHz) linear-array transducer. To find the cephalic vein, longitudinal and transverse color-Doppler ultrasonographic scans were made of the dorsal surface of the flipper. To find the jugular vein, scans of the midline of the lateral surface of the neck were performed. Once the vein had been located, a 16- to 22-gauge 51-mm needle catheter was inserted into the skin beneath the ultrasound probe, inclined at 15-25 degrees to the skin surface. The successful insertion of the catheter inside the vein was monitored by ultrasound. The authors believe that the procedure described offers a good option for fashioning a simple, nontraumatic, and durable vascular access in sea turtles compared with previously described techniques. Caretta caretta, cephalic vein, jugular vein, ultrasonography, vascular catheterization. PMID:20945652
Di Bello, Antonio; Valastro, Carmela; Freggi, Daniela; Saponaro, Vittorio; Grimaldi, Domenico
The rat spinal-cord–injury (SCI) model is widely used to study the pathologic mechanisms that contribute to sensory and motor dysfunction in humans. This model is thought to mimic many of the negative outcomes experienced by humans after spinal contusion injury. We theorized that manual bladder expression contributed to the kidney and bladder lesions reported in previous studies using the rat SCI model. In the present study, rats were surgically implanted with bladder catheters after spinal contusion injury to provide continuous drainage of urine. After 72 h, the rats were euthanized and their kidneys and bladders examined histologically. BUN, serum creatinine, and urine protein were compared at 0 and 72 h after surgery. Kidney and bladder lesions were similar in SCI rats with and without implanted bladder catheters. BUN at 72 h was higher than baseline values in both groups, whereas serum creatinine was higher at 72 h compared with baseline values only in the catheterized rats. These findings indicate that suprapubic bladder catheterization does not reduce hydronephrosis in SCI rats and that the standard of care for bladder evacuation should continue to be manual expression of urine.
Robinson, Mary A; Herron, Alan J; Goodwin, Bradford S; Grill, Raymond J
ABSTRACT This study proposed a modified procedure, using a small balloon catheter (SB catheter, 45 ml), for reducing bladder damage in cows. Holstein cows and the following catheters were prepared: smaller balloon catheter (XSB catheter; 30 ml), SB catheter and standard balloon catheter (NB catheter; 70 ml, as the commonly used, standard size). In experiment 1, each cow was catheterized. The occurrence of catheter-associated hematuria (greater than 50 RBC/HPF) was lower in the SB catheter group (0.0%, n=7) than in the NB catheter group (71.4%, n=7; P<0.05). In experiment 2, general veterinary parameters, urine pH, body temperature and blood values in cows were not affected before or after insertion of SB catheters (n=6). The incidence of urinary tract infection (UTI) was 3.0% per catheterized day (n=22). In experiment 3, feeding profiles, daily excretion of urinary nitrogen (P<0.05) and rate from nitrogen intake in urine (P<0.01), were higher with use of the SB catheter (n=13) than with the use of the vulva urine cup (n=18), indicating that using the SB catheter can provide accurate nutritional data. From this study, we concluded that when using an SB catheter, the following results occur; reduction in bladder damage without any veterinary risks and accuracy in regard to feeding parameters, suggesting this modified procedure using an SB catheter is a useful means of daily urine collection.
TAMURA, Tetsuo; NAKAMURA, Hiroshi; SATO, Say; SEKI, Makoto; NISHIKI, Hideto
Composite indicators are increasingly used for bench-marking countries' performances. Yet doubts are often raised about the robustness of the resulting countries' rankings and about the significance of the associated policy message. We propose the use of uncertainty analysis and sensitivity analysis to gain useful insights during the process of building composite indicators, including a contribution to the indicators' definition of
M. Saisana; A. Saltelli; S. Tarantola
Two X-ray diffraction imaging techniques have been applied for the first time to the study of previously unnoted mosaic detail in color-zoned Brazilian tourmaline. The divergence source-image distortion (DSID) technique gives maximum values for misorienta...
C. O. Pollard
A pH indicator and dextrose were incorporated into growth media as a modification of microbial microtiter methods for determining the minimal inhibitory concentration of antimicrobial drugs. This modified method was tested to evaluate the ease of reading end points by changes in the indicator color. Application of the procedure to two media, three indicators, and eight species of bacteria indicated that definitive end points could be reached as a result of indicator color change caused by acid production during bacterial growth. This method is accurate and reproducible. It is a modification which eliminates a need for plating and facilitates the reading of minimal inhibitory concentration end points.
Tippett, L. O.; Zeleznick, L. D.; Robb, C. A.
Recent years have seen in both human and veterinary medicine the development of numerous techniques allowing for evaluation and classification of changes in individual organs and tissues. Despite introduction of such techniques into diagnostics as among others, CT, MRI, CEUS or elastography, biopsy is still considered a "golden standard" and it is a procedure performed in order to obtain a final diagnosis. There are many biopsy techniques, such as fine needle aspiration biopsy, core biopsy as well as methods of performing a procedure, e.g. blind biopsy, biopsy under USG control and biopsy during laparotomy. In the article usefulness of biopsy techniques in relation to diagnostics of individual abdominal organ, as well as the procedure technique, contraindication and complications are discussed. PMID:24597324
Gli?ska-Suchocka, K; Jankowski, M; Kubiak, K; Spuzak, J; Dzimira, S; Nicpo?, J
Acute limb ischemia due to vascular closure devices is an infrequent complication. However, its incidence is increasing because the use of these devices has become commonplace after cardiac catheterization and coronary angioplasty. It is therefore important for interventional cardiologists to be acquainted with the knowledge and cognitive skills of managing this complication in the catheterization laboratory. The present report describes a strategy to manage this complication in a cardiac catheterization laboratory that is not equipped with standard fluoroscopic equipment for peripheral interventions.
Chan, Albert W; Brown, Robert IG
This paper summarises my experience, over 14 years, treating over 1350 patients suffering from lumbar disc pathology, using minimally invasive intradiscal decompressive percutaneous techniques. The vast majority underwent the method introduced by Onik in 1985, referred to as \\
L'incontinence anale est un handicap physique, psychique et social majeur qui a de nombreuses causes différentes. Les méthodes actuellement disponibles pour améliorer les symptômes de cette incontinence sont les méthodes médicales et de rééducation d'une part et les méthodes chirurgicales d'autre part. Quatre techniques chirurgicales répondent à ces objectifs pour la plupart des malades: la sphinctérorraphie, la neuromodulation des racines sacrées, et les deux techniques de substitution que sont le sphincter artificiel et la graciloplastie dynamisée. La réparation sphinctérienne directe est la technique la plus utilisée dans le traitement chirurgical de l'incontinence anale (IA) par lésion sphinctérienne. Cette technique est envisageable chez les malades ayant une incontinence fécale en rapport avec des lésions limitées du sphincter anal externe. La technique chirurgicale est simple (myorraphie par suture directe ou en paletot) et bien codifiée. Les résultats fonctionnels sont imparfaits et se dégradent avec la durée du suivi. Une continence parfaite après réparation sphinctérienne est rarement acquise de façon durable: le malade candidat à cette approche thérapeutique doit en être averti.
Laalim, Said Ait; Hrora, Abdelmalek; Raiss, Mohammed; Ibnmejdoub, Karim; Toughai, Imane; Ahallat, Mohammed; Mazaz, Khalid
In order to investigate effects of khat chewing on uteroplacental blood flow, eight awake, chronically catheterized guinea pigs were fed 2.2 g khat leaves/kg in late pregnancy and regional blood flows were measured with the microsphere technique. Seven animals fed with aspen leaves in the same amounts served as controls. The mean concentration of (+)-norpseudoephedrine in urine 3 h after the end of the feeding was 4.6 micrograms/ml in the khat-fed group with no detectable amounts in the controls. Placental blood flow was reduced by 10% 75 min and by 24% 180 min after khat feeding. Since the khat dose used gave urinary concentrations of (+)-norpseudoephedrine of the same magnitude as those reported in khat chewing women, khat chewing in pregnancy may reduce placental blood flow and impair fetal growth. PMID:3419201
Jansson, T; Kristiansson, B; Qirbi, A
Background. Homograft aortic valve replacement has been performed in 107 patients during the past 7 years. Two primary methods of implantation were used (intraaortic and root replacement). Results of both methods are presented.Methods. Intraaortic implantation (subcoronary or cylinder technique) was performed in 36 patients (mean age, 54 years) for aortic stenosis or regurgitation (31 patients) and endocarditis (5 patients). Aortic
Richard L Prager; Carl R Fischer; Bobby Kong; James P Byrne; Diane J Jones; M. LaWaun Hance; Otto Gago
Introduction. Auricular reconstruction is a great challenge in facial plastic surgery. With the advances in surgical techniques and biotechnology, different options are available for consideration. The aim of this paper is to review the knowledge about the various techniques for total auricular reconstruction based on the literature and our experience. Methods. Approximately 179 articles published from 1980 to 2013 were identified, and 59 articles were included. We have focused on the current status of total auricular reconstruction based on our personal experience and on papers of particular interest, published within the period of review. We have also included a prospective view on the tissue engineering of cartilage. Results. Most surgeons still practice total auricular reconstruction by employing techniques developed by Brent, Nagata, and Firmin with autologous rib cartilage. Within the last years, alloplastic frameworks for reconstruction have become well established. Choosing the reconstruction techniques depends mainly on the surgeon's preference and experience. Prosthetic reconstruction is still reserved for special conditions, even though the material is constantly improving. Tissue engineering has a growing potential for clinical applicability. Conclusion. Auricular reconstruction still receives attention of plastic/maxillofacial surgeons and otolaryngologists. Even though clinical applicability lags behind initial expectations, the development of tissue-engineered constructs continues its potential development.
Storck, K.; Staudenmaier, R.; Buchberger, M.; Strenger, T.; Kreutzer, K.; von Bomhard, A.; Stark, T.
Purpose: Nosocomial fungal infections are important cause of morbidity and mortality in hospital patients. Urinary catheters have been held responsible to cause a large number of hospital acquired Urinary Tract Infections (UTIs). This study was undertaken to determine the incidence of nosocomial Candiduria associated with in dwelling urinary catheters, to characterize the species and assess their resistance to antifungal agents. Materials & Methods: Urine specimens from 510 catheterized patients were inoculated on Sabauraud Dextrose Agar; the species identification of Candida isolates was done by biochemical tests and antifungal susceptibility testing was done by disc diffusion method. Results: Candida was isolated in 112 (21.96%) specimens. Of these, Candida albicans was commonly isolated in 50.89% followed by C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. guillermondi and C. pseudotropicalis. Fluconazole resistance was encountered in some isolates. All C. glabrata and C. krusei were uniformly resistant to fluconazole and 8 of 16 C. tropicalis were also resistant to it. But only 7 of 57 isolates of C. albicans were resistant to it. Resistance to Nystatin was seen in 34 isolates. Similarly, emergence of resistance was also seen to Ketoconazole and Itraconazole in 24 of 112 isolates. Amphoterecin B resistance was exhibited by 3 C. albicans, 2 C. tropicalis, 1 C. glabrata and 1 C. krusei strain. C. albicans is an important nosocomial pathogen causing UTI in catheterized patients, nevertheless role of other species of Candida as emergent pathogens and resistance to antifungal drugs needs to be emphasized. PMID:24701478
Mishra, Meena; Agrawal, Seema; Raut, Sharmila; Kurhade, A M; Powar, R M
Objective: To evaluate cardiac performance following coronary artery surgery using two different techniques of cardioplegia?Design: Randomized prospective study?Setting: Adult cardiothoracic intensive care unit in a university hospital?Study population: Thirty patients undergoing isolated coronary surgery?Interventions: Patients were randomized to receive either intermittent antegrade warm blood cardioplegia with normothermic bypass (group\\u000a 1) or combined antegrade and retrograde cold crystalloid cardioplegia with hypothermic
L. Jacquet; P. Honore; R. Beale; D. Valadi; R. Dion; M. Goenen
Control charts are practical tools to monitor various school indicators (attendance rates, standardized test scores, grades, and graduation rates) by displaying data on the same scale over time. This article shows how principals can calculate the upper natural-process limit, lower natural-process limit, and upper control limit for attendance. (15…
Limitations exist in applying the conventional microbial methods to the detection of human fecal contamination in water. Recently, there has been an increased interest in developing supplemental and/or alternate indicators of human contamination to better define water quality an...
Today's imaging studies accurately delineate the extent of glomus tumors of the temporal bone. Microsurgical techniques allow total removal of even the largest tumors with acceptable morbidity. While surgical management is the principal treatment of glomus tumors, stereotactic fractionated radiation therapy may be used as an alternative treatment when there is a risk of cranial neuropathy with surgical management. We should be aware of the full range of management options and base treatment choice on the age and medical condition of the patient and location and size of the tumor. PMID:19245781
de la Cruz, Antonio; Teufert, Karen B; Santa Cruz, Santiago
In this work, remote sensing-based assessments of actual evapotranspiration using METRIC integrated with a water balance model\\u000a provided accurate estimates of irrigation performance. This new methodology was applied and tested in the Genil–Cabra Irrigation\\u000a Scheme located in southern Spain during the 2004–2005 irrigation season. The performance indicators used, the annual relative\\u000a irrigation supply (ARIS) and the irrigation water productivity (IWP),
C. SantosIgnacio; Ignacio J. Lorite; M. Tasumi; R. G. Allen; E. Fereres
Excluding specific neurosurgical indications for cortical localization or peripheral nerve surgery, the use of sensory evoked\\u000a potentials as a monitor in the operating room should be controversial at this time. Whether appropriate or not, legal and\\u000a medical forces have largely established the use of somatosensory evoked potential monitoring as a standard during procedures\\u000a that threaten the integrity of the spinal
John D. Michenfelder
The Trilinos Project is an effort to facilitate the design, development, integration and ongoing support of mathematical software libraries within an object-oriented framework. It is intended for large-scale, complex multiphysics engineering and scientific applications [2, 4, 3]. Epetra is one of its basic packages. It provides serial and parallel linear algebra capabilities. Before Trilinos version 11.0, released in 2012, Epetra used the C++ int data-type for storing global and local indices for degrees of freedom (DOFs). Since int is typically 32-bit, this limited the largest problem size to be smaller than approximately two billion DOFs. This was true even if a distributed memory machine could handle larger problems. We have added optional support for C++ long long data-type, which is at least 64-bit wide, for global indices. To save memory, maintain the speed of memory-bound operations, and reduce further changes to the code, the local indices are still 32-bit. We document the changes required to achieve this feature and how the new functionality can be used. We also report on the lessons learned in modifying a mature and popular package from various perspectives - design goals, backward compatibility, engineering decisions, C++ language features, effects on existing users and other packages, and build integration.
Jhurani, Chetan; Austin, Travis M.; Heroux, Michael Allen; Willenbring, James Michael
Objectives. Our objective was to determine whether catheterization data obtained after a fenestrated Fontan operation influenced patient management or predicted functional status.Background. Cardiac catheterization after a fenestrated Fontan operation is undertaken to identify residual lesions and to observe the patient's response to test occlusion of the baffle fenestration.Methods. Sixty patients undergoing both a fenestrated Fontan operation before July 1991 and
Nancy D. Bridges; James E. Lock; John E. Mayer; Janice Burnett; Aldo R. Castaneda
Background. Multiple sclerosis (MS) healthcare providers (HCP) have undergone considerable educational efforts regarding the importance of evaluating and treating pelvic floor disorders, specifically, urinary dysfunction. However, limited data are available to determine the impact of catheterization on patient quality of life (QoL). Objectives. To describe the use of urinary catheterization among MS patients and determine the differences between those who report positive versus negative impact of this treatment on QoL. Methods. Patients were queried as part of the 2010 North American Research Committee On Multiple Sclerosis survey; topics included 1) urinary/bladder, bowel, or sexual problems; 2) current urine leakage; 3) current catheter use; 4) catheterizing and QoL. Results. Respondents with current urine leakage were 5143 (54.7%), of which 1201 reported current catheter use (12.8%). The types of catheters (intermittent self-catheterization and Foley catheter (indwelling and suprapubic)) did not differ significantly. Of the current catheter users, 304 (25.35%) respondents reported catheterization negatively impacting QoL, 629 (52.4%) reported a positive impact on QoL, and 223 (18.6%) reported neutral QoL. Conclusions. A large proportion of catheterized MS patients report negative or positive changes in QoL associated with urinary catheterization. Urinary catheterization does not appear to have a universally negative impact on patient QoL.
Frasure, Heidi E.; Mahajan, Sangeeta T.
Transarterielle Chemoembolisation (TACE) des hepatozellulren Karzinoms: Technik, Indikationsstellung und Ergebnisse Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma: Technique, Indication and Results
To present current data on technique, indications and results of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The principle of TACE is the intra-arterial injection of chemotherapeutic drug combinations like doxoru- bicin, cisplatin and mitomycin into the hepatic ar- tery, followed by lipiodol injection, Gelfoam for vessel occlusion and degradable microspheres. The side effects and complications after TACE range from
S. Zangos; J. O. Balzer; M. Nabil; P. Rao; K. Eichler; W. O. Bechstein; S. Zeuzem; A. Abdelkader
Background One of the most daunting complications of cardiac catheterization is a cerebrovascular event (CVE). We aimed to assess the real?life incidence, etiology, and risk factors of cardiac catheterization?related acute CVEs in a large cohort of patients treated in a single center. Methods and Results We undertook a retrospective analysis of 43 350 coronary procedures performed on 30 907 procedure days over the period 1992?2011 and compared patient and procedural characteristics of procedures complicated by CVEs with the remaining cohort. CVEs occurred in 47 cases: 43 were ischemic, 3 intracerebral hemorrhages, and 1 undetermined. The overall CVE rate was 0.15%, with percutaneous coronary intervention (PCI) and diagnostic coronary angiography rates 0.23% and 0.09%, respectively. Using a forward stepwise multivariate logistic regression model including patient demographic and procedural characteristics, a total of 5 significant predictors were defined: prior stroke (OR=15.09, 95% CI [8.11 to 28.08], P<0.0001), presence of coronary arterial thrombus (OR=2.79, 95% CI [1.25 to 6.22], P=0.012), age >75 years (OR=3.33, 95% CI [1.79 to 6.19], P<0.0001), triple vessel disease (OR=2.24, 95% CI [1.20 to 4.18], P=0.011), and performance of intervention (OR=2.21, 95% CI [1.12 to 4.33], P=0.021). An additional analysis excluded any temporal change of CVE rates but demonstrated a significant increase of all high?risk patient features. Conclusion In a single?center, retrospective assessment over nearly 20 years, cardiac catheterization?related CVEs were very rare and nearly exclusively ischemic. The independent predictors for these events were found to be the performance of an intervention and those associated with increased atherosclerotic burden, specifically older age, triple vessel disease, and prior stroke. The presence of intracoronary thrombus appears also to raise the risk of procedure?related CVE.
Korn-Lubetzki, Isabelle; Farkash, Rivka; Pachino, Rachel M.; Almagor, Yaron; Tzivoni, Dan; Meerkin, David
Saving water in irrigated agriculture is increasingly relevant, as the irrigation sector is in many regions the biggest water consumer, but must be a sustainable activity. Therefore, the need urges for water use control methods and water resources planning. In irrigated agriculture, the right way for saving water is constituted by the increase of efficiency in water management. This work validates procedures and methodologies with remote sensing to determine the water availability in the soil at each moment and therefore the opportunity for the application of the water volume strictly necessary to optimize crop growth (irrigation opportunity and irrigation amount). The analysis applied to the Irrigation District of Divor, Évora, having used 7 experiment plots, which are areas watered by center-pivot systems, cultivated to corn. Data were determined from multispectral and infrared images of the cultivated surface obtained by satellite or by flying unmanned platform and integrated with parameters of the atmosphere and of the crops for calculating biophysical indicators and indices of water stress in the vegetation (NDVI, Kc, Kcb, CWSI). Therefore, evapotranspiration (ETc) was estimated, with which crop water requirement was calculated, with the opportunity and the amount of irrigation water to allocate. As this information is geographic referenced, maps can be prepared with GIS technology, describing water situation and the opportunity for watering crops. If the remote images are available with enough high spatial and temporal resolution, the frequent availability of maps can serve as a basis for a farmers irrigation advice system and for the regional irrigation authority to make decisions on the irrigation management at the regional scale. This can be a significant contribute to an efficient water management technology and a sustainable irrigated agriculture. Key-Words: Remote Sensing, Vegetation Index, Crop Coefficients, Water Balance
Toureiro, Célia; Serralheiro, Ricardo
The combination of right portal vein ligation with complete parenchyma dissection ("in-situ split", ISS) for rapid hypertrophy induction of the left-lateral liver lobe is a novel strategy to convert primarily irresectable liver tumours into a resectable stage. Available data so far show a 60-80?% growth induction of the remnant liver within 7(-?9) days. Certainly, a novel concept that comprises two operations within a very short time period raises questions. Based on the very few literature reports that have been published so far, as well as our own experience, we here discuss technical issues such as the use of a plastic sheet on the resection margin, the possibility of laparoscopic dissection and the timing of the second operation. Moreover, aspects of the preoperative diagnostic work-up that is necessary are assessed. Finally, open questions, e.g., concerning the influence of preoperative chemotherapy and the use of ISS in patients with cirrhosis are evaluated. In summary, the assessment of chances and risks of this novel concept with regard to indication and technical issues helps to provide the potentially curative option of the "in-situ split" procedure to more patients with marginal or even irresectable liver tumours. PMID:24022245
Lang, S A; Loss, M; Schlitt, H J
Surgical therapy for treatment-resistant obsessive compulsive disorder (OCD) remains an effective option for well-selected patients managed within a multidisciplinary setting. Historically, lesions within the limbic system have been used to control both obsessive thoughts and repetitive compulsions associated with this disease. We discuss classical targets as well as contemporary neuromodulatory approaches that have been shown to provide symptomatic relief. Recently, deep brain stimulation (DBS) of the anterior limb of the internal capsule/ventral striatum received Conformité Européene (CE) mark and Food and Drug Administration (FDA) approvals for treatment of intractable OCD. Remarkably, this is the first such approval for neurosurgical intervention in a strictly psychiatric indication in modern times. This target is discussed in detail along with alternative targets currently being proposed. We close with a discussion of gamma knife capsulotomy, a modality with deep historical roots. Further directions in the surgical treatment of OCD will require better preoperative predictors of postoperative responses, optimal selection of individualized targets, and rigorous reporting of adverse events and standardized outcomes. To meet these challenges, centers must be equipped with a multidisciplinary team and patient-centered approach to ensure adequate screening and follow up of patients with this difficult-to-treat condition. PMID:24099662
Tierney, Travis S; Abd-El-Barr, Muhammad M; Stanford, Arielle D; Foote, Kelly D; Okun, Michael S
Third-degree atrioventricular block has been well documented during ventricular catheterization of patients with underlying conduction abnormalities. Two cases reported here describe patients with normal conduction at baseline who sustained complete heart block during ventricular catheterization. Catheterizing physicians should be aware of this risk, which has not been previously reported. PMID:2354513
Brachfeld, C A; Marshall, J; Volosin, K J; Groh, W C
Over a 17-year period, 92 patients with esophageal disease underwent colon interposition or bypass, with each operation performed by the same surgeon. The indication was cure of cancer in 20 patients, relief of dysphagia in 55 (cancer in 17 patients and benign in 38), loss of gastrointestinal (G.I.) continuity in ten, and tracheoesophageal fistula in seven patients (malignant in five, benign in 2). The thirty-day operative mortality rate was 5%, and the hospital mortality rate was 9%. Graft necrosis occurred in seven of 92 patients, four of whom later underwent a successful second reconstruction. Thirteen patients required subsequent revisional surgery. In 85 patients, the left colon based on the inferior mesenteric artery was used, and in seven, the right colon was used. Technical insights were gained to help preserve the blood supply to the graft and improve its function in transporting food. Thirty-four patients were available for interview 2-17 years after operation (median of 5 years) 28 of whom had benign disease, and six of whom had malignant disease); 82% of the patients felt they were cured of their preoperative symptoms, 18% improved, and none worsened. Eighty-eight per cent of the patients were able to receive an unrestricted diet. All patients except one were satisfied with the results of surgery, and, asked what they would do if they had to make the choice again, all responded that they would have the operation. Twenty-six of the interviewed patients had their eating ability evaluated with a test meal and the transit time of a liquid and solid barium bolus measured. Compared to controls, patients with colon interpositions consumed a smaller capacity meal over a longer period of time and were not dependent on liquids to flush the food through the colon graft. A colon interposition provides good quality of deglutition, is very durable, and is the organ of choice for patients who require an esophageal substitute and are potential candidates for long survival. Images Figs. 3A and B.
DeMeester, T R; Johansson, K E; Franze, I; Eypasch, E; Lu, C T; McGill, J E; Zaninotto, G
Introduction Ultrasound-guided (UG) technique is the recommended procedure for central venous catheterization (CVC). However, as ultrasound may not be available in emergency situations, guidelines also propose that physicians remain skilled in landmark (LM) placement. We conducted this prospective observational study to determine the learning curve of the LM technique in residents only learning the UG technique. Methods During the first three months of their rotation in our ICU, residents inexperienced in CVC used only the real-time UG technique. During the following three months, residents were allowed to place CVC by means of the LM technique when authorized by the attending physician. Results A total of 172 procedures (84 UG and 88 LM) were performed by the inexperienced residents during the study. The success rate was lower (72% versus 84%; P?=?0.05) and the complication rate was higher (22% versus 10%; P?=?0.04) for LM compared to UG procedures. Comparison between the five last UG procedures and the first five LM procedures performed demonstrated that the transition between the two techniques was associated with a marked decrease of the success rate (65% versus 93%; P?=?0.01) and an increase of the complication rate (33% versus 8%; P?=?0.01). After 10 LM procedures, residents achieved a success rate and a complication rate of 81% and 6%, respectively. Conclusions Residents who only learn the UG technique will not be immediately able to perform the LM technique, but require specific training based on at least 10 LM procedures. The question of whether or not the LM technique should still be taught when an ultrasound device is not available must therefore be addressed.
Many hydrological applications need precipitation information at locations where measurements are often not available. To overcome this basic problem, the simplest way is to use spatial interpolation techniques for transferring the information from measurement sites to a location of interest. Since the performance of a spatial interpolation technique strongly depends on the availability of measurements, the technique might fail for a data sparse region. To address this question in more detail, we analyze the performance of various interpolation techniques ranging from a nearest neighbor approach to more sophisticated kriging techniques for the Volta basin in West Africa. This study region is characterized by a low station density, precipitation time series with long data gaps and less reliable measurements, high precipitation variability on different spatiotemporal scales and a strong demand of reliable techniques for providing spatially distributed precipitation data sets in a fine resolution. The target variables are the annual, monthly and daily precipitation amount and further daily precipitation indices e.g. the precipitation probability and transition probabilities. An interpolation of the latter variables is of interest e.g. as input information for a stochastic generation of daily precipitation time series at arbitrary (e.g. gridded) locations. The database is an archive of daily observations ranging from 1970 and 2010 collected at more than 200 sites. This precipitation archive is probably the most comprehensive data set with daily measurements for this region. The performance of the interpolation technique is determined based on a leave-one out cross-validation using sophisticated performance measures such as the linear error in probability space. The target variables are interpolated on a regular grid with a resolution of 5 km covering the Volta basin to provide this information for subsequent studies in this region. The outcomes of this study indicate that the selected kriging techniques slightly outperform the other techniques in many situations and seem to provide valuable information for many sites. However, the performance of an interpolation technique strongly depends on the spatial variability of the interpolation variable and is therefore low for an interpolation of the daily precipitation amount. In future, the gridded precipitation data sets are transferred to an online database to provide this information for hydrological and non-hydrological studies.
Bliefernicht, Jan; Laux, Patrick; Waongo, Moussa; Annor, Thompson; Harald, Kunstmann
The scope of this article is to assess the suitability of the measurement techniques and the cutoff points of anthropometric indicators of abdominal obesity adopted in Brazil, and summarize the results. This involves a review of the literature published from 1990 to 2010 and indexed in the MEDLINE, LILACS and SciELO databases. The inclusion criteria for articles were: original research articles with abstracts available of experimental or observational design conducted in Brazil, in English, Spanish or Portuguese; articles about assessment of abdominal obesity with the use of anthropometric indicators of central distribution. Eighteen articles characterized according to author and publication year, study site, study type, sample size, age, sex, anthropometric indicators, measurement techniques, cutoff points and main results were selected. A divergence was found between studies in terms of standardized technical procedures and cutoff points. The results of this review recommend the standardized use of the validated measurement techniques and cutoff points in order to facilitate comparison of the results of the epidemiological studies into abdominal obesity and their adequate use in clinical practice. PMID:24897475
Menezes, Tarciana Nobre de; Rocha, Fabiana Lucena; Belém, Patrícia Leite de Oliveira; Pedraza, Dixis Figueroa
We are introducing a new continuous hydrostatic pressure system for identification and catheterization of epidural space in adults. One hundred and eight patients scheduled for elective endoscopic urological procedures were enrolled in this prospective randomized study. They were assigned to perform loss of resistance epidural technique by either the conventional saline-filled syringe (group C) or the new pressure technique (group P). The latter depends on observing passage of free flow of pressurized normal saline (50 mmHg) connected to epidural needle during its advancement, and then the epidural catheter was inserted to "float" easily while saline was flowing. Ten ml of bupivacaine 0.5 % with 50 ?g fentanyl were injected. Time to identify epidural space, number of attempts, ease of catheterization, sensory and motor block by Bromage scale after 20 min, quality of anesthesia and any side effects were recorded. Significant reduction was found in group P versus group C concerning time to identify epidural space [20 (6-40) vs. 60.5 (23-75) s with p = 0.001], number of attempts [1 (1-2) vs. 1 (1-4) with p = 0.02] and motor block [1 (0-3) vs. 2 (0-2) with p = 0.02], respectively. No significant difference in epidural catheterization, sensory block, quality of anesthesia and incidence of side effects. We concluded that this new technique is an easy way to identify epidural space using available tools in the operating room. PMID:23408046
Samhan, Yasser M; El-Sabae, Hossam H; Khafagy, Hanan F; Maher, Mohamed A
BACKGROUND Atherosclerotic renal artery (RA) stenosis contributes to hypertension, renal insufficiency and end stage renal disease, and is independently associated with adverse cardiovascular events. Percutaneous renal intervention is efficacious in treating renovascular hypertension and may be effective in stabilizing or improving renal function, thereby reducing cardiovascular risk. However, high rates of procedural complications have been reported. OBJECTIVES To determine the nature and frequency of complications of percutaneous renal intervention using contemporary techniques and equipment in a high-volume cardiac catheterization laboratory. METHODS Consecutive patients undergoing attempted RA stenting for atherosclerotic RA stenosis in the cardiac catheterization laboratory at the Vancouver General Hospital (Vancouver, British Columbia) between June 2000 and March 2007 were enrolled in a prospective registry. Baseline clinical characteristics, procedural and technical information, and complications were recorded. RESULTS A total of 132 RAs were stented in 106 patients during 108 procedures. The procedural success rate was 100%, with no related death, myocardial infarction, nephrectomy or dialysis. Major complications included three pseudoaneurysms (2.8%) and acute deterioration in renal function in six patients (5.5%), although renal function returned to baseline in one patient at 12 months. CONCLUSIONS RA stenting can be successfully and safely performed using contemporary techniques, and the low complication rates described should be the minimum standard for contemporary trials evaluating RA stenting.
Jokhi, Percy P; Ramanathan, Krishnan; Walsh, Simon; Fung, Anthony Y; Saw, Jacqueline; Fox, Rebecca S; Zalunardo, Nadia; Buller, Christopher E
Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized. Images Fig. 1A. Fig. 1B. Fig. 2. Fig. 3. Fig. 4.
Brismar, B; Hardstedt, C; Jacobson, S
Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide not only for symptomatic bradycardia, but also for the management of arrhythmia and heart failure. Their use in more elderly patients with significant comorbidities is rising steeply and consequently long-term complications are increasingly arising. Such an increase in device therapy is being paralleled by an increase in the requirement for system extraction. Safe lead extraction is central to the management of much of the complications related to pacemakers. The most common indication for lead extraction is system infection Adhesions in chronically implanted leads can become major obstacles to safe lead extraction and life-threatening bleeding and cardiac perforations may occur. Over the last 20 years, specific tools and techniques for transvenous lead extraction have been developed to assist in freeing the lead body from the adhesions. This article provides a comprehensive review of the indications, tools, techniques and outcomes for transvenous lead extraction. The success rate largely depends on the time from implant. Up to 12 months from implant, it is rare that traction alone will not suffice. For longer lead implant duration, no single technique is sufficient to address all extractions, but laser provides the best chance of extracting the entire lead. Operator experience is vital in determining success as familiarity of a wide array of techniques will increase the likelihood of uncomplicated extraction. Long implantation time, lack of operator experience, ICD lead type and female gender are risk factors for life-threatening complications. Lead extraction should therefore, ideally be performed in high volume centres with experienced staff and on-site support from a cardiothoracic surgical team able to deal with bleeding complications from cardiovascular perforation. PMID:20642712
Farooqi, F M; Talsania, S; Hamid, S; Rinaldi, C A
Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization. We estimate that septic involvement of this joint may be as common as one in 500 catheterizations. We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization. Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis. Both patients responded well to antibiotic treatment. Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis. We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization. PMID:7835020
Aglas, F; Gretler, J; Rainer, F; Krejs, G J
A multipurpose "wire-ship" catheter has been developed for selective catheterization of branches arising from the aorta. The catheter tip is formed in three dimensions to allow simple selective catheterization and to provide improved stability during injection of contrast media by power injector or by hand. For successful catheterization it is essential to match the diameter of the catheter coil to the aortic lumen at the specific level to be studied; consequently, five standard sizes of coil diameter from 10--18 mm are currently produced. With an additional side hole in the coil, semiselective angiograms may be obtained. The wire-whip catheter has been used in over 200 angiographic examinations. The renal, celiac, superior and inferior mesenteric circulations have been most commonly studied, but other aortic branches such as the bronchial, intercostal, phrenic, and lumbar arteries have been catheterized as well. There have been no serious complications. PMID:743714
In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3rd h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24th h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.
Tuncez, Abdullah; Kaya, Zeynettin; Aras, Dursun; Y?ld?z, Abdulkadir; Gul, Enes Elvin; Tekinalp, Mehmet; Karakas, Mehmet Fatih; K?sac?k, Halil Lutfu
Febrile infants undergoing urethral catheterization (UC) are often not treated for pain and distress. The aim was to evaluate the effectiveness of midazolam premedication. We compared a convenience sample of infants who underwent UC with midazolam with those who did not receive midazolam. Outcome measures were Visual Analog Scale assessment, duration of cry, and emergency department length of stay. Thirty-two study participants and 18 controls were prospectively enrolled. Midazolam premedication showed a 53% decrease in the mean Visual Analog Scale score when parents assessed distress (33.6 vs. 71.7, P<0.0001) and a 48% decrease when nurses assessed distress (28.7 vs. 55.5, P<0.0002); the median cry duration was significantly shorter (0 vs. 240 s). Serious adverse events were not observed during sedation and at 48 h after discharge. Study participants had longer emergency department length of stay compared with the controls (191.5 vs. 139 min, P<0.017). In this cohort, midazolam significantly reduced the distress associated with UC without causing serious adverse events. PMID:24323046
Weiser, Giora; Cohen, Dana; Krauss, Baruch; Galbraith, Roger; Shavit, Itai
Invasive prenatal testing has become an important way to evaluate fetuses at increased risk for hereditary disorders. In utero sampling of fetal skin, liver, and muscle may be required to diagnose before-birth disorders that cannot be diagnosed by analysis using chorionic villi or amniotic fluid. In the next few years, many of these conditions will be detected by DNA analysis, and the need for these procedures may decrease dramatically. First performed by fetoscopy, fetal tissue sampling is now most frequently done by inserting a biopsy needle under continuous ultrasonographic guidance. We describe the indications, techniques, complications, and experience with obtaining fetal skin, liver, and muscle biopsy specimens. Images
Cadrin, C; Golbus, M S
The Keller/Brandes operation for the correction of hallux valgus consists of a resection of the base of the first phalanx and narrowing of the forefoot by resection of the exostosis of the first metatarsal head and reduction of the luxated sesamoid complex, thus reducing the metatarsus primus varus. The indication to this procedure is given in the elder patient with arthritic changes in the first metatarsophalangeal joint. Though this operation is "mutilating", we have found favourable results in the recent literature as in 50 of our patients being very good and good in 82%, moderate in 8% and poor in 10% of the cases. In order to obtain a good result we emphasize the importance of a correct indication, adequate preoperative measures, a perfect operative technique and a well guided postoperative management. PMID:1805444
Burckhardt, A; Abbühl, U
Aims Real-time MRI creates images with superb tissue contrast that may enable radiation-free catheterization. Simple procedures are the first step towards novel interventional procedures. We aim to perform comprehensive transfemoral diagnostic right heart catheterization in an unselected cohort of patients entirely using MRI guidance. Methods and results We performed X-ray and MRI-guided transfemoral right heart catheterization in consecutive patients undergoing clinical cardiac catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium-filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI catheterization. Complete guidewire-free catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolinium-filled MRI balloons. Conclusion In this early experience, comprehensive transfemoral right heart catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.
Ratnayaka, Kanishka; Faranesh, Anthony Z.; Hansen, Michael S.; Stine, Annette M.; Halabi, Majdi; Barbash, Israel M.; Schenke, William H.; Wright, Victor J.; Grant, Laurie P.; Kellman, Peter; Kocaturk, Ozgur; Lederman, Robert J.
Catheterized intestinal loops may be a valuable model to elucidate key components of the host response to various treatments within the small intestine of ruminants. We examined whether catheterizing ileal loops in sheep affected the overall health of animals and intestinal function, whether a bacterial treatment could be introduced into the loops through the catheters, and whether broad-spectrum antibiotics could sterilize the loops. Escherichia coli cells transformed to express the GFP gene were introduced readily into the loops through the catheters, and GFP E. coli cells were localized within the injected loops. Catheterized loops, interspaces, and intact ileum exhibited no abnormalities in tissue appearance or electrical resistance. Expression of the IFN?, IL1?, IL4, IL6, IL12p40, IL18, TGF?1, and TNF? cytokine genes did not differ significantly among the intact ileum, catheterized loops, and interspaces, nor did the expression of the gene for inducible nitric oxide synthase. Broad-spectrum antibiotics administered during surgery did not sterilize the loops or interspaces and did not substantively change the composition of the microbiota. However, antibiotics reduced the overall number of bacterial cells within the loop and the relative abundance of community constituents. We concluded that catheterization of intestinal loops did not adversely affect health or loop function in sheep. Furthermore, allowing animals to recover fully from surgery and to clear pharmaceuticals will remove any confounding effects due to these factors, making catheterized intestinal loops a feasible model for studying host responses in ruminants.
Inglis, G Douglas; Kastelic, John P; Uwiera, Richard R E
We investigated the role of K(ATP) channel on acute urinary retention (AUR) induced bladder dysfunction. Eight-week-old female Sprague-Dawley rats were divided into seven groups: a sham-operated control group, an AUR group, and five AUR groups treated with: two different K(ATP) channel openers namely nicorandil (3 or 10mg/kg), or cromakalim (100 or 300microg/kg), or one K(ATP) channel inhibitor namely glibenclamide (5mg/kg). The drugs were administered 30min before induction of AUR. After the urethra was obstructed with a clip, AUR was induced by intravesical infusion of 2.5ml of saline via cystostomy. Following a 30min obstruction the bladder was allowed to drain with a catheter in place for 60min with real-time monitoring of intravesical pressure and blood flow. After the experimental period, the bladder function was assessed, using organ bath techniques (carbachol and 100mM KCl). AUR increased the intravesical pressure and decreased the blood flow. The subsequent catheterization decreased the intravesical pressure and increased the blood flow. AUR group reduced significantly the contractile responses to both carbachol and KCl compared with the control group. Nicorandil and cromakalim but not glibenclamide prevented the bladder dysfunction after AUR suggesting that K(ATP) channel openers may prevent the bladder dysfunction caused by AUR and subsequent catheterization. PMID:20303940
Ohmasa, Fumiya; Saito, Motoaki; Shimizu, Shogo; Taniguchi, Sousuke; Dimitriadis, Fotios; Satoh, Itaru; Kinoshita, Yukako; Satoh, Keisuke
Chromosome damage (CD) and sister chromatid exchange (SCE) levels were studied in lymphocytes from 30 pediatric heart catheterization patients receiving radiation during diagnostic fluoroscopy and cineangiography procedures. Forty-eight-hour CD and 72-hr SCE cultures were prepared from sequential samples taken from each patient: samples 1-3 via the catheter the same day (1) before exposure, (2) after fluoroscopy, and (3) after cineangiography; and sample 4 by venipuncture the next morning. Significant increases in CD (dicentrics, rings, and fragments), but not SCE, were observed. From a mean base level of 0.4% cells with CD, the CD levels increased 2-3-fold in samples 3 and 4 (p = .001). Rings only occurred in samples 3 and 4. While increased CD levels also correlated with increasing age, body surface area, and weight, partial correlations controlling for these factors clearly indicate that the CD effects are principally attributable to the radiological procedures (p = .001). Increased CD levels correlated with both the roentgen dose of cineangiography exposure (p = .002) and the volume of contrast medium (p = .000); however, partial correlations, controlling for either factor, indicate that the contrast medium was the principal factor (p = .006). PMID:3678209
Shafer, D A; Raviele, A A; Dunbar, V G; Click, L A
Chromosome damage (CD) and sister chromatid exchange (SCE) levels were studied in lymphocytes from 30 pediatric heart catheterization patients receiving radiation during diagnostic fluoroscopy and cineangiography procedures. Forty-eight-hour CD and 72-hr SCE cultures were prepared from sequential samples taken from each patient: samples 1-3 via the catheter the same day (1) before exposure, (2) after fluoroscopy, and (3) after cineangiography; and sample 4 by venipuncture the next morning. Significant increases in CD (dicentrics, rings, and fragments), but not SCE, were observed. From a mean base level of 0.4% cells with CD, the CD levels increased 2-3-fold in samples 3 and 4 (p = .001). Rings only occurred in samples 3 and 4. While increased CD levels also correlated with increasing age, body surface area, and weight, partial correlations controlling for these factors clearly indicate that the CD effects are principally attributable to the radiological procedures (p = .001). Increased CD levels correlated with both the roentgen dose of cineangiography exposure (p = .002) and the volume of contrast medium (p = .000); however, partial correlations, controlling for either factor, indicate that the contrast medium was the principal factor (p = .006).
Shafer, D.A.; Raviele, A.A.; Dunbar, V.G.; Click, L.A.
Detecting and quantifying crop residue cover on agricultural fields is essential in identifying conservation tillage practices and estimating carbon sequestration, both of which are important goals within the Agricultural Policy Framework of Agriculture and Agri-Food Canada. Crop residue is traditionally measured using ground survey techniques such as the line-transect method or visual (drive-by) assessment but these techniques are tedious, time-consuming and subjective. With the increased number of advanced earth observation satellites, remote sensing has now become a viable option for mapping agricultural land management practices and percent crop residue cover. A wide variety of indices such as the Normalized Difference Index (NDI) and the Modified Soil Adjusted Crop Residue Index (MSACRI) were developed using multispectral data for this purpose but results have been mixed. Advanced classification techniques including linear spectral mixture analysis (SMA) and spectral angle mapper (SAM) provide an alternative to derive percent crop residue cover. Landsat-7 SLC-Off data were acquired over an agricultural study site in Eastern Ontario on May 25 2005. Simultaneous ground data were collected to characterize residue type, position, direction and percent cover. NDI, MSACRI, SMA and SAM were all computed and used to derive percent crop residue cover information. Preliminary results indicate that the SMA model predicts percent crop residue cover over agricultural fields with the most success, especially over fields of corn residue with an R2 value of 0.85 (RMSE of 12.46 and D of 0.99). However, further investigation is needed where residue models are validated against a larger dataset with greater variability in percent crop residue cover.
Pacheco, Anna; McNairn, Heather; Smith, Anne M.
High-density pericardial fluid may be seen on noncontrast CT performed following cardiac catheterization (CC), raising the possibility of hemopericardium. Our goal was to determine the clinical course and associations of incidentally discovered high-attenuation pericardial fluid on noncontrast CT performed soon after CC. Hospital database search over a 7.5-year period identified 211 patients who underwent CT of the chest and/or abdomen within 60 h before or after CC, 150 having CC first. Pericardial fluid volume and attenuation as well as relevant laboratory and clinical parameters were recorded. Bivariate associations with average pericardial fluid attenuation (HUavg) were assessed. Using the 61 patients with CT before CC as controls, 44 of the patients with CC first had attenuation values greater than the mean?+?2SD of 22.6 Hounsfield unit (HU) and 19 had attenuation values greater than the maximum control patient value of 39.8 HU. All patients with incidental finding of high-density pericardial fluid followed a benign course. Bivariate correlations showed time gap between CC and CT (rho?=?-0.50, p?0.001), estimated glomerular filtration rate (eGFR) (rho?=?-0.24, p?=?0.004), and female gender (median (IQR) 17.4 (13.6, 29.6) vs. 15.8 (9.9, 23.7), p?=?0.02) to be associated with HUavg. In multiple linear regression analysis, only time gap and female gender were independently significantly associated with average attenuation (both p?0.001). The finding that patients with incidentally discovered high-density pericardial fluid followed an uneventful course suggests a benign etiology such as vicarious excretion, and in patients who are otherwise stable, observation rather than immediate intervention should be considered. PMID:24638997
Avery, Laura L; Jain, Vineet R; Cohen, Hillel W; Scheinfeld, Meir H
1. To determine the extracellular volume (ECV) in fetal sheep and its distribution between the plasma and interstitial spaces, ECV, blood volume (BV) and haematocrit were measured in ten chronically catheterized fetal sheep aged 121-133 days. Relationships with age, weight and other fetal variables, including glomerular filtration rate (GFR), were studied. 2. ECV was measured as the mean of the volumes of distribution of [3H]inulin and [14C]mannitol extrapolated to time zero. The time zero volume of distribution was 1506 +/- 79 ml (means +/- S.E.M.) for inulin and 1590 +/- 80 ml for mannitol. The ECV was 1548 +/- 79 ml (632 +/- 18 ml (kg fetal wt)-1). BV, measured using 51Cr-labelled red cells, was 351 +/- 27 ml (141 +/- 6 ml kg-1). Haematocrit, plasma volume and interstitial volume were 34 +/- 1%, 229 +/- 17 ml (92 +/- 3 ml kg-1) and 1319 +/- 63 ml (540 +/- 17 ml kg-1), respectively. 3. Interstitial volume per kilogram fell with increasing fetal weight (P = 0.026). BV per kilogram did not change with weight or age. 4. The plasma: interstitial volume ratio was 0.17 +/- 0.01. This ratio increased as fetal weight and age increased (P = 0.026 and P = 0.044), that is, the proportion of ECV that was contained outside the vascular compartment was lower in heavier or older fetuses. 5. Since GFR was 3.4 +/- 0.4 ml min-1, the entire fetal ECV was filtered by the fetal kidney only 3.1 +/- 0.3 times per day.
Gibson, K J; Lumbers, E R
Studies of care of patients with central venous catheters report a 3-7% incidence of catheter-induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self-adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. This dressing was used for the care of 100 consecutive patients with central venous catheters. Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers. PMID:6425522
Vazquez, R M; Jarrard, M M
A rapid and non-surgical method for jugular catheterization in pigs was set up in 30 piglets of 6.2 kg, 23 pigs of 46 kg and 84 kg and two lactating multiparous sows. The animal was restrained on a V-shaped table (piglets) or with a rope around the mandible (slaughter pigs and sows). The vein was located with the Vacutainer system and a wire guide was inserted into the Vacutainer needle up to the vein lumen. When the needle was removed, the catheter was inserted over the wire guide and advanced until it penetrated the skin and thereafter, the vein wall. The catheter was fixed outside by a large tape and coiled inside a patch just behind the ears. The technique utilizes readily available material and is no more risky for the animal than a single blood sampling. Moreover, it can be performed within 15 to 20 min (including animal restraint) within pens. This new approach might have important implications not only for research purposes by facilitating repeated blood samplings but also for projects which require a rapid and easy method for testing of any kind of pharmaceutical or other type of products under husbandry conditions. PMID:10780845
Matte, J J
Context Suprapubic cystostomy (SPC) catheterization is a common and important technique for the management of vesicular drainage, especially in patients with neurogenic bladder. Some serious complications include bowel perforation and obstruction. Findings A 55-year-old man with C6 American Spinal Injury Association B tetraplegia and a urethral stricture requiring a chronic SPC was admitted for recurrent urosepsis. Computed tomography (CT) of the abdomen revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC (30 French/10-mm silicone catheter with a 10-ml balloon) was removed and replaced with a similar suprapubic catheter (30 French/10-mm silicone catheter with an 8-ml balloon). Symptoms recurred 2 months later and he was readmitted for urosepsis. CT of the abdomen again revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC was removed, and the patient was given a 14 French/4.67-mm urethral silicone catheter with a 5-ml balloon. Follow-up CT of the abdomen 2 months later showed complete resolution of the hydronephrosis and hydroureter. Of note, urodynamic studies 2 years earlier revealed an extremely small bladder with a capacity less than 20 ml. Conclusion This case illustrates that obstruction of the ureter by the tip of an SPC can be a cause of recurrent hydronephrosis and urosepsis.
Adeyemo, Bamidele; Makovitch, Steven; Foo, Dominic
We present two cases of central venous catheterization (CVC) in which an ultrasound-guided in-plane approach was used. Case 1 was a 60-year-old man with acute myelogenous leukemia in whom a right supraclavicular CVC was performed. He had pancytopenia (leukocytes 2,000/?L; erythrocytes 350 × 10(4)/?L; platelets 5.6 × 10(4)/?L), and abnormal coagulability (prothrombin time-international normalized ratio 1.35). A linear array transducer was positioned cephalad to the right clavicle and rotated 30° clockwise. The 21-gauge needle was manipulated from outside of the transducer. A CV catheter (CV legaforce EX(®); Terumo Co., Japan) was placed and stitched near the right clavicle. The patient felt no discomfort caused by the catheter. Case 2 was a 64-year-old women with malignant lymphoma whose right internal jugular vein was surrounded by abnormally enlarged lymph nodes. CVC was performed by the in-plane supraclavicular approach, avoiding puncture of the lymph node. This novel CVC technique is useful to minimize the risk of complications and patient discomfort by indwelling catheter. PMID:22547165
Yamauchi, Masanori; Sasaki, Hideaki; Yoshida, Tsukasa; Niiya, Tomohisa; Mizuno, Eri; Narimatsu, Eichi; Yamakage, Michiaki
An algorithm to search for the optimum set of modulation indices that will optimize a given simultaneous range/command/telemetry communications link is presented. This technique provides a way to suppress the ranging signal in order to limit performance degradation in the data channel due to interference from the ranging channel to a desired level, given a specified ranging accuracy. The link (when optimized) will (1) provide maximum available power to both the data and ranging channels for a specified degradation in the data channel so that it will transmit at the required data rate, (2) achieve a specified ranging accuracy over a maximum distance, under a certain set of conditions, and (3) provide adequate power for carrier tracking without degrading the data-channel thresholds. In addition, both data and ranging channels will fall below the threshold at the same point.
Nguyen, Tien Manh
This clinic trial, randomized and blinded was done to determine efficient whether reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary (UTI) tract infections without retention becoming a problem. Fifty women undergoing vaginal plastic repair to either 1 or 3 days catheterization. Of 25 patients catheterized for both group postoperative urinary retention occurred in 2 (8%) and required a new catheter. Of 25 patients catheterized for 1 day UTI was diagnosed in 1 (4%) and in 5(20) of those catheterized for 3 days, mean postoperative stay was 2 day for patients catheterized for 1 day and 3 days for those for 3 days. The differences are statistically significant, therefore catheter time may safely be reduced to 1 day. This may be associated with a reduced rate postoperative urinary retention, urinary tract infection, and stay postoperative. PMID:9441144
Alonzo-Sosa, J E; Flores-Contreras, J T; Paredes-Canul, M
Epidermal growth factor (EGF) has been reported to stimulate adrenocorticotropin hormone (ACTH), growth hormone and prolactin secretion from pituitary tissue in vitro, and in large doses evokes ACTH secretion in adult sheep in vivo. In order to assess a possible role for EGF in the pituitary hyperfunction characteristic of the in utero fetus, we measured changes in plasma immunoreactive ACTH concentrations after acute administration of saline, purified mouse EGF or synthetic ovine corticotropin releasing factor (CRF) to chronically catheterized fetal sheep. Both CRF and EGF were associated with increases in plasma immunoreactive ACTH concentrations. Peak values 60 min after 10-micrograms injections of either EGF or CRF increased from baseline ACTH values of 61 +/- 11 pg/ml to 191 +/- 37 and 178 +/- 25 pg/ml, respectively. Dose-response studies indicate that at low doses (less than 20 micrograms) EGF is as potent a stimulus for ACTH release as CRF. EGF infusion was not associated with detectable changes in circulating CRF, catecholamines, arginine vasopressin levels, or plasma growth hormone concentrations. We speculate that EGF may be important in the regulation of pituitary function in the developing mammalian fetus.
Polk, D H; Ervin, M G; Padbury, J F; Lam, R W; Reviczky, A L; Fisher, D A
The number of adults with congenital heart disease (CHD) requiring diagnostic and/or therapeutic cardiac catheterization has been increasing. However, there have been few studies on the complications of performing cardiac catheterization in adults with CHD. The aim of this study was to determine the incidence of complications during congenital cardiac catheterization in both adults and pediatric patients. A total of 2134 consecutive cardiac catheterizations performed between 2003 and 2008 were prospectively analyzed. Complications were graded from 1 to 5 based on severity and these, with ? grade 3 being defined as major. During the study period, 576 procedures (393 diagnostic, 90 interventional, and 93 electrophysiological) were performed in adult patients (? 18 years). Complex heart disease was present in 435 of 576 procedures (75.6 %). A total of 65 complications (11.3 %) with 13 major complications including 1 death (2.3 %) were encountered. The most common complications were arrhythmias. The majority of complications were successfully treated or temporary, and all but one of the patients were without residua. Of the 1558 pediatric procedures performed during the same period, we found a total of 229 complications (14.7 %), of which 89 (5.7 %) were major complications including 5 deaths. The safety of performing cardiac catheterization for adult CHD appears to be similar to that for pediatric patients. The complication rates in adults with CHD are low, but not negligible. PMID:22457096
Mori, Yoshiki; Takahashi, Kazuhiro; Nakanishi, Toshio
The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1-3), and 83% for adults and 90.3%, 1.25 (range, 1-5), and 49% for children, respectively. All the differences were statistically significant (p < 0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p > 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.
Tercan, Fahri [Baskent Universitesi, Adana Arastirma ve Uygulama Merkezi (Turkey)], E-mail: firstname.lastname@example.org; Oguzkurt, Levent; Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology (Turkey); Eker, Hatice Evren [Baskent University Faculty of Medicine, Department of Anesthesiology (Turkey)
The technique of normal and retrograde rat liver perfusion has been widely used to probe zonal differences in drug-metabolizing activities. The validity of this approach mandates the same tissue spaces being accessed by substrates during both normal and retrograde perfusions. Using the multiple-indicator dilution technique, we presently examine the extent to which retrograde perfusion alters the spaces accessible to noneliminated references. A bolus dose of 51Cr-labeled red blood cells, 125I-albumin, 14C-sucrose and 3H2O was injected into the portal (normal) or hepatic (retrograde) vein of rat livers perfused at 10 ml per min per liver. The outflow perfusate was serially collected over 220 sec to characterize the transit times and the distribution spaces of the labels. During retrograde perfusion, red blood cells, albumin and sucrose profiles peaked later and lower than during normal perfusion, whereas the water curves were similar. The transit times of red blood cells, albumin and sucrose were longer (p less than 0.005), whereas those for water did not change. Consequently, retrograde flow resulted in significantly larger sinusoidal blood volumes (45%), albumin Disse space (42%) and sucrose Disse space (25%) than during normal flow, whereas the distribution spaces for total and intracellular water remained unaltered. The distension of the vascular tree was confirmed by electron microscopy, by which occasional isolated foci of widened intercellular recesses and spaces of Disse were observed. Cellular ultrastructure was otherwise unchanged, and there was no difference found between normal and retrograde perfusion for bile flow rates, AST release, perfusion pressure, oxygen consumption and metabolic removal of ethanol, a substrate with flow-limited distribution, which equilibrates rapidly with cell water (hepatic extraction ratios were virtually identical: normal vs. retrograde, 0.50 vs. 0.48 at 6 to 7.4 mM input concentration).
St-Pierre, M.V.; Schwab, A.J.; Goresky, C.A.; Lee, W.F.; Pang, K.S.
To be considered for resective (curative) surgery, most seizures have to been proved to arise exclusively from one area of the brain that is functionally silent. The drug-resistance must be certain, and the patient must be strongly motivated to undergo surgery. Temporal lobectomy for drug-resistant temporo-mesial epilepsy is now scientifically validated by a randomized controlled trial. Hemispherotomy, which consists in complete disconnection of one hemisphere, is a curative technique, which may be considered where there is a pre-existing hemiplegia associated with a structural abnormality of the contralateral hemisphere. Therefore, it is rarely performed in adult patients. Stereotactic radiosurgery is also a curative technique, which shares most of its indications with those of temporo-mesial resections. Callosotomy is a palliative technique, which consists in disconnecting the hemispheres, one from the other. It may be considered in individuals having frequent atonic seizures (drop attacks). Multiple subpial transection involves transection of transverse fibers, leaving longitudinal fibers intact. It may be performed if the epileptogenic focus is located in an eloquent brain area. The complication rate of resective surgery is low. Controlateral motor impairement is the main permanent complication related to cortical resection. It is a rare occurrence (1 to 2 percent of cases) due to peroperative lesions of the sylvian vasculature, or of the anterior choroidal artery, or even of the motor area. Postoperative hematomas, infections, or hydrocephalus may also occur in 2 to 6 percent of cases, depending on the authors. Some postoperative neuropsychological complications are reported in the literature, especially after surgery on the dominant side. Hydrocephalus and infection are the most frequent complications occurring after hemispherotomy (10 percent of cases). Dysconnexion syndrome is a rare complication, which can be seen after total callosotomy. It is unusual for the effects of disconnection after anterior callosotomy to represent significant handicap. Permanent postoperative worsening of a pre-existing neurological impairement, as well as hematomas, are seen in less than 10 percent of the cases after multiple subpial transection. In conclusion, surgery is an important therapeutic option, which has to be considered as soon as the epileptic disease appears to be drug-resistant, particularly in case of temporo-mesial epilepsy. PMID:15331966
Bladder neck incision or transurethral incision of the prostate is a procedure described for men with bladder outflow obstruction associated with a gland size of less than 30 ml. We report a case of a man with detrusor dysfunction who was having increasing difficulty performing clean intermittent self-catheterization of the bladder. The successful use of the 120 W lithium triborate laser to perform a "mini-photoselective vaporization of the prostate" ("mini-PVP") enabled discharge of the patient on the same day as well as resolution of the patient's difficulties in performing self-catheterization. Mini-PVP has proven to be a simple and effective approach to resolution of a prostate configuration impeding the process of clean intermittent self-catheterization.
Bladder neck incision or transurethral incision of the prostate is a procedure described for men with bladder outflow obstruction associated with a gland size of less than 30 ml. We report a case of a man with detrusor dysfunction who was having increasing difficulty performing clean intermittent self-catheterization of the bladder. The successful use of the 120 W lithium triborate laser to perform a "mini-photoselective vaporization of the prostate" ("mini-PVP") enabled discharge of the patient on the same day as well as resolution of the patient's difficulties in performing self-catheterization. Mini-PVP has proven to be a simple and effective approach to resolution of a prostate configuration impeding the process of clean intermittent self-catheterization. PMID:23061005
Spernat, Daniel; Woo, Henry Hyunshik
Lichens are widely used to assess the atmospheric pollution by heavy metals and radionuclides. However, few studies are available in publications on using lichens to qualitatively assess the atmospheric pollution levels. The paper presents research results applying epiphytic lichens as bio-monitors of quantitative atmospheric contamination with uranium. The observations were conducted during 2.5 years in the natural environment. Two experimental sites were used: one in the vicinity of a uranium contamination source, the other one - at a sufficient distance away to represent the background conditions. Air and lichens were sampled at both sites monthly. Epiphytic lichens Hypogimnia physodes were used as bio-indicators. Lichen samples were taken from various trees at about 1.5m from the ground. Air was sampled with filters at sampling stations. The uranium content in lichen and air samples as well as isotopic mass ratios (235)U/(238)U were measured by mass-spectrometer technique after uranium pre-extraction. Measured content of uranium were 1.45 mgkg(-1) in lichen at 2.09 E-04 microgm(-3) in air and 0.106 mgkg(-1) in lichen at 1.13 E-05 microgm(-3) in air. The relationship of the uranium content in atmosphere and that in lichens was determined, C(AIR)=exp(1.1 x C(LICHEN)-12). The possibility of separate identification of natural and man-made uranium in lichens was demonstrated in principle. PMID:16083999
Golubev, A V; Golubeva, V N; Krylov, N G; Kuznetsova, V F; Mavrin, S V; Aleinikov, A Yu; Hoppes, W G; Surano, K A
The present status of catheter-directed therapy in pediatric congenital and acquired heart disease is reviewed. Balloon pulmonary valvotomy, established as the procedure of choice for children and adults with isolated pulmonary stenosis, has now been extended to neonates with critical pulmonary stenosis. Balloon mitral and aortic valvotomy are being performed for congenital and acquired stenoses, although indications and optimal techniques remain to be established. Balloon angioplasty of coarctation effectively relieves obstruction in native and post-operative aortic arch stenoses, but remains controversial due to late aneurysm formation. Balloon angioplasty of branch pulmonary artery hypoplasia and stenosis, despite a relatively low success rate and significant complications, remains the procedure of choice due to lack of better therapeutic options. Transcatheter closure of congenital and acquired vessels and defects is being performed with increasing frequency. Embolization of aortopulmonary collaterals and shunts using Gianturco coils is safe and effective in selected patients. Although Rash-kind umbrellas are most commonly used for closure of a patent ductus arteriosus, their use, especially in closing intracardiac defects, remains investigational. PMID:2966559
Perry, S B; Keane, J F; Lock, J E
Introduction The aim of this study is to determine the efficacy of preoperative ureteral catheterization as a prophylactic measure to prevent\\u000a ureteral injury and related complications.\\u000a \\u000a \\u000a \\u000a Methods All major gynecologic operations performed between January 1996 and December 2007 were included and prospectively randomized\\u000a into with and without catheterization groups. The medical records allowed the identification of all urinary tract complications\\u000a and ureteral
Mou-Tsy Chou; Chung-Jing Wang; Ray-Chang Lien
The soil erodibility index (EI) of Conservation Reserve Program (CRP) lands, which was the major criterion for CRP enrollment, was assessed for six counties in southwestern Kansas using USGS seamless digital elevation model data and Geographical Informational System techniques. The proportion of land areas with EI values of 8 or lower was less than 1% of the entire study area and most of the land areas (72.5%) were concentrated on EI values between 8 and 24. Although land acreage with EI values of 24 or higher decreased dramatically, the proportion of CRP lands to the other land-use types did not change much from low to high EI levels. The soil EI and physical soil characteristics of the CRP lands were compared to those of other land-use types. In general, the mean EI values of the land-use types were strongly correlated with physical soil properties, including organic matter content, clay content, available water capacity, permeability, and texture. CRP lands were compared in detail with cropland in terms of their soil characteristics to infer the pivotal cause of the land transformation. Although there was no significant statistical difference in EI between cropland and CRP soils, soil texture, soil family, and permeability were statistically different between the two. Statistical analyses of these three variables showed that CRP soils had coarser texture and higher permeability on average than cropland soils, indicating that CRP lands in the study area are drier than cropland soils. Therefore, soil moisture characteristics, not necessarily soil erosion potential, might have been the key factor for CRP enrollment in the study area. PMID:16328681
Park, Sunyurp; Egbert, Stephen L
Abstract Cardiac catheterization is important for the management of patients with pulmonary arterial hypertension (PAH). It is used for diagnosis, assessment, and monitoring of PAH patients, as well as to perform interventions such as balloon atrial septostomy and coil embolization of collateral vessels. Although reports on the risks of catheterization in PAH patients are scarce, many centers hesitate to perform these procedures in such fragile patients. We performed a retrospective chart review of all cardiac catheterizations performed in PAH patients over 10 years at our pulmonary hypertension center. Demographic, hemodynamic, and outcome data were collected. Complication rates were determined, and multivariate proportional hazards modeling was performed to identify predictors of catheterization-related complications. There were 1,637 catheterizations performed in 607 patients over 10 years. Pediatric patients accounted for 50% of these cases, 48% were performed in patients with idiopathic PAH, and 49% were performed under general anesthesia. While the overall complication rate was 5.7%, the rate of major complications was only 1.2% (). Although there were 8 deaths during the admission following catheterization, only 4 of these were related to the procedure, yielding a catheterization-related mortality of 0.2%. In conclusion, when performed at a pulmonary hypertension center with expertise in the care of PAH patients, cardiac catheterization is associated with low complication rates and mortality, and it should remain an important tool in the management of these patients.
The aim of this study is to evaluate the effectiveness of the ‘lure and kill’ technique, commonly called Mass Trapping (MT), compared with the larvicidal technique in olive fruit fly control. Data from different agro-ecological and management conditions were collected in several mass trapping areas in the regions of Tuscany and Liguria during 1999, 2000 and 2001. Data were organized
R. Petacchi; I. Rizzi; D. Guidotti
The most frequent and acute complications of subclavian vein catheterization are arterial puncture to the subclavian artery and pneumothorax. We report an arterial puncture directly to the pulmonary artery in infant during subclavian vein catheterization. PMID:18502370
Lu, Wen-Hsien; Huang, Ta-Cheng; Pan, Jun-Yen; Wang, Hsiao-Ping; Lin, Chu-Chuan; Chen, Ying-Yao; Hsieh, Kai-Sheng
In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devi- ces were uncommon, ''implantables,'' such as intracoronary stents and PFO\\/ASD clo- sure devices, were in their infancy, and percutaneous valve replacement was not a consideration.
Charles E. Chambers; Michael D. Eisenhauer; Lynn B. McNicol; Peter C. Block; William J. Phillips; Gregory J. Dehmer; Frederick A. Heupler; James C. Blankenship
Summary: We report the endovascular treatment of a dural carotid cavernous fistula in a 67-year-old woman in whom superior petrosal sinus catheterization was performed to access the venous site of the fistula. To our knowledge, this retrograde venous route via the superior petrosal sinus has not been previously described. Dural carotid cavernous fistulas (DCCFs) are a rare cause of eye
Charbel Mounayer; Michel Piotin; Laurent Spelle; Jacques Moret
The objective of the present study was to determine the amount of a medicinal agent entering the tympanic cavity during catheterization of the Eustachian tube in 26 patients presenting with exudative otitis and admitted for its treatment to N.I. Pirogov Clinical Hospital No 1, Moscow. The patients were managed by combined therapy in conjunction with catheterization of the Eustachian tube using radiocontrast matter (the iodine containing (76%) preparation trazograf having viscosity identical with that of dexamethasone). The administration of trazograf was followed by multispiral CT of the temporal bones. It was shown that trazograf penetrated into the tympanic cavity during catheterization of the Eustachian tube and accumulated inside it in 19.2% and 77% of the cases respectively. This finding suggests that the therapeutic effect in the patients presenting with exudative otitis is due not only to the direct action of the pharmaceutical product being used on the site of inflammation but also to the restoration of the draining and aerating functions of the course of Eustachian tube catheterization. PMID:24429856
Magomedov, M M; Levina, Iu V; Nikitin, A Iu; Bardina, E A; Magomedov, G M; Ibragimov, Sh I; Maksimova, M A
The development of right heart catheterization has provided the clinician the ability to diagnose patients with congenital and acquired right heart disease, and to monitor patients in the ICU with significant cardiovascular illnesses. The development of bedside pulmonary artery catheterization has become a standard of care for the critically ill patient since its introduction into the ICU almost 40 years ago. However, adoption of this procedure into the mainstream of clinical practice occurred without prior evaluation or demonstration of its clinical or cost-effectiveness. Moreover, current randomized, controlled trials provide little evidence in support of the clinical utility of pulmonary artery catheterization in the management of critically ill patients. Nevertheless, the right heart catheter is an important diagnostic tool to assist the clinician in the diagnosis of congenital heart disease and acquired right heart disease, and moreover, when catheter placement is proximal to the right auricle (atria), this catheter provides an important and safe route for administration of fluids, medications, and parenteral nutrition. The purpose of this manuscript is to review the development of right heart catheterization that led to the ability to conduct physiologic studies in cardiovascular dynamics in normal individuals and in patients with cardiovascular diseases, and to review current controversies of the extension of the right heart catheter, the pulmonary artery catheter.
Nossaman, Bobby D.; Scruggs, Brittni A.; Nossaman, Vaughn E.; Murthy, Subramanyam N.; Kadowitz, Philip J.
Oxygen consumption was measured in 500 patients (151 F, 349 M, ages 12-84 yr.) undergoing routine cardiac catheterization. Sex, age, and heart rate were found to be the strongest predictors of oxygen consumption index (OCI). Males had higher OCI values than females at any age. Older patients of both sexes had lower OCI values than younger patients. Heart rate correlated
Roderick H. Crocker; Ira S. Ockene; Joseph S. Alpert; Linda A. Pape; James E. Dalen; Nicholas Lange
Limited data regarding the optimal risk assessment strategy for evaluating candidates for orthotopic liver transplantation (OLT) exist. Our center has adopted a policy of performing cardiac catheterization (CATH) in patients with predefined risk factors, and this is followed by percutaneous coronary intervention (PCI) when it is indicated, even in the presence of negative stress test findings. The aim of this single-center, retrospective study of all patients who underwent OLT between 2000 and 2010 was to assess the effect of our policy on cardiovascular (CV) complications and survival rates after OLT. Data, including 1-year all-cause and CV mortality, postoperative myocardial infarctions (MIs), and frequencies of CATH and PCI, were abstracted. The study was divided into 3 subperiods to reflect the changes in policy over this period: (A) 2000-2004, (B) 2005-2008, and (C) 2009-2010. One thousand two hundred twenty-one patients underwent OLT between 2000 and 2010. The rate of catheterization increased during the 3 time periods (P?0.001), as did the rate of PCI (P?0.05). All-cause mortality decreased over the periods (P?0.001), as did the MI rate (P?0.001). Thirty-five of the 57 patients requiring PCI had normal stress tests. The mortality rate associated with postoperative MIs was significantly higher than the overall all-cause mortality rate. In conclusion, a significant improvement in the overall survival rate over the 3 analyzed time periods was noted. Increases in the frequencies of CATH and PCI corresponded to significant reductions in postoperative MIs and 1-year all-cause mortality rates. The increased use of CATH and PCI was associated with reduced overall all-cause mortality through reductions in the incidence of both fatal and nonfatal MIs. Further analyses of the role of stress testing and CATH in evaluating and treating patients before OLT are required to optimize this process. PMID:24648247
Maddur, Haripriya; Bourdillon, Patrick D; Liangpunsakul, Suthat; Joseph Tector, A; Fridell, Jonathan A; Ghabril, Marwan; Lacerda, Marco A; Bourdillon, Charlotte; Shen, Changyu; Kwo, Paul Y
The authors report on their own experiences with a not unknown, but not widely used catheter technique. On the basis of 607 transbrachial angiographies, they have established the possibilities and occasional dangers of this method. They conclude that the transbrachial technique is suitable not only for aortography, but also for selective angiography and vascular interventions. In cases involving cooperative patients, this method can furnish a basis for the angiography of outpatients. PMID:10349324
Nagy, E; Morvay, Z; Makula, E
A laboratory experiment reinforces the concept of acid-base equilibria while introducing a common application of spectrophotometry and can easily be completed within a standard four-hour laboratory period. It provides students with an opportunity to use advanced data analysis techniques like data smoothing and spectral deconvolution to…
Alter, Krystyn P.; Molloy, John L.; Niemeyer, Emily D.
Some challenging pathologic conditions of the biliary tract cannot be treated with endoscopy alone, and a combined approach with rendezvous techniques is frequently needed. Three different totally percutaneous rendezvous techniques were successfully applied in three cases. The rendezvous techniques were performed either with bilateral catheterization of bile ducts to treat a challenging type IV biliary stenosis and iatrogenic biliary damage or with biliary catheterization and percutaneous puncture of the anastomotic loop to treat a biliodigestive anastomosis failure with bile leakage. PMID:24674222
De Robertis, Riccardo; Contro, Alberto; Zamboni, Giulia; Mansueto, Giancarlo
Part I of the present paper described the development of a substance for endovascular embolization from homologous fibrinogen, aprotinin, thrombin, metrizamide and CaCl2. Part II deals with the applicability of a controlled-viscosity fibrin mixture via different types of arterial catheters. In a flow-dynamic model the embolizing medium injected via a double syringe was shown to block a blood flow corresponding approximately to the flow encountered in cerebral angioma vessels. In the course of animal experiments the embolization of mesenteric arteries of rabbits showed the distribution of the embolizing medium to be dependent on its viscosity; the action of an embolizing medium applied by means of a double syringe was studied in the femoral arteries of rabbits. Scintigraphy was used to study the distribution of the substance in the body of the experimental animal after intravenous (i.v.) application; long-term studies of embolized auricular arteries in rabbits revealed parchment-like necroses after 5 to 10 days and the presence of radiopaque substances in the ear stumps after 6 weeks. PMID:7124468
This paper presents a novel, magnetic resonance imaging (MRI)-compatible, force sensor suitable for cardiac catheterization procedures. The miniature, fiber-optic sensor is integrated with the tip of a catheter to allow the detection of interaction forces with the cardiac walls. The optical fiber light intensity is modulated when a force acting at the catheter tip deforms an elastic element, which, in turn, varies the distance between a reflector and the optical fiber. The tip sensor has an external diameter of 9 Fr (3?mm) and can be used during cardiac catheterization procedures. The sensor is able to measure forces in the range of 0-0.85?N, with relatively small hysteresis. ?A nonlinear method for calibration is used and real-time MRI in vivo experiments are carried out, to prove the feasibility of this low-cost sensor, enabling the detection of catheter-tip contact forces under dynamic conditions. PMID:21118758
Polygerinos, Panagiotis; Ataollahi, Asghar; Schaeffter, Tobias; Razavi, Reza; Seneviratne, Lakmal D; Althoefer, Kaspar
Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines.
Cornelius, Carl-Peter; Ehrenfeld, Michael
Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.
Arrivi, Alessio; Tanzilli, Gaetano; Puddu, Paolo Emilio; Truscelli, Giovanni; Dominici, Marcello; Mangieri, Enrico
Delayed onset of neck hematoma following central venous catheterization without arterial puncture is uncommon. Herein, we present a patient who developed a delayed neck hematoma after repeated attempts at right internal jugular venous puncture and subsequent enoxaparin administration. Progressive airway obstruction occurred on the third day after surgery. Ultrasound examination revealed diffuse hematoma of the right neck, and fibreoptic examination of the airway revealed pharyngeal edema. After emergent surgical removal of the hematoma, the patient was extubated uneventfully.
Wu, Pei-Ju; Chau, Siu-Wah; Lu, I-Cheng; Hsu, Hung-Te; Cheng, Kuang-I
Complications during insertion of a subclavian central venous line are rare but potentially serious. This case report describes the radiological abnormality of a one-sided pleural effusion during a routine control directly after a difficult central venous catheterization. We illustrate the findings, the initial emergency management, and our procedure to rule out an iatrogenic hemothorax. Possible differential diagnoses and strategies for management of a suspected complication are discussed.
Complications during insertion of a subclavian central venous line are rare but potentially serious. This case report describes the radiological abnormality of a one-sided pleural effusion during a routine control directly after a difficult central venous catheterization. We illustrate the findings, the initial emergency management, and our procedure to rule out an iatrogenic hemothorax. Possible differential diagnoses and strategies for management of a suspected complication are discussed. PMID:24563796
Casanova, Michel; Ummenhofer, Wolfgang
Radiation exposure from pediatric cardiac catheterization may be substantial, although published estimates vary. We sought to report patient radiation dose across a range of diagnostic and interventional cases in a modern, high-volume pediatric catheterization laboratory. We retrospectively reviewed diagnostic and interventional cases performed in our pediatric catheterization laboratory from 1 April 2009 to 30 September 2011 for which radiation usage data were available as reported by the Artis Zee(®) (Siemens Medical Solutions) system. Electrophysiology cases were excluded. Radiation dose was quantified as air kerma dose (mGy) and dose-area product (DAP; ?Gy m(2)). The DAP was converted to an effective dose millisievert (mSv) using the Monte Carlo method. Radiation usage data were available from 2,265 diagnostic and interventional cases with an overall median air kerma dose of 135 mGy [interquartile range (IQR) 59-433], median DAP of 760 ?Gy m(2) (IQR 281-2,810), of which 75 % (IQR 59-90 %) was derived from fluoroscopy, and median effective dose of 6.2 mSv (IQR 2.7-14.1). Air kerma dose from a single camera >2,000 mGy occurred in 1.8 % of cases. Significant differences in all measures of radiation exposure existed based on procedural and interventional types (p = 0.0001), with interventional cases associated with the highest effective dose after adjusting for patient weight category (p < 0.001). Patient weight, age, fluoroscopy time, and proportional use of digital acquisition were independent predictors of exposure (p ? 0.001; R (2) = 0.59-0.64). In a modern, large-volume pediatric catheterization laboratory, the median effective dose is 6.2 mSv with a wide range of exposure based on patient- and procedure-specific factors. Radiation monitoring is an important component of a pediatric laboratory and further dose reduction strategies are warranted. PMID:24442220
Glatz, Andrew C; Patel, Akash; Zhu, Xiaowei; Dori, Yoav; Hanna, Brian D; Gillespie, Matthew J; Rome, Jonathan J
Whether catheterization of the right heart should be performed routinely in all patients undergoing coronary angiography for assessment of coronary artery disease is controversial. To objectively assess the utility of routine right heart catheterization, hemodynamic data from 2,178 patients studied for angina having no signs, symptoms, or history of congestive heart failure were analyzed retrospectively. The salient results are as follows: 0.9% patients had unsuspected mitral valve gradients greater than or equal to 5 mm Hg; 0.4% had occult left-to-right shunts; 1% had pulmonary hypertension (pulmonary artery systolic pressure greater than or equal to 40 mm Hg) not attributable to an elevated mean pulmonary capillary wedge pressure (PCWP); 4.8% had PCWP greater than or equal to 18 mm Hg; 6% had cardiac indexes less than or equal to 2.0 L/min/m2, suggesting subclinical left ventricular failure. Overall, 14.5% of patients had at least one abnormal right-sided hemodynamic variable revealed by right heart catheterization. The frequency of abnormalities increased with increasing Canadian Cardiovascular Society grade of angina. Ten percent of grade 1, 14% of grade 2, 15% of grade 3, and 19% of patient 4 patients had at least one abnormality (phi 2 test, p less than or equal to 0.005). It is concluded that the right heart catheterization adds an important dimension to the diagnosis and treatment of patients undergoing coronary angiography for assessment of coronary artery disease and might significantly influence subsequent patient management. PMID:3376836
Barron, J T; Ruggie, N; Uretz, E; Messer, J V
The purpose of this study was to evaluate the angiographic and histopathologic changes in the superficial femoral artery (SFA) in heparinized sheep shortly after catheterization with an 8-Fr sheath and manual compression hemostasis either with standard manual compression (SMC) or with the use of a procoagulant chitosan-based HemCon Bandage. The evaluation was done in 38 SFAs of 19 heparinized (100 mg/kg) sheep. After a 5-min catheterization with an 8-Fr sheath, a 5-min compression was applied. Follow-up angiograms to evaluate hemostasis were done immediately after release of compression and then at 2.5-min intervals until no extravasation was present. Compression was reapplied between angiograms. Final angiograms were performed approximately 30 min after hemostasis and after 3 min of passive flexion and extension of sheep hind limbs. Sheep were then euthanized and SFA specimens with surrounding tissues excised for histopathologic evaluation. Both types of compression caused similar changes in the catheterized SFAs. Follow-up angiograms showed mild arterial narrowing in 14 SFAs and intraluminal clots in 9 SFAs. Histology revealed periarterial hematoma in all 38 specimens. Intraluminal thrombi consisting predominantly of platelets and fibrin were present in 32 SFAs. Their size varied from superficial elevations (8 arteries) to medium-sized, 1- to 2-mm, polypoid protrusions (15 arteries) to large polypoid clots, 3-4 mm long (9 arteries). In six SFAs, the arterial access sites were not included in the obtained specimens. In conclusion, hemostasis with manual compression is achieved in the acute phase by formation of a predominantly platelet-fibrin thrombus occluding the arterial wall access site and often extending significantly into the arterial lumen. The healing process of arterial access sites should be explored several days after catheterization.
Kim, Young Hwan; Pavcnik, Dusan, E-mail: email@example.com; Kakizawa, Hideyaki; Uchida, Barry T. [Oregon Health Sciences University, Dotter Interventional Institute (United States); Burke, Allen [Armed Forces Institute of Pathology, Department of Genitourinary Pathology (United States); Loriaux, Marc [Oregon Health Sciences University, Department of Pathology (United States); Keller, Frederick S.; Rosch, Josef [Oregon Health Sciences University, Dotter Interventional Institute (United States)
The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection). PMID:24626369
Cunha, Madalena; Santos, Eduardo; Andrade, Ana; Jesus, Rita; Aguiar, Carlos; Marques, Filipa; Enes, Filipa; Santos, Mafalda; Fernandes, Raquel; Soares, Sara
A stability-indicating reversed-phase high-performance liquid chromatographic (RP-HPLC) method was developed for the determination of sodium bisulfate (SB), an antioxidant, in injectable dosage form. The chromatographic separation was achieved on a Zorbax CN (250 mm × 4.6 mm, 5 ?m) column, with a mobile phase consisting of a buffer mixture of 0.03 M tetrabutylammonium hydrogen sulfate, 0.01 M potassium dihydrogen orthophosphate, and acetonitrile at a ratio of 70:30 (v/v) and a flow rate of 0.7 mL/min. The eluted compound was monitored at a wavelength of 215 nm using a UV detector. The method described herein separated sodium bisulfite from all other formulation components within a run time of 10 min. The method also generated linear results over an SB concentration range of 10 to 990 ?g/mL, and the limit of quantification was found to be 10 ?g/mL. The stability indicating capability of the method was established by performing forced degradation experiments. The RP-HPLC method that was developed was validated according to the International Conference on Harmonization (ICH) guidelines. This method was successfully applied in the quantitative determination of SB in a stability study of Amikacin sulfate injection. The procedure described herein is simple, selective, and reliable for routine quality control analysis as well as stability testing. PMID:22145114
Trivedi, Harshal Kanubhai; Patel, Mukesh C
A stability-indicating micellar electrokinetic chromatography (MEKC) method was developed and validated for simultaneous analysis of delapril (DEL) and manidipine (MAN) using salicylic acid as an internal standard. The MEKC method was performed using a fused-silica capillary (effective length of 72 cm) with 50 mM of borate buffer and 5 mM of anionic surfactant sodium dodecylsulfate at pH 9.0 as the background electrolyte. The separation was achieved at 25 kV applied voltage and 35 degrees C. The injection was performed at 50 mbar for 5 s, with detection at 208 nm. The method was linear in the range of 15-150 microg/mL (r2 = 0.9966) for DEL and 5-50 microg/mL (r2 = 0.9985) for MAN with adequate results for the precision (< or = 1.87%) and accuracy (98.94% for DEL and 100.65% for MAN). The specificity of the method and its stability-indicating capability was demonstrated through forced degradation studies, which showed that there was no interference from the excipients. The Plackett-Burman experimental design was used for robustness evaluation, giving results within the acceptable range. The method was successfully applied for analysis of the drugs, and the results were compared to an LC method, resulting in nonsignificant differences (P = 0.78 and 0.84 for DEL and MAN, respectively). PMID:24672867
Todeschini, Vítor; Sangoi, Maximiliano da Silva; Meira, Alianise da Silva; Miron, Diogo; Lange, Alini Dall Cortivo; Volpato, Nadia Maria
A sensitive, selective, precise and stability-indicating high-performance thin-layer chromatographic (HPTLC) method for analysis of repaglinide both as a bulk drug and in nanoemulsion formulation was developed and validated. The method employed TLC aluminum plates precoated with silica gel 60F-254 as the stationary phase. The solvent system consisted of chloroform/methanol/ammonia/glacial acetic acid (7.5:1.5:0.9:0.1, v/v/v/v). This system was found to give compact spots for repaglinide (R f value of 0.38 ± 0.02). Repaglinide was subjected to acid and alkali hydrolysis, oxidation, photodegradation and dry heat treatment. Also, the degraded products were well separated from the pure drug. Densitometric analysis of repaglinide was carried out in the absorbance mode at 240 nm. The linear regression data for the calibration plots showed good linear relationship with r (2)= 0.998 ± 0.032 in the concentration range of 50-800 ng. The method was validated for precision, accuracy as recovery, robustness and specificity. The limits of detection and quantitation were 0.023 and 0.069 ng per spot, respectively. The drug undergoes degradation under acidic and basic conditions, oxidation and dry heat treatment. All the peaks of the degraded product were resolved from the standard drug with significantly different R f values. Statistical analysis proves that the method is reproducible and selective for the estimation of the said drug. As the method could effectively separate the drug from its degradation products, it can be employed as a stability-indicating one. Moreover, the proposed HPTLC method was utilized to investigate the degradation kinetics in 1M NaOH. PMID:24082694
Akhtar, Juber; Fareed, Sheeba; Aqil, Mohd
Vessel Catheterization is a clinical procedure usually performed by a specialist by means of X-ray fluoroscopic guide with contrast-media. In the present paper, we present a simple and efficient algorithm for vessel segmentation which allows vessel separation and extraction from the background (noise and signal coming from other organs). This would reduce the number of projections (X-ray scans) to reconstruct a complete and accurate 3D vascular model and the radiological risk, in particular for the patient. In what follows, the algorithm is described and some preliminary experimental results are reported illustrating the behaviour of the proposed method.
Franchi, Danilo; Rosa, Luigi; Placidi, Giuseppe [Department of Science and Biomedical Technologies, University of L'Aquila, Via Vetoio 10, 67100 Coppito, L'Aquila (Italy)
Pneumomediastinum is a rare event in subclavian central venous catheterization. However in severe thoracotraumatized patients, such as with bilateral hemopneumothorax, the catherization may be hazardous and made complex by occurrence pneumomediastinum, even the procedure is rightly carried out. We suggest that in such a risky condition, if it is mandatory, it should be carried out in a more placid condition, such as avoidance of high PEEP ventilation, setting lower tidal volume, or brief interruption of positive ventilation, to reduce the likelihood of unperceivable pneumomediastinum. PMID:17972623
Chen, Liang-Chih; Tzao, Chi; Liaw, Wen-Jinn; Horng, Huei-Chi; Cherng, Chen-Hwan; Wong, Chih-Shung; Wu, Ching-Tang
This paper describes a complication of selective femorocerebral catheterization which was due to iatrogenic embolization of atherosclerotic material originating from the bifurcation of the common carotid artery. After analysis of the catheter maneuvers inherent to the special shape of the type of catheter used (Sidewinder, Cordis Corporation), it is concluded that this complication resulted from incorrect catheter manipulation and an incorrect choice of the dimensions of the preshaped part of the catheter in relation to the diameter of the aortic arch. Two recommendations to avoid this complication are made. PMID:896031
Thijssen, H O; Maduro, V; Wong-Chung, R
Here in we are reporting a 35-year-old pregnant, hypertensive woman with a strict descending aorta coarctation. She had two missing pregnancies which were complicated with hypertension, but which were not diagnosed for any pathologies before. We diagnosed coarctation of aorta, but however postponed her treatment after delivery of baby, because hypertension was under control with medical treatment and she had no complication. She had an uneventful delivery. MRI angiography revealed coarctation of aorta and it was successfully treated by using an endovascular covered stent during a single cardiac catheterization. Endovascular covered stent implantation is an easy, safe and effective method for treating coarctation of aorta in adults.
Ural, Alper V; Caglar, Ilker Murat; Caglar, Fatma Nihan Turhan; Ciftci, Serkan; Karakaya, Osman
\\u000a Invasive pediatric cardiology developed as a subspecialty over the past four decades after first pediatric angiogram was performed\\u000a by Agustin Castellanos in 1937 . With the introduction of the balloon septostomy by William Rashkind to alleviate cyanosis\\u000a in transposition of the great arteries , the field of interventional pediatric cardiology was initiated and subsequently\\u000a expanded explosively. It plays a role
... amyloidosis Causes of congestive heart failure or cardiomyopathy Coronary artery disease Heart defects that are present at birth ( ... include: Cardiac tamponade Heart attack Injury to a coronary artery Irregular heartbeat Low blood pressure Reaction to the ...
Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the "Lopasce technique" (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6-125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6-26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%-80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions. PMID:23952057
Ozkaya, Ozay; Egemen, Onur; Barutça, Seda Asfuro?lu; Akan, Mithat
Cerebral angiography can be performed with either a small-diameter, thin-walled catheter, or with a larger catheter using the "headhunter" technique. However, neither of these methods is satisfactory for catheterizing tortuous or angular arteries. The author has developed a variable stiffness guidewire (VSGW), which uses a small catheter and enables the neuroradiologist to catheterize tortuous arteries. The VSGW can be changed from flexible to stiff and back again while in the artery. New angiographic techniques based on four simple catheter curves are described. Using these techniques, the author has achieved an overall success rate of 98%. PMID:7352223
Willson, J K
The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.
Son, Hee Won; Lee, Ok-Kyung; Park, Soon Eun; Cho, Young Woo
Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site. Discussion If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia. Trial registration ClinicalTrials.gov Identifier NCT01428830.
Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects.
Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.
Elementary Physics Considerations Indicate an Elegant Construction Technique For the Pyramids At Giza. Our Information Indicates They and the Sphinx Were Engineered and Built Around BCE 2500, Not Earlier!
Archimedes articulated an applied physics experience of many children who observe the upward movement of floating objects when they get into their "tubs." This same principle can effectively allow massive Egyptian construction blocks and obelisks to be elevated and erected. Platform bases at Giza were leveled by means of water channels that were cut into the rock. There is a canal behind the pyramids. The bathtub technique can elevate or transport the water-borne block (or obelisk) to sites involved, including the Sphinx temple. Water outflow from the barge locks (tubs) can erode Sphinx surrounds, without invoking 7000+ year-ago rainy weather. Our previously detailed account of how constellations, Canis Major, Phoenix, Leo can be detected at sites like America's Stonehenge, while they are below the local horizon, also indicates ancient Egyptians may have done likewise. Orion, or Leo the Sphinx could have been detected while they were in the "underground," around BCE 2500, in alignments otherwise requiring a date of BCE 1050.
Mc Leod, Roger D.; Mc Leod, David M.
Background Radiation can be used effectively for diagnosis and medical treatment, but it can also cause cancers later on. Children with congenital heart disease frequently undergo cardiac catheterization procedures for diagnostic or treatment purposes. Despite the clear clinical benefit to the patient, the complexity of these procedures may result in high cumulative radiation exposure. Given children’s greater sensitivity to radiation and the longer life span during which radiation health effects can develop, an epidemiological cohort study is being launched in France to evaluate the risks of leukaemia and solid cancers in this specific population. Methods/design The study population will include all children who have undergone at least one cardiac catheterization procedure since 2000 and were under 10 years old and permanent residents of France at the time of the procedure. Electronically stored patient records from the departments of paediatric cardiology of the French national network for complex congenital heart diseases (M3C) are being searched to identify the children to be included. The minimum dataset will comprise: identification of the subject (file number in the centre or department, full name, sex, date and place of birth), and characteristics of the intervention (date, underlying disease, type of procedure, technical details, such as fluoroscopy time and dose area product, (DAP), which are needed to reconstruct the doses received by each child). The cohort will be followed up through linkage with the two French paediatric cancer registries, which have recorded all cases of childhood leukaemia and solid cancers in France since 1990 and 2000, respectively. Radiation exposure will be estimated retrospectively for each child. 4500 children with catherizations between 2000 and 2011 have been already included in the cohort, and recruitment is ongoing at the national level. The study is expected to finally include a total of 8000 children. Discussion This French cohort study is specifically designed to provide further knowledge about the potential cancer risks associated with paediatric cardiac catheterization procedures. It will also provide new information on typical dose levels associated with these procedures in France. Finally, it should help improve awareness of the importance of radiation protection in these procedures.
The use of checklists is recommended for the assessment of competency in central venous catheterization (CVC) insertion. To explore the use of a global rating scale in the assessment of CVC skills, this study seeks to compare its use with two checklists, within the context of a formative examination using simulation. Video-recorded performances of…
Ma, Irene W. Y.; Zalunardo, Nadia; Pachev, George; Beran, Tanya; Brown, Melanie; Hatala, Rose; McLaughlin, Kevin
Ninety patients with spinal cord injury were managed by aseptic intermittent catheterization program I (preventing the over-distension of the bladder) and program II (allowing overdistension) in which recovery of bladder function and the clinical effects were comparatively investigated. Using program I, cases with positive BCR restored the automaticity of the bladder on average 8 weeks after injury. When urinary incontinence first occurs during aseptic intermittent catheterization, urinary training may be commenced since the bladder has then recovered from spinal shock. Cases with no BCR do not restore automatic bladder contraction. Program II delayed or weakened the recovery of bladder function considerably. Patients with incomplete lesions and sacral sparing, particularly those with urinary sensation, should be managed by program I which does not impair recovery of the bladder. It is possible to prevent urinary incontinence and infection, if paraplegics with complete lesions are managed by program II. The percentage of urinary infection was 22.6 +/- 16.0% (N = 90) during aseptic intermittent catheterization (non-touch technic) among whom no statistically significant difference between those with trigger voiding (22.2 +/- 17.2%, N = 57) and those with self-catheterization (23.2 +/- 14.0%, N = 33) was found. PMID:4050623
Iwatsubo, E; Iwakawa, A; Koga, H; Imamura, A; Yamashita, H; Komine, S
Pancreatic cancer is the disease of gastrointestinal cancer with the poorest prognosis. At present, in addition to surgery, multimodality treatment combining a variety of therapeutic methods is used. We usually employ the following combination of surgery, radiotherapy and chemotherapy: D2 surgery with pylorus-preserving pancreatoduodenectomy (PPPD), intraoperative radiotherapy (IORT), and portal catheterization (PC) with fluorouracil as the chemotherapy. In this study, we made a historical comparison of PPPD and PD and obtained the following findings: (1) PPPD allows almost the same extent of D2 dissection as conventional PD, and achieves radical treatment without any problems; (2) suppression of local recurrence by IORT cannot be expected from the results of the comparison between the four approaches, i.e. surgery alone, surgery + IORT, surgery + PC and surgery + IORT + PC, and (3) the rate of liver metastasis in patients treated by PC was significantly low. PMID:10026447
Takahashi, S; Aiura, K; Saitoh, J; Hayatsu, S; Kitajima, M; Ogata, Y
Background Trans-radial coronary artery catheterization is gaining popularity, heparin has been proven to reduce the rate of radial artery occlusion, intra-venous or intra-arterial heparin have no effect on the radial artery occlusion, we investigate the effect of route of heparin administration on different procedure related parameters. Methods We randomized 150 consecutive patients to receive intra-venous (75 patients) or intra-arterial (75 patients) heparin; the two groups were compared regarding different procedure related parameters. Results The success rate was over 99% and rate of radial artery spasm was about 5%. There was no statistically significant difference between the two groups regarding the parameters tested. Conclusion The trans-radial angiography can be performed successfully in the Saudi population, Studies with larger sample size are needed to show a significant difference between intra-arterial and intra-venous heparin administration.
Almansori, Mohammed; Ouf, Shady
Despite increased use of robotic catheter navigation systems for endovascular intervention procedures, current master-slave platforms have not yet taken into account dexterous manipulation skill used in traditional catheterization procedures. Information on tool forces applied by operators is often limited. A novel force/torque sensor is developed in this paper to obtain behavioural data across different experience levels and identify underlying factors that affect overall operator performance. The miniature device can be attached to any part of the proximal end of the catheter, together with a position sensor attached to the catheter tip, for relating tool forces to catheter dynamics and overall performance. The results show clear differences in manipulation skills between experience groups, thus providing insights into different patterns and range of forces applied during routine endovascular procedures. They also provide important design specifications for ergonomically optimized catheter manipulation platforms with added haptic feedback while maintaining natural skills of the operators. PMID:23286093
Rafii-Taril, Hedyeh; Payne, Christopher J; Riga, Celia; Bicknell, Colin; Lee, Su-Lin; Yang, Guang-Zhong
Stimulation of cells with calcium-mobilizing agonists frequently results in inositol 1,4,5-trisphosphate (InsP3)-mediated discharge of Ca from an internal store. We report here a technique for directly monitoring Ca within this and other stores in gastric epithelial cells. This technique takes advantage of the propensity of the acetoxymethyl ester derivative of the fluorescent dye mag-fura-2 (which is sensitive to Ca concentrations above 5 microM) to accumulate in subcellular compartments where it can report changes in the free Ca concentration. Intact dye-loaded cells responded to cholinergic stimulation with a decrease in the 350 nm/385 nm excitation ratio, as measured in individual cells with a digital imaging microscope, consistent with reduced Ca concentration in one or more cellular compartments. When cells were permeabilized with digitonin and incubated in an "intracellular buffer," the cytoplasmic dye was released, leaving the mag-fura-2 in the internal store. InsP3 caused the ratio from the trapped indicator to decrease (i.e., Ca was released) in a dose-dependent manner, and this effect was blocked by the InsP3 receptor antagonist heparin. Ca sequestration into the internal store was ATP-dependent, and reuptake into the InsP3-sensitive pool was blocked by thapsigargin, a specific inhibitor of the Ca-ATPase of the internal store. We used this technique to investigate the role of Cl on the release and reloading of the InsP3-sensitive internal store and found that Ca uptake was reduced in Cl-free solutions, suggesting an important function for Cl in the refilling of this pool. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4
Hofer, A M; Machen, T E
The staff at interventional radiological procedures is exposed to high levels of ionizing radiation. This applies especially to measures at cardiac catheterization laboratories. In this study the annual radiation exposure to the staff was estimated by measuring the dose rate under characteristic conditions. It could be shown that the resulting radiation exposure was strongly dependent on the radiation protection measures and is also dependent on the operation conditions of the x-ray-tube. The effective dose for the physician wearing a lead apron and thyroid shield was determined to about 1.7 mSv/a. Without a thyroid shield an effective dose of about 3.5 mSv/a resulted. This corresponds to approximately the natural background radiation of about 2.4 mSv/a in the Federal Republic of Germany. From the number of procedures performed we could derive an effective dose of approximately 1-2 microSv per application for the physician, averaged over all types of procedures. Further, it could be shown that the readings of the film badges, usually worn by the staff, underestimate the effective dose by approximately a factor of two. This is because the film badges do not include the contribution of the unshielded parts of the body to effective dose. From the estimated annual effective dose, a lifetime dose of 68 mSv was estimated for a 40-year working career. The corresponding lifetime risk for induced fatal cancer due to radiation exposure was determined to 0.3% applying the ICRP risk factor of 4 x 10(-2) Sv-1. Considering the NCRP recommendations for a safe occupation, working in a cardiac catheterization laboratory can be considered as safe when applying all radiation protection measures. However, changing the protection measures and modifying the parameters of the x-ray-tube can lead to strong changes of the radiation exposure and the resulting risk estimation. PMID:9235797
Folkerts, K H; Münz, A; Jung, S
Total urinary incontinence is a difficult problem faced by the urologist. Several techniques to increase ureteral resistance\\u000a have been described. The majority of them rely on intermittent catheterization for bladder emptying, especially in neurogenic\\u000a incontinence. We have developed a new procedure in which a bladder flap is used to create a neourethra. This urethral extension\\u000a acts as a flap valve
Joao L. Pippi Salle; Gordon A. McLorie; Darius J. Bägli; Antoine E. Khoury
Postoperative acute renal failure (ARF) is not uncommon after cardiac surgery and after angiography. However, limited information exists regarding the influence of the interval between cardiac catheterization and subsequent cardiac surgery and amount of contrast agent used during this procedure on the occurrence of postoperative ARF. Data for 423 consecutive adult patients who underwent elective cardiac surgery after cardiac catheterization were examined retrospectively. The influence of interval between cardiac catheterization and cardiac surgery on postoperative ARF (defined as postoperative serum creatinine > or =2 times baseline and >2 mg/dl and/or need for renal replacement therapy) was evaluated using multivariable logistic regression. ARF occurred in 24 patients (5.7%). Median time to angiography was 2 days (interquartile range 1 to 4.5), and median dose of contrast used was 1.36 ml/kg (interquartile range 1.12 to 1.69). Surgery on the day of cardiac catheterization was independently associated with increased risk of ARF (adjusted odds ratio 3.1, 95% confidence interval 1.1 to 8.8). This risk of ARF was highest in patients who underwent surgery on the same day as angiography and with a dose of contrast higher than median (14.6%) and lowest when surgery was delayed beyond 1 day of angiography and contrast dose was median or less (2.4%; adjusted odds ratio for same-day surgery and dose higher than median 4.2, 95% confidence interval 1.2 to 14.2). Cardiac surgery performed on the day of cardiac catheterization and higher dose of contrast agent used were both independently associated with increased risk of postoperative ARF. In conclusion, these findings suggest that delaying cardiac surgery beyond 24 hours of exposure to contrast agents (when feasible) and minimizing the use of these agents have significant potential to decrease the incidence of postoperative ARF in patients undergoing elective cardiac surgery. PMID:18394443
Ranucci, Marco; Ballotta, Andrea; Kunkl, Alessia; De Benedetti, Donatella; Kandil, Hassan; Conti, Daniela; Mollichelli, Nadia; Bossone, Eduardo; Mehta, Rajendra H
Background Several studies suggest that standard verbal and written consent information for treatment is often poorly understood by patients and their families. This study examined the effect of an interactive computer-based information program on patients’ understanding of cardiac catheterization. Methods 135 adult patients scheduled to undergo diagnostic cardiac catheterization were randomized to receive details about the procedure using either standard institutional verbal and written information (SI), or interactive computerized information (ICI) preloaded on a laptop computer. Understanding was measured using semi-structured interviews at baseline (i.e, before information was given), immediately following cardiac catheterization (Early understanding), and two weeks post-procedure (Late understanding). The primary study outcome was the change from baseline to Early understanding between groups. Results Subjects randomized to the ICI intervention had significantly greater improvement in understanding compared to those who received the SI (net change 0.81; 95% confidence interval: 0.01, 1.6). Significantly more subjects in the ICI group had complete understanding of the risks of cardiac catheterization (53.6% vs 23.1%, P< 0.05) and options for treatment (63.2% vs 46.2%, P< 0.05) compared to the SI group, respectively. Several predictors of improved understanding were identified including baseline knowledge (P< 0.001), younger age (P = 0.002), and use of the ICI (p = 0.003). Conclusions Results suggest that an interactive computer-based information program for cardiac catheterization may be more effective in improving patient understanding than conventional written consent information. This technology, therefore, holds promise as a means of presenting understandable detailed information regarding a variety of medical treatments and procedures.
Tait, Alan R.; Voepel-Lewis, Terri; Moscucci, Mauro; Brennan-Martinez, Colleen M.; Levine, Robert
There are only 7 cases reported in the literature of squamous cell cancer of the bladder in patients performing intermittent self-catheterization (ISC). We report on an eighth case, and the first case described in a patient with a Mitrofanoff continent appendicovesicostomy. A description of the case and review of the literature are presented. Risk factors for squamous cell cancer include recurrent urinary tract infections, keratinising squamous metaplasia (leukoplakia) and local mucosal trauma from intermittent self-catheterization. There is no recognized or validated monitoring program for patients performing ISC who may also have these risk factors. Reasonable protocols may include regular urinary cytology and cystoscopy with random or targeted bladder biopsies. Squamous cell cancer may present late in this cohort of patients and is associated with a dismal prognosis.
Casey, Rowan G.; Cullen, Ivor M.; Crotty, Tom; Quinlan, David M.
Rupture of the central veins with venous pseudoaneurysm formation is an unusual complication of central venous catheterization. Only seven cases of brachiocephalic venous pseudoaneurysm have been reported in the literature (among these only one was secondary to central venous catheterization). Plain radiographic examination of the chest may show widening of the mediastinum, pleural effusion (haemothorax), and/or opacity overlying the hemithorax of the injured vein. Further evaluation using either computed tomography or magnetic resonance imaging can be performed. Venography is considered an important tool, especially when an intervention is planned. We present the first reported case of brachiocephalic vein pseudoaneurysm treated solely with thrombin injection. The imaging, other treatment options, and literature review of brachiocephalic venous pseudoaneurysm are also discussed. PMID:24042960
Elsaadany, Amr Maged; Alaeddin, Fida Hasan; Alsuhaibani, Hamad Abdulla
The objective of this study was to establish a minimally-invasive, ultrasound (US)-guided technique for the placement of indwelling catheters into the portal, hepatic, and cranial mesenteric veins as well as the abdominal aorta. Catheters were placed in eight healthy dairy cows on day 1. The patency of catheters was tested daily until day 14 when a necropsy was carried out. On day 6, energy intake and hepatic net output of glucose, removal of lactate, and oxygen were determined in seven cows. Post mortem examination revealed that all implanted catheters were in the intended locations. Loss of patency in one portal vein catheter on day 9 was attributable to a fibrin clot. Significant correlations were found between mean energy intake and mean hepatic plasma flow (r=0.91; P=0.004), hepatic glucose output (r=0.81; P=0.027) and hepatic removal of lactate (r=-0.70; P=0.08) and oxygen (r=-0.77; P=0.039), as well as between hepatic glucose net output and removal of lactate (r=-0.92; P=0.004). Minimally-invasive, US-guided transcutaneous catheter placement into the cranial mesenteric, portal and hepatic veins as well as the technique for catheterization of the abdominal aorta appear to be safe, and suitable for studies of quantitative hepatic metabolism in cattle. PMID:21924930
Starke, A; Wussow, K; Matthies, L; Kusenda, M; Busche, R; Haudum, A; Beineke, A; Pfarrer, C; Rehage, J
Long-term urinary catheterization results in polymicrobial bacteriuria and is complicated by fever, bacteremia, acute pyelonephritis, and death. Escherichia coli is a common urine isolate from catheterized patients and can persist for months. We hypothesized that fimbria-mediated adherence contributes to its persistence. For 1 year, urine specimens were collected from 51 patients greater than or equal to 65 years of age who were catheterized for greater than or equal to 30 days. E. coli was isolated at greater than or equal to 10(5) CFU/ml from 447 (36%) of 1,230 weekly urine specimens from 26 patients. Week 1 isolates from 52 definable episodes were tested for hemagglutination, hybridization with gene sequences from the pil and pap operons, in vitro adherence to catheter material, binding of 125I-labeled Tamm-Horsfall protein, hemolysin and colicin V production, and serum resistance. The proportions of isolates of short (1 week only), medium (2 to 11 weeks) and long (greater than or equal to 12 weeks) episodes of bacteriuria which expressed type 1 fimbriae as assayed by mannose-sensitive hemagglutination were 59, 65, and 92%, respectively. Isolates with the pil operon (the genome for type 1 fimbriae) from episodes lasting greater than 1 week expressed mannose-sensitive hemagglutination more frequently (P = 0.011) than pil-positive isolates from episodes of less than or equal to 1 week. Isolates from episodes of greater than 1 week also bound significantly more Tamm-Horsfall protein than isolates from episodes of less than or equal to 1 week (P = 0.044). Although nearly half of the isolates produced P fimbriae, an important virulence factor for the development of pyelonephritis, no correlation with persistence could be made. Overall, the E. coli isolates expressed traits similar to those of strains that caused cystitis. Type 1 fimbriae appear to be important for the persistence of E. coli in the long-term-catheterized urinary tract.
Mobley, H L; Chippendale, G R; Tenney, J H; Hull, R A; Warren, J W
Background We evaluated the exact quantitative long-term impact of repeated catheterizations, vascular closure devices (VCDs) and cardiovascular risk factors on the femoral artery after cardiac catheterization. Methods A total of 2,102 available femoral angiograms from 827 consecutive patients were analyzed using caliper-based quantitative vascular analysis (QVA). These patients underwent coronary interventions between 01/2005-04/2007, and had at least one additional catheterization procedure through the ipsilateral femoral access site from 12/2001 until 01/2008. Multivariate analysis was performed to control for confounding variables. The primary outcome was change in artery size. Results The average punctured artery diameter was 6.5mm±2.1mm. The average time between first case and last follow-up was 349 days. There was no significant change of the punctured artery size over time after the index procedure (P=0.15) and no change associated with the use of VCDs (P=0.25) after multivariate analysis. Smaller arteries were associated with female gender (?1.22mm, P<0.0001), presence of angiographic peripheral vascular disease (PVD, ?1.19mm, P<0.0001), and current (?0.48mm, P=0.001) or former (?0.23mm, P=0.01) smoking status, while previous statin therapy was associated with an increase in artery size (+0.47mm, P<0.0001). VCDs were used less often compared to manual compression in cases preceding the first detection of angiographic PVD (P<0.001). Conclusion VCDs are not associated with a change in the artery size or progression of PVD. Overall, there is no change in vessel size over time after repeat catheterizations, with a decrease in vessel size associated with current and former smoking, and an increase with previous statin therapy.
Tiroch, Klaus A.; Matheny, Michael E.; Resnic, Frederic S.
Radial access has lower risk of vascular complication for cardiac catheterization and is rapidly replacing femoral access. There are few unique complications associated with this approach. We present 3 cases of sterile granulomatous reaction associated with a specific hydrophilic radial sheath and possibly contribution by radial wrist band [TR band; Terumo Medical used for hemostasis after sheath removal (2101 cotton tail lane somerset NJ, USA)]. Awareness of this association will help clinicians use appropriate preventive measures. PMID:22323832
De Leon, Dexter; Swank, Gary; Mirza, M Ayoub
Background Quality improvement (QI) has been shown to be effective in improving hospital care in high-income countries, but evidence of its use in low- and middle-income countries has been limited to date. The impact of a QI intervention to reduce patient waiting time and overcrowding for cardiac catheterization—the subset of procedures associated with the most severe bottlenecks in patient flow at the National Heart Institute in Cairo—was investigated. Methods A pre-post intervention study was conducted to examine the impact of a new scheduling system on patient waiting time and overcrowdedness for cardiac catheterization. The sample consisted of 628 consecutive patients in the pre-intervention period (July–August 2009) and 1,607 in the postintervention period (September–November 2010). Results The intervention was associated with significant reductions in waiting time and patient crowdedness. On average, total patient waiting time from arrival to beginning the catheterization procedure decreased from 208 minutes to 180 minutes (13% decrease, p < .001). Time between arrival at registration and admission to inpatient ward unit decreased from 33 minutes to 24 minutes (27% decrease, p < .001). Patient waiting time immediately prior to the catheterization laboratory procedure decreased from 79 minutes to 58 minutes (27% decrease, p < .001). The percentage of patients arriving between 7:00 A.M. and 9:00 A.M. decreased from 88% to 44% (50% decrease, p < .001), reducing patient crowding. Conclusion With little financial investment, the patient scheduling system significantly reduced waiting time and crowdedness in a resource-limited setting. The capacity-building effort enabled the hospital to sustain the scheduling system and data collection after the Egyptian revolution and departure of the mentoring team in January 2011.
Wong, Rex; Hathi, Sejal; Linnander, Erika L.; Banna, Adel El; Maraghi, Mohamed El; Din, Randah Zain El; Ahmed, Ashraf; Hafez, Abdel Rahman; Allam, Adel A.; Krumholz, Harlan M.; Bradley, Elizabeth H.
This study examines the utilization patterns of myocardial perfusion imaging (MPI) and cardiac catheterization (CC) under Taiwan's national health insurance program. This study used the longitudinal health insurance database with 1,000,000 people were randomly selected from the national health insurance research database. This study obtained data from these patients with coronary artery disease (CAD) and comparison with the utilization of MPI or CC between 2005 and 2009. The incidence of CAD did not significantly change, while the prevalence of CAD, utilization of MPI, and the utilization of CC for the CAD patients increased annually. There were the most CAD patients in Northern Taiwan (43.5%), followed by Southern, Central, and Eastern Taiwan. The utilizations of both of MPI (12.7 per 100 CAD patients) and CC (10.6 per 100 CAD patients) were most frequent in Northern Taiwan followed by Southern, Central, and Eastern Taiwan. However, the MPI/CC ratio was 1.20 in Northern Taiwan, followed by Southern, Central, and Eastern Taiwan (0.88, 0.64, and 0.52, respectively, P = 0.0008). The use of MPI was higher than CC only in Northern Taiwan. MPI may be underutilized to serve the role of gatekeeper for CC in the other regions. PMID:23515948
Lin, Ming-Chia; Yen, Ruoh-Fang; Chen, Huei-Yung; Muo, Chih-Hsin; Wang, Hsin-Ell; Chen, Chuan-Lin; Kao, Chia-Hung
Background Prompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations. Objectives One of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain. Methods We report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution. Results There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy. Conclusions In this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy.
Shamim, Shariq; McCrary, Justin; Wayne, Lori; Gratton, Matthew
A retrospective cohort study was conducted on the risk of radiation-induced cancer mortality following cardiac catheterization. The study included 4,891 children with congenital heart disease who were assessed by cardiac catheterization during 1946 to 1968 at The Hospital for Sick Children, Toronto. The cohort was matched against the Ontario cancer death file from 1950 to 1975. The average period of follow-up was 13 years and more than 66,000 person-years have been accrued from the cohort. No deaths from breast cancer or thyroid cancer were identified. Five cancer deaths were observed and compared with 4.8 expected deaths based on Ontario cancer death rates. The five cancer deaths resulted from three leukemias, one Wilms tumor, and one unspecified nervous system tumor. The preliminary findings did not demonstrate a significant leukemia risk arising from diagnostic cardiac catheterizations. Continued follow-up of this cohort is required to evaluate the risk of breast and thyroid cancers which can occur more than 20 years following radiation exposure.
Spengler, R.F.; Cook, D.H.; Clarke, E.A.; Olley, P.M.; Newman, A.M.
A retrospective cohort study was conducted on the risk of radiation-induced cancer mortality following cardiac catheterization. The study included 4,891 children with congenital heart disease who were assessed by cardiac catheterization during 1946 to 1968 at The Hospital for Sick Children, Toronto. The cohort was matched against the Ontario cancer death file from 1950 to 1975. The average period of follow-up was 13 years and more than 66,000 person-years have been accrued from the cohort. No deaths from breast cancer or thyroid cancer were identified. Five cancer deaths were observed and compared with 4.8 expected deaths based on Ontario cancer death rates. The five cancer deaths resulted from three leukemias, one Wilms' tumor, and one unspecified nervous system tumor. The preliminary findings did not demonstrate a significant leukemia risk arising from diagnostic cardiac catheterizations. Continued follow-up of this cohort is required to evaluate the risk of breast and thyroid cancers which can occur more than 20 years following radiation exposure.
Spengler, R.F.; Cook, D.H.; Clarke, E.A.; Olley, P.M.; Newman, A.M.
Patients with end-stage liver disease frequently require invasive cardiac procedures in preparation for liver transplantation. Because of the impaired hepatic function, these patients often have a prolonged prothrombin time and elevated international normalized ratio (INR). To determine whether an abnormal prothrombin time/INR is predictive of bleeding complications from invasive cardiac procedures, we retrospectively reviewed, for bleeding complications, the databases and case records of our series of patients with advanced cirrhosis who underwent cardiac catheterization. A total of 157 patients underwent isolated right-sided heart catheterization, and 83 underwent left-sided heart catheterization or combined left- and right-sided heart catheterization. The INR ranged from 0.93 to 2.35. No major procedure-related complications occurred. Several patients in each group required a blood transfusion for gastrointestinal bleeding but not for procedure-related bleeding. No significant change was found in the hemoglobin after right-sided or left-sided heart catheterization, and no correlation was found between the preprocedure INR and the change in postprocedure hemoglobin. When comparing patients with a normal (?1.5) and elevated (>1.5) INR, no significant difference in hemoglobin after the procedure was found in either group. In conclusion, despite an elevated INR, patients with end-stage liver disease can safely undergo invasive cardiac procedures. An elevated INR does not predict catheterization-related bleeding complications in this patient population. PMID:22728001
Townsend, Jacob C; Heard, Richard; Powers, Eric R; Reuben, Adrian
BACKGROUND Doppler echocardiography has been proposed as an appropriate non-invasive assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterisation and to determine the effect of different echocardiographic variables on its measurement. METHODS In this descriptive-analytic study, patients with diagnosed ischemic heart disease were selected by nonrandomized sampling method. Selected population underwent M-mode and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E (Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated. Immediately after echocardiography all patients underwent left heart catheterization for LVEDP measurement. The relation between different echocardiographic measurements and LVEDP, obtained by cardiac catheterization, was evaluated. RESULTS In this study, 47 patients with ischemic heart disease with mean age (±SD) of 53±13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44, P=0.001, and also between LVEDP and PV-DT in patients with A/E VTI ?1.1(r=?0.58, P=0.02). There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP >18mmHg (r=0.76, P=0.03) and those with LVEDP ?18 mmHg and A/E VTI <1.1 (r=0.37, P=0.03). The correlation between LVEDP and A/E VTI was more significant in men, in patients aged >50 years with EF >55%, without LVH, without MR and those with coronary artery disease (P<0.05). CONCLUSION Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT are able to measure LVEDP especially in male patients aged >50 years, without LVH, without MR and those with coronary artery disease but it is necessary to determine specific conditions and factors affecting these indices, by further studies.
Sanei, Hamid; Tavassoli, Aliakbar; Shojaei, Mohammad
Subcutaneous (SC) rehydration therapy (SCRT), originally referred to as "hypodermoclysis," shows promise as an alternative to intravenous (IV) fluid administration for treatment of dehydration. A simple, safe, and effective technique, SCRT is indicated for treatment of mild-to-moderate dehydration. Augmentation of SCRT with administration of a recombinant human formulation of the hyaluronidase enzyme at the infusion site gives rise to SC fluid administration rates up to 5-fold faster than those achieved without the enzyme, making the technique more clinically practical. Unlike older, animal-derived forms of hyaluronidase, recombinant human hyaluronidase has a lower chance of allergic reactions with repeated dosing. Clinical trials have demonstrated that recombinant human hyaluronidase effectively and safely facilitates fluid delivery in adults and children and is well accepted by parents and clinicians. In the emergency department setting, SCRT may be an appropriate alternative to IV fluid administration in certain situations because it is less invasive and generally less painful, while still permitting administration of appropriate volumes of rehydration fluids. Subcutaneous rehydration therapy appears to be particularly useful in patients who present with mild-to-moderate dehydration and have had failed attempts at oral rehydration. The SC route also provides benefits in patients with small, collapsed, or difficult-to-visualize veins or in those who may be agitated or distressed by IV catheterization. Continued research will further clarify the role of recombinant human hyaluronidase-facilitated SCRT in the rehydration treatment algorithm. PMID:21378529
Spandorfer, Philip R
Intense scientific and clinical evaluation have brought about great improvements in cardiac CT. This is no longer merely an experimental technique, rather it has become a clinical application that is ready to fulfill its promise of replacing invasive cardiac catheterization in certain patient populations. Among the proven indications is the evaluation of patients with atypical chest pain, the morphological evaluation of the coronary arteries in cases of suspected congenital anomalies, and before surgical intervention, as well as the evaluation of coronary revascularizations. The use of CT angiography for the exhaustive evaluation of cardiac and non-cardiac pathology in patients with acute chest pain in the emergency department is currently being investigated. Because the heart is continuously moving, CT coronary angiography represents a greater technical challenge than other applications of CT. On the other hand, rapid technical development requires acquisition protocols to be adjusted constantly. However, users that know the general techniques of computed tomography can overcome these challenges. The aim of this article is to provide those interested and involved in CT angiography with a manual to enable them to follow our method step by step. We include considerations regarding the correct selection of patients, patient medication, radiological protection, contrast enhancement, acquisition and reconstruction parameters, image display, image analysis techniques, and the radiological report. Our recommendations are based on our experience, which runs from the evolution of multiple-row detector CT scanners for cardiac applications from its beginnings to the most modern presentations of advanced acquisition modalities, including dual-source CT, which we consider to be the precursor of this test in routine clinical practice. PMID:18367060
Schoepf, U J; Thilo, C; Fernández, M J; Costello, P
Purpose: To study the association of recurrent symptomatic urinary tract infections (UTIs) with the long-term use of clean intermittent catheterization (CIC) for the management of neurogenic bladder in patients with spinal cord injury (SCI). Methods: Retrospective study of 61 SCI patients with neurogenic bladder managed by CIC. Subjects were selected from 210 SCI patients seen at the Yale Urology Medical Group between 2000 and 2010. Medical UTI prophylaxis (PRx) with oral antimicrobials or methenamine/ascorbic acid was used to identify patients with recurrent UTI. The number of positive cultures (?103 cfu/mL) within a year prior to starting PRx was used to confirm the recurrence of UTI. Results: Fifty-one male and 10 female subjects were managed with CIC. Forty-one (67%) subjects were placed on medical PRx for symptomatic recurrent UTI. Seventeen (28%) subjects had at least 3 positive cultures within the year prior to starting PRx. Fifteen of 20 (75%) subjects not on PRx had no complaints of UTI symptoms in the final year of follow-up. Conclusion: Recurrent symptomatic UTIs remain a major complication of long-term CIC in SCI patients. Although CIC is believed to have the fewest number of complications, many SCI patients managed with long-term CIC are started on medical PRx early in the course of management. Future studies are needed to determine the efficacy of routine UTI PRx in these patients as well as determine what factors influence why many patients on CIC experience frequent infections and others do not.
Edokpolo, Leonard U.; Stavris, Karen B.; Foster, Harris E.
Study Design Non-randomized pilot trial Objectives Determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism, and (2) decrease the rate of symptomatic urinary tract infection (UTI). Setting Outpatient SCI clinic in a Veterans Affairs hospital (USA) Methods Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least 1 UTI, and had documented bacteruria within the past year. All subjects received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days then removed. Subjects were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (?102 cfu/ml) of E. coli 83972 in urine cultures for > 3 days after catheter removal and (2) the rate of symptomatic UTI while colonized with E. coli 83972. Results Thirteen subjects underwent 19 insertions of study catheters. Eight subjects (62%) became successfully colonized for > 3 days after catheter removal. In these 8 subjects, the rate of UTI while colonized was 0.77 per patient-year, in comparison to the rate of 2.27 UTI per patient-year prior to enrollment. Conclusions E. coli 83972-coated urinary catheters are a viable means to achieve bladder colonization with this potentially protective strain in persons practicing ICP.
Prasad, Aakansha; Cevallos, Manuel E.; Riosa, Sarah; Darouiche, Rabih O.; Trautner, Barbara W.
Purpose It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. Materials and Methods A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. Results Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. Conclusions Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.
Kim, Jinsup; Kim, Dae Sung; Lee, Yong Seong
Transradial cardiac catheterization (TRCC) has unique technical challenges such as access difficulty related to anatomical variations and/or radial artery (RA) spasm. We sought to evaluate the incidence of anatomical variations of the RA and whether they would affect RA spasm and procedural achievement of TRCC. A total of 744 consecutive patients who underwent TRCC were analyzed by routine radial arteriography. Anatomical variations were defined as abnormal origin of the RA and/or radioulnar loop and/or tortuous configuration. RA spasm was defined as >75 % stenosis at first radial arteriography. Overall, anatomical variations were noted in 68 patients (9.1 %), including 39 cases of abnormal origin (5.2 %), 11 cases of radioulnar loop (1.5 %), and 42 cases of tortuous configuration (5.6 %). Transradial procedures failed in 26 patients (3.5 %), and more frequently in patients with anatomical variation than in those with normal anatomy (23.5 % vs 1.5 %, P < 0.001). Importantly, on multivariate analysis the presence of anatomical variation was a distinct predictor of transradial procedure failure (odds ratio (OR) 17.80; 95 % CI 7.55-43.73; P < 0.001). RA spasm was observed in 83 patients (11.2 %), and more frequently in patients with anatomical variation than in those with normal anatomy (35.3 % vs 8.7 %, P < 0.001). Anatomical variation (OR 4.74; 95 % CI 2.61-8.47; P < 0.001) and female gender (OR 2.23; 95 % CI 1.01-4.73; P = 0.041) were distinct predictors of RA spasm. Anatomical variations were observed in 9.1 % of the patients, and strongly correlated with RA spasm and procedural achievement of TRCC. PMID:23430268
Numasawa, Yohei; Kawamura, Akio; Kohsaka, Shun; Takahashi, Masashi; Endo, Ayaka; Arai, Takahide; Ohno, Yohei; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi
While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators). PMID:23728476
Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam
Background Patterns of care for acute myocardial infarction (AMI) strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes. Methods We identified all patients (n = 35,289) admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities. Results Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography [odds ratio (OR), 2.04; 95% confidence interval (CI), 1.93–2.16] and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17–1.32) were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91–1.15) and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88–0.98) were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar [adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89–1.16; congestive heart failure: 1.02; 95% CI, 0.90–1.15; unstable angina: 0.93; 95% CI, 0.85–1.02; mortality: 0.99; 95% CI, 0.93–1.05)]. Conclusion Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of catheterization did not translate into a higher use of non-invasive tests or have an impact on the fatal and non-fatal outcomes available for study in our administrative database.
Halabi, Abdul R; Beck, Christine A; Eisenberg, Mark J; Richard, Hugues; Pilote, Louise
A simplified technique of fallopian tube catheterization is described in which the tube is recanalized with a guidewire alone. The technique has been used to treat 13 infertile women, age range 27-39 years (mean 32 years), with a diagnosis of proximal tubal obstruction. One tube was perforated; all other tubes were successfully recanalized. Three women conceived within 10 months of the procedure. The technique has results similar to the standard coaxial catheter method but is simple and quick. PMID:8088047
Millward, S F; Claman, P; Leader, A; Spence, J E
Technetium-99m hexamethyl propylenamine oxime lung clearance in the estimation of pulmonary hypertension in congenital heart disease: A preliminary comparative study with cardiac catheterization and pathology.
Thirty-six patients ranging in age from 7 months to 15 years and weighing from 5300 g to 49 kg (24 undergoing corrective surgery and 12 cases with reversed shunt and no operation) underwent technetium 99m hexamethyl propylenamine oxime (Tc-99m HMPAO) lung clearance study and the results were compared with catheterization and pathology. Patients were allocated into three groups with respect to pathological grading (Heath-Edwards' classification) and the results were correlated on the basis of pathology. In group I (grades I and II), Pearson correlation coefficient was 0.86 with pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and Tc-99m HMPAO lung clearance (t1/2). Pearson correlation coefficients were 0. 863 and 0.88 in the second (grade III) and third group (with reversed shunt and no operation). There were statistically significant differences among the groups with respect to PAP, PVR, or t1/2. The results of radionuclide study (t1/2) were very well correlated within the groups with respect to hemodynamic parameters (PAP and PVR). Tc-99m HMPAO has potential as a highly sensitive indicator for detecting early and minimal microvascular lung injuries, and it may reflect accurate lung clearance and retention enabling an estimation of the state of pulmonary hypertension. PMID:10368452
Yener, A; Gunaydin, S; Olgunturk, R; Tunaoglu, S; Ozdogan, M E
The best established lateralized cerebral function is speech production, with the majority of the population having left hemisphere dominance. An important question is how to best assess the laterality of this function. Neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI) are increasingly used in clinical settings to…
Van der Haegen, Lise; Cai, Qing; Seurinck, Ruth; Brysbaert, Marc
Environment Canada has developed a set of environmental indicators that are easily measurable and provide useful clues on the state of the environment. This Web site provides a listing of those indicators that Environment Canada monitors. For each indicator, there is a detailed description of the environmental indicator, how it relates to larger environmental problems, and what is being done to reduce the threat. A number of Web links are provided for further information on each indicator.
Accurate measurement of oxygen consumption (VO2) is important to precise calculation of blood flow using the Fick equation. This study aimed to validate the breath-by-breath method (BBBM) of measuring oxygen consumption VO2 compared with respiratory mass spectroscopy (MS) for intubated children during cardiac catheterization. The study used MS and BBBM to measure VO2 continuously and simultaneously for 10 min in consecutive anesthetized children undergoing cardiac catheterization who were intubated with a cuffed endotracheal tube, ventilated mechanically, and hemodynamically stable, with normal body temperature. From 26 patients, 520 data points were obtained. The mean VO2 was 94.5 ml/min (95 % confidence interval [CI] 65.7-123.3 ml/min) as measured by MS and 91.4 ml/min (95 % CI 64.9-117.9 ml/min) as measured by BBBM. The mean difference in VO2 measurements between MS and BBBM (3.1 ml/min; 95 % CI -1.7 to +7.9 ml/min) was not significant (p = 0.19). The MS and BBBM VO2 measurements were highly correlated (R (2) = 0.98; P < 0.0001). Bland-Altman analysis showed good correspondence between MS and BBBM, with a mean difference of -3.01 and 95 % limits of agreement ranging from -26.2 to +20.0. The mean VO2 indexed to body surface area did not differ significantly between MS and BBBM (3.4 ml/min m(2); 95 % CI -1.4 to 8.2; p = 0.162). The mean difference and limits of agreement were -3.8 ml/min m(2) (range, -19.9 to 26.7). Both MS and BBBM may be used to measure VO2 in anesthetized intubated children undergoing cardiac catheterization. The two methods demonstrated excellent agreement. However, BBBM may be more suited to clinical use with children. PMID:24352664
Guo, Long; Cui, Yong; Pharis, Scott; Walsh, Mark; Atallah, Joseph; Tan, Meng-Wei; Rutledge, Jennifer; Coe, J Y; Adatia, Ian
The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3).
Kaul, S.; Lilly, D.R.; Gascho, J.A.; Watson, D.D.; Gibson, R.S.; Oliner, C.A.; Ryan, J.M.; Beller, G.A.
The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related,\\u000a and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central\\u000a venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion\\u000a were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis
Goro Nagashima; Toshiki Kikuchi; Hitomi Tsuyuzaki; Rumiko Kawano; Hiroyuki Tanaka; Hiroshi Nemoto; Kazumi Taguchi; Kazuhisa Ugajin
Basically the indications for instrumentation of the lower cervical spine (C3-C7) are to provide immediate stability or to enhance stability to the unstable spine. To access the instability of the spine the three column model was introduced. The anterior column comprises the anterior half of the vertebral body and anterior half of the intervertebral disc as well as the anterior
Wee Fu Tan
An international symposium on ecological indicators was developed to explore both the potential of ecological indicators and the issues surrounding their development and implementation. his symposium presented state-of-the-science information on the identification, application re...
Seven single-site statistical downscaling methods for daily temperature and precipitation, including four deterministic algorithms [analog model (ANM), quantile mapping with delta method extrapolation (QMD), cumulative distribution function transform (CDFt), and model-based recursive partitioning (MOB)] and three stochastic algorithms [generalized linear model (GLM), Conditional Density Estimation Network Creation and Evaluation (CaDENCE), and Statistical Downscaling Model-Decision Centric (SDSM-DC] are evaluated at nine stations located in the mountainous region of Iran's Midwest. The methods are of widely varying complexity, with input requirements that range from single-point predictors of temperature and precipitation to multivariate synoptic-scale fields. The period 1981-2000 is used for model calibration and 2001-2010 for validation, with performance assessed in terms of 27 Climate Extremes Indices (CLIMDEX). The sensitivity of the methods to large-scale anomalies and their ability to replicate the observed data distribution in the validation period are separately tested for each index by Pearson correlation and Kolmogorov-Smirnov (KS) tests, respectively. Combined tests are used to assess overall model performances. MOB performed best, passing 14.5 % (49.6 %) of the combined (single) tests, respectively, followed by SDSM, CaDENCE, and GLM [14.5 % (46.5 %), 13.2 % (47.1 %), and 12.8 % (43.2 %), respectively], and then by QMD, CDFt, and ANM [7 % (45.7 %), 4.9 % (45.3 %), and 1.6 % (37.9 %), respectively]. Correlation tests were passed less frequently than KS tests. All methods downscaled temperature indices better than precipitation indices. Some indices, notably R20, R25, SDII, CWD, and TNx, were not successfully simulated by any of the methods. Model performance varied widely across the study region.
Farajzadeh, M.; Oji, R.; Cannon, A. J.; Ghavidel, Y.; Massah Bavani, A.
Summary \\u000a Dorsal fusion with the internal fixator has become the standard treatment of instabilities and deformities of the thoracolumbar\\u000a spine. With our new device, the modular spine fixator (MSF), which has been specially designed for short-distance instrumentations,\\u000a we have increasingly been treating unstable injuries of the thoracolumbar spine by one-level stabilization. Prerequisite is\\u000a an accurate evaluation of the indication, including
A. Junge; L. Gotzen; T. v. Garrel; E. Ziring; K. Giannadakis
Minute durable plate-like thermal indicators are employed for precision measuring static and dynamic temperatures of well drilling fluids. The indicators are small enough and sufficiently durable to be circulated in the well with drilling fluids during the drilling operation. The indicators include a heat resistant indicating layer, a co-acting meltable solid component and a retainer body which serves to unitize each indicator and which may carry permanent indicator identifying indicia. The indicators are recovered from the drilling fluid at ground level by known techniques. 8 figs.
Gaven, J.V. Jr.; Bak, C.S.
Minute durable plate-like thermal indicators are employed for precision measuring static and dynamic temperatures of well drilling fluids. The indicators are small enough and sufficiently durable to be circulated in the well with drilling fluids during the drilling operation. The indicators include a heat resistant indicating layer, a coacting meltable solid component and a retainer body which serves to unitize each indicator and which may carry permanent indicator identifying indicia. The indicators are recovered from the drilling fluid at ground level by known techniques.
Gaven, Jr., Joseph V. (Oakton, VA); Bak, Chan S. (Newbury Park, CA)
The incidence of major complications associated with nonionic contrast media has not been defined in a large study. Accordingly, cardiovascular complications, especially thrombotic events, were prospectively evaluated in 8,517 consecutive patients undergoing diagnostic cardiac catheterization with either iopamidol (n = 6,293) or iohexol (n = 2,224). Thrombotic events were defined as coronary embolus, coronary occlusion, transient ischemic attack or stroke occurring at the time of catheterization. Thrombotic events occurred in 15 patients (0.18%). Coronary thrombus or embolus occurred in 7 patients, a thromboembolus from the ventricular catheter occurred in 1 patients and transient ischemic attack or stroke occurred in 7 patients. Six of 15 patients with thrombotic events were premedicated with heparin. Thrombotic events were unusual in that they tended to occur in clusters within short time intervals. On 1 occasion, a thrombus was observed in the catheter tip before embolization. Other cardiovascular complications were similarly low with an incidence of ventricular tachycardia/fibrillation of 0.1%, profound bradycardia of 0.2% and prolonged angina of 0.3%. There were 2 deaths unrelated to thrombotic events. Although the clinical thrombotic events associated with nonionic contrast have an unusual temporal clustering and may result in major complications, the overall incidence (0.18%) of these thrombotic complications with nonionic contrast agents is quite similar to that reported with ionic contrast media. PMID:2353655
Davidson, C J; Mark, D B; Pieper, K S; Kisslo, K B; Hlatky, M A; Gabriel, D A; Bashore, T M
The authors report their experience with surgical treatment of hypospadias about 557 cases. From 1974 to 1981, only 84 cases were cured by classical procedures (Mathieu, Van der Meulen, Perlemutter, Duplay-Fèvre, Leveuf-Cendron), sometimes with Cahuzac uretroplasty). The age when correction depended from the type of hypospadias and several times were after necessary. From 1981 to 1992, 463 cases were operated, always between 18 month to two years of age, with only one operative with therapeutic indications are actually such proposed: distal meatotomy or modified MAGPI procedure for glandular hypospadias; Duplay uretroplasty for coronal form; Mathieu or onlay island flap for anterior and medial penil types without curvature; Mollard or Duckett uretroplasty for penil forms with chordee; Then, for posterior types, complementary posterior Duplay uretroplasty, or vesical ou buccal grafts. PMID:7995967
Dodat, H; Philibert, M; Takvorian, P; Paulus, C; James-Pangaud, I
Abstract Background and Purpose: Ureteral reconstructive surgery necessitates adequate exposure of the ureteral lesion and results in large abdominal incisions. Robot assistance allows the performance of complex ureteral reconstructive surgery through small incisions. The current series includes only cases of Boari flaps performed by robot assistance and attempts to describe in detail the technique, review the literature, as well as to expand the experience in the current literature. Patients and Methods: Eight patients underwent ureteral reimplantation by Boari flap technique. The indications for the performance of the procedure included ureteral stricture from iatrogenic injury in three patients, recurrent ureteral stricture after multiple endoscopic stone management procedures in one patient, ureteral stricture from previous malignant disease in the pelvis or abdomen in three patients, and ureteral stricture due to trauma in one patient. Five cases were located in the left side and three cases in the right side. A variety of parameters were recorded in a prospective database including the time for robot docking and total operative time as well as catheterization and drainage time. The follow-up of the patients included the performance of renal ultrasonography 4 weeks, 3, 6, and 12 months after the procedure. Results: Mean age of the patients was 50.8 (range 39-62) years and mean body mass index was 26.2 (range 23.22-29.29) kg/m(2). Operative time ranged 115 and 240 (mean 171.9) minutes. Mean blood loss was 161.3 (50-250) mL. Conversion to open surgery did not take place in the current series. No intraoperative complications were observed. Postoperative complications included one case of prolonged anastomotic leakage. Conclusion: The robot-assisted approach is efficient in the performance of ureteral reimplantation with Boari flap. Low blood loss, short catheterization time, low complication rate, and excellent reconstructive outcome are associated with the approach. Robot assistance seems to be beneficial for ureteral reconstructive surgery. PMID:24428629
Do, Minh; Kallidonis, Panagiotis; Qazi, Hasan; Liatsikos, Evangelos; Ho Thi, Phuc; Dietel, Anja; Stolzenburg, Jens-Uwe
This present paper deals with the development and validation of a stability indicating high performance liquid chromatographic method for the quantitative determination of Memantine hydrochloride. Memantine hydrochloride was derivatized with 0.015 M 9-fluorenylmethyl chloroformate (FMOC) and 0.5 M borate buffer solution by keeping it at room temperature for about 20 minutes and the chromatographic separation achieved by injecting 10 ?L of the derivatized mixture into a Waters HPLC system with photodiode array detector using a kromasil C18 column (150 × 4.6 mm), 5 ?. The mobile phase consisting of 80% acetonitrile and 20% phosphate buffer solution and a flow rate of 2 milliliter/minute. The Memantine was eluted at approximately 7.5 minutes. The volume of FMOC used in derivatization, concentration of FMOC and derivatization time was optimized and used. Forced degradation studies were performed on bulk sample of Memantine hydrochloride using acid (5.0 Normal (N) hydrochloric acid), base (1.0 N sodium hydroxide), oxidation (30% hydrogen peroxide), thermal (105°C), photolytic and humidity conditions. The developed LC method was validated with respect to specificity, precision (% RSD about 0.70%), linearity (linearity of range about 70–130 ?g/mL), ruggedness (Overall % RSD about 0.35%), stability in analytical solution (Cumulative % RSD about 0.11% after 1450 min.) and robustness.
Narola, Bhavil; Singh, A.S.; Santhakumar, P. Rita; Chandrashekhar, T.G.
Germination of Dryopteris spores is mediated by the physiologically active, far-red-absorbing form of phytochrome, Pfr, and external Ca2+ is necessary for the transduction of the light signal. Because knowledge about the cytoplasmic calcium ion concentration, [Ca2+]i, is of great importance for understanding the role of calcium during signal transduction, this value was measured using fura-2 in fern spores undergoing the normal developmental progression into germination. Fura-2 was loaded into the spores by electroporation, which does not disrupt the normal process of germination. The intensity of the fluorescence emission of the loaded fura-2 was analysed by a microspectrophotometric assay of single spores, and successful loading could be obtained by the application of ten electrical pulses (field strength 7.5 kV cm-1, half-life (time constant) 230 microseconds). Fura-2 was alternately excited by light of wavelengths 355 and 385 nm through an inverted fluorescence microscope, and the emitted fura-2 fluorescence was collected by a silicon-intensified video camera. The cytoplasmic calcium ion concentration was calculated from the ratio of the camera output obtained for both wavelengths and displayed by a pseudo-color technique. Spores responded to changes of the extracellular Ca2+ concentration, and this observation is considered as evidence that fura-2 is loaded into the cytoplasm. The substitution of a low external [Ca2+] (1 mM ethyleneglycol-bis(2-aminoethylether)-N,N,N',N'-tetraacetic acid (EGTA)) by 1 mM CaCl2 caused a fast increase of [Ca2+]i from approx. 50 nM to above 500 nM. In contrast, the subsequent substitution of CaCl2 by EGTA decreased [Ca2+]i again below 100 nM within 0.5 h. Furthermore, the application of ionomycin could initiate a change in [Ca2+]i according to the Ca2+ gradient established between the extracellular medium and cytoplasm. In spores sown on a Ca(2+) -free medium, [Ca2+]i, analysed in a buffer containing EGTA, was found to be around 50 nM during the first days of cultivation, independent of the irradiation protocol. However, if spores were grown in darkness on a Ca(2+) -containing medium and analysed in EGTA, [Ca2+]i was significantly higher (> or = 500 nM). In red-light-irradiated spores, [Ca2+]i was found to decrease with increasing time after irradiation, and was determined to be less than 100 nM when analysis was done 44 h after germination was initiated by the light treatment.
Scheuerlein, R.; Schmidt, K.; Poenie, M.; Roux, S. J.
A nuclear reactor system is described in which a position indicator is provided for detecting and indicating the position of a movable element inside a pressure vessel. The movable element may be a valve element or similar device which moves about an axis. Light from a light source is transmitted from a source outside the pressure vessel to a first region inside the pressure vessel in alignment with the axis of the movable element. The light is redirected by a reflector prism to a second region displaced radially from the first region. The reflector prism moves in response to movement of the movable element about its axis such that the second region moves arcuately with respect to the first region. Sensors are arrayed in an arc corresponding to the arc of movement of the second region and signals are transmitted from the sensors to the exterior of the reactor vessel to provide indication of the position of the movable element.
Tanner, David E. (Poway, CA)
One of the most treatable causes of lower back pain and associated sciatica is lumbar disc herniation (LDH), which is characterized by rupture of the hard outer wall (annulus fibrosis) in a lumbar intervertebral disc. In the current study, we aimed to: (1) develop and characterize a rat model of sciatica induced by LDH, while introducing a novel method of epidural catheterization; (2) use this model to evaluate the effect of osthole on pain due to LDH, and (3) gain insight into the mechanisms through which osthole affects sciatica induced by LDH. The results indicate that our newly developed rat model maintained mechanical allodynia for 28 days without reduction. Moreover, cyclooxygenase-2 (COX-2) and nitric oxide synthase (NOS) were overexpressed in the associated inflammatory response, which is consistent with clinical manifestations of the disease. We then used this model to study the effect and mechanisms through which osthole affected pain due to LDH. Our study suggests that osthole is capable of reversing hyperalgesia due to LDH, potentially through modulation of activity of COX-2 and NOS, two important proteins for the exacerbation of pain due to LDH. Finally, a molecular modeling simulation showed that osthole has unique binding capabilities to both NOS and COX-2. As the model-induced mechanical hyperalgesia response was consistent, and the position of the catheter tip and the extension/spreading of the drug in the epidural space were reliable, this study developed an improved model to study remedies for sciatic pain. Moreover, our studies demonstrate that osthole may be a feasible treatment for the reduction of pain due to hyperalgesia. PMID:23018204
Wei, Ming; Mo, Sui-Lin; Nabar, Neel R; Chen, Yuling; Zhang, Jin-Jun; He, Qiu-Lan; Zou, Xue-Nong; Liu, Xian-Guo; Sun, Lai-Bao; Zhou, Shu-Feng
Objectives. This study was performed to test the safety and efficacy of a novel bioabsorbable hemostatic puncture closure device deployed through an arterial sheath.Background. Cardiac catheterization procedures are associated with a risk of complications at the arterial access site. Increasing numbers of interventional procedures requiring large sheaths or intense anticoagulation underline the need for occure, rapid methods of obtaining hemostasis
William G. Kussmaul; Maurice Buchbinder; Patrick L. Whitlow; Umit T. Aker; Richard R. Heuser; Spencer B. King; Kenneth M. Kent; Martin B. Leon; Daniel M. Kolansky; Joseph G. Sandza
The intent of this plan is to describe the needs and standards for cardiac surgery units and cardiac catheterization services, applicable to the five counties of this Health Service Area. A cardiac surgery center is capable of performing open heart surger...
Alternative medicine is widely used, but lacks consensus regarding its amenability to scientific investigation. Anxiety increases morbidity and mortality in ischemic heart disease. We performed two studies of Palmtherapy, an alternative treatment, for anxiety before cardiac catheterization. In the first study, patients were randomized to receive pressure at particular points on the palm, or at incorrect locations, for about 50
Yossef Blaer; Jamal Jafari; Anna Podberezsky; Tamar David; Leonardo Reizin; Jonathan Benjamin
Purpose: To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization.Methods: We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started.Results: Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated.Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis.Conclusions: Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment inpatients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.
Tsetis, Dimitrios K. [Medical School of Heraklion, Department of Radiology, University Hospital Heraklion, 71500 Heraklion-Stravrakia, Crete (Greece); Kochiadakis, George E. [Medical School of Heraklion, Department ofCardiology, University Hospital of Heraklion, Crete (Greece); Hatzidakis, Adam A. [Medical School of Heraklion, Department of Radiology, University Hospital Heraklion, 71500 Heraklion-Stravrakia, Crete (Greece); Skalidis, Emannuel I. [Medical School of Heraklion, Department of Cardiology, University Hospital of Heraklion, Crete (Greece); Chryssou, Evangelia G.; Tritou, Ioanna N. [Medical School of Heraklion, Department of Radiology, University Hospital Heraklion, 71500 Heraklion-Stravrakia, Crete (Greece); Vardas, Panos E. [Medical School of Heraklion, Department of Cardiology, University Hospital of Heraklion, Crete (Greece); Gourtsoyiannis, Nicholas C. [Medical School of Heraklion, Department ofRadiology, University Hospital Heraklion, 71500 Heraklion-Stravrakia, Crete (Greece)
The objective quantitative evaluation of the extent of plaques is necessary for epidemiologic studies and for the estimation of the effects of various cleaning methods and agents. Numerous indices have been elaborated for this purpose. Relation planimetry is used for the detection and exact evaluation of small differences. The surfaces are measured with a compensating planimeter, the slides to be evaluated being projected on a white sheet by means of a microfilm reader. In this way, the plaque covered surfaces are determined as percentages of the total surfaces. PMID:283608
Change vector analysis to categorise land cover change processes using the tasselled cap as biophysical indicator: description: implementing Landsat TM and ETM to detect land cover and land use changes in the mount Cameroon region using the CVA technique with the tasselled cap as biophysical indicator.
The continuous extraction of wood and the conversion of forest to small- and large-scale agricultural parcels is rapidly changing the land cover of the mount Cameroon region. The changes occur at varying spatial scales most often not more than 2ha for the small-scale subsistence farms and above 10ha for the extensive agricultural plantations of cocoa and palm. Given the importance of land use and land cover data in conservation planning, accurate and efficient techniques to provide up-to-date change information are required. A number of techniques for realising the detection of land cover dynamics using remotely sensed imagery have been formulated, tested and assessed with the results varying with respect to the change scenario under investigation, the information required and the imagery applied. In this study the Change Vector Analysis (CVA) technique was implemented on multitemporal multispectral Landsat data from the Thematic Mapper (TM) and Enhanced Thematic Mapper (ETM) sensors to monitor the dynamics of forest change in the mount Cameroon region. CVA was applied to multi-temporal data to compare the differences in the time-trajectory of the tasseled cap greenness and brightness for two successive time periods - 1987 and 2002. The tasseled cap was selected as biophysical indicator because it optimises the data viewing capabilities of vegetation, representing the basic types of land cover - vegetation, soil and water. Classes were created arbitrarily to predict the technique's potential in monitoring forest cover changes in the mount Cameroon region. The efficiency of the technique could not be fully assessed due to the inavailability of sufficient ground truth data. Assessment was based on the establishment of an error matrix of change versus no-change. The overall accuracy was 70%. The technique nevertheless demonstrated immense potentials in monitoring forest cover change dynamics especially when complemented with field studies. PMID:18193332
Siwe, Rene Ngamabou; Koch, Barbara
Interventional cardiology requires precise assessment of coronary anatomy and physiology. Unfortunately, however, important interventional decisions are frequently made on the basis of arteriographic data alone. Increasing evidence suggests that visual interpretation of coronary arteriographic studies is irreproducible, inaccurate, and poorly predictive of coronary physiology. Moreover, arteriography is of little value in assessing endothelial ulceration and mural thrombus, which are important pathophysiologic features of unstable angina and acute myocardial infarction. In response to these limitations, several diagnostic transcatheter techniques have been developed that allow more complete assessment of coronary physiology and function. These include fiberoptic angioscopy, reflection spectroscopy (which can combine automated laser therapy with diagnosis), ultrasonic catheterization, and translesional gradient determination. Doppler catheterization permits the assessment of overall coronary flow reserve with the aid of induced hyperemia, whereas subselective digital radiography allows the evaluation of regional coronary flow reserve. The coronary flow reserve, however, may be falsely lowered immediately after balloon dilation, because of endothelial injury, repeated ischemia, or the administration of vasoactive drugs. To circumvent this problem, we have developed impedance-catheter and impedance-guidewire systems that, by applying impedance technology and the principles of indicator dilution, are capable of measuring absolute coronary blood flow. For a flow indicator, we use 0.5 mL of glucose solution (D5W), which has little effect on intrinsic blood flow. The validity of this approach has been demonstrated in experimental and clinical studies. The impedance guidewire is less obstructive than the catheter system, so it probably will become the method with clinical application. (Texas Heart Institute Journal 1989;16:195-203) Images
Vogel, Robert A.; Martin, Lisa W.
A urethral dysuria cystograph (CUMS (Cistografia Ureteral Miccional Seriada)) is the first diagnostic procedure, by means of x-rays, to evaluate bladder-urethral reflux. It consists of a bladder catheter to administer a radiopaque contrast dye through the ureter. To use the aforementioned technique without any asepsis measures and without knowledge about it can lead to possible complications. By means of a retrospective study using a sample of 181 patients, the authors have evaluated the incidence of possible complications and/or subsequent discomfort due to a urethral dysuria cystograph (CUMS). As final results, by means of an after test telephone call, the authors observed that 96.7% of the children who underwent this technique did not manifest any type of complication nor urinary discomfort. PMID:20014629
Alcázar García, A; Daviu Llorens, E; Daza Laguna, A; Durán Feliubadalo, C; Pons Torrents, X
In routine clinical practice the variations of the radial artery are the main reason for technical failure during transradial catheterization. If these variations are well documented, however, they do not represent a problem in the transradial approach. Therefore, we report here a rare case of the radial artery which is very strange but potentially valuable for the clinical practice: it arises at a right angle from the brachial artery and passes behind the biceps brachii tendon. Based on our findings and on an extensive literature review, we propose for the first time a clinically oriented classification of the variations of the radial artery. This classification is related to the catheterization success at the usual access site of the radial artery at the wrist.
Jelev, L., E-mail: firstname.lastname@example.org; Surchev, L. [Medical University Sofia, Department of Anatomy, Histology and Embryology (Bulgaria)
The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results.
Kaul, S.; Finkelstein, D.M.; Homma, S.; Leavitt, M.; Okada, R.D.; Boucher, C.A.
It has been postulated that one or more plasma digitalis-like compounds may play an important role in body fluid regulation and in essential hypertension, although very little is known about their possible role in general haemodynamics. We therefore measured plasma inhibition of human kidney Na+,K+-ATPase and plasma cross-reactivity with digoxin antibodies in 11 normotensive cardiopathic subjects admitted to our clinic for heart catheterization. Possible correlations with haemodynamic parameters were studied. Plasma digoxin-like activity correlated directly with left atrial pressure and with pulmonary circulation data. The ability of the plasma to inhibit Na+,K+-ATPase showed an inverse correlation with cardiac output and cardiac index. No correlations were found with any of the other parameters measured, notably systemic resistance, blood pressure and natriuresis. These findings suggest the presence of more than one substance sharing chemical properties with digitalis: (1) a substance cross-reacting with digoxin antibodies and dependent on pulmonary vascular congestion; and (2) a substance capable of inhibiting the Na+-K+ pump and present in large amounts in heart diseases with a reduced cardiac index. PMID:2853742
Delva, P; Devynck, M A; Degan, M; Pernollet, M G; Capra, C; Meyer, P; Lechi, A
To assess feasibility of proper hepatic artery catheterization using a 3D model obtained from preprocedural computed tomographic angiography (CTA), fused with real-time fluoroscopy, during transarterial chemoembolization of hepatocellular carcinoma. Twenty consecutive cirrhotic patients with hepatocellular carcinoma undergoing transarterial chemoembolization were prospectively enrolled onto the study. The early arterial phase axial images of the preprocedural CTA were postprocessed on an independent workstation connected to the angiographic system (Innova 4100; GE Healthcare, Milwaukee, WI), obtaining a 3D volume rendering image (VR) that included abdominal aorta, splanchnic arteries, and first and second lumbar vertebrae. The VR image was manually registered to the real-time X-ray fluoroscopy, with the lumbar spine used as the reference. The VR image was then used as guidance to selectively catheterize the proper hepatic artery. The procedure was considered successful when performed with no need for intraarterial contrast injections or angiographic acquisitions. The procedure was successful in 19 (95 %) of 20 patients. In one patient, celiac trunk angiography was required for the presence of a significant ostial stenosis that was underestimated at computed tomography. Time for image reconstruction and registration was <10 min in all cases. The use of preprocedural CTA model with fluoroscopy enables confident and direct catheterization of the proper hepatic artery with no need for preliminary celiac trunk angiography, thus reducing radiation exposure and contrast media administration.
Bargellini, Irene, E-mail: email@example.com; Turini, Francesca; Bozzi, Elena; Lauretti, Dario; Cicorelli, Antonio; Lunardi, Alessandro; Cioni, Roberto; Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)] [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)
Although large animals, such as dogs and nonhuman primates, often are used for more than 1 pharmacokinetics study, common practice is to use only naive rodents for pharmacokinetics studies. We undertook a series of studies to validate whether surgically cannulated nonnaive rats could be used again after a 7-d washout. When vascular catheters are cared for appropriately, we find that they remain patent for more than 2 wk, with negligible drug carryover. Hematocrit decreased approximately 11% after pharmacokinetics studies but rebounded to prestudy levels after a 7-d washout. We empirically tested whether drugs known to alter drug disposition (1-aminobenzotriazole and quinidine) had residual effects on drug disposition after a 7-d washout and found that they did not. This finding suggests that after a 7-d washout, nonnaive rats likely would produce pharmacokinetics data similar to those of naive rats. We also tested reference compounds in naive and nonnaive rats and found no difference in pharmacokinetics parameters. Using surgically cannulated rats for a second study was feasible because of the relatively noninvasive nature of pharmacokinetics sampling (unrestrained rats attached to automated blood samplers). In addition, reusing surgically altered animals yields considerable cost savings. Our studies indicate that pharmacokinetics parameters did not differ significantly between naive and nonnaive rats. Cost–benefit analysis, monetary considerations, and validation studies support using rats for a second study after a 7-d washout period.
Deshmukh, Sujal V; Durston, Jessica; Shomer, Nirah H
Objective. Polyvinyl chloride (PVC) is commonly used as a catheter material in catheters for clean intermittent catheterization (CIC) but, owing mainly to environmental concerns, a PVC-free material has been proposed. The objective of this study was to compare patients' tolerability for catheters made of PVC and a newly developed PVC-free material. Material and methods. This was a prospective, randomized, crossover study in 104 male patients with maintained urethra sensibility who practised CIC. The patients evaluated in a randomized order a PVC and a PVC-free LoFric® catheter after 1 week's use of each. The material properties and tolerability, i.e. reported perceived discomfort, of each catheter were compared and adverse events documented. Results. Twenty-nine (28%) and 15 (14%) patients reported discomfort when using the PVC catheter and the PVC-free LoFric catheter, respectively. A comparison showed that five patients (5%) reported discomfort with the PVC-free and not with the PVC catheter, and 19 patients (18%) reported discomfort with the PVC and not with the PVC-free catheter (p = 0.0066). Forty patients reported a total of 91 adverse events, of which the most common were discomfort in terms of pain, a burning sensation and bleeding. Conclusions. Generally low discomfort rates were reported in the study population, suggesting a high tolerance for CIC with catheters of both the PVC and the PVC-free materials. The lowest discomfort was, however, found when CIC was performed using the PVC-free LoFric catheter.
Greis, Gunvor; Johansson, Birgit; Grundtmann, Agneta; Pahlby, Yvonne; Torn, Solveig; Axelberg, Hanna; Carlsson, Petrea
Abstract The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right ventricular (RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume (EDV; 176–117 mL; P < 0.001) and RV end-systolic volume (ESV; 129–64 mL; P < 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure (PAP) correlated moderately with ESV (r = 0.46, P < 0.001). Postoperatively, PAP correlated with EDV (r = 0.45, P < 0.001) and ESV (r = 0.44, P < 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre- and postoperation end-systolic and end-diastolic RV mass (P < 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different (P < 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre- and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.
Background Inexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC simulated skills training on performance on real patients and to examine whether watching a video of the procedure immediately before assessment enhanced clinical performance. Methods This was an experimental study of the effect of a UC simulation-based skills course on medical students’ short-term (after one week) and long-term (after six weeks) performance. The additional effect of video instruction before performance testing on real patients was studied in a randomized trial. Sixty-four students participated in the study, which was preceded by a pilot study investigating the validity aspects of a UC assessment form. Results The pilot study demonstrated sufficient inter-rater reliability, intra-class correlation coefficient 0.86, and a significant ability to discriminate between trainee performances when using the assessment form, p= 0.001. In the main study, more than 90% of students demonstrated an acceptable performance or better when tested on real patients. There was no significant difference in the total score between the one-week and the six-week groups when tested on real patients and no significant difference between the video and the control groups. Conclusions Medical students demonstrated good transfer of UC skills learned in the skills lab to real clinical situations up to six weeks after training. Simulated UC training should be the standard for all medical school curricula to reduce avoidable complications. However, this study did not demonstrate that an instructional video, as a supplement to simulated skills training, improved clinical UC performance. Trial registration Current Controlled Trials ISRCTN:ISRCTN90745002
Background Isolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored. Methods A total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study. Results The pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic pressure gradient showed statistically significant decrease. The pre-BPV RV-PA systolic pressure gradient and 3 month post-BPV systolic pressure gradient showed statistically significant decrease. The consistency between the echocardiographic data and cardiac catheterization data shows statistically significant consistency. The mean pressure gradient and systolic pressure gradient on the echocardiography shows high consistency when comparing with the cardiac catheterization data. Conclusion Our study shows that BPV in PS is a safe and effective procedure in children and adolescent. The standard echocardiographic evaluation of PS, during diagnosis and follow-up, should include mean transpulmonic pressure gradient, as well as the peak systolic pressure gradient. The success of the procedure should be held off until at least 3 months, only if the patients do not show any symptoms.
Kim, Do Hoon; Park, Su-Jin; Jung, Jo Won; Kim, Nam Kyun
... medicine -- such as clopidogrel (Plavix), prasugrel (Efient), or ticagrelor (Brilinta) -- after this procedure. These medicines are blood ... Primary and secondary prevention of cardiovascular disease: ... Therapy and Prevention of Thrombosis, 9th ed: American College ...
An opportunity for a student to evaluate his or her own performance enhances self-awareness and promotes self-directed learning. Using three outcome measures of competency of procedure, communication skills, and learning motivation, the effects of self-evaluation using a video recording of the student's Foley catheterization was investigated in this study. The students in the experimental group (n = 20) evaluated their Foley catheterization performance by reviewing the video recordings of their own performance, whereas students in the control group (n = 20) received written evaluation guidelines only. The results showed that the students in the experimental group had better scores on competency (p < 0.001), communication skills (p < 0.001), and learning motivation (p = 0.018) than the control group at the post-test, which was conducted 8 weeks after the pretest. Self-awareness of one's own performance developed by reviewing a videotape appears to increase the competency of clinical skills in nursing students. PMID:20411863
Yoo, Moon Sook; Yoo, Il Young; Lee, Hyejung
This article is a review of the related approaches in the field – including the newest ones associated with a specific retrospective study on in-patients from our Clinic Division (preliminary results). Aim. Study design : To objectively assess whether there are significant differences regarding some specific key biological and psychometric parameters related to the use of hydrophilic catheters vs. non-hydrophilic ones. Materials and Methods: We have evaluated the outcomes of long term IC using by comparatively using the afore-mentioned two different types of catheters, on two lots (totally 45 patients with mainly retention type of neurogenic bladder): 30 post SCI patients, using exclusively hydrophilic catheters and respectively, 10 same kinds of patients that used exclusively non-hydrophilic catheters. Additionally, there were 5 patients included in both lots as they have started IC with non-hydrophilic catheters and since 2008 they have switched on using hydrophilic ones. The methods used were primary data acquisition based on a unitary questionnaire and statistical analyses. Results and discussion : Mainly: the patients that used exclusively hydrophilic type of catheters (median: “None”) vs. those using exclusively non-hydrophilic type of catheters (median: “One every 4 months”) presented: a significantly lower number of inflammatory episodes at scrotal level (p-value: 0.0001 WT), a significantly lower number of post/intra/inter catheterization bleeding episodes (p-value: 0.0001 WT), a very slightly lower number of UTI activations and expressed a significant higher satisfaction level (p-value <0.0001 WT). However, speculating a conceptual relation with the lower number of inflammatory episodes at scrotal level, it is to be thought that bigger lots of patients could provide, in this respect, significant results too. This study is to be continued, in order to further validate these preliminary, quite promising results, on bigger lots through the complex/ rigorous assessment methodology already used. Abbreviations IC – intermittent catheterism, SCI – spinal cord injury, CIC – clean intermittent catheterization, PVP – polyvinyl pyrolidone, UTI – urinary tract infections, WHO – World Health Organization, ICFDH – International Classification of Functioning, Disability and Health, PVC – polyvinyl chloride, RISCI - Initiation of a national informatics network for dynamic clustering of patients with spinal cord injury, QoL - Quality of life.
Spinu, A; Onose, G; Daia, C; Pantu, C; Anghelescu, A; Onose, L; Mihaescu, A
Right atrial pressure alterations during echocardiography-guided-catheterization predict tricuspid valvular impairment: a novel method for the creation of a rabbit model of Staphylococcus aureus endocarditis
Background We previously reported the use of a catheter system to damage the tricuspid valve and create infectious endocarditis (IE) in an animal model. The current study aims to create a faint IE model suitable for antibiotic prophylaxis using a low bacterial inoculum. We also aim to explore a way to quantitatively assess valvular impairment and to predict the success of the IE models during catheterization. Methods Ninety rabbits were assigned to two groups according to the density of bacteria inoculated (1?×?105 CFU for Group A and 1?×?104 CFU for Group B). A catheter system consisting of a polyethylene catheter and a guide wire were used to damage the valve. The catheter system was passed through the rabbits’ tricuspid valves under echocardiographic guidance. A pressure transducer was used to assess right atrial pressure (PRA) before and just after valvular damage to calculate the pressure alterations (?PRA). The animals in group A and B were divided into 3 subgroups according to the ?PRA (0–5 mmHg for Groups A1 and B1; 5–10 mmHg for Groups A2 and B2; 10–15 mmHg for Groups A3 and B3). Staphylococcus aureus (ATCC 29213) inoculation was performed 24 hr after cardiac catheterization. Results Faint IE was confirmed in 20%, 93.3%, 26.7%, 6.7%, 20%, and 33.3% of the rabbits in Groups A1, A2, A3, B1, B2, and B3, respectively. There was no difference in the LV/RV ratio and VTR of the No-IE, faint-IE, and severe IE animals. Faint IE rabbits had a larger ?PRA than No-IE rabbits (7.81?±?1.21 vs. 2.48?±?1.0, P?0.01, for Group A; 7.60?±?1.32 vs. 2.98?±?1.08, P?0.01, for Group B). The ?PRA of severe IE and faint IE rabbits was significantly different (13.11?±?1.31 vs. 7.81?±?1.21, P?0.01, for Group A; 12.73?±?1.44 vs.7.60?±?1.32, P?0.01, for Group B). Conclusion ?PRA could be used to assess valvular impairment. Controlling the value of ?PRA during catheterization and inoculating of an appropriate dose of bacteria was associated with a successful IE model.
Objective Critically ill patients supported with extracorporeal membrane oxygenation (ECMO) are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one ICU to another. No studies to date have systematically evaluated intra-hospital transport (IHT) while on ECMO. This study aims to evaluate indications, process, interventions, and effectiveness of patients undergoing IHT. Design Retrospective cohort analysis. Setting Cardiac intensive care unit in a tertiary care children's hospital. Patients All patients requiring IHT while on ECMO between January 1996 and March 2007 were included and analyzed in detail. Measurement and Main Results A total of 57 IHTs for cardiac catheterization (CC) and head CT scans were analyzed. In 14/20 (70%) of CC patients, a management change occurred as a result of the diagnostic CC. In 10/17 (59%) bedside echo was of limited value in defining the critical problem. In the interventional group the majority of transports were for atrial septostomy. In the head CT group significant pathology was identified, which led to management change. No major complications occurred during these IHTs. Conclusions IHT while on ECMO is labor intensive and requiring extensive logistic support, it can be carried out safely in experienced hands and results in important therapeutic and diagnostic yields. To our knowledge this is the first study designed to evaluate safety and efficacy of IHT for patients receiving ECMO support.
Prodhan, Parthak; Fiser, Richard T; Cenac, Sophia; Bhutta, Adnan T; Fontenot, Eudice; Moss, Michelle; Schexnayder, Stephen; Seib, Paul; Chipman, Carl; Weygandt, Lauren; Imamura, Michiaki; Jaquiss, Robert DB; Dyamenahalli, Umesh
Urine (U) and serum (S) were obtained every 2 hours during a 12- or 24-hour period from eight healthy 96-hour-old pony or horse foals. Dams' milk samples were obtained concurrently. Urine volume was measured during this 12- or 24-hour period. The mean amount of urine produced was 148 +/- 20 ml/kg/day. Baseline urinalyses were evaluated on all foals at two days of age, before any manipulation. Urine generally was dilute (less than 1.008) but the specific gravity was as high as 1.027 in one normal foal. Continuous (12 or 24 hour) urinary catheterization resulted in bacteriuria but not white blood cells in the urine. Prolonged catheterization did not cause foals to become febrile or exhibit clinical signs of cystitis or other illness. Urinary electrolyte excretion, urinary electrolyte clearances, and fractional electrolyte excretions (FE) were measured. When compared with normal values reported in adult horses, excretion, clearance, and FE were similar for sodium (Na) but higher for potassium (K), phosphorus (P), and calcium (Ca). There were no significant differences between data collected during different time periods, and it was concluded that the use of single sample urine/serum estimates of fractional excretion in the neonatal foal was an appropriate indicator of the renal handling of electrolytes, and when viewed in conjunction with urinalysis and other serum parameters, a valuable aid to evaluating renal function. PMID:1673477
Brewer, B D; Clement, S F; Lotz, W S; Gronwall, R
EMAP has traditionally relied on indicators of ecological condition to report on the extent to which coastal waters are impaired. Correlations between biological indicators and physical or chemical indicators may generate hypotheses about potential causes of impairment but are n...
Reports on an effort to develop indicators for vocational education. Recommendations include (1) the process of indicator development must be continuous; (2) the need for both reflective thought and experience is important to indicator development; and (3) some of the indicators must be pushed to the stage of actual use. (Author/CT)
Scholl, Steve; Copa, George H.
Ecologists have proposed hundreds of quantitative indicators of the status of ecosystems for evaluation of and reporting on the status of marine ecosystems. The talk applies a common approach to classifying indicators, summarises the main properties of each class of indicator, and provides some illustrations.Indicators of ecosystem status have roles in both communication and decision support. For both roles, strengths
ENTRI is an international, collaborative effort hosted by the Consortium for International Earth Science Information Network (CIESIN) charged with providing "information about environmental treaties and national resource indicators." These treaties are organized into nine issue areas which cover land use change and desertification, transboundary air pollution, and trade and the environment, among others. Treaties can be searched or browsed. Free text searching of the treaties and treaty summaries is also available.
Effect of intermittent urethral catheterization and oxybutynin bladder instillation on urinary continence status and quality of life in a selected group of spinal cord injury patients with neuropathic bladder dysfunction
Objectives: A comparative assessment of (i) urinary continence status, (ii) quality of life, and (iii) sexuality in spinal cord injury patients prior to, and during intermittent catheterization with adjunctive intravesical oxybutynin therapy (Cystin: manufactured by Leiras Oy, Helsinki, Finland).Setting: A hospital, and community-based study of selected adult, male, spinal cord injury patients registered with the Regional Spinal Injuries Centre, Southport.Patients:
S Vaidyananthan; B M Soni; E Brown; P Sett; K R Krishnan; J Bingley; S Markey; S Vaidyanathan
The acute glycemic effects of concentrated dietary fibers (DF) versus whole-grain rye were studied in porto-arterial catheterized pigs. Two white wheat breads with wheat arabinoxylan (AX) or oat ?-glucan (BG), two rye breads with intact rye kernels (RK) or milled rye (GR), and a low DF white wheat bread were fed to six pigs in a randomized crossover design. Blood profiles were collected for 4 h after feeding. Glucose absorption was reduced in pigs fed the AX bread at 60 min postprandial (3.1 mmol/min for AX compared to 9.4 mmol/min for WF, P = 0.02) and insulin secretion was lowered at 30 min postprandial for AX and GR (74.4 and 129 pmol/min for AX and GR, respectively, compared to 738 pmol/min for WF, P < 0.04). In conclusion, the GR and AX breads were most effective in improving insulin economy, suggesting that arabinoxylan from wheat and rye induces similar outcomes in the metabolic response. PMID:23919413
Christensen, Kirstine L; Hedemann, Mette S; Lærke, Helle N; Jørgensen, Henry; Mutt, Shivaprakash J; Herzig, Karl-Heinz; Bach Knudsen, Knud E
The utility of ergonovine testing for coronary artery spasm was assessed in 3,447 patients with angiographically insignificant (less than 50% diameter stenosis) or no coronary artery disease. No patients clinically had Prinzmetal's variant angina. Overall, 4% had a positive ergonovine test result, defined by spasm causing greater than or equal to 75% focal stenosis. Complications related to ergonovine use occurred in 11 patients (0.03%). In a training sample of 1,136 patients (studied between 1980 and 1984), two independent predictors of spasm were found by using multivariate analysis: the amount of visible coronary artery disease on the coronary angiogram (p less than 0.0001) and a smoking history (p = 0.001). A model to predict spasm based on these variables was validated in a test group of 2,311 patients who received ergonovine from 1985 to 1989. This model allowed the identification of a subset of 400 patients in the validation sample who had a 10% positive test rate compared with a 2% positive test rate in the remaining patients. These results should permit clinicians who use provocative testing in the catheterization laboratory to reserve testing for the subset of this group of patients most likely to have abnormal findings. PMID:1607510
Harding, M B; Leithe, M E; Mark, D B; Nelson, C L; Harrison, J K; Hermiller, J B; Davidson, C J; Pryor, D B; Bashore, T M
The Ecological Indicator Program in NERL is developing indicators for two key purposes. The first is to characterize the biological condition of shallow streams and large rivers. The second is to develop diagnostic indicators to evaluate the causes of impairment to these commun...
This letter presents a systematic approach that composes network congestion warning indices and lights of given power service areas. Based on typical power system analysis methods and engineering judgments, a set of indices and congestion severity measures were developed. The composite indices include the normal condition margin index and the contingency margin index, and each includes three measures with corresponding
T. Y. Hsiao; C. N. Lu; Edwin Liu
An on-line indicator connected to each fuse of an electrical circuit includes an LED which becomes illuminated if its protected fuse blows. Groups of these on-line indicators can be connected via on OR gate to a single master fuse status indicator which a...
Landscape ecology deals with the patterning of ecosystems in space. Methods are needed to quantify aspects of spatial pattern that can be correlated with ecological processes. The present paper develops three indices of pattern derived from information theory and fractal geometry. Using digitized maps, the indices are calculated for 94 quadrangles covering most of the eastern United States. The indices
R. V. O'Neillr; J. R. Krummel; R. H. Gardner; G. Sugihara; B. Jackson; D. L. DeAngelist; B. T. Milne; M. G. Turner; B. Zygmunt; S. W. Christensen; V. H. Dale; R. L. Graham
In this report the National Science Board presents the second step in the process begun with Science Indicators--1972 of developing indicators of the state of science in the United States. The goal of this effort is a periodical series of indices of the strengths and weaknesses of science and technology in the United States and the changing…
National Science Foundation, Washington, DC. National Science Board.
Context: Ultrasound-guided internal jugular vein (IJV) cannulation is known for increasing success rate and decreasing rate of complications. The ultrasound image can be used as a real time image during cannulation or to prelocate the IJV before attempting cannulation. Aims: This study compares both the ultrasound-guided technique with the classical anatomical landmark technique (central approach) for right IJV cannulation in terms of success rate, complications, and time for cannulation. Settings and Design: A prospective, randomized, observational study was conducted at a tertiary care hospital. Material and Methods: One hundred twenty patients requiring IJV cannulation were included in this study and were randomly allocated in three groups. Number of attempts, success rate, venous access time, catheterization time, and complications were observed in each group. Statistical Analysis Used: Statistical analysis was performed using STATA-9 software. Demographic data were compared using one-way analysis of variance (ANOVA). Nonparametric data were compared using the Kruskall–Wallis test, and multiple comparisons were done applying The Mann–Whitney test for individual pairs of groups. Nominal data were compared by applying the Chi-square test and Fisher exact test. Results: Successful cannulation (?3 attempt) was achieved in 90.83% of patients without any statistical significant difference between the groups. Venous access time and catheterization time was found to be significantly less in both the ultrasound groups than the anatomical land mark group. Number of attempts and success in first attempt was similar between the groups. Conclusions: Both the ultrasound techniques are found to be better than the anatomical landmark technique. Further, ultrasound-guided prelocation was found to be as effective as ultrasound guided real-time imaging technique for right IJV cannulation.
Ray, Bikash R; Mohan, Virender K; Kashyap, Lokesh; Shende, Dilip; Darlong, Vanlal M; Pandey, Ravindra K
A series of Energy Conservation Indicators were developed for the Department of Energy to assist in the evaluation of current and proposed conservation strategies. As descriptive statistics that signify current conditions and trends related to efficiency of energy use, indicators provide a way of measuring, monitoring, or inferring actual responses by consumers in markets for energy services. Related sets of indicators are presented in some 30 one-page indicator summaries. Indicators are shown graphically, followed by several paragraphs that explain their derivation and highlight key findings. Indicators are classified according to broad end-use sectors: Aggregate (economy), Residential, Commercial, Industrial, and transportation. In most cases annual time series information is presented covering the period 1960 through 1981.
Light flashes on to indicate high current. Simple, inexpensive display circuit indicates when 3,000-A welding current flows in welding gun. Onset of welding current induces voltage and current in 1,000-turn, 28-gauge copper-wire coil. Single-transistor amplifier amplifies induced current, energizing light-emitting diode (LED) connected to collector of transistor. Light from LED gives simple, direct indication of welding current.
Hensley, Milton C.; Huston, Steven W.; Kroy, Ralph E.
This report is an attempt at a new method of coating the surface of the cylinder with materials that undergo chemical change at definite temperatures as indicated by a change in color. In this way it was hoped that the substance itself would indicate directly the position of its isotherms, which in measurements with thermocouples requires a tedious amount of labor.
Surveyed students, faculty, administrative staff, governing board, and employers affiliated with a public two-year college to determine their perceptions of various quality indicators and congruence between the groups. Found that all groups placed importance on indicators of customer satisfaction and skill development; beyond that, considerable…
Cleary, Thomas S.
This report is a product of the implementation of a quality indicator system for Colorado's public higher education system. In 1999, the Colorado Commission on Higher Education established a core set of nine indicators, for which data were gathered and benchmarks were identified for measuring performance in terms of these benchmarks. The first…
Colorado Commission on Higher Education, Denver.
The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas.
Control, Center F.
Covering roughly half of the basin landmass, forests are a vital inland component of the Great Lakes basin ecosystem. Adding forest indicators to the SOLEC suite has been a priority in recent years, and SOLEC 2004 will be marked by the submission of data on the first three indicators of forest health. Healthy forests are crucial to maintaining and restoring
This report provides a compilation of indicators of school readiness used in national, state, and local surveys in the United States, delineating the advantages and disadvantages for each indicator. The report begins with a legend to assist in interpreting the tables and includes contact information for national and state surveys. The remainder of…
Calkins, Julia; Ling, Thomson; Moore, Eric; Halle, Tamara; Hair, Beth; Moore, Kris; Zaslow, Marty
A retractable indicator assembly may be mounted on a container which transmits air through the container and removes deleterious gases with an activated charcoal medium in the container. The assembly includes: an elongate indicator housing has a chamber therein; a male adaptor with an external threads is used for sealing engagement with the container; a plug located at the upper end of the housing; a housing that includes a transparent wall portion for viewing at least a portion of the chamber; a litmus indicator, moveable by a retractable rod from a retracted position within the container to an extended position within the chamber of the housing; and an outer housing that is secured to the upper end of the rod, and protects the indicator housing while the litmus indicator is in its normally retracted position. The assembly may be manually manipulated between its extended position wherein the litmus indicator may be viewed through the transparent wall of the indicator housing, and a retracted position wherein the outer housing encloses the indicator housing and engages the exterior of the container.
Hackler, George R. (Inventor); Gamboa, Ronald J. (Inventor); Dominquez, Victor (Inventor)
Describes the use of an indicator made from the pigment in red cabbage. Cabbage is grated then soaked in water. When the water is a strong red, the cabbage is strained out. The cabbage-juice indicator is then used to test for acids and bases. Includes a list of good foods to test for acidity and alkalinity. (PVD)
In this report the National Science Board presents the first results from a newly initiated effort to develop indicators of the state of the scientific enterprise in the Unite States. The ultimate goal of this effort is a set of indices which will reveal the strengths and weaknesses of U.S. science and technology, in terms of the capacity and…
National Science Foundation, Washington, DC. National Science Board.
Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial).
The treatment of calcified coronary lesions by percutaneous coronary intervention has been shown to be associated with poor outcomes and an increased rate of complications. However, the impact of coronary calcification in patients undergoing coronary artery bypass grafting (CABG) is unknown. A total of 755 patients presenting with acute coronary syndrome in the Acute Catheterization and Urgent Intervention Triage Strategy trial underwent CABG. Patients were divided into 3 groups according to the presence and extent of coronary calcifications (lesion level: severe, moderate, none to mild) as assessed by an independent angiographic core laboratory. Major ischemic and bleeding outcomes were assessed at 30 days and 1 year. Severe calcification was found in 103 patients (13.6%), moderate calcification in 249 patients (33.0%), and none-to-mild calcification in 403 patients (53.4%). The presence of severe calcification compared with moderate or none to mild was associated with a significantly higher unadjusted rate of death (11.8% vs 3.7% vs 4.5%, p = 0.006), death or myocardial infarction (MI; 31.1% vs 19.7% vs 16.4%, p = 0.006), and major adverse cardiac event (MACE; 32.0% vs 22.6% vs 20.8%, p = 0.059) at 1 year. By multivariate analysis, severe calcification (vs nonsevere calcification) was identified as an independent predictor of 1-year MACE (hazard ratio 1.49, 95% confidence interval 1.01 to 2.21, p = 0.04) and death or MI (hazard ratio 1.77, 95% confidence interval 1.18 to 2.66, p = 0.006). In conclusion, the presence of severe coronary calcification was associated with worse outcomes after CABG, including an increased risk of death. The presence of severe coronary calcification was identified as an independent predictor of MACE and death or MI 1 year after CABG. PMID:24012035
Ertelt, Konstanze; Généreux, Philippe; Mintz, Gary S; Reiss, George R; Kirtane, Ajay J; Madhavan, Mahesh V; Fahy, Martin; Williams, Mathew R; Brener, Sorin J; Mehran, Roxana; Stone, Gregg W
Reducing door-to-balloon (D + B) time during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) reduces mortality. Prehospital 12-lead electrocadiography (ECG) with cardiac catheterization laboratory (CCL) activation may reduce D + B time. Paramedic-performed ECG was initiated in the city of San Diego in January 2005 with STEMI diagnosis based on an automated computer algorithm. We undertook this study to determine the effect of prehospital CCL activation on D + B time for patients with acute STEMI brought to our institution. All data were prospectively collected for patients with STEMI including times to treatment and clinical outcomes. We evaluated 78 consecutive patients with STEMI from January 2005 to June 2006, and the study group consisted of all patients with prehospital activation of the CCL (field STEMI; n = 20). The control groups included concurrently-treated patients with STEMI during the same period who presented to the emergency department (nonfield STEMI; n = 28), and all patients with STEMI treated in the preceding year (2004) (historical STEMI; n = 30). Prehospital CCL activation significantly reduced D + B time (73 +/- 19 minutes field STEMI, 130 +/- 66 minutes nonfield STEMI, 141 +/- 49 minutes historical STEMI; p <0.001) with significant reductions in door-to-CCL and CCL-to-balloon times as well. The majority of patients with field STEMI achieved D + B times of <90 minutes (80% field STEMI, 25% nonfield STEMI, 10% historical STEMI; p <0.001). In conclusion, this study demonstrates that prehospital electrocardiographic diagnosis of STEMI with activation of the CCL markedly reduces D + B time. PMID:18178399
Brown, Jason P; Mahmud, Ehtisham; Dunford, James V; Ben-Yehuda, Ori
The addition of whole-breast external beam radiotherapy (EBRT) to breast-conserving surgery results in a significant reduction in the risk of death due to breast cancer, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Because of this, and with a view to patterns of local recurrence, irradiation of the tumour bed has been explored in selected patients with early breast cancer using a variety of radiotherapeutic modalities. This review article explores the treatment options for partial breast irradiation and examines their role within the field of breast cancer treatment.
Stewart, A J; Khan, A J; Devlin, P M
Endoleaks after endovascular aortic repair (EVAR) are a common cause of treatment failure and secondary interventions. Endoleak classification is important to determine both prognosis as well as need for treatment. With increasingly complex endovascular aortic procedures, endoleak classification according to the original classification has become more difficult. A classification into direct and indirect endoleaks as well as precise anatomical description is often more pragmatic. This manuscript outlines mechanisms of endoleak formation and their treatment. PMID:24796903
Törnqvist, P; Resch, T
Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has\\u000a been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery\\u000a as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained\\u000a complete and long-term relief from pain by the less invasive endoscopic treatment.
Morihisa Hirota; Tooru Asakura; Atsushi Kanno; Tooru Shimosegawa
Summary In a child undergoing combined transarterial and direct percutaneous puncture embolization of an extensive and complex facial arteriovenous malformation, severe arterial spasm fixed a flow-directed microcatheter in an ethmoidal branch of the left ophthalmic artery. Multiple traction attempts failed to remove the microcatheter. After catheterization of the distal, post central retinal artery part of the same ophthalmic artery, with a second flow-directed microcatheter and following intraarterial papaverine injection through this second microcatheter, the fixed microcatheter could be removed without complication. This case demonstrates a technique that can be attempted before deciding to leave the microcatheter in the patient or to remove it surgically.
Celedin, S.; Song, J.K.; Valavanis, A.
In this chemistry activity, learners make indicator solution from red cabbage. Then, learners test everyday foods and household substances using the cabbage juice indicator. Learners will record the color change, approximate pH (using the pH scale), and identify if it is an acid or base. As an extension, learners can make pH paper strips to conduct an "at home" pH test of other household items. The indicator solution can be frozen in ice trays and when mixed with alcohol, can last for months. For safety reasons, adult supervision is recommended.
House, The S.
World Development Indicators 2011, the 15th edition in its current format, aims to provide relevant, high-quality, internationally comparable statistics about development and the quality of peoples lives around the globe. This edition of World Development...
World Development Indicators 2012 is a compilation of relevant, high-quality, and internationally comparable statistics about development and the quality of peoples lives. Organized around six themesworld view, people, the environment, the economy, states...
Sustainability is about preserving human existence. Indicators and metrics are absolutely necessary to provide at least a semi-quantitative assessment of progress towards or away from sustainability. Otherwise, it becomes impossible to objectively assess whether progress is bei...
Environmental Public Health Indicators (EPHIs), quantitative measures of health factors and environmental influences tracked over time, can be used to identify specific areas and populations for intervention and prevention efforts and to evaluate the outcomes of implemented polic...
Objective: Carinal resection is the most complicated procedure in tracheobronchial surgery. The main aspects of the technique are still debated at the present time. We present our experience of 231 carinal resections with analysis of operative techniques, complications and long-term survival. Methods: Since 1979 we have performed 231 carinal resections. Indications for surgery included lung cancer in 151 cases (65.4%),
Vladimir A. Porhanov; Igor S. Poliakov; Andrew P. Selvaschuk; Anatoly I. Grechishkin; Sergei D. Sitnik; Igor F. Nikolaev; Jury P. Efimtsev; Leonid G. Marchenko
Participants in the workshop session were actively engaged in a hands-on, minds-on approach to learning about indicators and evaluation processes. The six hour session was broken down into three two hour sessions. Each session was built upon an instructional model which moved from general understanding to specific IITA application. Examples and practice exercises served to demonstrate tand reinforce the workshop concepts. Each successive session built upon the previous session and addressed the major steps in the evaluation process. The major steps covered in the workshop included: project descriptions, writing goals and objectives for categories, determining indicators and indicator systems for specific projects, and methods and issues of data collection. The workshop served as a baseline upon which the field centers will build during the summer in undertaking a comprehensive examination and evaluation of their existing K-12 education projects.
Canright, Shelley; Grabowski, Barbara
One of the most intractable problems in international health research is the lack of comparability of health measures across countries or cultures. We develop a cross-country measurement model for health, in which functional limitations, self-reports of health, and a physical measure are interrelated to construct health indices. To establish comparability across countries, we define the measurement scales by the physical measure while other parameters vary by country to reflect cultural and linguistic differences in response patterns. We find significant cross-country variation in response styles of health reports along with variability in genuine health that is related to differences in national income. Our health indices achieve satisfactory reliability of about 80% and their gradients by age, income, and wealth for the most part show the expected patterns. Moreover, the health indices correlate much more strongly with income and net worth than self-reported health measures. PMID:20572201
Meijer, Erik; Kapteyn, Arie; Andreyeva, Tatiana
One of the most intractable problems in international health research is the lack of comparability of health measures across countries or cultures. We develop a cross-country measurement model for health in which functional limitations, self-reports of health, and a physical measure are interrelated to construct health indices. To establish comparability across countries, we define the measurement scales by the physical measure while other parameters vary by country to reflect cultural and linguistic differences in response patterns. We find significant cross-country variation in response styles of health reports along with variability in genuine health that is related to differences in national income. Our health indices achieve satisfactory reliability of about 80% and their gradients by age, income, and wealth for the most part show the expected patterns. Moreover, the health indices correlate much more strongly with income and net worth than self reported health measures.
Meijer, Erik; Kapteyn, Arie; Andreyeva, Tatiana
Background In select patient populations, Doppler echocardiographic indices may be used to estimate left sided filling pressures. It is not known, however, whether changes in these indices track changes in left-sided filling pressures within individual healthy subjects or patients with heart failure with preserved ejection fraction (HFpEF). This knowledge is important as it would support, or refute, the serial use of these indices to estimate changes in filling pressures associated with the titration of medical therapy in patients with heart failure. Methods and Results Forty seven volunteers were enrolled: 11 highly screened elderly outpatients with a clear diagnosis of HFpEF, 24 healthy elderly subjects and 12 healthy young subjects. Each patient underwent right heart catheterization with simultaneous transthoracic echo. Pulmonary capillary wedge pressure (PCWP) and key echo indices (E/e’ & E/Vp) were measured at two baselines and during four preload altering maneuvers: lower body negative pressure (LBNP) -15 mmHg; LBNP -30 mmHg; rapid saline infusion of 10-15 ml/kg; and rapid saline infusion of 20-30 ml/kg. A random coefficient mixed model regression of PCWP vs. E/e’ and PCWP vs. E/Vp was performed for: 1) a composite of all data points; 2) a composite of all data points within each of the three groups. Linear regression analysis was performed for individual subjects. With this protocol, PCWP was manipulated from 0.8 to 28.8 mmHg. For E/e’, the composite random effects mixed model regression was PCWP = 0.58×E/e’+7.02 (p<0.001) confirming the weak but significant relationship between these two variables. Individual subject linear regression slopes (range: -6.76 to 11.03) and r2 (0.00 to 0.94) were highly variable and often very different than those derived for the composite and group regressions. For E/Vp, the composite random coefficient mixed model regression was PCWP = 1.95×E/Vp +7.48 (p=0.005); once again, individual subject linear regression slopes (range: -16.42 to 25.39) and r2 (range: 0.02 to 0.94) were highly variable and often very different than those derived for the composite and group regressions. Conclusions Within individual subjects the non-invasive indices E/e’ and E/Vp do not reliably track changes in left-sided filling pressures as these pressures vary, precluding the use of these techniques in research studies with healthy volunteers or the titration of medical therapy in patients with HFpEF.
Bhella, Paul S.; Pacini, Eric L.; Prasad, Anand; Hastings, Jeffrey L.; Adams-Huett, Beverley; Thomas, James D.; Grayburn, Paul A.; Levine, Benjamin D.
This volume is the ninth in the biennial "Science Indicators" series initiated by the National Science Board. The series provides a broad base of quantitative information about the structure and function of United States science and technology and comparisons with other advanced industrial countries. An overview of science and technology for the…
National Science Foundation, Washington, DC. National Science Board.
In this activity on page 2 of the PDF, learners discover how color changes can help scientists distinguish between acids and bases. Learners create colorful rainbow trout artwork using universal indicator solution and various household liquids. Safety note: learners must wear safety goggles.
Society, American C.
In the Human Development Index (HDI), life expectancy is the only indicator used in modeling the dimension "a long and healthy life". Whereas life expectancy is a direct measure of quantity of life, it is only an indirect measure of healthy years lived. In this paper we attempt to remedy this omission by introducing into the HDI the morbidity…
Engineer, Merwan; Roy, Nilanjana; Fink, Sari
Quality of life is considered to be a function of biophysical, environmental and social conditions. No system of quality of life indicators has been developed as yet, however some progress has been made lately to this end. Methods appropriate for designing quality ot life indexes are suggested in this paper. Such indexes could be used to evaluate different quality of
John C. Papageorgiou
Transfer of dye shows quality of contact between two mating parts. Mating parts checked for fit by spreading fluorescent dye on one, making brief light contact with other, and looking (under UV light) for transferred dye. Dye offers greater visibility under ultraviolet illumination, allowing better indication of how precisely parts match and what areas interfere.
Barns, C. E.; Gilbaugh, B. L.; Gin, B.; Holt, W. L.; Lesak, P.; Mancini, R.; Spencer, H. F.
Microdeletions in chromosome 22q11.2 are associated with DiGeorge syndrome (DGS), velo-cardio-facial syndrome (VCFS), and\\u000a several other syndromes, collectively referred to as DG\\/VCF. Non-dysmorphic patients with cardiac defects have also been attributed\\u000a to deletions in this chromosomal region. In this study 157 consecutively catheterized patients with isolated, non-syndromic\\u000a cardiac defects, and 25 patients with cardiac defects and additional stigmata (10 of
S. Borgmann; I. Luhmer; M. Arslan-Kirchner; H.-C. Kallfelz; J. Schmidtke
A system and method for indication of temperature exposures beyond a set of predetermined limits employs the salts of weak acid-strong base or of a strong acid-weak base compound as reactants. A device includes a housing and capsule. A first reactant and a liquid are included within the capsule. The liquid is chosen such that it expands upon freezing. The capsule is sized such that when the liquid freezes and expands, the capsule fractures. A second reactant is provided within the housing. The location of the second reactant and the method of attaching (if any) the second reactant to the housing may take various forms. When the liquid within the capsule freezes, it expands and fractures the capsule. Upon thawing, the reactant within the capsule escapes and mixes with the reactant located outside the capsule. A second embodiment is a time-temperature indicator. A flexible housing is used, allowing the user to manually deform the housing to fracture a capsule enclosed therein. The reactants combine to produce a color. The color is chosen to be a different color than the housing, allowing a person viewing the indicator device to quickly and easily determine the status of the object being monitored. The threshold temperature at which the device will indicate a changed condition may be varied. Exemplary temperatures include below the freezing temperature, at the freezing temperature, and above the freezing temperature. The capsule composition may be varied such that it melts at a predetermined temperature. Thus, the device may also be used to indicate whether a high temperature has been met or exceeded.
Erythropoietin (EPO) is the principal haematopoietic growth factor of the red blood cell line. Its major role is to stimulate the red blood cell production. EPO synthesis by peritubular cells in the kidney is regulated by oxygen concentration and must lead adaptation of the organism to face many different physiological situations. An imbalance can lead either to anaemia or polycythemia. Synthetic EPO, so-called recombinant, has definitively changed the treatment in the anaemia of chronic renal failure and regularly find new indications, legal (anaemia of cancer, anaemia of chronic inflammatory syndromes, myelodysplastic syndromes, neurology, cardiology...) or illegal (doping substance in sport). This article reviews the physiology, the role and the indications of EPO in clinical routine practice and define why and how EPO should be measured. We also focus on the analytical requirements for serum EPO concentration determination, especially in the differential diagnosis of polycythemias (secondary polycythemia/Polycythemia Vera). PMID:19789122
Klein, E; Georges, A; Brossaud, J; Bosredon, K de; Bordenave, L; Corcuff, J-B
There is disclosed a tamper-indicating seal that permits in the field inspection and detection of tampering. Said seal comprises a shrinkable tube having a visible pattern of markings which is shrunk over the item to be sealed, and a second transparent tube, having a second visible marking pattern, which is shrunk over the item and the first tube. The relationship between the first and second set of markings produces a pattern so that the seal may not be removed without detection.
Fiarman, Sidney (Port Jefferson, NY); Degen, Michael F. (Patchogue, NY); Peters, Henry F. (Brookhaven, NY)
Ferrofluidic device indicates point of highest magnetic-flux density in workspace. Consists of bubble of ferrofluid in immiscible liquid carrier in clear plastic case. Used in flat block or tube. Axes of centering circle on flat-block version used to mark location of maximum flux density when bubble in circle. Device used to find point on wall corresponding to known point on opposite side of wall.
Stegman, Thomas W.
Fifth-grade students use homemade plant-based acid/base indicators to learn about matter at an age-appropriate level and develop process skills. As a result of completing this lesson sequence the students should be able to perform many tasks using process skills such as observing chemical changes; identifying acids and bases by performing tests; classifying common household substances as acidic, basic (alkaline), or neutral; and developing a scheme for solving a performance-based scenario.
Townsend, Jeffery; Bunton, Kim
There is disclosed a tamper-indicating seal that permits in the field inspection and detection of tampering. Said seal comprises a shrinkable tube having a visible pattern of markings which is shrunk over th item to be sealed, and a second transparent tube, having a second visible marking pattern, which is shrunk over the item and the first tube. The relationship between the first and second set of markings produces a pattern so that the seal may not be removed without detection. The seal is particularly applicable to UF/sub 6/ cylinder valves.
Fiarman, S.; Degen, M.F.; Peters, H.F.
Prevalence studies generally find nosocomial urinary tract infections to be the most common type of nosocomial infection, accounting for between 21% and 45% of all HAIs. The main risk factor appears to be the presence of a urinary catheter, with an estimated 80% of these infections being associated with their use. This paper describes a model which quantifies the extent of the burden of these infections in terms of the number of patients affected and the costs incurred by the hospital sector; and identifies the potential benefits of the routine use of silver alloy coated catheters, as a means of reducing the incidence of this type of infection. An illustrative model of the annual costs and benefits associated with the routine use of this intervention in adult, non-day case patients admitted to the medical and surgical specialties of NHS hospitals throughout England is presented. The results suggest that a 14.6% reduction in the incidence of urinary tract infections in catheterized medical patients, and a 11.4% reduction in catheterized surgical patients, would cover the cost of the intervention. Any further reduction in incidence would result in net positive benefits. PMID:11358469
Plowman, R; Graves, N; Esquivel, J; Roberts, J A
Bandwidth efficient digital modulation techniques, proposed for use on and/or applied to satellite channels, are reviewed. In a survey of recent works on digital modulation techniques, the performance of several schemes operating in various environments are compared. Topics covered include: (1) quadrature phase shift keying; (2) offset - QPSK and MSK; (3) combined modulation and coding; and (4) spectrally efficient modulation techniques.
Schilling, D. L.
The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm. PMID:22737303
Park, Hye-Ran; Yoon, Seok-Mann; Shim, Jai-Joon; Kim, Sung-Ho
The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.
Park, Hye-Ran; Shim, Jai-Joon; Kim, Sung-Ho
Data on international energy indicators were tabulated and graphically represented. The following data are presented: world crude oil production, 1974 to October 1981; OPEC crude oil productive capacity; world crude oil and refined product inventory levels, 1975 to October, 1981; oil consumption in OECD countries, 1975 to October 1981; USSR crude oil production and exports, 1975 to October 1981; free world and US nuclear electricity generation, 1973 to December, 1981 and current capacity. Specific US data presented are: US domestic oil supply, 1977 to June, 1981; US gross imports of crude oil and products, 1973 to October, 1981; landed cost of Saudi crude current and 1974 dollars; US coal trade, 1975 to September, 1981; US natural gas trade, 1981; and energy/GNP ratio.
Rossi, E., Jr.
The 1980s and 90s have seen the proliferation of all forms of performance indicators as part of attempts to command and control health services. The latest area to receive attention is health outcomes. Published league tables of mortality and other health outcomes have been available in the United States for some time and in Scotland since the early 1990s; they have now been developed for England and Wales. Publication of these data has proceeded despite warnings as to their limited meaningfulness and usefulness. The time has come to ask whether the remedy is worse than the malady: are published health outcomes contributing to quality efforts or subverting more constructive approaches? This paper argues that attempts to force improvements through publishing health outcomes can be counterproductive, and outlines an alternative approach which involves fostering greater trust in professionalism as a basis for quality enhancements.
Davies, H. T.; Lampel, J.
Clozapine does not constitute a first-line treatment due to the occurrence of agranulocytosis. However, the benefit risk/ratio fully justifies its use in two situations: resistance to neuroleptics, intolerance to neuroleptics. There are no internationally recognized objective criteria to define resistance. The ones defined in the well-restricted methodological environment of a clinical trial are generally not applicable to daily practice. In particular, the accepted criteria do not always take into account the personal factors, the social and environmental context and rehabilitation programs. May et al. for example defined in 1988 the degree of response to therapy based on clinical improvement as well as social integration. It is widely recognized that if the severity of residual symptoms (grade 5 response) requires the hospitalization, treatment with clozapine is warranted. For partial responders to classical treatment (grade 4 response) who could benefit from clozapine, the risk ratio of clozapine needs to be further evaluated. The identification of predictive factors of response to therapy would allow a novel approach of this indication. According to certain authors, paranoid type responds best to therapy. However, the evidence collected to date needs to be confirmed. In particular, the effects of clozapine on predominantly negative symptoms require further investigations. In contrast to several european studies, intolerance to neuroleptics is rarely a reason for initiation of clozapine therapy. This would indicate that the appreciation of intolerance to neuroleptics notably varies from one country to the next. Intolerance criteria need to be further specified as well as the benefit risk/ratio.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1339759
Since 1995, KNMI published a series of books(1), presenting an annual reconstruction of weather and climate in the Low Countries, covering the period AD 763-present, or roughly, the last millennium. The reconstructions are based on the interpretation of documentary sources predominantly and comparison with other proxies and instrumental observations. The series also comprises a number of classifications. Amongst them annual classifications for winter and summer temperature and for winter and summer dryness-wetness. The classification of temperature have been reworked into peer reviewed (2) series (AD 1000-present) of seasonal temperatures and temperature indices, the so called LCT (Low Countries Temperature) series, now incorporated in the Millennium databases. Recently we started a study to convert the dryness-wetness classifications into a series of precipitation; the so called LCP (Low Countries Precipitation) series. A brief outline is given here of the applied methodology and preliminary results. The WMO definition for meteorological drought has been followed being that a period is called wet respectively dry when the amount of precipitation is considerable more respectively less than usual (normal). To gain a more quantitative insight for four locations, geographically spread over the Low Countries area (De Bilt, Vlissingen, Maastricht and Uccle), we analysed the statistics of daily precipitation series, covering the period 1900-present. This brought us to the following definition, valid for the Low Countries: A period is considered as (very) dry respectively (very) wet if over a continuous period of at least 60 days (~two months) cq 90 days (~three months) on at least two out of the four locations 50% less resp. 50% more than the normal amount for the location (based on the 1961-1990 normal period) has been measured. This results into the following classification into five drought classes hat could be applied to non instrumental observations: Very wet period (+2): Wide scale river flooding, marshy acres and meadows.-Farmers cope with poor harvests of hay, grains, fruit etc. resulting in famines.-Late grape harvests, poor yield quantity and quality of wine. Wet period (+1): High water levels cq discharges of major rivers, tributaries and brooks, local river floodings, marshy acres and meadows in the low lying areas.-Wearisome and hampered agriculture. Normal (0) Dry period (-1): Low water levels cq discharges of major rivers, tributaries and brooks. Some brooks may dry up.-Summer half year: local short of yield of grass, hay and other forage.-Summer half year: moor-, peat- and forest fires. Very dry period (-2): Very low water levels cq discharges of major rivers and tributaries. Brooks and wells dry up. Serious shortage of drinking water; especially in summer.-Major agricultural damage, shortage of water, mortality stock of cattle. Shortage of grain. Flour can not be produced due to water mills running out of water, shortage of bread, bread riots, famines.-Large scale forest and peat areas, resulting in serious air pollution. Town fires. By verifying the historical evidence on these criterions, a series of 5 step indices ranging from very dry to very wet for summer and winter half year of the Low Countries was obtained. Subsequently these indices series were compared with the instrumentally observed seasonal precipitation sums for De Bilt (1735-2008), which is considered to be representative for the Central Netherlands. For winter (Oct-March) and summer half year (Apr.-Sept.) the accumulated precipitation amounts are calculated; these amounts are approximately normally distributed. Based on this distribution, the cumulative frequency distribution is calculated. By tabulating the number of summers in the pre-instrumental period 1201-1750 for each of the drought classes, a distribution is calculated which is then related to the modern accumulated precipitation distribution. Assuming that the accumulated precipitation amount has not been below (above) the mean precipitation minus (plus) three standard deviations for
van Engelen, A. F. V.; Ynsen, F.; Buisman, J.; van der Schrier, G.
We introduce the concept of the ensemble averaging for financial markets. We address the question of equality of ensemble and time averaging in their sequence and investigate if these averagings are equivalent for large amount of equity indices and branches. We start with the model of Gaussian-distributed returns, equal-weighted stocks in each index and absence of correlations within a single day and show that even this oversimplified model captures already the run of the corresponding index reasonably well due to its self-averaging properties. We introduce the concept of the instant cross-sectional volatility and discuss its relation to the ordinary time-resolved counterpart. The role of the cross-sectional volatility for the description of the corresponding index as well as the role of correlations between the single stocks and the role of non-Gaussianity of stock distributions is briefly discussed. Our model reveals quickly and efficiently some anomalies or bubbles in a particular financial market and gives an estimate of how large these effects can be and how quickly they disappear.
Kolesnikov, A. V.; Rühl, T.
First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described.
Dagli, Mandeep; Ramchandani, Parvati
First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described. PMID:23204641
Dagli, Mandeep; Ramchandani, Parvati
This dossier about cogeneration techniques comprises 12 parts dealing successively with: the advantages of cogeneration (examples of installations, electrical and thermal efficiency); the combustion turbine (principle, performances, types); the alternativ...
A few overall indicators of hydrologic alteration are needed to describe the health of a river and the degree of hydrologic alteration caused by various forms of river regulation. Currently over 170 hydrologic indicators have been developed to describe different components of flow regimes. One example is the Indicators of Hydrologic Alteration (IHA), a set of 33 indicators for characterizing
Yongxuan Gao; Richard M. Vogel; Charles N. Kroll; N. LeRoy Poff; Julian D. Olden
Long bone fractures are relatively common in cattle, whether they result from a self-inflicted trauma or from external actors (herd mate or farm machinery). Various advanced orthopedic techniques have been described to stabilize and treat fractures in cattle with success. Unfortunately the use of most of those techniques remains unrealistic in a field setting, rendering the realization of splints and casts still accurate for the treatment of long bone fracture in cattle. This article refers to the use of all external coaptation and their specific indications as well as their limitations. PMID:24534659
Mulon, Pierre-Yves; Desrochers, André
The North Carolina Community College System BioNetwork's interactive eLearning tools (IETs) are reusable chunks of training that can be deployed in a variety of courses or training programs. IETs are designed to enhance, not replace hands-on training. Learners are able to enter a hands-on lab experience better prepared and more confident. This particular IET delves into aseptic technique and how to work under a laminar airflow hood. Using animations, quizzes, games, and a final evaluation, this interactive lesson will help students understand the lab and important techniques for biology technicians.
Using statistic indicators as vectors of information relative to the operational status of a phenomenon, including a religious one, is unanimously accepted. By introducing a system of statistic indicators we can also analyze the interfacing areas of a phenomenon. In this context, we have elaborated a system of statistic indicators specific to the…
Herteliu, Claudiu; Isaic-Maniu, Alexandru
Irrigation Techniques: Water Science for Schools shows how crops are irrigated on a farm and explains why one method might be better than another: flood (furrow) irrigation, drip or spray irrigation. Also described are some things that many farmers do to become more efficent irrigators.
The project consists of two parts, the written text and the videotape. The text describes how the project idea was formulated, the sources of data used, and how the videotape script was developed. The script describes the concept of relaxation techniques,...
With tales of hacked networks and websites being reported by the media daily, people assume that hacking must be easy. But, in truth, the tools and techniques employed by hackers are extremely complex, utilizing a broad range of technologies. The number of mechanisms for breaking into systems, whatever the objective, is on the increase with new tools emerging continuously. This
Theoretical and experimental work on a Universal Indicated Turbulence Meter is described. A mathematical transfer function from turbulence input to output indication was developed. A random ergodic process and a Gaussian turbulence distribution were assumed. A calibration technique based on this transfer function was developed. The computer contains a variable gain amplifier to make the system output independent of average velocity. The range over which this independence holds was determined. An optimum dynamic response was obtained for the tubulation between the system pitot tube and pressure transducer by making dynamic response measurements for orifices of various lengths and diameters at the source end.
Chapin, W. G.
Transit performance can be evaluated through quantitative indicators. As the provision of efficient and effective transit service are appropriate goals to be encouraged by federal and state governments, these goals are used to develop performance indicators.
Gordon J. Fielding; Roy E. Glauthier; Charles A. Lave
A hybrid X-ray and magnetic resonance imaging system (XMR) has been proposed as an interventional guidance for cardiovascular catheterisation procedure. However, very few hospitals can benefit from the XMR system because of its limited availability. In this paper we describe a new guidance strategy for cardiovascular catheterisation procedure. In our technique, intra-operative patient position is estimated by using a chest
Gang Gao; Segolene Tarte; Andy King; Yingliang Ma; Phani Chinchapatnam; Tobias Schaeffter; Reza Razavi; Dave Hawkes; Derek Hill; Kawal Rhode
This page from Foothill-De Anza Community College describes a course on nanoscience for those who need an introduction to the subject. This course is the fifth in a five course series that leads to a certificate in nanoscience, nanotechnology, and nanomaterials engineering. Students will obtain a survey of fabrication techniques as well as "hands-on experience creating thin film materials, and quality control 'shadowing' in a clean energy technology fabrication facility." The projects required by the class are also described.
Sensitive and selective detection techniques are of crucial importance for capillary electrophoresis (CE), microfluidic chips, and other microfluidic systems. Electrochemical detectors have attracted considerable interest for microfluidic systems with features that include high sensitivity, inherent miniaturization of both the detection and control instrumentation, low cost and power demands, and high compatibility with microfabrication technology. The commonly used electrochemical detectors can be classified into three general modes: conductimetry, potentiometry, and amperometry.
Chen, Gang; Lin, Yuehe
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART. PMID:24782010
Huang, Jack Yu Jen; Rosenwaks, Zev
Device locates transient power interruptions occurring in electrical equipment. Indicator operates on principle that circuit in normal use retains residual current in the line prior to an interruption.
Bezant, K. R.
Discusses science/society interface and difficulties involved in developing realistic science indicators. Topics include: intrinsic vs. extrinsic indicators; four problems society faces as a result of technological activities (toxic chemicals, radioactive wastes, auto safety, cancer); research and development (R&D) priorities; international…
This article deals with the interrelation of ecological and economic aspects through the use of indicators. Two aspects are painted out: the first being the measurement of the economic value of ecological services, and the second being the integration of economic aspects into comprehensive indicator systems.The measurement of the economic value provides a means of determining consumer-orientated values of landscapes
Elisabeth Osinski; Jochen Kantelhardt; Alois Heissenhuber
This report discusses the use of performance indicators (PIs) in higher education, focusing on definitions, frameworks, examples, and implications for universities. It notes that demands for accountability have led to intense interest in university performance measures, and that early indicators simply described the university or the system and…
Research File, 1995
EPA's Office of Research and Development (ORD) has prepared fifteen technical guidelines to evaluate the suitability of an ecological indicator in a monitoring program. The guidelines were fashioned to provide a consistent framework for indicator review and to provide guidance fo...
Described as a self-indicating instant radiation dosimeter for monitoring high energy radiations, such as X-ray. The dosimeter contains a radiation sensitive, color changing, indicating composition, e.g., a diacetylene (R--C=C--C=C--R', where R and R' are...
G. N. Patel
0. Abstract The objective of this paper is to analyse the role of sustainability indicators when considered as discursive elements of the sustainability discourse. Sustainability indicators have the particularity of having a scientific-objective appearance, and we argue that this allows their users to link sustainability utterances with the scientific discourse, which is one today’s main sources of legitimacy. Thanks to
The bladder can be denervated at several levels: centrally, at the level of the sacral nerves; peripherally, on the pelvic nerves; or in the bladder, by cutting the relevant structures, by injecting substances toxic to nerves, or by hyperbaric bladder distension. These procedures target the sensory or motor nerves to weaken or to interrupt the detrusor reflex arc. Most of the procedures introduced previously, e.g. bladder trans-section by open operation, endoscopic or transvesical phenolization, hyperbaric bladder distension, and peripheral denervation of the bladder, have now been abandoned. Although some of these techniques had a high initial success rate in abolishing detrusor overactivity and in controlling incontinence, the relapse rate within 18 months approached 100%. In the early 1950s, much of the denervation surgery was performed on sacral roots and nerves. Nowadays, sacral de-afferentiation of the bladder by dorsal sacral root rhizotomy of S2-S5, using specialized techniques, either intradurally or at the conal level, has proved to be a very effective procedure for patients with spinal cord injuries and detrusor hyper-reflexia, functional low compliance and reflex incontinence, which cannot be managed by any other means. In conclusion, although in approximately 90% of patients the symptoms of an overactive bladder will be eliminated or improved by conservative methods of treatment, bladder denervation procedures still have a place in the management of these patients. In particular, with these procedures a low-pressure bladder system can be obtained and urinary continence restored in patients with complete suprasacral spinal cord lesions. PMID:11954191
This paper shows that, when the VIX or VXN indices of implied volatility increase, the S&P100 and NASDAQ100 stock indices exhibit on average negative returns, hence the'fear factor'associated with high levels of implied volatility in financial markets. However, attractive (from a mean-variance perspective) positive returns should then be expected on average in the immediate short-term. In this framework, very high
Little is known of cancer rehabilitation needs in Europe. EUROCHIP-3 organised a group of experts to propose a list of population-based indicators used for describing cancer rehabilitation across Europe. The aim of this study is to present and discuss these indicators. A EUROCHIP-3 expert panel reached agreement on two types of indicators. (a) Cancer prevalence indicators. These were proposed as a means of characterising the burden of cancer rehabilitation needs by time from diagnosis and patient health status. These indicators can be estimated from cancer registry data or by collecting data on follow-up and treatments for samples of cases archived in cancer registries. (b) Indicators of rehabilitation success. These include: return to work, quality of life, and satisfaction of specific rehabilitation needs. Studies can be performed to estimate these indicators in individual countries, but to obtain comparable data across European countries it will be necessary to administer a questionnaire to randomly selected samples of patients from population-based cancer registry databases. However, three factors complicate questionnaire studies: patients may not be aware that they have cancer; incomplete participation in surveys could lead to bias; and national confidentiality laws in some cases prohibit cancer registries from approaching patients. Although these studies are expensive and difficult to perform, but as the number of cancer survivors increases, it is important to document their needs in order to provide information on cancer control. PMID:23237740
Baili, Paolo; Hoekstra-Weebers, Josette; Van Hoof, Elke; Bartsch, Hans Helge; Travado, Luzia; Garami, Miklos; Di Salvo, Francesca; Micheli, Andrea; Veerus, Piret
Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics (AAP) recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks. This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision. These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.
Abdulwahab-Ahmed, Abdullahi; Mungadi, Ismaila A.
The performance characteristics of Irreversible Humidity Indicators were evaluated in a constant temperature/humidity chamber at various combinations of temperature and humidity conditions. The test results revealed significant information on its actuatio...
A. K. Lo
New information display units are examined in this article -- linear gas-discharge indicators (LGI), permitting continuous visual monitoring of parametric variations. Owing to their small dimensions and simplicity of regulation, the LGI can markedly reduc...
D. I. Ageikin V. V. Pechnikov A. B. Pokryvailo V. A. Torgonenko
This document presents fifteen technical guidelines to evaluate the suitability of an ecological indicator for a particular monitoring program. The guidelines are organized within four evaluation phrases: conceptual relevance, feasibility of implementation, response variability...
Presents some introductory experiments involving the reaction between EDTA and several metal ions using metallochromic indicators. The experiments represent familiar reactions and are followed by suggestions for extension into areas of discovery work by students. (Author/SA)
Jones, A. V.; Nelson, M.
Our work present an overview of the various analytical techniques for determining numbers of faecal index and indicator bacteria as well as selected pathogens in water samples. It includes conventional and new (principally molecular biology) techniques and outlines the performance characteristics of the different methods. Our work describes the more \\
Mihaela Bruma; C. Tofan
When dealing with early non-small cell lung cancer (NSCLC) sublobar resections still remain part of the surgical armamentarium. In selected patients with lung cancer, the combination of the potential benefits of parenchyma sparing procedures to the limited trauma provided by Video Assisted Thoracic Surgery (VATS) techniques can become very appealing. Two main groups are included: non-anatomical (wedges) and anatomical (segmentectomies) excisions. We describe the techniques, results and potential indications of both of these techniques.
Delgado Roel, Maria
The indications for selective intraoperative cholangiography (IOC) include a clinical history of jaundice, pancreatitis, elevated\\u000a bilirubin level, abnormal liver function test results, increased amylase levels, a high lipase level, or dilated common bile\\u000a duct on preoperative ultrasonography. Although these clinical features are widely accepted as indications for IOC, they have\\u000a not been tested for their ability to predict choledocholithiasis. Charts
Edward H. Livingston; Jordan A. G. Miller; Brian Coan; Robert V. Rege
Despite the advances of reconstructive surgical techniques, there are still indications for enterostoma constructions. Terminal colostomies are constructed after abdominoperineal rectal amputations. The terminal ileostomy is the procedure of choice after total colectomies for Crohn's disease. Loop colostomies are still a possibility for stool diversion procedures and for decompression in acute colonic obstruction. Loop ileostomies reduce load before ileal anastomoses and are increasingly used as diverting stomas in cases of colonic anastomoses. The cecal tube fistula, which does not divert the fecal stream completely, has the special advantage of easy, spontaneous closure. PMID:2577627
Vestweber, K H; Paul, A; Spangenberger, W; Mennigen, R
Breast cancer remains the leading cause of cancer-related mortality in women. Comprehensive genomics, proteomics, and metabolomics studies are emerging that offer an opportunity to model disease biology, prognosis, and response to specific therapies. Although many biomarkers have been identified through advances in data mining techniques, few have been applied broadly to make patient-specific decisions. Here, we review a selection of breast cancer prognostic indicators and their implications. Our goal is to provide clinicians with a general evaluation of emerging computational methodologies for outcome prediction.
Yang, Xinan; Ai, Xindi; Cunningham, John M
This Methodology Booklet provides a comprehensive review and methodology guiding principles for constructing energy efficiency indicators, with illustrative examples of application to individual countries. It reviews work done by international agencies and national government in constructing meaningful energy efficiency indicators that help policy makers to assess changes in energy efficiency over time. Building on past OECD experience and best practices, and the knowledge of these countries' institutions, relevant sources of information to construct an energy indicator database are identified. A framework based on levels of hierarchy of indicators -- spanning from aggregate, macro level to disaggregated end-use level metrics -- is presented to help shape the understanding of assessing energy efficiency. In each sector of activity: industry, commercial, residential, agriculture and transport, indicators are presented and recommendations to distinguish the different factors affecting energy use are highlighted. The methodology booklet addresses specifically issues that are relevant to developing indicators where activity is a major factor driving energy demand. A companion spreadsheet tool is available upon request.
Sathaye, Jayant; Price, Lynn; McNeil, Michael; de la rue du Can, Stephane
Using a technique that requires a subject to consult an imagined or remembered spatial array while performing a visual task, a reliable reduction in the number of directed eye movements that are available for the acquisition of visual information is shown.
Galanter, E.; Hochberg, J.
Introduction: Osteoporosis is a regressive change which occurs in the bone and it is seldom diagnosed before the occurrence of fractures. Hence, determination of mandibular bone density is of paramount importance for the detection of this silent disease. Aims and Objectives: The purpose of this study was to evaluate the influences of gender and age on the radiomorphometric indices and to assess the differences in the various indices, if any, between digital and analog radiographs. Materials and Methods: Two hundred and fifty six panoramic radiographs (128 digital and 128 analog) were obtained and they were grouped into 8 age groups which were between 21 to 60 years with 5 year intervals between them, with equal sex distributions. The mandibular cortical index (MCI), mental index (MI) and panoramic mandibular index (PMI) were analyzed. Results: C2 and C3 categories of MCI increased as age advanced in females. MI showed a significant difference in genders and MI Values decreased from younger to older females. PMI (p<0.05) was significant for both the genders. Conclusion: This study showed that MCI, MI and PMI indices were useful for identifying patients with low skeletal bone mineral densities (BMD) or osteoporosis and that digital panoramic radiographs were better than analog radiographs for measuring the indices.
Govindraju, Poornima; Chandra, Poornima
We apply the Random Matrix Theory and complex network techniques to 20 global financial indices and study the correlation and network properties before and during the financial crisis of 2008 respectively. We find that the largest eigenvalue deviate significantly from the upper bound which shows a strong correlation between financial indices. By using a sliding window of 25 days we find that largest eigenvalue represent the collective information about the correlation between global financial indices and its trend indicate the market conditions. It is confirmed that eigenvectors corresponding to second largest eigenvalue gives useful information about the sector formation in the global financial indices. We find that these clusters are formed on the basis of the geographical location. The correlation network is constructed using threshold method for different values of threshold ? in the range 0 to 0.9, at ?=0.2 the network is fully connected. At ?=0.6, the Americas, Europe and Asia/Pacific form different clusters before the crisis but during the crisis Americas and Europe are strongly linked. If we further increase the threshold to 0.9 we find that European countries France, Germany and UK consistently constitute the most tightly linked markets before and during the crisis. We find that the structure of Minimum Spanning Tree before the crisis is more star like whereas during the crisis it changes to be more chain like. Using the multifractal analysis, we find that Hurst exponents of financial indices increases during the period of crisis as compared to the period before the crisis. The empirical results verify the validity of measures, and this has led to a better understanding of complex financial markets.
Kumar, Sunil; Deo, Nivedita
Within this work in which it has been aimed to indicate the attitudes of High School Students to environment, indication of the attitudes of high school students in Nigde has been regarded as the problem matter. This analysis has the qualification of survey model and techniques of questionnaire and observation have been used. The investigation has…
A hybrid X-ray and magnetic resonance imaging system (XMR) has been proposed as an interventional guidance for cardiovascular catheterisation procedure. However, very few hospitals can benefit from the XMR system because of its limited availability. In this paper we describe a new guidance strategy for cardiovascular catheterisation procedure. In our technique, intra-operative patient position is estimated by using a chest surface reconstructed from a photogrammetry system. The chest surface is then registered with the same surface derived from pre-procedure magnetic resonance (MR) images. The catheterisation procedure can therefore be guided by a roadmap derived from the MR images. Patients were required to hold the breath at end expiration during MRI acquisition. The surface matching accuracy is improved by using a robust trimmed iterative closest point (ICP) matching algorithm, which is especially designed for incomplete surface matching. Compared to the XMR system, the proposed guidance strategy is low cost and easy to set up. Experimental data were acquired from 6 volunteers and 1 patient. The patient data were collected during an electrophysiology procedure. In 6 out of 7 subjects, the experimental results show our method is accurate in term of reciprocal residual error (range from 1.66m to 3.75mm) and constant (closed-loop TREs range from 1.49mm to 3.55mm). For one subject, trimmed ICP failed to find the optimal transform matrix (residual = 4.89, TRE = 9.32) due to the poor quality of the photogrammetry-reconstructed surface. More studies are being carried on in clinical trials.
Gao, Gang; Tarte, Segolene; King, Andy; Ma, Yingliang; Chinchapatnam, Phani; Schaeffter, Tobias; Razavi, Reza; Hawkes, Dave; Hill, Derek; Rhode, Kawal
Stereotactical radiotherapy is a very high precision procedure, limited to radiosurgery since a long time. Technologic progress permitted to develop radiotherapy in stereotactical conditions, leading to a lot of innovations. Previously indicated for cerebral pathologies, this procedure is now developed for extracerebral locations. In pediatrics, stereotactical radiotherapy is still limited, delivered precociously, due to the possibility of long-term late effects that needs to be to addressed. This review reports the different useful conditions, technical evolutions, and the current validated pediatric indications, with differences from adults, and future directions. Current state of pediatric stereotactical radiotherapy used in France is presented. PMID:19762263
Stereotactic radiotherapy is a very high precision procedure, which has been limited to radiosurgery for a long time. Technological improvements allowed the development of radiotherapy in stereotactic conditions, leading to a lot of innovations. Previously indicated for cerebral pathologies, this procedure is now developed for extracerebral locations. In paediatrics, stereotactic radiotherapy is still limited, delivered precociously, due to the possibility of long-term late effects that needs to be addressed. This review reports the different useful conditions, technical evolutions, and the current validated paediatric indications, with differences from adults, and future directions. PMID:22658965
Bernier-Chastagner, V; Supiot, S; Carrie, C; Helfre, S
Foils serve as consumable thermometers. Stainless-steel tab with circular window holds brazing-foil sample in place. Tab tacked to object to be tested with capacitive-discharge spot welder operating in range 10 + 1 joules. After measurements, tabs and samples chiseled off, leaving tested object fairly well intact. Technique used on objects made of alloys with iron, nickel, or cobalt as principal ingredients.
Schlaff, J. W.
Several novel tamper-indicating devices, originally developed under DOE auspices for arms control applications, might be useful in nonproliferation. Some devices that have reached the laboratory prototype stage could provide specialized alternatives to established seals. As locks and cables, the following might be useful: (1) a brittle ceramic lock--impervious to toxic, radiation, and thermal extremes--interrogated for identification and continuity by ultrasonic means, (2) a flexible ceramic-fiber seal that also tolerates severe environments, (3) an ultrasonic smart-material strip seal, and (4) an RF-resonant coaxial cable, verified by radio frequency and microwave signals. To validate the identity of secured surfaces, joints, welds, and fasteners--two techniques are applicable: (1) the scanning electron microscope, which examines three- dimensional micron-level topography, and (2) the plastic-casting fingerprint, a simple low-cost technique, analogous to human fingerprinting. The techniques mentioned above have one or more of the potential advantages of low cost, immediate availability, security for large-area enclosures, application to hazardous environments, usability in the FSU, or suitability for covert use.
This article presents the author's critique of Anthony F. J. van Raan's article titled, "Measurement of Central Aspects of Scientific Research: Performance, Interdisciplinarity, Structure." van Raan makes an excellent case for using bibliometric data to measure some central aspects of scientific research and to construct indicators of groups:…
Katz, J. Sylvan
We are working on an enabling technology to facilitate the development of physiological indices of mental workload that could be used in high performance aircraft. To date, we have designed and implemented the core components of a neural-network based alg...
A. Gevins H. M. Leong
Geospatial Indicators (GI) is an exploration into the use of GIS, remote sensing and spatial reasoning methods to identify regions at risk due to inadequate food and water resources that are a result of inherent environmental scarcity, stress due to environmental dynamics and change, or inadequate social capital. The purpose is to lay an evidentiary foundation to assess risk on
Richard Cicone; Thomas Parris; Jeffrey Miller; David Cunningham; Gregory Koeln
A first object of the present invention is providing a method for indicating the quality of tracks in a passive sonar system. Another object of the invention is providing such a method that is not overly sensitive to track status changes. Accordingly, the...
W. R. Lane
The lack of, development of, and mismanagement of water are the basic causes of environmental degradation and desertification in many arid regions. The signs, magnitude and severity of desertification can be established through such hydrological indicators as reduced area of water bodies, increased runoff and consequently decreased rainwater infiltration, accelerated soil erosion and sedimentation, and deteriorated ground-water resources. Case studies
K. D. Sharma
In a computerized eye examination, there are times when the examiner is not at the patient's side. Hence, it was anticipated that non-verbal indicators (i.e., EKG, blink, GSR) might be used to aid the computer in converging upon the proper lens correction...
E. Marg G. Hung