Do the Changes in the Serum Levels of IL-2, IL-4, TNFα, and IL-6 Reflect the Inflammatory Activity in the Patients with Post-ERCP Pancreatitis?

PubMed Central

Kilciler, Guldem; Musabak, Ugur; Bagci, Sait; Yesilova, Zeki; Tuzun, Ahmet; Uygun, Ahmet; Gulsen, Mustafa; Oren, Sema; Oktenli, Cagatay; Karaeren, Necmettin

2008-01-01

Background. Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP) procedure and there are some reports showing cytokine changes in ERCP-induced pancreatits. Goals. To investigate the association between early changes (within 24 hours) in the serum interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)α, and IL-6 levels and the development of post-ERCP pancreatitis. Study. Forty five consecutive patients who underwent therapeutic ERCP and 10 patients with acute pancreatitis without ERCP were enrolled to the study. Serum concentrations of IL-2, IL-4, TNFα, and IL-6 were determined immediately before, 12 hours and 24 hours after ERCP. Results. Seven of the 45 patients (15.5%) developed post-ERCP pancreatitis. The levels of IL-4 at 24 hours after ERCP were significantly lower in the patients with post-ERCP pancreatitis than in those without pancreatitis, while TNFα levels at 12 hours after ERCP were higher in the complicated group than those of the uncomplicated group. The ratios of TNFα/IL-4 at 12 and 24 hours after ERCP were found significantly higher in the patients with post-ERCP pancreatitis than in those without pancreatitis. IL-6 in the complicated patients was found significantly increased at 24 hours after ERCP. Conclusions. The enhancement of serum TNFα and IL-6 levels in the patients with ERCP-induced pancreatitis reflects the inflammatory activity. Additionally, these cytokines together with IL-4 can be used in clinical laboratory monitoring of ERCP. PMID:18670651

Meta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP).

PubMed

Burstow, Matthew J; Yunus, Rossita M; Hossain, Md Belal; Khan, Shahjahan; Memon, Breda; Memon, Muhammed A

2015-06-01

The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious. The aim was to conduct a meta-analysis of randomized controlled trials (RCTs) investigating the treatment of GSP by early ERCP ± ES versus conservative management and analyzing the patient outcomes. A search of Medline, Embase, Science Citation Index, Current Contents, PubMed, and the Cochrane Database of Systematic Reviews identified all RCTs comparing early ERCP to conservative management in GSP published between January 1970 and January 2014. Search terms included "Endoscopic retrograde cholangiopancreatography (ERCP)"; "Endoscopic sphincterotomy"; "Gallstones"; "Bile duct stones"; "Gallstone pancreatitis"; "Biliary pancreatitis"; "Randomize/Randomised controlled trials"; "Conservative management/treatment"; "Human"; "English." Only prospective RCTs comparing early intervention (ie, between 24 and 72 h) with ERCP ± ES versus conservative management in GSP were included. Data extraction and critical appraisal was carried out independently by 2 authors (M.J.B. and M.A.M.) using predefined data fields. Variables analyzed included severity of pancreatitis (mild or severe), overall mortality, overall complications which included pseudocyst formation, organ failure (renal, respiratory, and cardiac), abnormal coagulation, biliary sepsis, and development of pancreatic abscess/phlegmon. The quality of RCTs was assessed using Jadad's scoring system. Random-effects model was used to calculate the outcomes of both binary and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran Q statistic and I2 index. The meta-analysis was prepared in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Eleven RCTs consisting of 1314 patients (conservative management=662, ERCP=652) were analyzed. There was a near significant decrease in mortality for ERCP group compared with conservatively managed patients with severe pancreatitis [odds ratio (OR) 0.45; 95% confidence interval (CI), 0.19, 1.09; P=0.08]. In patients with mild pancreatitis, mortality results were comparable for both groups (OR 0.66; 95% CI, 0.02, 28.75; P=0.83). Overall complications were significantly reduced in the ERCP group in severe pancreatic patients (OR 0.32; 95% CI, 0.17, 0.61; P=0.00). In those with mild disease, a strong trend to decreased complications in the ERCP group was seen, however, this was not significant (OR 0.67; 95% CI, 0.43, 1.03; P=0.06). This meta-analysis demonstrates a significant decrease in complications in patients with severe GSP managed with early ERCP/ES compared with conservative management. As far as the mortality is concerned, no significant decrease was observed in mortality even in severe GSP patients treated with early ERCP/ES.

NEEDLE KNIFE SPHINCTEROTOMY - THE CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL EXPERIENCE.

PubMed

Thomson, J T; Smith, M D; Omoshoro-Jones, J A O; Devar, J D; Khan, Z K; Jugmohan, B J

2017-06-01

Deep biliary cannulation is essential in performing a therapeutic ERCP. Cannulation can be enhanced through the utilization of a pre-cut by means of a needle knife sphincterotomy. Retrospective analysis of the Chris Hani Baragwanath Academic Hospital's ERCP database was performed. All ERCPs performed with the aid of a needle knife were identified and analysed for successful and unsuccessful deep biliary cannulation. 2830 ERCPs were performed during the study period. 369 (13%) required needle knife sphincterotomies and successful deep biliary cannulation was achieved in 229 (62%) of these patients. Repeat ERCPs were performed on 125 (34%) patients. 61 (49%) of the repeat ERCPs were performed because of previously failed cannulation. 34 (56%) of these repeat ERCPs resulted in successful deep biliary cannulation at re-attempt. 99% of successful cannulations at repeat ERCP had had a needle knife sphincterotomy at the first ERCP. Needle knife sphincterotomy improves deep biliary cannulation at initial ERCP and subsequent ERCPs with low incidences of complications.

Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatography.

PubMed

Nasiri, Jafar; Zamani, Farhad

2017-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a conventional technique for diagnosis and treatment of pancratobiliary diseases, which is associated with various complications, including pancreatitis, hemorrhage, cholangitis, perforation, and mortality. In our case, a 69-year-old woman with positive hepatobiliary symptoms underwent ERCP, at the end of which a rare complication (raccoon eye) occurred, which was hypothesized to be due to amyloidosis, but the patient refused to complete the diagnostic procedure and became symptom free after 3 weeks. Racoon eye or periorbital ecchymosis is caused by blood tracking into periorbital tissues, which is frequently observed after head trauma but is also observed in systemic diseases, such as amyloidosis, neuroblastoma, and surgical interventions. To the best of our knowledge, this is the first report of raccoon eye after ERCP; further reports will help to confirm that this complication should also be considered before performing ERCP and that complete diagnostic tests for the predisposing diseases prior to ERCP are necessary.

Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatography

PubMed Central

Nasiri, Jafar; Zamani, Farhad

2017-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a conventional technique for diagnosis and treatment of pancratobiliary diseases, which is associated with various complications, including pancreatitis, hemorrhage, cholangitis, perforation, and mortality. In our case, a 69-year-old woman with positive hepatobiliary symptoms underwent ERCP, at the end of which a rare complication (raccoon eye) occurred, which was hypothesized to be due to amyloidosis, but the patient refused to complete the diagnostic procedure and became symptom free after 3 weeks. Racoon eye or periorbital ecchymosis is caused by blood tracking into periorbital tissues, which is frequently observed after head trauma but is also observed in systemic diseases, such as amyloidosis, neuroblastoma, and surgical interventions. To the best of our knowledge, this is the first report of raccoon eye after ERCP; further reports will help to confirm that this complication should also be considered before performing ERCP and that complete diagnostic tests for the predisposing diseases prior to ERCP are necessary. PMID:28611566

EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy: A Multicenter Early Comparative Experience of Clinical Outcomes.

PubMed

Kedia, Prashant; Tarnasky, Paul R; Nieto, Jose; Steele, Stephen L; Siddiqui, Ali; Xu, Ming-Ming; Tyberg, Amy; Gaidhane, Monica; Kahaleh, Michel

2018-04-17

The standard of care for managing pancreaticobiliary disease in altered Roux-en-Y gastric bypass patients is laparoscopy-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP), but is limited by cost and adverse events. Recently a minimally invasive, completely endoscopic approach using endoscopic ultrasound (EUS) directed transgastric ERCP (EDGE) has been described. We aim to compare EDGE to LA-ERCP in this study. Patients from May 2005 to June 2017 with Roux-en-Y gastric bypass anatomy having undergone LA-ERCP or EDGE at 4 tertiary centers were captured in a registry. Patient demographics, procedural details, and clinical outcomes were measured for each group. Seventy-two patients (n=29 EDGE, n=43 LA-ERCP) were included in this study. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.5%) versus LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.5% vs. LA-ERCP 97.7%) and number of ERCP (EDGE 1.2 vs. LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. Adverse event rate for EDGE, 24% (7/29) and LA-ERCP, 19% (8/43) was similar. The total procedure time (73 vs. 184 min) and length of hospital stay (0.8 vs. 2.65 d) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was -6.6 lbs at an average 28-week follow-up. This study suggests that the EDGE procedure has similar technical success and adverse events compared with LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain.

Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones

PubMed Central

Tao, Tao; Zhang, Ming; Zhang, Qi-Jie; Li, Liang; Li, Tao; Zhu, Xiao; Li, Ming-Dong; Li, Gui-Hua; Sun, Shu-Xia

2017-01-01

AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy (ESWL) before endoscopic retrograde cholangiopancreatography (ERCP) vs ERCP only for problematic and large common bile duct (CBD) stones. METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups, an “ESWL + ERCP group” and an “ERCP-only” group. For ESWL + ERCP cases, ESWL was performed prior to ERCP. Clearance of the CBD, complications related to the ESWL/ERCP procedure, frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups. RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session (74.2% vs 71.0%, P = 0.135), but a higher clearance rate within the second treatment session (84.4% vs 51.6%, P = 0.018) and total stone clearance (96.0% vs 86.0%, P = 0.029). Moreover, ESWL prior to ERCP not only reduced ERCP procedure time (43 ± 21 min vs 59 ± 28 min, P = 0.034) and the rate of mechanical lithotripsy use (20% vs 30%, P = 0.025), but also raised the clearance rate of extremely large stones (80.0% vs 40.0%, P = 0.016). Post-ERCP complications were similar for the two groups. CONCLUSION Based on the higher rate of successful stone removal and minimal complications, ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones. PMID:28785149

Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis.

PubMed

Wani, Sachin; Hall, Matthew; Wang, Andrew Y; DiMaio, Christopher J; Muthusamy, V Raman; Keswani, Rajesh N; Brauer, Brian C; Easler, Jeffrey J; Yen, Roy D; El Hajj, Ihab; Fukami, Norio; Ghassemi, Kourosh F; Gonzalez, Susana; Hosford, Lindsay; Hollander, Thomas G; Wilson, Robert; Kushnir, Vladimir M; Ahmad, Jawad; Murad, Faris; Prabhu, Anoop; Watson, Rabindra R; Strand, Daniel S; Amateau, Stuart K; Attwell, Augustin; Shah, Raj J; Early, Dayna; Edmundowicz, Steven A; Mullady, Daniel

2016-04-01

There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Expert System Initiative in Logistic Readiness (EXSYN)

DTIC Science & Technology

1987-03-01

reduce the number of cooks. Specific units are designated "feeders" and have kitchen equipment to fulfill this mission. X. (QM) Emphasis is placed on...the conduct of the unit mission. Within the A-level especially critical items are disigned are pacing items or ERC-P. ERC-P equipment of the

Improving patient and user safety during endoscopic investigation of the pancreatic and biliary ducts

NASA Astrophysics Data System (ADS)

Chandler, John E.; Melville, C. David; Lee, Cameron M.; Saunders, Michael D.; Burkhardt, Matthew R.; Seibel, Eric J.

2011-03-01

Endoscopic investigation of the main pancreatic duct and biliary ducts is called endoscopic retrograde cholangiopancreatography (ERCP), and carries a risk of pancreatitis for the patient. During ERCP, a metal guidewire is inserted into the pancreatobiliary duct from a side-viewing large endoscope within the duodenum. To verify correct placement of the ERCP guidewire, an injection of radiopaque dye is required for fluoroscopic imaging, which exposes the patient and clinical team to x-ray radiation. A safer and more effective means to access the pancreatobiliary system can use direct optical imaging, although the endoscope diameter and stiffness will be significantly larger than a guidewire's. To quantify this invasiveness before human testing, a synthetic force-sensing pancreas was fabricated and attached to an ERCP training model. The invasiveness of a new, 1.7-mm diameter, steerable scanning fiber endoscope (SFE) was compared to the standard ERCP guidewire of 0.89-mm (0.035") diameter that is not steerable. Although twice as large and significantly stiffer than the ERCP guidewire, the SFE generated lower or significantly less average force during insertion at all 4 sensor locations (P<0.05) within the main pancreatic duct. Therefore, the addition of steering and forward visualization at the tip of the endoscope reduced the invasiveness of the in vitro ERCP procedure. Since fluoroscopy is not required, risks associated with dye injection and x-ray exposure can be eliminated when using direct optical visualization. Finally, the SFE provides wide-field high resolution imaging for image-guided interventions, laser-based fluorescence biomarker imaging, and spot spectral analysis for future optical biopsy.

Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center.

PubMed

Yandrapu, Harathi; Elhanafi, Sherif; Chowdhury, Farhanaz; Liu, Jiayang; Onate, Eduardo J; Dwivedi, Alok; Othman, Mohamed O

2017-01-01

Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP. This is a single-center retrospective data review of ERCP procedures done "before" and "after" the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired t-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes. A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the "before EUS" and "after EUS" time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54, P = 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (P = 0.0005) after the introduction of EUS. The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study.

PubMed

Lee, Tae Hoon; Hwang, Soon Oh; Choi, Hyun Jong; Jung, Yunho; Cha, Sang Woo; Chung, Il-Kwun; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

2014-02-17

Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P < 0.001). The mean successful cannulation time (standard deviation) was 559.4 (412.8) seconds in EPF, 314.8 (65.2) seconds in DGC, and 706.0 (469.4) seconds in PPS (P < 0.05). The DGC group had a relatively low successful cannulation rate (47.8%) but had a shorter cannulation time compared to the other groups due to early switching to the PPS method in difficult or failed DGC. Post-ERCP pancreatitis developed in 14 (10%) patients (9 mild, 1 moderate), which did not differ significantly among the groups (P = 0.870) or compared with the conventional group (P = 0.125). Based on the sequential protocol analysis, EPF, DGC, and PPS may be safe and feasible for DBC. The use of EPF in selected DBC criteria, DGC in unintentional pancreatic duct cannulations, and PPS in failed or difficult DGC may facilitate successful biliary cannulation.

Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

PubMed Central

Ahmed, Moiz; Kanotra, Ritesh; Savani, Ghanshyambhai T.; Kotadiya, Fenilkumar; Patel, Nileshkumar; Tareen, Sarah; Fasullo, Matthew J.; Kesavan, Mayurathan; Kahn, Ahsan; Nalluri, Nikhil; Khan, Hafiz M.; Pau, Dhaval; Abergel, Jeffrey; Deeb, Liliane; Andrawes, Sherif; Das, Ananya

2017-01-01

Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013. There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs. PMID:28382324

Comparison of complication outcomes in acute pancreatitis following ERCP and conservative management at UKM medical centre: a six years retrospective study.

PubMed

Zamri, Z; Razman, J

2012-11-01

Acute pancreatitis is one of the common reasons for surgical admission. It is a potentially lethal disease that is increasing in its incidence. The most common causes of acute pancreatitis is from gallstones and alcohol. Other causes of acute pancreatitis include hypertriglyceridaemia, hyperparathyroidism, pancreatic malignancy, Endoscopic retrograde cholangiopancreatography (ERCP), trauma, infectious agents, drugs, autoimmunity, and hereditary. The treatment of acute pancreatitis is mainly supportive. The complication of ERCP in acute pancreatitis can be divided into local complication (pancreatic abscess, pseudocyst), systemic complications (renal failure, respiratory failure, cardiogenic shock) and biliary sepsis (acute cholangitis and acute cholecystitis). However, early ERCP and possible sphincterotomy should be kept in mind for patients with severe disease and biliary obstruction who are not improving with medical therapy. This study is done to compare the complication rate of ERCP and conservative management in acute pancreatitis for past 6 years in Pusat Perubatan UKM. The study is conducted retrospectively and the study population was from January 2003 until December 2008. About 100 patients involving 51 males and 49 females were included in this study. All of them were diagnosed acute pancreatitis based on the serum amylase level of 4 times than normal value detected from Chemistry Pathology record, Pathology Department, PPUKM. Then, data were collected from the patient's file which include the demographic data and patient clinical presentation, ultrasound finding, either patient went for ERCP within 72 hours or not. If ERCP not done within 72 hours of admission then it will considered that the patient is under conservative management. From 100 patients that involved in this study about 44% was Malay, 36 % was Chinese, 18 % was Indian and the other 2 % was from other origin. There were 28 cases (28%) where ERCP was done within 72 hours, and the other 72 cases (72%) the treatment was conservative. Among 28 cases that ERCP was done within 72 hours after admission, 20 cases are mild where as only 8 cases are severe. However, in conservative group about 56 cases are mild and the other 16 are severe. Among the conservative group there are 12 cases which have complications. The complications are respiratory failure, renal failure, sepsis, shock and pancreatic necrosis. There are 7 cases whose have respiratory failure alone, 1 case developed renal failure and 1 case has a shock. 1 case developed both pancreatic necrosis with sepsis. 1 case each developed respiratory failure with sepsis and respiratory failure with renal failure. However no complications were noted in early ERCP group. As a conclusion in this study we found out that early ERCP have a significant role in acute pancreatitis compare to conservative management.

Activities in a social networking-based discussion group by endoscopic retrograde cholangiopancreatography doctors.

PubMed

Kang, Xiaoyu; Zhao, Lina; Liu, Na; Wang, Xiangping; Zhang, Rongchun; Liu, Zhiguo; Liang, Shuhui; Yao, Shaowei; Tao, Qin; Jia, Hui; Pan, Yanglin; Guo, Xuegang

2017-10-01

Online social networking is increasingly being used among medical practitioners. However, few studies have evaluated its use in therapeutic endoscopy. Here, we aimed to analyze the shared topics and activities of a group of endoscopic retrograde cholangiopancreatography (ERCP) doctors in a social networking-based endoscopic retrograde cholangiopancreatography discussion group (EDG). Six ERCP trainers working in Xijing Hospital and 48 graduated endoscopists who had finished ERCP training in the same hospital were invited to join in EDG. All group members were informed not to divulge any private information of patients when using EDG. The activities of group members on EDG were retrospectively extracted. The individual data of the graduated endoscopists were collected by a questionnaire. From June 2014 to May 2015, 6924 messages were posted on EDG, half of which were ERCP related. In total, 214 ERCP-related topics were shared, which could be categorized into three types: sharing experience/cases (52.3%), asking questions (38.3%), and sharing literatures/advances (9.3%). Among the 48 graduated endoscopists, 21 had a low case volume of less than 50 per year and 27 had a high volume case volume of 50 or more. High-volume graduated endoscopists posted more ERCP-related messages (P=0.008) and shared more discussion topics (P=0.003) compared with low-volume graduated endoscopists. A survey showed that EDG was useful for graduated endoscopists in ERCP performance and management of post-ERCP complications, etc. A wide range of ERCP-related topics were shared on the social networking-based EDG. The ERCP-related behaviors on EDG were more active in graduated endoscopists with an ERCP case volume of more than 50 per year.

Cost-Utility of Competing Strategies to Prevent Endoscopic Transmission of Carbapenem-Resistant Enterobacteriaceae

PubMed Central

Almario, Christopher V.; May, Folasade P.; Shaheen, Nicholas J.; Murthy, Rekha; Gupta, Kapil; Jamil, Laith H.; Lo, Simon K.; Spiegel, Brennan M.R.

2015-01-01

OBJECTIVES Prior reports have linked patient transmission of carbapenem-resistant Enterobacteriaceae (CRE, or “superbug”) to endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP). We performed a decision analysis to measure the cost-effectiveness of four competing strategies for CRE risk management. METHODS We used decision analysis to calculate the cost-effectiveness of four approaches to reduce the risk of CRE transmission among patients presenting to the hospital for symptomatic common bile duct stones. The strategies included: (1) perform ERCP followed by U.S. Food and Drug Administration (FDA)-recommended endoscope reprocessing procedures; (2) perform ERCP followed by “endoscope culture and hold”; (3) perform ERCP followed by ethylene oxide (EtO) sterilization of the endoscope; and (4) stop performing ERCP in lieu of laparoscopic cholecystectomy (LC) with common bile duct exploration (CBDE). Our outcome was incremental cost per quality-adjusted life year (QALY) gained. RESULTS In the base-case scenario, ERCP with FDA-recommended endoscope reprocessing was the most cost-effective strategy. Both the ERCP with culture and hold ($4,228,170/QALY) and ERCP with EtO sterilization ($50,572,348/QALY) strategies had unacceptable incremental costs per QALY gained. LC with CBDE was dominated, being both more costly and marginally less effective versus the alternatives. In sensitivity analysis, ERCP with culture and hold became the most cost-effective approach when the pretest probability of CRE exceeded 24%. CONCLUSIONS In institutions with a low CRE prevalence, ERCP with FDA-recommended reprocessing is the most cost-effective approach for mitigating CRE transmission risk. Only in settings with an extremely high CRE prevalence did ERCP with culture and hold become cost-effective. PMID:26526083

Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

PubMed Central

Muscarella, Lawrence F

2014-01-01

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE’s emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine’s “MEDLINE” database); the Food and Drug Administration’s Manufacturer and User Facility Device Experience database, or “MAUDE”; and the Internet (via Google’s search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at “Hospital X” located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital’s patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X’s infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer’s labeling, supplemented as needed with professional organizations’ published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endoscopy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind and near the forceps elevator located at the distal end of the ERCP endoscope, are recommended. If the ERCP endoscope features a narrow and exposed channel that houses a wire connecting the GI endoscope’s control head to this forceps elevator, then this channel’s complete reprocessing, including its flushing with a detergent using a procedure validated for effectiveness, is also emphasized. PMID:25324917

N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis

PubMed Central

Milewski, Janusz; Rydzewska, Grazyna; Degowska, Malgorzata; Kierzkiewicz, Maciej; Rydzewski, Andrzej

2006-01-01

AIM: Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP. METHODS: One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity. RESULTS: There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10 patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group. CONCLUSION: N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity. PMID:16773694

N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis.

PubMed

Milewski, Janusz; Rydzewska, Grazyna; Degowska, Malgorzata; Kierzkiewicz, Maciej; Rydzewski, Andrzej

2006-06-21

Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP. One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity. There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10 patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group. N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.

Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

PubMed Central

Yamauchi, Hiroshi; Kida, Mitsuhiro; Imaizumi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Koizumi, Wasaburo

2015-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy. PMID:26074685

A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis.

PubMed

Jowhari, Fahd; Hopman, Wilma M; Hookey, Lawrence

2017-03-01

Background and study aims  Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods  A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results  Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (-1.4 min, P  = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P  = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P  < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (-1.82, P = 0.015). Conclusions  Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.

Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures.

PubMed

Passi, Monica; Inamdar, Sumant; Hersch, David; Dowling, Oonagh; Sejpal, Divyesh V; Trindade, Arvind J

2018-03-01

Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups. A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group). Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007). The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

PubMed Central

Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

2011-01-01

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma

PubMed Central

Uppal, Dushant S; Wang, Andrew Y

2015-01-01

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral (or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy (PDT) or radiofrequency ablation (RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCP-directed RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy. PMID:26140095

Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma.

PubMed

Uppal, Dushant S; Wang, Andrew Y

2015-06-25

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral (or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy (PDT) or radiofrequency ablation (RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCP-directed RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.

Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography for obstructing pancreas head masses: combined or separate procedures?

PubMed

Aslanian, Harry R; Estrada, Juan D; Rossi, Federico; Dziura, James; Jamidar, Priya A; Siddiqui, Uzma D

2011-09-01

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are complementary procedures in the evaluation of obstructive jaundice. To determine the feasibility, accuracy, and safety of the combined performance of EUS-guided fine needle aspiration (FNA) and ERCP with biliary stenting in patients with obstructive jaundice. Retrospectively reviewed data from consecutive patients presenting with obstructive jaundice due to a pancreas mass at a tertiary referral hospital between April 2002 and November 2007 who underwent combined (under the same sedation and in the same room) or separate EUS and ERCP. Procedure duration, amount of sedative medication administered, ability to achieve biliary stent placement, and the diagnostic yield of EUS-FNA were evaluated. A total of 47 patients were evaluated: 29 patients underwent combined EUS and ERCP and 18 had separate procedures (median of 5 d between procedures). Stent placement at ERCP was successful in 72% combined procedures versus 88% separate ERCP. EUS-FNA diagnosis of malignancy was positive in 91.6% combined versus 87.5% separate. The only complication was self-limited melena after a combined procedure in 1 patient. The median time for combined procedures was 75 minutes versus 50 minutes for separate EUS and 50 minutes for ERCP. Combined EUS and ERCP can be performed under the same sedation with a median 25 minute greater procedure length and similarly high yields for diagnostic EUS-FNA. A nonsignificant trend toward lower biliary stent placement success rates with combined ERCP procedures merits further study. Benefits of a combined procedure may include expedited patient evaluation and the avoidance of repeated sedation.

Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients.

PubMed

Li, De-min; Zhao, Jie; Zhao, Qiu; Qin, Hua; Wang, Bo; Li, Rong-xiang; Zhang, Min; Hu, Ji-fen; Yang, Min

2014-08-01

In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (P<0.01%). There was no significant difference between these two groups in the rate of post-ERCP pancreatitis (PEP) and cholangitis. ERCP is safe and effective for Child-Pugh A and B cirrhotic patients with common bile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients.

[Effects of rectal indomethacin in the prevention of post-ERCP acute pancreatitis].

PubMed

Döbrönte, Zoltán; Toldy, Erzsébet; Márk, Levente; Sarang, Krisztina; Lakner, Lilla

2012-06-24

Recently non-steroidal anti-inflammatory drugs have seemed to reduce the frequency of post-ERCP pancreatitis in some prospective controlled trials, but the results have to be confirmed by further studies. To evaluate the efficacy of rectally administered indomethacin for the reduction of incidence of post-ERCP pancreatitis. A prospective randomized placebo-controlled study was conducted in 228 patients who underwent ERCP. Patients were randomized to receive a suppository containing 100 mg indomethacin or an inert placebo 10 mins before ERCP. Patients were evaluated clinically and biochemically by using serum amylase levels measured 24 h after the procedure. Pancreatitis and hyperamylasemia occurred more frequently in the placebo group, but the difference was not significant. In respect to the rate of pancreatitis, this tendency could particularly be observed in females, in patients older than 60 years and in patients with BMI lower than 25; however, it completely failed in cases with pancreatic duct filling or in those with pancreatic EST. Rectal indomethacin given before ERCP did not prove to be statistically effective in the reduction of the incidence of post-procedure pancreatitis. Further, controlled multicenter studies are required to assess safely the potential efficacy of indomethacin in the prevention of pancreatitis following ERCP.

Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection.

PubMed

O'Connor, U; Gallagher, A; Malone, L; O'Reilly, G

2013-02-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that combines the use of X-ray fluoroscopy and endoscopy for examination of the bile duct. Published data on ERCP doses are limited, including staff eye dose from ERCP. Occupational eye doses are of particular interest now as the International Commission on Radiological Protection (ICRP) has recommended a reduction in the dose limit to the lens of the eye. The aim of this study was to measure occupational eye doses obtained from ERCP procedures. A new eye lens dosemeter (EYE-D(™), Radcard, Krakow, Poland) was used to measure the ERCP eye dose, H(p)(3), at two endoscopy departments in Ireland. A review of radiation protection practice at the two facilities was also carried out. The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented. Staff eye doses in ERCP have the potential to exceed the revised ICRP limit of 20 mSv per annum when an overcouch X-ray tube is used. The EYE-D dosemeter was found to be a convenient method for measuring lens dose. Eye doses in areas outside of radiology departments should be kept under review, particularly in light of the new ICRP eye dose limit. Occupational eye lens doses from ERCP procedures have been established using a new commercially available dedicated H(p)(3) dosemeter.

Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis.

PubMed

Lee, Hee Seung; Chung, Moon Jae; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

2018-01-01

Acute pancreatitis is a common diagnosis worldwide, with gallstone disease being the most prevalent cause (50%). The American College of Gastroenterology recommends urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 h) for patients with biliary pancreatitis accompanied by cholangitis. Most international guidelines recommend that ERCP be performed within 72 h in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, but the optimal timing for endoscopy is controversial. We investigated the optimal timing for ERCP in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, and whether performing endoscopy within 24 h is superior to performing it after 24 h. We analyzed the clinical data of 505 patients with newly diagnosed acute pancreatitis, from January 1, 2005 to December 31, 2014. We divided the patients into two groups according to the timing of ERCP: < 24 h (urgent) and 24-72 h (early).Among the 505 patients, 73 were diagnosed with biliary pancreatitis and a bile duct obstruction without cholangitis. The mean age of the patients was 55 years (range: 26-90 years). Bile duct stones and biliary sludge were identified on endoscopy in 45 (61.6%) and 11 (15.0%) patients, respectively. The timing of ERCP within 72 h was not associated with ERCP-related complications (P = 0.113), and the total length of hospital stay was not different between urgent and early ERCP (5.9 vs. 5.7 days, P = 0.174). No significant differences were found in total length of hospitalization or procedural-related complications, in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, according to the timing of ERCP (< 24 h vs. 24-72 h).

Face and construct validity of a computer-based virtual reality simulator for ERCP.

PubMed

Bittner, James G; Mellinger, John D; Imam, Toufic; Schade, Robert R; Macfadyen, Bruce V

2010-02-01

Currently, little evidence supports computer-based simulation for ERCP training. To determine face and construct validity of a computer-based simulator for ERCP and assess its perceived utility as a training tool. Novice and expert endoscopists completed 2 simulated ERCP cases by using the GI Mentor II. Virtual Education and Surgical Simulation Laboratory, Medical College of Georgia. Outcomes included times to complete the procedure, reach the papilla, and use fluoroscopy; attempts to cannulate the papilla, pancreatic duct, and common bile duct; and number of contrast injections and complications. Subjects assessed simulator graphics, procedural accuracy, difficulty, haptics, overall realism, and training potential. Only when performance data from cases A and B were combined did the GI Mentor II differentiate novices and experts based on times to complete the procedure, reach the papilla, and use fluoroscopy. Across skill levels, overall opinions were similar regarding graphics (moderately realistic), accuracy (similar to clinical ERCP), difficulty (similar to clinical ERCP), overall realism (moderately realistic), and haptics. Most participants (92%) claimed that the simulator has definite training potential or should be required for training. Small sample size, single institution. The GI Mentor II demonstrated construct validity for ERCP based on select metrics. Most subjects thought that the simulated graphics, procedural accuracy, and overall realism exhibit face validity. Subjects deemed it a useful training tool. Study repetition involving more participants and cases may help confirm results and establish the simulator's ability to differentiate skill levels based on ERCP-specific metrics.

A comparative study of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in children with chronic liver disease.

PubMed

El-Karaksy, Hanaa M; El-Koofy, Nehal M; Okasha, Hussein; Kamal, Naglaa M; Naga, Mazen

2008-09-01

Endoscopic ultrasonography (EUS) is a less invasive modality and may be equal or superior to endoscopic retrograde cholangiopancreatography (ERCP) in visualizing the biliary tree. Its role and feasibility in children need to be accurately defined. This study aimed at evaluation of EUS in assessment of children with chronic liver disease (CLD) in comparison with ERCP. The present study was carried out between September 2004 and February 2006 on 40 children suffering from CLD. Patients were selected from the Pediatric Hepatology Unit, Cairo University Children's Hospital, Egypt. They were included if they had: sonographic (n = 8) or histopathological evidence of biliary pathology (n = 2); autoimmune hepatitis with high gamma glutammyl transpeptidase (GGT) levels and/or not responding to immunosuppressive therapy (n = 15); cryptogenic CLD (n = 13); neonatal cholestasis with relapsing or persistent course (n = 2). They all underwent EUS and ERCP. Three of six cases with intrahepatic biliary radicle dilatation had Caroli's disease by EUS and ERCP; and the other 3 had sclerosing cholangitis. EUS was equal to ERCP in diagnosis of biliary pathology. However, one false positive case was described to have dilatation and tortuosity of the pancreatic duct by EUS as compared to ERCP. EUS could detect early pancreatitis in 5 cases. One case with cryptogenic liver disease proved to have sclerosing cholangitis by both EUS and ERCP. EUS is an important diagnostic tool for biliary pathology and pancreatitis in children with pancreatico-biliary pathology. ERCP should be reserved for therapeutic purposes.

Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals.

PubMed

Trap, R; Adamsen, S; Hart-Hansen, O; Henriksen, M

1999-02-01

Increasing numbers of patients are undergoing endoscopic retrograde cholangiopancreatography (ERCP) prior to laparoscopic cholecystectomy, and more departments and doctors are performing ERCP, while new data from large prospective series have documented the risks of both diagnostic and therapeutic ERCP. The establishment in Denmark of a Patient Insurance Association, which has covered injury caused during investigation and treatment in public hospitals since July 1992, has made it possible to collect and analyze a large prospective series of ERCP complications for which compensation has been claimed. Thirty-nine consecutive claims for compensation due to complications after ERCP occurring between 1 July 1992 and 31 December 1996 were investigated. Case notes were reviewed, along with laboratory reports and radiographs. The complications were classified according to the international consensus. Claims for compensation were made in 39 cases from 25 hospitals. The indication for ERCP was appropriate in 31. Precut papillotomy for access had been performed in seven. The severity of the complications was mild in one patient, moderate in three patients, severe in 24, and fatal in nine; in two cases, the severity was not classifiable. The complications were: pancreatitis in 23 patients (seven cases fatal, one of which had involved a precut procedure), bleeding in two, perforation in nine (six had a precut procedure, one died), and other reasons in five (including one fatal case). Among the nine fatal cases, cannulation had not been achieved in two and the endoscopic retrograde cholangiogram was normal in four, one of whom underwent a sphincterotomy. One patient with a previous adenoma had an endoprosthesis removed, developed gangrenous cholecystitis afterward, and died. Thirty patients were eligible for compensation. The rejected cases included mild and moderate pancreatitis, a case of fatal hemorrhagic pancreatitis in which the patient had refused blood transfusion, and one patient who had pancreatitis prior to ERCP. ERCP, even for diagnostic purposes, may be associated with very serious and even fatal complications. The use of the precut procedure for access should still be considered dangerous. Other means of investigating the bile ducts should be developed. If endoscopic ultrasonography and magnetic resonance cholangiography prove to have the same diagnostic value as ERCP, which must be considered the gold standard for visualizing the ducts today, they might replace ERCP as the primary investigation in patients with an intermediate or low risk of bile duct stones; this would reduce the numbers of patients exposed to the risks of ERCP.

Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center.

PubMed

Garvey, Erin M; Haakinson, Danielle J; McOmber, Mark; Notrica, David M

2015-02-01

There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison of ionic, monomer, high osmolar contrast media with non-ionic, dimer, iso-osmolar contrast media in ERCP.

PubMed

Ogawa, Masami; Kawaguchi, Yoshiaki; Kawashima, Yohei; Mizukami, Hajime; Maruno, Atsuko; Ito, Hiroyuki; Mine, Tetsuya

2013-09-20

Pancreatitis is the most common and serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Several studies have compared contrast media (CM) with different osmolalities, but the results are conflicting. We conducted this study to clarify the difference between 2 CM used in ERCP. Five hundred and seventy-six patients were examined by using ERCP in our hospital during 2010. Out of these, 56 patients were enrolled in this study. We investigated the incidence of post ERCP pancreatitis (PEP) and hyperamylasemia. Serum amylase levels were compared in the 2 groups. Twenty-seven patients were treated with iodixanol and 29 with diatrizoate meglumine Na. The rate of PEP in the diatrizoate meglumine Na group and iodixanol group was 0% (0/29) and 7.4% (2/27), respectively (P = 0.228). The rate of hyperamylasemia was 10.3% (3/29) and 14.8% (4/27), respectively (P = 0.70). There were no significant differences between two groups for amylase levels pre-procedure (P = 0.082), 3 h post procedure (P = 0.744), or next morning (P = 0.265). There were no significant differences in the rates of PEP or hyperamylasemia between CMs in ERCP. We believe it is unnecessary to use the more expensive low osmolality CM in ERCP to prevent PEP.

EUS-guided methylene blue cholangiopancreatography for benign biliopancreatic diseases after failed ERCP.

PubMed

Consiglieri, Claudia F; Gornals, Joan B; Albines, Gino; De-la-Hera, Meritxell; Secanella, Lluis; Pelaez, Nuria; Busquets, Juli

2016-07-01

When ERCP fails, EUS-guided interventional techniques may be an alternative. The aim of this study was to evaluate the general outcomes and safety of EUS-guided methylene blue cholangiopancreatography in patients with failed ERCP in benign biliopancreatic diseases. Patients with benign biliopancreatic diseases and failed ERCP were included. EUS-guided cholangiopancreatography plus injection of methylene blue was performed, and then ERCP using coloring agent flow as an indicator of papilla orifice was performed. Procedures were prospectively collected in this observational, single-center study. Technical success, clinical success, and adverse events were analyzed retrospectively. Eleven patients were included (10 choledocholithiasis, 1 pancreatic stricture). The main reason for failed ERCP was an unidentifiable papilla. EUS-guided ductal access with cholangiopancreatography and papilla orifice identification was obtained in all cases. Technical success and clinical success rates of 91% were achieved, with successful biliopancreatic drainage in 10 patients. Adverse events included 1 peripancreatic abscess attributed to a precut, which was successfully treated. No adverse events were related to the first EUS-guided stage. EUS-guided cholangiopancreatography with methylene blue injection seems to be a feasible and helpful technique for treatment in patients with benign biliopancreatic diseases with previous failed ERCP because of an undetectable papilla. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system.

PubMed

Cirocchi, Roberto; Kelly, Michael Denis; Griffiths, Ewen A; Tabola, Renata; Sartelli, Massimo; Carlini, Luigi; Ghersi, Stefania; Di Saverio, Salomone

2017-12-01

The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%. This systematic review was registered in Prospective Register of Systematic Reviews, PROSPERO. Stapfer classification of ERCP-related duodenal perforations was used. The systematic search yielded 259 articles. Most frequent post-ERCP perforation was Stapfer type II (58.4%), type I second most frequent perforation (17.8%) followed by Stapfer type III in 13.2% and type IV in 10.6%. Rate of NOM was lowest in Stapfer type I perforations (13%), moderate in type III lesions (58.1%) and high in other types of perforations (84.2% in type II and 84.6% in IV). In patients underwent early surgical treatment (<24 h from ERCP) the most frequent operation was simple duodenal suture with or without omentopexy (93.7%). In patients undergoing late surgical treatment (>24 h from ERCP) interventions performed were more complex. In type I lesions post-operative mortality rate was higher in patients underwent late operation (>24 h). In type I lesions, failure of NOM occurred in 42.8% of patients. In type II failure of NOM occurred in 28.9% of patients and in type III there was failure of NOM in only 11.1%, none in type IV. Postoperative mortality after NOM failure was 75% in type I, 22.5% in type II and none died after surgical treatment for failure of NOM in type III perforations. This systematic review showed that in patients with Stapfer type I lesions, early surgical treatment gives better results, however the opposite seems true in Stapfer III and IV lesions. Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery.

PubMed

De Koning, Michael; Moreels, Tom G

2016-08-22

Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery. The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients. Seventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE. Male-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively. ERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.

A randomized controlled trial of preprocedure administration of parecoxib for therapeutic endoscopic retrograde cholangiopancreatography.

PubMed

Amornyotin, Somchai; Chalayonnawin, Wiyada; Kongphlay, Siriporn

2012-01-01

Parecoxib is occasionally used for analgesia in postprocedural patients. The clinical efficacy of parecoxib used for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. The aim of the study was to determine the clinical efficacy of preprocedure administration of parecoxib for therapeutic ERCP patients. Eighty-five patients who underwent therapeutic ERCP in a single year were randomly assigned to normal saline group (C, n = 43) and parecoxib group (P, n = 42). Patients in group C received normal saline and those in group P received 40 mg of parecoxib intravenously in equivalent volume. Patients in both groups received the saline or parecoxib 60 seconds before administration of the sedative agents. All patients were monitored for the depth of sedation by using the Narcotrend(TM) monitor, maintaining stage D0-E0 during ERCP. All patients were oxygenated with 100% O(2) via nasal cannula and sedated with 0.03 mg/kg of intravenous midazolam and 1 μg/kg of intravenous fentanyl as well as the titration of intravenous propofol. After the ERCP procedure, pethidine in an intramuscular dose of 0.5-1.0 mg/kg was used as rescue medication. The pain scores (visual analog scale [VAS], 0-10) at 2, 12, and 24 hours post-ERCP, the total number of doses of pethidine used, the dose volume of pethidine used, patient satisfaction, endoscopist satisfaction, and complications were recorded. There were no significant differences in sedative and analgesic agents used during the procedure, pain at 24 hours post-ERCP, endoscopist satisfaction, and complications in both groups. The total number of doses of pethidine used post-ERCP in group C was significantly higher than in group P. Additionally, the mean pain score at 2 and 12 hours post-ERCP in group C was significantly greater than in group P. Patient satisfaction in group P was higher than in group C. Preprocedure administration of parecoxib for therapeutic ERCP patients was clinically effective. The analgesic efficacy of a standard dose of parecoxib was clearly demonstrated during the first 12 hours postprocedure. Additionally, patient satisfaction in the parecoxib group was also higher than in the control group.

Surgical treatment of chronic pancreatitis in young patients.

PubMed

Zhou, Feng; Gou, Shan-Miao; Xiong, Jiong-Xin; Wu, He-Shui; Wang, Chun-You; Liu, Tao

2014-10-01

The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were analyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of steatorrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP intervention on delaying the progression of the disease and relieving the symptoms.

Therapeutic Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients With Acute Recurrent and Chronic Pancreatitis: Data From the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) Study.

PubMed

Troendle, David M; Fishman, Douglas S; Barth, Bradley A; Giefer, Matthew J; Lin, Tom K; Liu, Quin Y; Abu-El-Haija, Maisam; Bellin, Melena D; Durie, Peter R; Freedman, Steven D; Gariepy, Cheryl; Gonska, Tanja; Heyman, Melvin B; Himes, Ryan; Husain, Sohail Z; Kumar, Soma; Lowe, Mark E; Morinville, Veronique D; Ooi, Chee Y; Palermo, Joseph; Pohl, John F; Schwarzenberg, Sarah Jane; Werlin, Steven; Wilschanski, Michael; Zimmerman, M Bridget; Uc, Aliye

2017-07-01

The aim of this study was to characterize utilization and benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). From August 2012 to February 2015, 301 children with ARP or CP were enrolled in the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) study. Physicians reported utilization and benefit of therapeutic ERCP at enrollment. Differences were analyzed using appropriate statistical methods. One hundred seventeen children (38.9%) underwent at least 1 therapeutic ERCP. The procedure was more commonly performed in children with CP compared with those with ARP (65.8% vs 13.5%, P < 0.0001). Utility of therapeutic ERCP was reported to be similar between ARP and CP (53% vs 56%, P = 0.81) and was found to be helpful for at least 1 indication in both groups (53/99 patients [53.5%]). Predictors for undergoing therapeutic ERCP were presence of obstructive factors in ARP and CP, Hispanic ethnicity, or white race in CP. Therapeutic ERCP is frequently utilized in children with ARP or CP and may offer benefit in selected cases, specifically if ductal obstruction is present. Longitudinal studies are needed to clarify the efficacy of therapeutic ERCP and to explore subgroups that might have increased benefit from such intervention.

A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis.

PubMed

Elmunzer, B Joseph; Scheiman, James M; Lehman, Glen A; Chak, Amitabh; Mosler, Patrick; Higgins, Peter D R; Hayward, Rodney A; Romagnuolo, Joseph; Elta, Grace H; Sherman, Stuart; Waljee, Akbar K; Repaka, Aparna; Atkinson, Matthew R; Cote, Gregory A; Kwon, Richard S; McHenry, Lee; Piraka, Cyrus R; Wamsteker, Erik J; Watkins, James L; Korsnes, Sheryl J; Schmidt, Suzette E; Turner, Sarah M; Nicholson, Sylvia; Fogel, Evan L

2012-04-12

Preliminary research suggests that rectally administered nonsteroidal antiinflammatory drugs may reduce the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). In this multicenter, randomized, placebo-controlled, double-blind clinical trial, we assigned patients at elevated risk for post-ERCP pancreatitis to receive a single dose of rectal indomethacin or placebo immediately after ERCP. Patients were determined to be at high risk on the basis of validated patient- and procedure-related risk factors. The primary outcome was post-ERCP pancreatitis, which was defined as new upper abdominal pain, an elevation in pancreatic enzymes to at least three times the upper limit of the normal range 24 hours after the procedure, and hospitalization for at least 2 nights. A total of 602 patients were enrolled and completed follow-up. The majority of patients (82%) had a clinical suspicion of sphincter of Oddi dysfunction. Post-ERCP pancreatitis developed in 27 of 295 patients (9.2%) in the indomethacin group and in 52 of 307 patients (16.9%) in the placebo group (P=0.005). Moderate-to-severe pancreatitis developed in 13 patients (4.4%) in the indomethacin group and in 27 patients (8.8%) in the placebo group (P=0.03). Among patients at high risk for post-ERCP pancreatitis, rectal indomethacin significantly reduced the incidence of the condition. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00820612.).

Effects of thalidomide in experimental models of post-endoscopic retrograde cholangiopancreatography pancreatitis.

PubMed

Xiong, Guang-Su; Wu, Shu-Ming; Wang, Zhen-Hua; Mo, Jian-Zhong; Xiao, Shu-Dong

2007-03-01

Tumor necrosis factor-alpha (TNF-alpha) plays a central role in the pathogenesis of acute pancreatitis and related systemic complications. The authors hypothesized that it may also play an important role in the development of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). The aim of the study was to evaluate the effectiveness of thalidomide, an immunomodulator that exerts an inhibitory action on TNF-alpha by enhancing mRNA degradation, in reducing post-ERCP pancreatitis in a rat model. A total of 200 mg/kg thalidomide was given intragastric once a day (total 8 days) before the experimental models of post-ERCP pancreatitis were established. After 24 h, histology and edema of pancreas, serum amylase, and TNF-alpha mRNA in the pancreatic tissue were evaluated. Intraductal contrast infusion caused increases in serum amylase, edema, histological grade, and TNF-alpha mRNA of pancreas. The prophylactic use of thalidomide significantly reduced serum amylase, pancreatic edema and the histologic grade of pancreatitis accompanied by a decrease in mRNA expression of TNF-alpha in the pancreatic tissue. Prophylactic intragastric administration of thalidomide provides a protective effect in post-ERCP pancreatitis. The mechanism of the protective effects of thalidomide seems to be the reduction of expression of TNF-alpha mRNA in pancreatic tissue.

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002

PubMed Central

Lakatos, Laszlo; Mester, Gabor; Reti, Gyorgy; Nagy, Attila; Lakatos, Peter Laszlo

2004-01-01

AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing preoperative ERCP ( ≤ 90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct ( ≥ 8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient’s history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP. RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%. CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools). PMID:15526372

A randomized trial of rectal indomethacin and sublingual nitrates to prevent post-ERCP pancreatitis.

PubMed

Sotoudehmanesh, Rasoul; Eloubeidi, Mohamad Ali; Asgari, Ali Ali; Farsinejad, Maryam; Khatibian, Morteza

2014-06-01

Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Recent data suggest that indomethacin can reduce the risk of post-ERCP pancreatitis (PEP) in high-risk individuals. However, whether the combination of indomethacin and sublingual nitrates is superior to indomethacin alone is unknown. Therefore, we aimed to evaluate the efficacy of rectally administered indomethacin plus sublingual nitrate compared with indomethacin alone to prevent PEP. During a 17-month period, all eligible patients who underwent ERCP were enrolled in this study. We excluded patients who had undergone a prior endoscopic sphincterotomy. In a double-blind controlled randomized trial, patients received a suppository containing 100 mg of indomethacin, plus 5 mg of sublingual nitrate (group A), or a suppository containing 100 mg of indomethacin, plus sublingual placebo (group B), before ERCP. Serum amylase levels and clinically pertinent evaluations were measured in all patients after ERCP. Of the 300 enrolled patients, 150 received indomethacin plus nitrate. Thirty-three patients developed pancreatitis: 10 (6.7%) in group A and 23 (15.3%) in group B (P=0.016, risk ratio=0.39, 95% confidence intervals (CI): 0.18-0.86). More than 80% of the patients were at high risk of developing pancreatitis after ERCP. Absolute risk reduction, relative risk reduction, and number needed to treat for the prevention of PEP were 8.6% (95% CI: 4.7-14.5), 56.2% (95% CI: 50.6-60.8), and 12 (95% CI: 7-22), respectively. Combination of rectal indomethacin and sublingual nitrate given before ERCP was significantly more likely to reduce the incidence of PEP than indomethacin suppository alone. Multicenter trials to confirm these promising findings are needed.

Cholestasis caused by Fasciola gigantica.

PubMed

Beştaş, Remzi; Yalçin, Kendal; Çiçek, Muttalip

2014-01-01

Fascioliasis is an infectious disease caused by the hepatic trematodes Fasciola hepatica and Fasciola gigantica. Here, we report the case of Fasciola gigantica presenting with biliary obstruction and abdominal pain that was diagnosed and treated by endoscopic retrograde cholangiography (ERCP). A 46-year-old woman presented with right upper quadrant abdominal pain and jaundice. Physical examination revealed icterus and hepatomegaly. Laboratory findings revealed an increase in liver transaminases and bilirubin. Abdominal ultrasonography showed extrahepatic and intrahepatic bile duct dilatation. The patient underwent ERCP. One live Fasciola gigantica was removed from the common bile duct by ERCP. In conclusion, fascioliasis should be considered in the differential diagnosis of obstructive jaundice, especially in endemic regions, and it should be kept in mind that ERCP plays an important role in the diagnosis and treatment of these patients. To our knowledge, this is the second case report of Fasciola gigantica treated by ERCP in Turkey.

Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomized trial.

PubMed

Nathanson, Leslie K; O'Rourke, Nicholas A; Martin, Ian J; Fielding, George A; Cowen, Alistair E; Roberts, Roderick K; Kendall, Bradley J; Kerlin, Paul; Devereux, Benedict M

2005-08-01

Prospectively evaluate whether for patients having laparoscopic cholecystectomy with failed trans-cystic duct clearance of bile duct (BD) stones they should have laparoscopic choledochotomy or postoperative endoscopic retrograde cholangiography (ERCP). Clinical management of BD stones found at laparoscopic cholecystectomy in the last decade has focused on pre-cholecystectomy detection with ERCP clearance in those with suspected stones. This clinical algorithm successfully clears the stones in most patients, but no stones are found in 20% to 60% of patients and rare unpredictably severe ERCP morbidity can result in this group. Our initial experience of 300 consecutive patients with fluoroscopic cholangiography and intraoperative clearance demonstrated that, for the pattern of stone disease we see, 66% of patients' BD stones can be cleared via the cystic duct with dramatic reduction in morbidity compared to the 33% requiring choledochotomy or ERCP. Given the limitations of the preoperative approach to BD stone clearance, this trial was designed to explore the limitations, for patients failing laparoscopic trans-cystic clearance, of laparoscopic choledochotomy or postoperative ERCP. Across 7 metropolitan hospitals after failed trans-cystic duct clearance, patients were intraoperatively randomized to have either laparoscopic choledochotomy or postoperative ERCP. Exclusion criteria were: ERCP prior to referral for cholecystectomy, severe cholangitis or pancreatitis requiring immediate ERCP drainage, common BD diameter of less than 7 mm diameter, or if bilio-enteric drainage was required in addition to stone clearance. Drain decompression of the cleared BD was used in the presence of cholangitis, an edematous ampulla due to instrumentation or stone impaction and technical difficulties from local inflammation and fibrosis. The ERCP occurred prior to discharge from hospital. Mechanical and extracorporeal shockwave lithotripsy was available. Sphincter balloon dilation as an alternative to sphincterotomy to allow stone extraction was not used. Major endpoints for the trial were operative time, morbidity, retained stone rate, reoperation rate, and hospital stay. From June 1998 to February 2003, 372 patients with BD stones had successful trans-cystic duct clearance of stones in 286, leaving 86 patients randomized into the trial. Total operative time was 10.9 minutes longer in the choledochotomy group (158.8 minutes), with slightly shorter hospital stay 6.4 days versus 7.7 days. Bile leak occurred in 14.6% of those having choledochotomy with similar rates of pancreatitis (7.3% versus 8.8%), retained stones (2.4% versus 4.4%), reoperation (7.3% versus 6.6%), and overall morbidity (17% versus 13%). These data suggest that the majority of secondary BD stones can be diagnosed at the time of cholecystectomy and cleared trans-cystically, with those failing having either choledochotomy or postoperative ERCP. However, because of the small trial size, a significant chance exists that small differences in outcome may exist. We would avoid choledochotomy in ducts less than 7 mm measured at the time of operative cholangiogram and severely inflamed friable tissues leading to a difficult dissection. We would advocate choledochotomy as a good choice for patients after Billroth 11 gastrectomy, failed ERCP access, or where long delays would occur for patient transfer to other locations for the ERCP.

How do we manage post-OLT redundant bile duct?

PubMed

Torres, Victor; Martinez, Nicholas; Lee, Gabriel; Almeda, Jose; Gross, Glenn; Patel, Sandeep; Rosenkranz, Laura

2013-04-28

To address endoscopic outcomes of post-Orthotopic liver transplantation (OLT) patients diagnosed with a "redundant bile duct" (RBD). Medical records of patients who underwent OLT at the Liver Transplant Center, University Texas Health Science Center at San Antonio Texas were retrospectively analyzed. Patients with suspected biliary tract complications (BTC) underwent endoscopic retrograde cholangiopancreatography (ERCP). All ERCP were performed by experienced biliary endoscopist. RBD was defined as a looped, sigmoid-shaped bile duct on cholangiogram with associated cholestatic liver biomarkers. Patients with biliary T-tube placement, biliary anastomotic strictures, bile leaks, bile-duct stones-sludge and suspected sphincter of oddi dysfunction were excluded. Therapy included single or multiple biliary stents with or without sphincterotomy. The incidence of RBD, the number of ERCP corrective sessions, and the type of endoscopic interventions were recorded. Successful response to endoscopic therapy was defined as resolution of RBD with normalization of associated cholestasis. Laboratory data and pertinent radiographic imaging noted included the pre-ERCP period and a follow up period of 6-12 mo after the last ERCP intervention. One thousand two hundred and eighty-two patient records who received OLT from 1992 through 2011 were reviewed. Two hundred and twenty-four patients underwent ERCP for suspected BTC. RBD was reported in each of the initial cholangiograms. Twenty-one out of 1282 (1.6%) were identified as having RBD. There were 12 men and 9 women, average age of 59.6 years. Primary indication for ERCP was cholestatic pattern of liver associated biomarkers. Nineteen out of 21 patients underwent endoscopic therapy and 2/21 required immediate surgical intervention. In the endoscopically managed group: 65 ERCP procedures were performed with an average of 3.4 per patient and 1.1 stent per session. Fifteen out of 19 (78.9%) patients were successfully managed with biliary stenting. All stents were plastic. Selection of stent size and length were based upon endoscopist preference. Stent size ranged from 7 to 11.5 Fr (average stent size 10 Fr); Stent length ranged from 6 to 15 cm (average length 9 cm). Concurrent biliary sphincterotomy was performed in 10/19 patients. Single ERCP session was sufficient in 6/15 (40.0%) patients, whereas 4/15 (26.7%) patients needed two ERCP sessions and 5/15 (33.3%) patients required more than two (average of 5.4 ERCP procedures). Single biliary stent was sufficient in 5 patients; the remaining patients required an average of 4.9 stents. Four out of 19 (21.1%) patients failed endotherapy (lack of resolution of RBD and recurrent cholestasis in the absence of biliary stent) and required either choledocojejunostomy (2/4) or percutaneous biliary drainage (2/4). Endoscopic complications included: 2/65 (3%) post-ERCP pancreatitis and 2/10 (20%) non-complicated post-sphincterotomy bleeding. No endoscopic related mortality was found. The medical records of the 15 successful endoscopically managed patients were reviewed for a period of one year after removal of all biliary stents. Eleven patients had continued resolution of cholestatic biomarkers (73%). One patient had recurrent hepatitis C, 2 patients suffered septic shock which was not associated with ERCP and 1 patient was transferred care to an outside provider and records were not available for our review. Although surgical biliary reconstruction techniques have improved, RBD represents a post-OLT complication. This entity is rare however, endoscopic management of RBD represents a reasonable initial approach.

Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

PubMed Central

Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

2014-01-01

AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were treated with conservative management, including trans-arterial embolization to control the bleeding in one of the cases. All patients recovered without further incident. CONCLUSION: ERCP-related perforations may be difficult to diagnose by video endoscope and digital fluoroscope detection of retroperitoneal free air or contrast medium leakage can facilitate diagnosis. PMID:25400465

[ERCP success after 72 hours of pre-cut].

PubMed

Peñaloza-Ramírez, Arecio; Murillo-Arias, Andrés; Rodríguez-Mongui, Jaison; Carvajal-Flechas, Ricardo; Aponte-Ordoñez, Pedro

2018-01-01

Despite the advances of bile duct catheterization, its success is still not guaranteed. Few studies have been published regarding a second ERCP attempt, however those reports enhance the catheterization success Objective: To determine whether an ERCP performed 72 hours after a first precut papillotomy enhances the bile duct catheterization. A cohort study was performed including all patients that had ERCP with precut papilotomy without catheterization of the bile duct and 72 hours later were programmed to a new ERCP between September 2015 and September 2016. These patients did not have any distinctive characteristic such as age, gender or anatomy that were associated with the failure to catheterize the bile duct, compared to the general population. 16 patients were included with a mean age of 61,3 years (SD: 10,6), bile duct catheterization was successful in 14 cases. No complications presented after precut papilotomy. Both failures went to surgery. Our experience about an 87% successful bile duct catheterization, 72 hours after precut papillotomy allows us to suggest it as an alternative before considering surgery.

Liver Parenchyma Perforation following Endoscopic Retrograde Cholangiopancreatography.

PubMed

Kayashima, Hiroto; Ikegami, Toru; Kasagi, Yuta; Hidaka, Gen; Yamazaki, Koji; Sadanaga, Noriaki; Itoh, Hiroyuki; Emi, Yasunori; Matsuura, Hiroshi; Okadome, Kenichiro

2011-05-01

Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for the diagnosis and treatment of biliary and pancreatic diseases, it is still related with several severe complications. We report on the case of a female patient who developed liver parenchyma perforation following ERCP. She underwent ERCP with sphincterotomy and extraction of a common bile duct stone. Shortly after ERCP, abdominal distension was identified. Abdominal computed tomography revealed intraabdominal air leakage and leakage of contrast dye penetrating the liver parenchyma into the space around the spleen. Since periampullary perforation related to sphincterotomy could not be denied, she was referred for immediate surgery. Obvious perforation could not be found at surgery. Cholecystectomy, insertion of a T tube into the common bile duct, placement of a duodenostomy tube and drainage of the retroperitoneum were performed. She did well postoperatively and was discharged home on postoperative day 28. In conclusion, as it is well recognized that perforation is one of the most serious complication related to ERCP, liver parenchyma perforation should be suspected as a cause.

Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers.

PubMed

Al-Mansour, Mazen R; Fung, Eleanor C; Jones, Edward L; Zayan, Nichole E; Wetzel, Timothy D; Martin Del Campo, Sara E; Jalilvand, Anahita D; Suzo, Andrew J; Dettorre, Rebecca R; Fullerton, James K; Meara, Michael P; Mellinger, John D; Narula, Vimal K; Hazey, Jeffrey W

2018-06-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates. We retrospectively reviewed the charts of 1858 patients who underwent 2392 ERCP procedures performed by five surgeons between August 2003 and June 2016 in two centers. Demographic and historical data, indications, procedure-related data and 30-day complication and mortality data were collected and analyzed. The mean age was 53.4 (range 7-102) years and 1046 (56.3%) were female. 1430 (59.8%) of ERCP procedures involved a surgical endoscopy fellow. The most common indication was suspected or established uncomplicated common bile duct stones (n = 1470, 61.5%), followed by management of an existing biliary or pancreatic stent (n = 370, 15.5%) and acute biliary pancreatitis (n = 173, 7.2%). A therapeutic intervention was performed in 1564 (65.4%), a standard sphincterotomy in 1244 (52.0%), stent placement in 705 (29.5%) and stone removal in 638 (26.7%). When cannulation was attempted, the rate of successful cannulation was 94.1%. When cannulation was attempted during the patient's first ERCP the cannulation rate was 92.4%. 94 complications occurred (5.4%); the most common complication was post-ERCP pancreatitis in 75 (4.2%), significant gastrointestinal bleeding in 7 (0.4%), ascending cholangitis in 11 (0.6%) and perforation in 1 (0.05%). 11 mortalities occurred (0.5%) but none of which were ERCP-related. When performed by well-trained surgical endoscopists, ERCP is associated with high success rate and acceptable complication rates consistent with previously published reports and in line with societal guidelines.

Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Sphincterotomy for Suspected Sphincter of Oddi Dysfunction (SOD) Post Roux-En-Y Gastric Bypass.

PubMed

Lim, Chin Hong; Jahansouz, Cyrus; Freeman, Martin L; Leslie, Daniel B; Ikramuddin, Sayeed; Amateau, Stuart K

2017-10-01

Sphincter of Oddi dysfunction (SOD) is thought to be a cause of chronic abdominal pain post Roux-en-Y gastric bypass, and current practice of performing endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy is not supported by evidence. In addition to the complexity and risks of the procedure in patients with Roux-en-Y anatomy, the outcomes are uncertain and debatable. We performed a retrospective review and analysis of post-gastric bypass patients who had undergone ERCP with sphincterotomy to determine the effectiveness in patients with suspected SOD. Over a period of 5 years at the University of Minnesota, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had a previous Roux-en-Y gastric bypass and whom had a subsequent ERCP for suspected SOD. Patients were categorized by modified Milwaukee classification, and outcomes were evaluated by patients' self-reporting of symptoms at follow-up. We identified 50 patients who underwent laparoscopic-assisted gastrostomy for endoscopic retrograde cholangiopancreatography post Roux-en-Y gastric bypass over the study period. Within this group, 35 patients (70%) were suspected to have SOD. Nine patients (25.7%) were classified as type I, 19 patients (54.3%) type II, and seven patients (20%) type III. Thirty-four patients (97.1%) had biliary sphincterotomy, and 17 patients (48.6%) had both biliary and pancreatic sphincterotomy. Fourteen (40%) had repeated ERCP. At median follow-up of 11.5 months, type I SOD had two responders (25%), type II had nine responders (52.9%), and type III had one responder (14.3%). A subgroup analysis did not show significant differences in improvement of symptoms between patients whom had single versus repeated ERCP or biliary sphincterotomy alone versus both biliary and pancreatic sphincterotomy. Three patients (9%) had post-ERCP pancreatitis. SOD in patients post Roux-en-Y gastric bypass is complex due to multiple confounding factors. Rome III and Milwaukee classification systems assist us in the diagnosis and treatment of sphincter dysfunction until we have a better way to predict treatment response post sphincterotomy. Current treatment is based on the type of disorder and anatomy of biliary ducts. Types I and II sphincter dysfunction particularly associated with dilated biliary duct on imaging have the best response to endoscopic sphincterotomy and therefore should be considered taking into account the risks and benefit. Repeated sphincterotomy and concurrent pancreatic sphincterotomy is generally not useful.

Endoscopic retrograde cholangio-pancreatography practice in district general hospitals in North East England: a Northern Regional Endoscopy Group (NREG) study.

PubMed

Chatterjee, S; Rees, C; Dwarakanath, A D; Barton, R; MacDonald, C; Greenaway, J; Gregory, W; Reddy, A; Nylander, D L

2011-06-01

Endoscopic retrograde cholangio-pancreatography (ERCP) is an important tool for the management of pancreato-biliary disease. The aim of this study was to compare the current practice of ERCP in North East England against the key 2004 National Confidential Enquiry Report into Patient Outcome and Death (NCEPOD) recommendations and the standards set by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). This was a prospective multicentre study involving all hospitals in North East England, coordinated through the Northern Regional Endoscopy Group (NREG). Fourteen endoscopy units submitted data for 481 ERCPs. Mean dose of midazolam was 3.24 mg (standard deviation 1.35; range 1-8 mg). Coagulation profile results were available on 469 patients (97%). Radiological investigations were documented in 96% of the procedures (463 of 481) prior to ERCP. The most common indication for ERCP was related to choledocholithiasis and its complications.  All procedures were performed with a therapeutic intent. A total of 84% of all patients were either American Society of Anesthesiologists grade I or II. The selective biliary cannulation rate was 87.3%. The total completion rate of all procedures was 80.2% (381 of 475) and completion of therapy was 89.5% (425 of 475). The 30-day mortality rate was 2% (ten patients) and procedure-related complications occurred in 5% of patients. There were no deaths directly as a result of ERCP; all deaths were related to underlying medical conditions. The practice of ERCP in North East England adheres to the key recommendations of the NCEPOD and the standards set by JAG. The rates of complications compare favourably with those reported internationally.

Photodynamic Therapy in Patients with Advanced Hilar Cholangiocarcinoma: Percutaneous Cholangioscopic Versus Peroral Transpapillary Approach.

PubMed

Lee, Tae Yoon; Cheon, Young Koog; Shim, Chan Sup

2016-04-01

This study aimed to compare the clinical outcomes of patients with advanced hilar cholangiocarcinoma (CC) who underwent photodynamic therapy (PDT) with either percutaneous transhepatic cholangioscopy (PTCS) or endoscopic retrograde cholangiopancreatography (ERCP). PDT has been proposed as a promising therapy for treatment of unresectable hilar CC that is resistant to conventional standard treatment. However, few studies have compared the delivery methods of PDT in unresectable hilar CC patients. Thirty-seven adult patients with advanced hilar CC were included in this study. Twenty-four patients treated with PTCS-directed PDT and 13 patients treated with ERCP-directed PDT were analyzed retrospectively. The PTCS- and ERCP-directed PDT groups were comparable with respect to age, gender, health status, pretreatment bilirubin levels, Bismuth type, and hilar CC stage. The length of hospital stay differed significantly (p < 0.001) between the two groups, with a median hospital stay of 37 days (range, 13-77 days) in the ERCP-directed PDT group versus 63 days (range, 23-125 days) in the PTCS-directed group. PTCS-directed PDT patients demonstrated an overall survival similar to that of ERCP-directed PDT patients, with a median survival of 11.6 versus 9.5 months, respectively (p = 0.96). Only lower pre-PDT bilirubin levels (p = 0.002) were a significant predictor of improved survival in all patients who underwent PDT, as determined by multivariate analysis. Median metal stent patency was similar between the groups [PTCS-directed PDT group (n = 8), 6.2 months; ERCP-directed PDT group (n = 7), 7.2 months; p = 0.642]. Survival after PTCS- or ERCP-directed PDT was not statistically different in patients with advanced hilar CC. Lower pre-PDT bilirubin levels were associated with longer survival in all patients.

Preventing Post-ERCP Pancreatitis: The Role of Prophylactic Pancreatic Duct Stenting in the Rectal NSAID Era

PubMed Central

Bekkali, Noor-L-Houda; Thomas, Tom; Keane, Margaret Geraldine; Murray, Sam; Joshi, Deepak; Elsayed, Ghassan; Johnson, Gavin James; Chapman, Michael Huw; Pereira, Stephen Paul; Webster, George John Mitchell

2018-01-01

Background Rectal non-steroidal anti-inflammatory drug at endoscopic retrograde cholangiopancreatography is now the standard of care to reduce the risk of post-ERCP pancreatitis. Pancreatic duct stenting also reduces the risk of post- ERCP pancreatitis in high-risk patients, but failed pancreatic duct stenting carries an increased PEP rate (up to 35%). Study Aim To assess the impact on post-ERCP pancreatitis of successful and unsuccessful pancreatic duct stent placement in the setting of universal rectal non-steroidal anti-inflammatory drug use. Methods Between 2013–2015, all patients undergoing endoscopic retrograde cholangiopancreatographys in our tertiary referral centre (where rectal non-steroidal anti-inflammatory drugs are used routinely) were included. The electronic patient’s records were reviewed and the following parameters were analysed: indication for pancreatic duct stenting; deployment success; and adverse events. Results A total of 1633 endoscopic retrograde cholangiopancreatographys were performed, and pancreatic duct stenting was attempted in 324 cases (20%), with successful placement in 307 patients (95%). Contra-indications to non-steroidal anti-inflammatory drugs were found in 106 (6.5%) patients. Prophylactic stenting failed in 12 of 213 patients; of whom one patient developed post-ERCP pancreatitis (8%). Eighteen (9%) patients with prophylactic pancreatic duct stents developed post-ERCP pancreatitis compared to 1.4% without prophylactic stents (RR 8.4, p=0.04). Conclusion A lack of difference in post-ERCP pancreatitis in those who underwent successful, and unsuccessful, pancreatic duct stent placement may reflect the protective effect of non-steroidal anti-inflammatory drugs. This data adds to evidence suggesting that pancreatic duct stenting may be less important, even in high-risk patients, with the widespread use of non-steroidal anti-inflammatory drugs. PMID:29731700

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

PubMed Central

Nam, Hyeong Seok; Kang, Dae Hwan; Kim, Hyung Wook; Choi, Cheol Woong; Park, Su Bum; Kim, Su Jin; Ryu, Dae Gon

2017-01-01

AIM To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS). METHODS This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified. RESULTS Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications. CONCLUSION Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding. PMID:28321164

Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy.

PubMed

Inamdar, Sumant; Slattery, Eoin; Sejpal, Divyesh V; Miller, Larry S; Pleskow, Douglas K; Berzin, Tyler M; Trindade, Arvind J

2015-07-01

Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-balloon enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy. To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy. Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used. A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for enteroscopy, diagnostic, and therapeutic success (P < .001 for all). Adverse events occurred in 6.5% (95% CI, 4.7%-9.1%) of patients. There was no evidence of publication bias in this meta-analysis. Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis. SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction.

PubMed

Nam, Hyeong Seok; Kang, Dae Hwan; Kim, Hyung Wook; Choi, Cheol Woong; Park, Su Bum; Kim, Su Jin; Ryu, Dae Gon

2017-03-07

To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS). This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified. Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications. Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.

Risk Factors for Hepatic Morbidity Following Nonoperative Management: Multicenter Study

DTIC Science & Technology

2006-05-01

with a primary bile duct leak at ERCP. The last patient underwent laparotomy for a biliary -venous fistula that failed to resolve by ERCP and stenting ...the patient with a biliary -venous fistula underwent laparotomy and ERCP with stenting to manage this complication and then later, IR drainage of a...peritonitis,17 and stenting rather than sphincter- otomy is felt to expedite healing of biliary leaks.18 Al- though we had relatively few bile duct

Prophylaxis of pancreatitis with intravenous ketoprofen in a consecutive population of ERCP patients: a randomized double-blind placebo-controlled trial.

PubMed

de Quadros Onófrio, Fernanda; Lima, Julio Carlos Pereira; Watte, Guilherme; Lehmen, Romnei Lenon; Oba, Daniela; Camargo, Gabriela; Dos Santos, Carlos Eduardo Oliveira

2017-05-01

Background Acute pancreatitis is the most common complication after ERCP, occurring in about 4 % of the procedures. Only the placement of pancreatic duct prosthesis and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have shown benefit in the prevention of post-ERCP pancreatitis (PEP). Although the benefit of rectal administration of indomethacin or diclofenac is recommended by some studies and society guidelines especially in a selected group of high-risk patients, there is so far, no standardization of time or route of NSAID administration. The aim of the current study is to investigate the role of an intravenous NSAID administered before the procedure for PEP prevention. Methods In this randomized double-blind clinical trial, all consecutive patients who underwent ERCP were randomized to receive saline infusion with ketoprofen or saline, immediately before the procedure. Results A total of 477 patients were enrolled and completed follow-up. The majority of patients (72.1 %) had bile duct stones, and only 1.5 % had a clinical suspicion of sphincter of Oddi dysfunction. PEP developed in 5 of 253 (2 %) patients in the placebo group and in 5 of 224 (2.2 %) patients in the ketoprofen group (p = 1.). Conclusions Intravenous administration of ketoprofen immediately prior to ERCP did not result in reduction in PEP in a general population of ERCP patients.

The utility and yield of endoscopic ultrasonography for suspected choledocholithiasis in common gastroenterology practice.

PubMed

Quispel, Rutger; van Driel, Lydi M W J; Veldt, Bart J; van Haard, Paul M M; Bruno, Marco J

2016-12-01

Endoscopic ultrasonography (EUS) is an established diagnostic modality for diagnosing common bile duct (CBD) stones. Its use has led to a reduction in the number of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed for suspected choledocholithiasis. We aimed to explore the role of EUS in detecting CBD stones and/or sludge in common gastroenterology practice. We reviewed case records of 268 consecutive patients who underwent (EUS) procedures performed to confirm or rule out the presence of CBD stones and/or sludge between November 2006 and January 2011 in the Reinier de Graaf Hospital, Delft, The Netherlands, which is a nonacademic community hospital. On the basis of EUS findings, 169 of 268 (63%) patients did not undergo ERCP and were therefore not exposed to its risk of complications. Patients with positive findings on EUS (n=99) all underwent ERCP and endoscopic sphincterotomy. Only 57 of 99 (58%) had positive findings at ERCP. The main contributing factors to this finding seem to be time interval between EUS and ERCP and the type of CBD content (i.e. sludge, one CBD stone or more than one CBD stone) described. In our common gastroenterology practice, EUS plays an important role in selecting patients suspected to have CBD stones or sludge for ERCP. Much is to be learned about the probability of spontaneous passage of CBD stones and sludge into the duodenum.

Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

PubMed Central

Döbrönte, Zoltán; Szepes, Zoltán; Izbéki, Ferenc; Gervain, Judit; Lakatos, László; Pécsi, Gyula; Ihász, Miklós; Lakner, Lilla; Toldy, Erzsébet; Czakó, László

2014-01-01

AIM: To investigate the effectiveness of rectally administered indomethacin in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasaemia in a multicentre study. METHODS: A prospective, randomised, placebo-controlled multicentre study in five endoscopic units was conducted on 686 patients randomised to receive a suppository containing 100 mg indomethacin, or an inert placebo, 10-15 min before ERCP. Post-ERCP pancreatitis and hyperamylasaemia were evaluated 24 h following the procedure on the basis of clinical signs and laboratory parameters, and computed tomography/magnetic resonance imaging findings if required. RESULTS: Twenty-one patients were excluded because of incompleteness of their data or because of protocol violation. The results of 665 investigations were evaluated: 347 in the indomethacin group and 318 in the placebo group. The distributions of the risk factors in the two groups did not differ significantly. Pancreatitis developed in 42 patients (6.3%): it was mild in 34 (5.1%) and severe in eight (1.2%) cases. Hyperamylaesemia occurred in 160 patients (24.1%). There was no significant difference between the indomethacin and placebo groups in the incidence of either post-ERCP pancreatitis (5.8% vs 6.9%) or hyperamylasaemia (23.3% vs 24.8%). Similarly, subgroup analysis did not reveal any significant differences between the two groups. CONCLUSION: 100 mg rectal indomethacin administered before ERCP did not prove effective in preventing post-ERCP pancreatitis. PMID:25110443

Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

PubMed

Döbrönte, Zoltán; Szepes, Zoltán; Izbéki, Ferenc; Gervain, Judit; Lakatos, László; Pécsi, Gyula; Ihász, Miklós; Lakner, Lilla; Toldy, Erzsébet; Czakó, László

2014-08-07

To investigate the effectiveness of rectally administered indomethacin in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasaemia in a multicentre study. A prospective, randomised, placebo-controlled multicentre study in five endoscopic units was conducted on 686 patients randomised to receive a suppository containing 100 mg indomethacin, or an inert placebo, 10-15 min before ERCP. Post-ERCP pancreatitis and hyperamylasaemia were evaluated 24 h following the procedure on the basis of clinical signs and laboratory parameters, and computed tomography/magnetic resonance imaging findings if required. Twenty-one patients were excluded because of incompleteness of their data or because of protocol violation. The results of 665 investigations were evaluated: 347 in the indomethacin group and 318 in the placebo group. The distributions of the risk factors in the two groups did not differ significantly. Pancreatitis developed in 42 patients (6.3%): it was mild in 34 (5.1%) and severe in eight (1.2%) cases. Hyperamylaesemia occurred in 160 patients (24.1%). There was no significant difference between the indomethacin and placebo groups in the incidence of either post-ERCP pancreatitis (5.8% vs 6.9%) or hyperamylasaemia (23.3% vs 24.8%). Similarly, subgroup analysis did not reveal any significant differences between the two groups. 100 mg rectal indomethacin administered before ERCP did not prove effective in preventing post-ERCP pancreatitis.

Juxtapapillary duodenal diverticula early and late clinical and therapeutical implications.

PubMed

Straja, D; Marincaş, M; Alecu, M; Boroghina, G; Simion, L; Stanescu, A; Drilea, E; Brătucu, E

2009-01-01

The aim of this paper is to identify the early and late implications of JPDD for biliary pathology, as well as for endoscopic therapy and classical surgery dealing mainly with lithiasis. This paper is based on a retrospective study comprising a number of 675 ERCP performed on 601 patients between 1997-2007, out of which 399 cases were followed by therapeutic measures. A total of 79 procedures were performed on 65 cases with JPDD. The main criteria were: gender, age, indications regarding the performance of ERCP+/-ES, complications that occurred while carrying out these procedures. In all the cases examined (601) the percentage of JPDD reported was of 10.81%. The rate of complications in the sphincterotomized patients without JPDD was 5.75% and the rate in the sphincterotomized patients with JPDD was 14.89%. In conclusion, the paper discusses the clinical and therapeutic implications of JPDD in biliary pathology. It has been found that JPDD is an important etiological cause for the late diseases occurring after cholelithiasis surgery. JPDD also leads to immediate therapeutic implications such as: difficult cannulation and high incidence of ERCP+/-ES complications.

Gallstones

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... NASH Understanding Adult Overweight and Obesity Related Diagnostic Tests ERCP Your Digestive System and How it Works ...

ERCP in a cohort of 759 cases: A 6-year experience of a single tertiary centre in Libya.

PubMed

Tumi, Ali; Magadmi, Masoud; Elfageih, Salah; Rajab, Abdul-Fatah; Azzabi, Masoud; Elzouki, Abdel-Naser

2015-03-01

The aim of this study was to review the indications, findings, technical success, and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a large cohort of patients admitted to a single tertiary centre in Libya. A total of 759 consecutive ERCP procedures were performed in 704 patients from January 2005 through December 2010 at the Endoscopy Unit of Central Hospital, Tripoli, Libya. The patients' demographic characteristics, clinical information, ERCP indications, laboratory parameters, and post-ERCP complications were reviewed. Formal written consent was obtained from all patients prior to each procedure. The study included 280 (36.9%) males and 479 (63.1%) females with mean age ± standard deviation (SD) of 56.8 ± 18.7 years. Papillotomy was performed in 670 (88.3%) cases of the ERCP procedures. Common bile duct (CBD) stones were reported in 389 (51.3%) cases and were more frequent in females (234 cases, 60.1%) than males (155, 39.9%) (p = 0.01). The majority of the CBD stones were successfully retrieved with balloon extraction (304 cases, 78.2%), while mechanical lithotripsy (67 cases, 17.2%) and Dormia basket (11 cases, 2.8%) were used for difficult stones. Only seven (1.8%) cases were referred for surgery. Malignancy was found in 151 (19.9%) of the cases and was significantly more common in males than females (102, 67.5% vs. 49, 32.5%, respectively, p = 0.001). Stents for bile drainage were inserted in 26 (17.2%) of these cases. The complications encountered were acute pancreatitis in 30 cases (3.9%), minor bleeding in nine cases (1.2%), major bleeding in one case (0.15%), cholangitis in four cases (0.52%), and perforation in one case (0.15). Mortality was reported in three cases (0.4%). The ERCP indications and the related complications, in our centre in Libya, are comparatively consistent with those reported data in other countries. Successful biliary cannulation was achieved in most of the patients, and post-ERCP complications were uncommon except for pancreatitis, which occurred more frequently. Copyright © 2015 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Low-dose rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial.

PubMed

Otsuka, Taiga; Kawazoe, Seiji; Nakashita, Shunya; Kamachi, Saori; Oeda, Satoshi; Sumida, Chinatsu; Akiyama, Takumi; Ario, Keisuke; Fujimoto, Masaru; Tabuchi, Masanobu; Noda, Takahiro

2012-08-01

Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac or indomethacin) have shown promising prophylactic activity in post-ERCP pancreatitis (PEP). However, the 100-mg dose is higher than that ordinarily used in Japan. We performed a prospective randomized controlled study to evaluate the efficacy of low-dose rectal diclofenac for the prevention of PEP. Patients who were scheduled to undergo ERCP were randomized to receive a saline infusion either with 50 mg of rectal diclofenac (diclofenac group) or without (control group) 30 min before ERCP. The dose of diclofenac was reduced to 25 mg in patients weighing <50 kg. The primary outcome measure was the occurrence of PEP. Enrollment was terminated early because the planned interim analysis found a statistically significant intergroup difference in the occurrence of PEP. A total of 104 patients were eligible for this study; 51 patients received rectal diclofenac. Twelve patients (11.5%) developed PEP: 3.9% (2/51) in the diclofenac group and 18.9% (10/53) in the control group (p = 0.017). After ERCP, the incidence of hyperamylasemia was not significantly different between the two groups. Post-ERCP pain was significantly more frequent in the control group than in the diclofenac group (37.7 vs. 7.8%, respectively; p < 0.001). There were no adverse events related to diclofenac. Low-dose rectal diclofenac can prevent PEP.

One-step laparoscopic and endoscopic treatment of gallbladder and common bile duct stones: our experience of the last 9 years in a retrospective study.

PubMed

Liverani, Andrea; Muroni, Mirko; Santi, Francesco; Neri, Tiziano; Anastasio, Gerardo; Moretti, Marco; Favi, Francesco; Solinas, Luigi

2013-12-01

The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. Of those, 162 patients (8.2%; male/female 72/90) presented with GBS and suspected CBDS. We treated 54 cases (Group 1) with ERCP and LC within 48 to 72 hours. In 108 patients (Group 2) we performed LC with IOC and, if positive, was associated with IO-ERCP and sphincterotomy. In Group 1, a preoperative ERCP and LC were completed in 50 patients (30%). In four cases (2%), an ERCP and endobiliary stents were performed without cholecystectomy and then patients were discharged because of the severity of clinical conditions and advanced American Society of Anesthesiologists score (III to IV). Two months later a preoperative ERCP and removal of biliary stents were performed followed by LC 48 to 72 hours later. In Group 2, the IOC was performed in all cases and CBDS were extracted in 94 patients (87%). In two cases, the laparoscopic choledochotomy was necessary to remove large stones. In another two cases, an open choledochotomy was performed to remove safely the stones with T-tube drainage. In three cases, conversion was necessary to safely complete the procedure. The mean operative time was 95 minutes (range, 45 to 150 minutes) in Group 1 and 130 minutes (range, 50 to 300 minutes) in Group 2. The mean hospital stay was 6.5 days (range, 4 to 21 days) in Group 1 and 4.7 days (range, 3 to 14 days) in Group 2. Five cases (two in Group 2 and three in Group 1) presented with CBDS at 12 to 18 months after surgery. They were treated successfully with a second ERCP. There was no perioperative mortality. Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.

Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique?

PubMed

El-Geidie, Ahmed Abdel-Raouf

2011-08-01

The intraoperative use of endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy (LC) is a safe, single-stage option for the management of concomitant gallstones (GS) and common bile duct stones (CBDS). This study aims to compare between 2 techniques of combined laparoendoscopic management, which are laparoendoscopic Rendez-vous (LC/LERV) technique and standard ERCP after the completion of LC intraoperative endoscopic sphincterotomy (IOES). Patients with GS and suspected CBDS were included. They were divided into 2 groups; LC/LERV and LC/IOES. Both groups were compared for failure of endoscopic sphincterotomy/stone extraction, operative time, conversion rate, mortality/morbidity, and length of hospital stay. Between October 2007 and February 2010, 98 patients with GS and CBDS were eligible for inclusion in the study. They were prospectively randomized into 2 groups; LC/LERV (N=45) and LC/IOES (N=53). There were no differences in preoperative parameters between both groups. There was a significant difference in operative time (shorter for LC/IOES). No difference was noted in success/failure rate, post-ERCP pancreatitis. Both Standard ERCP after the completion of LC and LC/LERV are valid single-session management for CBD stones, but LC-ERCP may be preferred.

Endoscopic management of bile leakage after liver transplantation.

PubMed

Oh, Dong-Wook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

2015-05-23

Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.

[Retrospective evaluation of 500 endoscopic cholangiopancreatographies performed at the Instituto Nacional de la Nutrición "Salvador Zubiran"].

PubMed

Elizondo, J; Gallo, S; Valdovinos, M A; Paez, R

1989-01-01

We evaluated 500 endoscopic retrograde cholangiopancreatographies (ERCP) performed on 422 patients during a 5-year period in the Gastrointestinal Endoscopy Department, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F. ERCP combines endoscopic and radiologic techniques in order to obtain high quality opacification of pancreatic and biliary ducts. The rate of success for cannulation was 90%; desired duct opacification was possible in 89%. The most frequent indication for ERCP was to establish the differential diagnosis for jaundice; biliary stones in the common bile duct was the most frequent diagnosis, followed by normal biliary ducts. Pancreatography was normal in 74% of patients. ERCP complications were detected in 5.6%; fever and transient pain was the most common complaint in 1.6%. Mortality attributable to the procedure was 0.8%. From histological corroboration of cases by surgery or postmortem studies, diagnostic sensitivity was 92%, specificity 76%, positive predictive value 96% and a prevalence of 89%. We conclude that ERCP is highly sensitive and specific in diagnosing bilio-pancreatic-duodenal disease. Our results are comparable to other's experiences published throughout the world.

Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis.

PubMed

Bar-Meir, S; Geenen, J E; Hogan, W J; Dodds, W J; Stewart, E T; Arndorfer, R C

1979-03-01

Papillary stenosis is an imprecisely defined clinical syndrome which eludes definitive diagnosis. In this study we evaluated 26 patients with suspected papillary stenosis by manometric examination of the sphincter of Oddi done during ERCP examination. Basal pressure in the sphincter of Oddi was elevated in 14 of the patients. Of these 14 patients, 10 underwent sphincterotomy and all experienced improvement in clinical symptoms after their surgery. We suggest that ERCP manometry is a useful procedure for identifying patients with papillary stenosis who may benefit from sphincterotomy.

Impact of nitroglycerin and glucagon administration on selective common bile duct cannulation and prevention of post-ERCP pancreatitis.

PubMed

Katsinelos, Panagiotis; Lazaraki, Georgia; Chatzimavroudis, Grigoris; Katsinelos, Taxiarchis; Georgakis, Nikos; Anastasiadou, Kyriaki; Gatopoulou, Anthi; Zeglinas, Christos; Psarras, Kyriakos; Kountouras, Jannis

2017-01-01

Easy common bile duct (CBD) cannulation is associated with low complication rate. This study aimed to investigate the potential impact of nitroglycerin and glucagon administration on selective CBD cannulation and prevention of post-ERCP pancreatitis. A prospective single center, double-blind randomized study in which a total of 455 patients were randomly assigned to CBD cannulation by receiving 6 puffs (2.4 mg) sublingual nitroglycerin and glucagon 1 mg intravenously (n = 227, group A) or 6 puffs sterile water and 20 mg hyoscine-n-butyl bromide intravenously (n = 228, group B). After ERCP, patients were followed for the development of drugs' side-effects and post-ERCP complications. There were no statistically significant differences between the two groups regarding demographic data and ERCP findings. Success rate of selective CΒD cannulation was 95.15% in group A versus 82.29% in group B (p < .001). Time required for CBD cannulation was 2.82 ± 2.31 min in group A versus 4.27 ± 3.84 min in group B (p = .021). Needle-knife papillotomy was used in 11 (4.85%) patients of group A and 39 (17.11%) patients of group B (p = .001). The frequency of post-ERCP pancreatitis was significantly lower in group A than in group B (3.08% versus 7.46%, p = .037). No difference was observed between the two groups with regard to the occurrence of post-procedure hemorrhage. There was no procedure-related mortality; no adverse event related to the combination regimen was observed. Combined nitroglycerin and glucagon administration achieves a high selective CBC cannulation rates with concomitant reduction of post-ERCP pancreatitis incidence. However, further relative large-scale studies are needed to confirm our findings before definite conclusions can be drawn (Clinical trial registration number: NT: 4321).

Clinical outcome of single plastic stent treatment of benign iatrogenic biliary strictures: is the outcome predetermined?

PubMed

Rajab, Murad A; Go, Jorge; Silverman, William B

2014-12-01

Endoscopic retrograde cholangiopancreatography (ERCP) is used for the management of benign iatrogenic biliary strictures after cholecystectomy and liver transplantation. Multiple stents can injure biliary circulation. If resolution of reversible ductal edema and/or ischemia is the mechanism for successful therapy then single stent placement for benign biliary stricture should work. Retrospectively reviewed ERCP records between November 1999 and 2012 provided 25 patients with repeat ERCPs performed at 10-week intervals or if symptoms of stent occlusion were present. If strictures did not improve between stent changes and if removal was not an option, hepaticojejunostomy was used. Strictures resolved in 72% of patients. Seven patients underwent hepaticojejunostomy. Three had ERCP-related complications. No stricture recurrence occurred during the follow-up period. Endoscopic single plastic stent treatment of benign biliary iatrogenic strictures has comparable success to multiple stenting. Many postsurgical strictures may have reversible ischemic/edematous component with stenting to maintain bile drainage.

Laparoscopic Common Bile Duct Exploration in Patients With Gallstones and Choledocholithiasis

PubMed Central

Rodriguez, Omaira; Bellorín, Omar; Sánchez, Renata; Benítez, Gustavo

2010-01-01

Objectives: To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). Methods: This is a descriptive, comparative study. Patients with an indication of common bile duct exploration between February 2005 and October 2008 were included. We studied 2 groups: Group A: patients with failed ERCP who underwent LCBDE plus LC. Group B: patients with common bile duct stones managed with the 1-step approach (LCBDE + LC) with no prior ERCP. Results: Twenty-five patients were included. Group A: 9 patients, group B: 16 patients. Success rate, operative time, and hospital stay were as follows: group A 66% vs group B 87.5%; group A 187 minutes vs 106 minutes; group A 4.5 days vs 2.3 days; respectively. Conclusion: Patients with failed ERCP should be considered as high-complex cases in which the laparoscopic procedure success rate decreases, and the conversion rate increases considerably. PMID:20932377

[Obstructive cholangiopathy: are endoscopic retrograde cholangiopancreatography and papillotomy always really necessary?].

PubMed

Pierie, J P; van Vroonhoven, T J

1999-07-17

In two women aged 76 and 29 years, who presented with cholangitis and small ductus choledochus calculi and with painless icterus respectively, endoscopic retrograde cholangiopancreatography (ERCP) was carried out with papillotomy. Both developed a duodenal perforation which, however, could not be localized. The first patient eventually died, the second recovered after prolonged hospitalization. A third patient, a 53-year-old man, developed abdominal pain and fever four days after laparoscopic cholecystectomy. ERCP was planned, but in the meantime the patient showed signs of recovery. The ERCP was carried out nevertheless. It failed and the patient suffered a prolonged recovery with necrotizing pancreatitis and multiple operations necessitating a temporary colostoma. In all three patients the endoscopic procedure was performed routinely without strict individualized indication. ERCP and papillotomy may be relatively safe procedures, but it should always be considered whether they will really serve the patient.

Selective use of preoperative endoscopic retrograde cholangiopancreatography in the era of laparoscopic cholecystectomy.

PubMed

Nataly, Yogesh; Merrie, Arend E; Stewart, Ian D

2002-03-01

The use of endoscopic retrograde cholangiopancreatography (ERCP) in the management of suspected common bile duct (CBD) stones prior to laparoscopic cholecystectomy is common. The associated morbidity can be significant. The present study determines significant predictors of CBD stones and improves the selection of patients for preoperative ERCP. All preoperative ERCP for suspected CBD stones in the year 1998 were studied retrospectively. Univariate and multivariate analyses of a number of clinical, biochemical and radiological variables were carried out to determine the best predictors of CBD stones. A total of 112 patients had successful preoperative ERCP. Sixty-one per cent of these were negative for stones and the morbidity was 9%. Univariate analysis revealed the following variables as predictors: cholangitis (P = 0.006), abnormal serum bilirubin > or = 3 days (P = 0.002), serum alkaline phosphatase > or = 130 U/L (P = 0.002), deranged liver function tests (P = < 0.001) and CBD diameter > or = 8 mm (P = 0.009) with positive predictive values of 80%, 68%, 49%, 38% and 52%, respectively. Multivariate analysis revealed the model with the best ability to discriminate for CBD stones (P = 0.0005) was cholangitis, abnormal serum bilirubin for > or = 3 days and CBD diameter > or = 8 mm. The best predictors from this study had a sensitivity of 80% and a specificity of 27%. The predictors of CBD stones are imprecise. Until laparoscopic exploration of CBD becomes widely available, ERCP prior to cholecystectomy will remain popular. The use of stricter selection criteria can reduce the number of negative preoperative ERCP.

Gabexate in the prophylaxis of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials.

PubMed

Zheng, Minghua; Chen, Yongping; Yang, Xinjun; Li, Ji; Zhang, Youcai; Zeng, Qiqiang

2007-02-12

Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and the benefit of its pharmacological treatment is unclear. Although prophylactic use of gabexate for the reduction of pancreatic injury after ERCP has been evaluated, the discrepancy about gabexate's beneficial effect on pancreatic injury still exists. This study aimed to evaluate the effectiveness and safety of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of gabexate in the prevention of post-ERCP pancreatitis (PEP) including three RCTs conducted in Italy and one in China. All of the four RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR) for gabexate mesilate were 0.67 [95% CI (0.31 to approximately 1.47), p = 0.32] for PEP, 3.78 [95% CI (0.62 to approximately 22.98), p = 0.15] for severe PEP, 0.68 [95% CI (0.19 to approximately 2.43), p = 0.56] for the case-fatality of PEP, 0.88 [95% CI (0.72 to approximately 1.07), p = 0.20] for post-ERCP hyperamylasemia, 0.69 [95% CI (0.39 to approximately 1.21), p = 0.19] for post-ERCP abdominal pain, thus indicating no beneficial effects of gabexate on acute pancreatitis, the death rate of PEP, hyperamylasemia and abdominal pain. No evidence of publication bias was found. Gabexate mesilate can not prevent the pancreatic injury after ERCP. It is not recommended for the use of gabexate mesilate in the prophylaxis of PEP.

Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail.

PubMed

Sugimoto, Mitsuru; Takagi, Tadayuki; Suzuki, Rei; Konno, Naoki; Asama, Hiroyuki; Sato, Yuki; Irie, Hiroki; Watanabe, Ko; Nakamura, Jun; Kikuchi, Hitomi; Waragai, Yuichi; Takasumi, Mika; Hikichi, Takuto; Ohira, Hiromasa

2018-06-14

To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups. Pancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086) vs 78.5 (5.0-1266.5), P = 0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia (≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis. Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

Rectal indomethacin versus placebo to reduce the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography: results of a controlled clinical trial.

PubMed

Andrade-Dávila, Víctor Fernando; Chávez-Tostado, Mariana; Dávalos-Cobián, Carlos; García-Correa, Jesús; Montaño-Loza, Alejandro; Fuentes-Orozco, Clotilde; Macías-Amezcua, Michel Dassaejv; García-Rentería, Jesús; Rendón-Félix, Jorge; Cortés-Lares, José Antonio; Ambriz-González, Gabriela; Cortés-Flores, Ana Olivia; Alvarez-Villaseñor, Andrea del Socorro; González-Ojeda, Alejandro

2015-07-21

Acute pancreatitis is the most common major complication after endoscopic retrograde cholangiopancreatography (ERCP). Many drugs have been evaluated for prophylaxis, including nonsteroidal anti-inflammatory drugs (NSAIDs), which are potent inhibitors of phospholipase A2 and play a role in the pathogenesis of acute pancreatitis. Rectal NSAIDs have been shown in prospective studies to decrease the incidence of this complication, but the indication is not generalized in clinical practice. The aim of this study was to evaluate the efficacy of rectal administration of indomethacin in reducing the incidence of post-ERCP pancreatitis in high-risk patients. This was a controlled clinical trial where patients with an elevated risk of developing post-ERCP pancreatitis were assigned to receive 100 mg of rectal indomethacin or a 2.6 g suppository of glycerin immediately after ERCP, without placement of a pancreatic stent. The patients were determined to be at high risk based on validated patient- and procedure-related risk factors. Post-ERCP pancreatitis was defined as the presence of new upper abdominal pain, hyperamylasemia/hyperlipasemia (at least three times the upper limit) 2 hours after the procedure and hospitalization at least 48 hours because of the complication. Pancreatitis severity was defined according to Cotton's criteria. One hundred sixty-six patients were included; 82 in the study group and 84 in the placebo group. Patients had at least one major and/or two minor risk factors for developing post-ERCP pancreatitis. The incidence of the complication was 4.87% (4/82) in the study group and 20.23% (17/84) in the placebo group; this difference was significant (P = 0.01). According to Cotton's criteria, 17 patients (80.9%) developed mild pancreatitis and 4 (19.1%) had moderate pancreatitis; 3 of these 4 patients belonged to the placebo group (P = 0.60). Based on these results, an absolute risk reduction of 0.15 (15%), a relative risk reduction of 0.75 (75%) and a number needed to treat of 6.5 patients were calculated to prevent an episode of post-ERCP pancreatitis. There was no mortality. Rectal indomethacin reduced the incidence of post-ERCP pancreatitis among patients at high risk of developing this complication. National Clinical Trials NCT02110810. Date April 7, 2014.

Utility of MRCP in clinical decision making of suspected choledocholithiasis: An institutional analysis and literature review.

PubMed

Badger, Wesley R; Borgert, Andrew J; Kallies, Kara J; Kothari, Shanu N

2017-08-01

The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. MRCP vs. operative intervention as the initial choice of treatment/imaging modality. We performed a retrospective review of the electronic medical records for all patients with a coded diagnosis of choledocholithiasis from 2011 to 2014. The initial diagnostic modality was assessed for each hospital encounter. The statistical characteristics of MRCP as compared to fluoroscopic imaging of the biliary tree (ERCP, IOC) were analyzed. Overall, 527 hospital encounters were identified. Initial intervention included ERCP in 63%, MRCP in 12%, and cholecystectomy in 25% of patients. Patients undergoing cholecystectomy first, compared to MRCP or ERCP, tended to have lower values for alkaline phosphatase (P < 0.001) and AST (P = 0.002) as well as be of younger age (P < 0.0001). Of the patients that underwent MRCP as their initial procedure, 82% subsequently underwent either ERCP or laparoscopic cholecystectomy. In patients who underwent an initial MRCP followed by either ERCP or IOC, the predictive performance of MRCP was as follows: sensitivity = 0.90, specificity = 0.86, positive predictive value = 0.97, negative predictive value = 0.60, agreement (Cohen's Kappa) = 0.64. There is a significant difference in the laboratory evaluation and demographics of patients undergoing ERCP, MRCP, and laparoscopic cholecystectomy. MRCP was followed with a more invasive test a majority of the time. Since MRCP did not change the management of patients with suspected choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

Incidence, risk factors and ERCP outcome for biliary complications after cadaveric OLT.

PubMed

Martins, Fernanda Prata; De Paulo, Gustavo Andrade; Conceição, Raquel Dilgerian; Zurstrassen, Maria Paula; Thomé, Tadeu; Ferraz-Neto, Ben-Hur; Ferrari, Angelo Paulo

2011-01-01

Biliary complications (BC) occur in up to 39.5% of patients after orthotopic liver transplantation (OLT), being an important source of post-transplant morbidity. The aim is to evaluate the incidence of BC after OLT, associated risk factors and outcome after endoscopic treatment. A retrospective case series between June 2005 and December 2008, including 195 patients that underwent 216 OLT from deceased donors. Thirty-one patients (14.3%) presented at least 1 BC, anastomotic stricture being the most frequent (83.8%). Non-anastomotic stricture was present in 1 (3.2%) and anastomotic fistula in 1. One patient presented anastomotic disconnection at ERCP. BC occurred 94.6 (7-487) days after OLT. Twenty-seven patients underwent endoscopic treatment, on average 2.6 ERCPs were performed per patient. Global endoscopic treatment success rate was 77.3%; being 73.7% for stenosis and 100% (3/3) for anastomotic fistula with stenosis. Recurrence of biliary stricture was observed in 3 patients, all referred to endoscopic re-treatment. ERCP complications: 2 (2.8%) stent migrations, 1 (1.4%) early stent occlusion, 1 (1.4%) respiratory distress and 1(1.4%) severe acute pancreatitis and death. There was no correlation between studied risk factors and BC's occurrence. ERCP was effective for the treatment of BC after OLT. Studied risk factors had no correlation with BC.

Endoscopic Management of Bile Leakage after Liver Transplantation

PubMed Central

Oh, Dongwook; Lee, Sung Koo; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Seo, Dong-Wan; Kim, Myung-Hwan

2015-01-01

Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Methods Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. Results In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. Conclusions ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients. PMID:25717048

Results of the open surgery after endoscopic basket impaction during ERCP procedure.

PubMed

Yilmaz, Sezgin; Ersen, Ogun; Ozkececi, Taner; Turel, Kadir S; Kokulu, Serdar; Kacar, Emre; Akici, Murat; Cilekar, Murat; Kavak, Ozgur; Arikan, Yuksel

2015-02-27

To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

No Benefit of Oral Diclofenac on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

PubMed

Ishiwatari, Hirotoshi; Urata, Takahiro; Yasuda, Ichiro; Matsusaki, Shimpei; Hisai, Hiroyuki; Kawakami, Hiroshi; Ono, Michihiro; Iwashita, Takuji; Doi, Shinpei; Kawakubo, Kazumichi; Hayashi, Tsuyoshi; Sonoda, Tomoko; Sakamoto, Naoya; Kato, Junji

2016-11-01

Pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication. Rectal diclofenac (100 mg) has been shown to reduce the incidence of pancreatitis; however, this dosage form is unavailable in several countries. We aimed to investigate the preventive effect of oral diclofenac on pancreatitis after ERCP in a multicenter, randomized, prospective, placebo-controlled, double-blind trial. Patients undergoing a first ERCP in seven high-volume centers between July 2012 and August 2014 were considered eligible. Participants were administered oral diclofenac (50 mg) or placebo before and after ERCP. The primary endpoint was the incidence of pancreatitis. A subgroup analysis was performed for patients at high or low risk of pancreatitis. Secondary endpoints were pancreatic enzyme levels (amylase and lipase). We initially enrolled 430 patients (216 in the diclofenac and 214 in the placebo group), and 23 were excluded after randomization. The overall incidence of pancreatitis was 9.8 % (20/205) and 9.4 % (19/202) in the diclofenac and placebo groups, respectively (p = 0.90). The incidence of pancreatitis was 20.3 % (13/64) and 21.3 % (13/61) in patients at high risk of pancreatitis (p = 0.78) and 5.0 % (7/141) and 4.3 % (6/141) in patients at low risk of pancreatitis in the diclofenac and placebo groups (p = 0.94), respectively. There were no significant differences in serum amylase and lipase levels between the two groups before and 24 h after ERCP. Oral administration of diclofenac before and after ERCP showed no benefit in the prevention of pancreatitis. UMIN000008109.

Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection.

PubMed

Itokawa, Fumihide; Itoi, Takao; Ishii, Kentaro; Sofuni, Atsushi; Moriyasu, Fuminori

2014-04-01

In patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection. BAE-ERCP procedures were carried out in 62 patients (HJ with R-Y:Whipple resection=34:28). Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P=0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P=0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively. BAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined?

PubMed

Gornals, Joan B; Esteban, José Miguel; Guarner-Argente, Carlos; Marra-Lopez, Carlos; Repiso, Alejandro; Sendino, Oriol; Loras, Carme

2016-11-01

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice.

PubMed

Tziatzios, Georgios; Gkolfakis, Paraskevas; Papanikolaou, Ioannis S; Dimitriadis, George; Triantafyllou, Konstantinos

2016-04-01

Despite the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient's liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP.

PubMed

García-Cano, Jesús; Viñuelas Chicano, Miriam; Del Moral Martínez, María; Muñiz Muñoz, Marta; Murillo Matamoros, Claudio; Suárez Matías, Miguel; Valiente González, Laura; Martínez Pérez, Teresa; Martínez Fernández, Raquel; Gómez Ruiz, Carmen Julia; Pérez García, José Ignacio; Morillas Ariño, Julia

2018-04-24

the guidewire (GW) may enter the pancreatic duct during common bile duct (CBD) cannulation attempts in endoscopic retrograde cholangiopancreatography (ERCP). After GW passage into the pancreas, the most effective maneuver for CBD cannulation and pancreatitis prevention has not been determined. to study CBD cannulation and post-ERCP pancreatitis rates when a pancreatic stent is inserted after an unintentional GW cannulation of the pancreatic duct. a retrospective analysis of patients undergoing ERCP for biliary drainage that were included prospectively into a database. After unintentional GW cannulation of the pancreatic duct, a straight 5-Fr and 4-cm long plastic stent was inserted. The stents had no internal flaps to facilitate expulsion. CBD cannulation attempts were made above the stent. A pancreatic sphincterotomy was performed in patients older than 60 years before stent insertion. a total of 46 pancreatic stents were inserted during 154 ERCP (29.8%) procedures. In the stent group, CBD cannulation was accomplished in 44/46 (95.6%) subjects. A total of 21/46 (45.6%) pancreatic sphincterotomies were performed. Only 1/46 (2.17%) mild pancreatitis cases were observed and most stents were spontaneously expelled. in this study, the CBD was eventually reached with the insertion of a plastic pancreatic stent after an unintentional GW passage into the pancreatic duct while attempting a CBD cannulation. No adverse events were observed following pancreatic stent insertion.

Clinical usefulness of a short-type, prototype single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: preliminary experiences.

PubMed

Kawamura, Takuji; Uno, Koji; Suzuki, Azumi; Mandai, Koichiro; Nakase, Kojiro; Tanaka, Kiyohito; Yasuda, Kenjiro

2015-01-01

A limited number of endoscopic retrograde cholangiopancreatography (ERCP) accessories are compatible with the conventional single-balloon enteroscope (SBE) because of the latter's dimensions. The aim of the present study was to assess the utility of a prototype SBE that has a shorter working length and a wider channel than the conventional SBE. ERCP procedures carried out between January 2012 and July 2013 using the short SBE prototype were reconstructions such as Billroth II (B-II), post-gastrectomy with Roux-en-Y (RY-G), and post-choledochojejunostomy with Roux-en-Y (RY-CJ). We retrospectively analyzed the rate of reaching the blind end of the intestine, the diagnostic success rate, the interventional success rate, and the frequency of related complications. Twenty-seven ERCP procedures on 18 patients analyzed comprised two B-II, 15 RY-G, and 10 RY-CJ reconstructions. With a mean procedure time of 56 min (range 40-150 min), the rate of reaching the blind end, the diagnostic success rate, and the interventional success rate were 24/27 (89%), 20/27 (74%), and 19/27 (70%), respectively. There were no major ERCP-related complications in any patient. The prototype short-type SBE appears safe and effective for use in ERCP, and is compatible with conventional endoscopy accessories. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis.

PubMed

Kwon, Richard S; Young, Benjamin E; Marsteller, William F; Lawrence, Christopher; Wu, Bechien U; Lee, Linda S; Mullady, Daniel; Klibansky, David A; Gardner, Timothy B; Simeone, Diane M

2016-09-01

This study aimed to determine if the improved pain response to endoscopic retrograde cholangiopancreatogrphy (ERCP) and pancreatic stent placement (EPS) predicts pain response in patients with chronic pancreatitis after modified lateral pancreaticojejunostomy (LPJ). A multi-institutional, retrospective review of patients who underwent successful EPS before LPJ between 2001 and 2010 was performed. The primary outcome was narcotic independence (NI) within 2 months after ERCP or LPJ. A total of 31 narcotic-dependent patients with chronic pancreatitis underwent successful EPS before LPJ. Ten (32%) achieved post-LPJ NI (median follow-up, 8.5 months; interquartile range [IQR], 2-38 months). Eight (80%) of 10 patients with NI post-ERCP achieved NI post-LPJ. Two (10%) without NI post-ERCP achieved NI post-LPJ. Narcotic independence post-EPS was associated strongly with NI post-LPJ with an odds ratio of 38 (P = 0.0025) and predicted post-LPJ NI with a sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 90.5%, 80%, and 90.5%, respectively. Narcotic independence after EPS is associated with NI after LPJ. Failure to achieve NI post-ERCP predicts failure to achieve NI post-LPJ. These results support the need for larger studies to confirm the predictive value of pancreatic duct stenting for better selection of chronic pancreatitis patients who will benefit from LPJ.

Efficiency and Safety of One-Step Procedure Combined Laparoscopic Cholecystectomy and Eretrograde Cholangiopancreatography for Treatment of Cholecysto-Choledocholithiasis: A Randomized Controlled Trial.

PubMed

Liu, Zhiyi; Zhang, Luyao; Liu, Yanling; Gu, Yang; Sun, Tieliang

2017-11-01

We aimed to evaluate the efficiency and safety of one-step procedure combined endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) for treatment of patients with cholecysto-choledocholithiasis. A prospective randomized study was performed on 63 consecutive cholecysto-choledocholithiasis patients during 2008 and 2011. The efficiency and safety of one-step procedure was assessed by comparing the two-step LC with ERCP + endoscopic sphincterotomy (EST). Outcomes including intraoperative features, postoperative features (length of stay and postoperative complications) were evaluated. One- or two-step procedure of LC with ERCP + EST was successfully performed in all patients, and common bile duct stones were completely removed. Statistical analyses showed that length of stay and pulmonary infection rate were significantly lower in the test group compared with that in the control group (P < 0.05), whereas no statistical difference in other outcomes was found between the two groups (all P > 0.05). The one-step procedure of LC with ERCP + EST is superior to the two-step procedure for treatment of patients with cholecysto-choledocholithiasis regarding to the reduced hospital stay and inhibited occurrence of pulmonary infections. Compared with two-step procedure, one-step procedure of LC with ERCP + EST may be a superior option for cholecysto-choledocholithiasis patients treatment regarding to hospital stay and pulmonary infections.

The Role of Endoscopic Biliary Drainage without Sphincterotomy in Gallstone Patients with Cholangitis and Suspected Common Bile Duct Stones Not Detected by Cholangiogram or Intraductal Ultrasonography

PubMed Central

Goong, Hyeon Jeong; Moon, Jong Ho; Lee, Yun Nah; Choi, Hyun Jong; Choi, Seo-Youn; Choi, Moon Han; Kim, Min Jin; Lee, Tae Hoon; Park, Sang-Heum; Lee, Hae Kyung

2017-01-01

Background/Aims Treatment for cholangitis without common bile duct (CBD) stones has not been established in patients with gallstones. We investigated the usefulness of endoscopic biliary drainage (EBD) without endoscopic sphincterotomy (EST) in patients diagnosed with gallstones and cholangitis without CBD stones by endoscopic retrograde cholangiopancreatography (ERCP) and intraductal ultrasonography (IDUS). Methods EBD using 5F plastic stents without EST was performed prospectively in patients with gallstones and cholangitis if CBD stones were not diagnosed by ERCP and IDUS. After ERCP, all patients underwent laparoscopic cholecystectomy. The primary outcomes were clinical and technical success. The secondary outcomes were recurrence rate of biliary events and procedure-related adverse events. Results Among 187 patients with gallstones and cholangitis, 27 patients without CBD stones according to ERCP and IDUS received EBD using 5F plastic stents without EST. The stents were maintained in all patients until laparoscopic cholecystectomy, and recurrence of cholangitis was not observed. After cholecystectomy, the stents were removed spontaneously in 12 patients and endoscopically in 15 patients. Recurrence of CBD stones was not detected during the follow-up period (median, 421 days). Conclusions EBD using 5F plastic stents without EST may be safe and effective for the management of cholangitis accompanied by gallstones in patients without CBD stones according to ERCP and IDUS. PMID:28104896

Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP.

PubMed

Buscail, L; Escourrou, J; Moreau, J; Delvaux, M; Louvel, D; Lapeyre, F; Tregant, P; Frexinos, J

1995-04-01

The usefulness and accuracy rate of endoscopic ultrasonography (EUS) in the diagnosis of chronic pancreatitis (CP) were prospectively evaluated in 81 patients with suspected pancreatic disease. All underwent EUS, abdominal ultrasonography (AUS), and computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 55 of the cases. The diagnosis of CP was established in 44 patients (CP group) including 24 with a calcified form. No pancreatic disease was observed in 18 patients (control group), and 19 patients had a pancreatic tumor. In the CP group AUS was less accurate than EUS in visualizing the pancreas, performances of CT scan being identical to EUS in this respect. A good correlation was observed between EUS and ERCP for visualization and measurement of the Wirsung duct. The most significant changes observed by EUS in the CP group were dilatation of the main pancreatic duct, heterogeneous echogenicity of the pancreatic parenchyma, and cysts < 20 mm in size even in noncalcified CP or with normal pancreatograms. Sensitivity of EUS for diagnosis of CP was 88% (AUS, 58%; ERCP, 74%; CT scan, 75%), the specificity being 100% for ERCP and EUS, 95% for CT scan, and 75% for AUS. The good performances of EUS allow early diagnosis of CP in symptomatic patients since heterogeneous echogenicity of the pancreatic parenchyma seems to be almost specifically associated with the disease.

Results of the open surgery after endoscopic basket impaction during ERCP procedure

PubMed Central

Yilmaz, Sezgin; Ersen, Ogun; Ozkececi, Taner; Turel, Kadir S; Kokulu, Serdar; Kacar, Emre; Akici, Murat; Cilekar, Murat; Kavak, Ozgur; Arikan, Yuksel

2015-01-01

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases. PMID:25722797

Sedative techniques for endoscopic retrograde cholangiopancreatography.

PubMed

Garewal, Davinder; Powell, Steve; Milan, Stephen J; Nordmeyer, Jonas; Waikar, Pallavi

2012-06-13

Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable therapeutic procedure that cannot be performed without adequate sedation or general anaesthesia. A considerable number of ERCPs are performed annually in the UK (at least 48,000) and many more worldwide. The primary objective of our review was to evaluate and compare the efficacy and safety of sedative or anaesthetic techniques used to facilitate the procedure of ERCP in adult (age > 18 years) patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 8); MEDLINE (1950 to September 2011); EMBASE (1950 to September 2011); CINAHL, Web of Science and LILACS (all to September 2011). We searched for additional studies drawn from reference lists of retrieved trial materials and review articles and conference proceedings. We considered all randomized or quasi-randomized controlled studies where the main procedures performed were ERCPs. The three interventions we searched for were (1) conscious sedation (using midazolam plus opioid) versus deep sedation (using propofol); (2) conscious sedation versus general anaesthesia; and (3) deep sedation versus general anaesthesia. We considered all studies regardless of which healthcare professional administered the sedation. We reviewed 124 papers and identified four randomized trials (with a total of 510 participants) that compared the use of conscious sedation using midazolam and meperidine with deep sedation using propofol in patients undergoing ERCP procedures. All sedation was administered by non-anaesthetic personnel. Due to the clinical heterogeneity of the studies we decided to review the papers from a narrative perspective as opposed to a full meta-analysis. Our primary outcome measures included mortality, major complications and inability to complete the procedure due to sedation-related problems. Secondary outcomes encompassed sedation efficacy and recovery. No immediate mortality was reported. There was no significant difference in serious cardio-respiratory complications suffered by patients in either sedation group. Failure to complete the procedure due to sedation-related problems was reported in one study. Three studies found faster and better recovery in patients receiving propofol for their ERCP procedures. Study protocols regarding use of supplemental oxygen, intravenous fluid administration and capnography monitoring varied considerably. The studies showed either moderate or high risk of bias. Results from individual studies suggested that patients have a better recovery profile after propofol sedation for ERCP procedures than after midazolam and meperidine sedation. As there was no difference between the two sedation techniques as regards safety, propofol sedation is probably preferred for patients undergoing ERCP procedures. However, in all of the studies that were identified only non-anaesthesia personnel were involved in administering the sedation. It would be helpful if further research was conducted where anaesthesia personnel were involved in the administration of sedation for ERCP procedures. This would clarify the extent to which anaesthesia personnel should be involved in the administration of propofol sedation.

A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitroglycerin as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis.

PubMed

Tomoda, Takeshi; Kato, Hironari; Mizukawa, Sho; Muro, Shinichiro; Akimoto, Yutaka; Uchida, Daisuke; Matsumoto, Kazuyuki; Yamamoto, Naoki; Horiguchi, Shigeru; Tsutsumi, Koichiro; Okada, Hiroyuki

2016-01-01

Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP). A preliminary research suggested that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) with nitroglycerin might reduce the incidence of post-ERCP pancreatitis (PEP) more effectively than NSAIDs alone. We conduct a two-arm, multicenter, prospective, randomized, superiority trial to evaluate the additional effect of nitroglycerin for prevention of PEP. A total of 900 patients randomly receive 50 mg diclofenac suppository either alone or with 5 mg isosorbide dinitrate sublingual tablet. The primary endpoint is the occurrence of PEP. This study will clarify whether NSAIDs plus nitroglycerin can prevent PEP.

Complications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events

PubMed Central

Niv, Yaron; Gershtansky, Yael; Kenett, Ron S; Tal, Yossi; Birkenfeld, Shlomo

2011-01-01

Introduction: The number of malpractice claims against physicians and health institutes is increasing continuously in Israel as in the rest of the Western world, and has become a serious financial burden. Aim: In this study we analyzed the reports of gastroenterologists on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) adverse events to the risk management authority between January 1, 2000 and December 31, 2006. Methods: All the reported adverse events associated with ERCP and EUS of health institutes and covered by Madanes Insurance Agency were summarized and analyzed. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an Excel worksheet, discussed, and evaluated. Results: Forty-two cases of ERCP and EUS adverse events were reported. There were nine cases of men (21.4%) and the average age was 69.3 ± 14.3 years. During this period, 10,647 procedures were performed by the institutes concerned and the number of adverse events was 20.2 to 67.8 per year for 10,000 procedures. Perforation occurred in one out of 367 procedures, bleeding in one out of 5323 procedures, teeth trauma in one out of 5323 procedures, and respiratory complications in one out of 10,647 procedures. Conclusion: This is the first study in Israel about physicians’ reports of ERCP and EUS adverse events. Physicians reported only about severe adverse events with high rate of mortality and morbidity. PMID:21753900

Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP

PubMed Central

Haytural, Candan; Aydınlı, Bahar; Demir, Berna; Bozkurt, Elif; Parlak, Erkan; Dişibeyaz, Selçuk; Saraç, Ahmet; Özgök, Ayşegül; Kazancı, Dilek

2015-01-01

Introduction. Using single anesthetic agent in endoscopic retrograde cholangiopancreatography (ERCP) may lead to inadequate analgesia and sedation. To achieve the adequate analgesia and sedation the single anesthetic agent doses must be increased which causes undesirable side effects. For avoiding high doses of single anesthetic agent nowadays combination with sedative agents is mostly a choice for analgesia and sedation for ERCP. Aim. The aim of this study is to investigate the effects of propofol alone, propofol + remifentanil, and propofol + fentanyl combinations on the total dose of propofol to be administered during ERCP and on the pain scores after the process. Materials and Method. This randomized study was performed with 90 patients (ASA I-II-III) ranging between 18 and 70 years of age who underwent sedation/analgesia for elective ERCP. The patients were administered only propofol (1.5 mg/kg) in Group Ι, remifentanil (0.05 μg/kg) + propofol (1.5 mg/kg) combination in Group II, and fentanyl (1 μg/kg) + propofol (1.5 mg/kg) combination in Group III. All the patients' sedation levels were assessed with the Ramsey Sedation Scale (RSS). Their recovery was assessed with the Aldrete and Numerical Rating Scale Score (NRS) at 10 min intervals. Results. The total doses of propofol administered to the patients in the three groups in this study were as follows: 375 mg in Group I, 150 mg in Group II, and 245 mg in Group III. Conclusion. It was observed that, in the patients undergoing ERCP, administration of propofol in combination with an opioid provided effective and reliable sedation, reduced the total dose of propofol, increased the practitioner satisfaction, decreased the pain level, and provided hemodynamic stability compared to the administration of propofol alone. PMID:26576424

Feasibility, safety, and effectiveness of transcranial direct current stimulation for decreasing post-ERCP pain: a randomized, sham-controlled, pilot study.

PubMed

Borckardt, Jeffrey J; Romagnuolo, Joseph; Reeves, Scott T; Madan, Alok; Frohman, Heather; Beam, Will; George, Mark S

2011-06-01

Emerging evidence shows that transcranial direct current stimulation (tDCS), a minimally invasive brain stimulation technique, has analgesic effects in chronic pain patients and in healthy volunteers with experimental pain. No studies have examined the analgesic effects of tDCS immediately after surgical/endoscopic procedures. Endoscopy investigating abdominal pain, especially ERCP, can cause significant postprocedural pain. To test the feasibility, efficacy, and safety of tDCS on post-ERCP pain and analgesia use. Randomized, sham-controlled, pilot study. Tertiary-care medical center. This study involved 21 patients who were hospitalized overnight for ERCP for unexplained right upper quadrant pain. Twenty minutes of real 2.0 mA tDCS or sham (anode over left prefrontal cortex; cathode over gut-representation of right sensory cortex) immediately after ERCP. Pain (visual analogue scale, McGill pain questionnaire, brief pain inventory), patient-controlled analgesia use, adverse events. Real tDCS was associated with 22% less total hydromorphone use, versus sham. The slope of the cumulative patient-controlled analgesia usage curve was significantly steeper in the sham tDCS group (F [2,13] = 15.96; P = .0003). Real tDCS patients reported significantly less pain interference with sleep (t [17] = 3.70; P = .002) and less throbbing pain (t [16] = 2.37; P = .03). Visual analogue scale pain and mood scores (4 hours post-ERCP) suggested a nonsignificant advantage for real tDCS, despite less hydromorphone use. Side effects of tDCS were limited to mild, self-limited tingling, itching, and stinging under electrodes. Small sample size, variability in chronic pain, and chronic opioid use. In this pilot study, tDCS appears to be safe, has minimal side effects, and may reduce postprocedural analgesia requirements and subjective pain ratings. Future studies appear warranted. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children?

PubMed

Keil, Radan; Drabek, Jiri; Lochmannova, Jindra; Stovicek, Jan; Rygl, Michal; Snajdauf, Jiri; Hlava, Stepan

2016-01-01

Trauma is one of the most common causes of morbidity and mortality in the pediatric population. The diagnosis of pancreatic injury is based on clinical presentation, laboratory and imaging findings, and endoscopic methods. CT scanning is considered the gold standard for diagnosing pancreatic trauma in children. This retrospective study evaluates data from 25 pediatric patients admitted to the University Hospital Motol, Prague, with blunt pancreatic trauma between January 1999 and June 2013. The exact grade of injury was determined by CT scans in 11 patients (47.8%). All 25 children underwent endoscopic retrograde cholangiopancreatography (ERCP). Distal pancreatic duct injury (grade III) was found in 13 patients (52%). Proximal pancreatic duct injury (grade IV) was found in four patients (16 %). Major contusion without duct injury (grade IIB) was found in six patients (24%). One patient experienced duodeno-gastric abruption not diagnosed on the CT scan. The diagnosis was made endoscopically during ERCP. Grade IIB pancreatic injury was found in this patient. One patient (4%) with pancreatic pseudocyst had a major contusion of pancreas without duct injury (grade IIA). Four patients (16%) with grade IIB, III and IV pancreatic injury were treated exclusively and nonoperatively with a pancreatic stent insertion and somatostatine. Two patients (8%) with a grade IIB injury were treated conservatively only with somatostatine without drainage. Eighteen (72 %) children underwent surgical intervention within 24 h after ERCP. ERCP is helpful when there is suspicion of pancreatic duct injury in order to exclude ductal leakage and the possibility of therapeutic intervention. ERCP can speed up diagnosis of higher grade of pancreatic injuries.

[Choledocholithiasis in Edgardo Rebagliati Martins Hospital. Lima-Peru. 2010-2011. Incidence, risk factors, diagnostic and therapeutic aspects].

PubMed

Llatas Pérez, Juan; Hurtado Roca, Yamilee; Frisancho Velarde, Oscar

2011-01-01

to determine the incidence, frequency of risk factors, diagnostic aspects (clinics, biochemical, and images) and therapeutic aspects of the choledocholithiasis. Descriptive and prospective analysis of 51 patients who signed informed consent for study of choledocholithiasis by ERCP (endoscopic retrograde cholangiopancreatography). Of the 51 patients, 36 (70.6%) confirmed choledocholithiasis by ERCP. Its incidence was 10.4%. The mean age was 63.75 years, BMI 25.59 kg/m2 and 55.6% were women. Abdominal pain was present in 94.4% of patients. Total bilirubin in the group with choledocholithiasis was 5.8 mg / dl at baseline and 4.2 mg / dl in hospitalization. 11.1% debuted with pancreatitis and 30.6% with cholangitis. In 68.7% of patients with cholangitis was confirmed choledocholithiasis by ERCP. The specificity of ultrasound was 0.80 (95% CI 0.6- 1). The specificity of the nuclear magnetic resonance was 0.25 (95% CI 0.17-0.67). Of the 51 patients with ERCP, 4 (7.80%) do pancreatitis, 1(1.96%) cholangitis and 2 (3.92%) bleeding Choledocholithiasis occurs in older people, female and overweight with an incidence of 10.4%. Abdominal pain is the most common symptom. A total bilirubin more tan 4mg/dl occurs in patients with choledocholithiasis. The complications of choledocholithiasis (pancreatitis and cholangitis) were more frequent than reported in the literature. Both the specificity of cholangitis for choledocholithiasis, the specificity of ultrasound and the specificity of the nuclear magnetic resonance were lower than reported in the literature. ERCP complications were slightly higher than that reported in the literature.

Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure

PubMed Central

Artifon, Everson L.A.; Loureiro, Jarbas F.; Baron, Todd H.; Fernandes, Kaie; Kahaleh, Michel; Marson, Fernando P.

2015-01-01

Background and Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage in patients with distal malignant biliary obstruction, but it fails in up to 10% of cases. Percutaneous transhepatic cholangiography (PTC) and surgical bypass are the traditional drainage alternatives. This study aimed to compare technical and clinical success, quality of life, and survival of surgical biliary bypass or hepaticojejunostomy (HJT) and endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDT) in patients with distal malignant bile duct obstruction and failed ERCP. Patients and Methods: A prospective, randomized trial was conducted. From March 2011 to September 2013, 32 patients with malignant distal biliary obstruction and failed ERCP were studied. The HJT group consisted of 15 patients and the CDT group consisted of 14 patients. Technical and clinical success, quality of life, and survival were assessed prospectively. Results: Technical success was 94% (15/16) in the HJT group and 88% (14/16) in the CDT group (P = 0.598). Clinical success occurred in 14 (93%) patients in the HJT group and in 10 (71%) patients in the CDT group (P = 0.169). During follow-up, a statistically significant difference was seen in mean functional capacity scores, physical health, pain, social functioning, and emotional and mental health aspects in both techniques (P < 0.05). The median survival time in both groups was the same (82 days). Conclusion: Data relating to technical and clinical success, quality of life, and survival were similar in patients who underwent HJT and CDT drainage after failed ERCP for malignant distal biliary obstruction. PMID:26374583

A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage.

PubMed

Sayar, Suleyman; Olmez, Sehmus; Avcioglu, Ufuk; Tenlik, Ilyas; Saritas, Bunyamin; Ozdil, Kamil; Altiparmak, Emin; Ozaslan, Ersan

2016-01-01

Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage. Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed. Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases. ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula.

Increased risk and severity of ERCP-related complications associated with asymptomatic common bile duct stones.

PubMed

Saito, Hirokazu; Kakuma, Tatsuyuki; Kadono, Yoshihiro; Urata, Atsushi; Kamikawa, Kentaro; Imamura, Haruo; Tada, Shuji

2017-09-01

 Endoscopic removal of asymptomatic common bile duct stones (CBDS) is generally recommended. Although many reports have described the risk of complications in endoscopic retrograde cholangiopancreatography (ERCP), no studies have addressed this problem in the context of asymptomatic CBDS. This study examines the risk of complications arising in ERCP for asymptomatic CBDS.  This retrospective study included 425 patients with naive papilla who underwent therapeutic ERCP for choledocholithiasis at 2 institutions in Japan for 2 years. The risk of complications was examined in patients who were divided into the asymptomatic and symptomatic CBDS groups. We used propensity score analysis to adjust for confounding effects.  Complications were observed in 32 (7.5 %) of the 425 patients. Of the 358 patients with symptomatic CBDS, 14 patients (3.9 %) had complications. In contrast, of the 67 patients with asymptomatic CBDS, 18 patients (26.9 %) had complications. Propensity score analysis revealed that asymptomatic CBDS was a significant risk factor, with a significantly higher incidence of complications compared with symptomatic CBDS (odds ratio, 5.3). Moderate to severe complications were observed in 15 of 18 patients (83.3 %) in the asymptomatic CBDS group, with significantly more moderate to severe complications than those in the symptomatic CBDS (odds ratio, 6.7).  Asymptomatic CBDS carried a high risk of ERCP-related complications, and these were often more severe. In asymptomatic CBDS, endoscopic treatment should be carefully performed after considering the patient's background, and detailed explanation of its possible complications should be given to patients in advance.

Development of a cylindrical diffusing optical fiber probe for pancreatic cancer therapy

NASA Astrophysics Data System (ADS)

Lee, Sangyeob; Park, Gaye; Park, Jihoon; Yu, Sungkon; Ha, Myungjin; Jang, Seulki; Ouh, Chihwan; Jung, Changhyun; Jung, Byungjo

2017-02-01

Although the patients with cancer on pancreas or pancreaticobiliary duct have been increased, it is very difficult to detect and to treat the pancreatic cancer because of its low accessibility and obtuseness. The pancreatic cancer has been diagnosed using ultrasonography, blood test, CT, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and etc. Normally, light can be delivered to the target by optical fibers through the ERCP or EUS. Diffusing optical fibers have been developed with various methods. However, many of them have mechanical and biological problems in the use of small-bend-radius apparatus or in tissue area. This study developed a therapeutic cylindrical diffusing optical fiber probe (CDOFP) for ERCP and EUS which has moderate flexibility and solidity to treat the cancer on pancreaticobiliary duct or pancreas. The CDOFP consists of a biocompatible Teflon tube and multimode glass fiber which has diffusing area processed with laser and high refractive index resin. The CDOFP was characterized to investigate the clinical feasibility and other applications of light therapy using diffusing optical fiber. The results presented that the CDOFP may be used in clinic by combining with endoscopic method, such as ERCP or EUS, to treat cancer on pancreas and pancreaticobiliary duct.

Diclofenac Does Not Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis in Low-Risk Units.

PubMed

Rainio, Mia; Lindström, Outi; Udd, Marianne; Louhimo, Johanna; Kylänpää, Leena

2017-08-01

Nonsteroidal anti-inflammatory drugs have an inhibitory role in pathogenesis of pancreatitis. Guidelines from the European Society of Gastrointestinal Endoscopy recommend routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP for all patients without contraindications. Our aim was to evaluate the effect of diclofenac in preventing post-ERCP pancreatitis (PEP) in a high-volume, low-PEP-risk ERCP unit. The rate and severity of PEP were compared in groups of 1000 historical controls prior to the routine use of diclofenac and in 1000 patients receiving 100 mg diclofenac before ERCP. PEP occurred in 56 (2.8%) of the 2000 patients, and the rate of the pancreatitis was 2.8% in control group and 2.8% in diclofenac group (p = 1.000). The PEP rate among the native papilla patients was 3.9% in control group and 3.6% in diclofenac group (p = 0.803). In subgroup analysis of patients with a high risk of PEP, diclofenac neither prevented PEP nor made its course milder. In an unselected patient population in a center with a low incidence of PEP, diclofenac seems to have no beneficial effect.

Identification of risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in a high volume center.

PubMed

Phillip, Veit; Schwab, Miriam; Haf, David; Algül, Hana

2017-01-01

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several patients´ or procedure related risk factors for post-ERCP pancreatitis (PEP) have been suggested. The aim of this study was to validate the risk factors for PEP in a high-volume center. All patients undergoing first time ERCP at a tertiary referral center between December 2010 and October 2013 were retrospectively included. PEP was defined according to the Atlanta Classification. 344 patients were included in the final analysis. The risk to develop PEP was increased in patients with chronic pancreatitis (odds ratio 3.7) and after inadvertent cannulation of the pancreatic duct (odds ratio 2.2), which occurred in 26.5% of the patients. Inadvertent cannulation occurred significantly more frequently in patients with difficult cannulation of the papilla duodeni major (odds ratio 12.7; p<0.001). ERCP on call was associated with an increased risk for difficult cannulation (odds ratio 3.0). Inadvertent cannulation of the pancreatic duct is a procedure related risk factor for PEP. Measurements on preventing inadvertent cannulation of the pancreatic duct should be established and studies on prophylactic measurements should focus particularly on patients with inadvertent cannulation of the pancreatic duct.

Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

PubMed Central

Tan, Justin H.; Coakley, Fergus V; Wang, Zhen J.; Poder, Liina; Webb, Emily; Yeh, Benjamin M.

2010-01-01

Background Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study is to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP). Methods Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings. Results The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in 2 of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology. Conclusion An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery. PMID:21724120

Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures

PubMed Central

Heinzow, Hauke S; Kammerer, Sara; Rammes, Carina; Wessling, Johannes; Domagk, Dirk; Meister, Tobias

2014-01-01

AIM: To compare endoscopic retrograde cholangio-pancreatography (ERCP), intraductal ultrasound (IDUS), endosonography (EUS), endoscopic transpapillary forceps biopsies (ETP) and computed tomography (CT) with respect to diagnosing malignant bile duct strictures. METHODS: A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS, ETP, EUS, and CT. The sensitivity, specificity, and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery. For each of the diagnostic measures, the sensitivity, specificity, and accuracy rates were calculated. In all cases, the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo. A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and the χ2 test as appropriate. A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test. Differences were considered statistically significant if P < 0.05. RESULTS: A total of 234 patients (127 males, 107 females, median age 64, range 20-90 years) with indeterminate bile duct strictures were included. A total of 161 patients underwent operative exploration; thus, a surgical histopathological correlation was available for those patients. A total of 113 patients had malignant disease proven by surgery; in 48 patients, benign disease was surgically found. In these patients, the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics (ERCP, CT, or EUS). Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a follow-up of at least 12 mo; the median follow-up was 34 mo. Twenty-three patients had extended malignant disease, and thus were considered palliative. A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91% (ERCP/IDUS), 59% (ETP), 92% (IDUS + ETP), 74% (EUS), and 73% (CT), respectively. In the subgroup analysis, the accuracy rates (%, ERCP + IDUS/ETP/IDUS + ETP; EUS; CT) for each tumor entity were as follows: cholangiocellular carcinoma: 92%/74%/92%/70%/79%; pancreatic carcinoma: 90%/68%/90%/81%/76%; and ampullary carcinoma: 88%/90%/90%/76%/76%. The detection rate of malignancy by ERCP/IDUS was superior to ETP (91% vs 59%, P < 0.0001), EUS (91% vs 74%, P < 0.0001) and CT (91% vs 73%, P < 0.0001); EUS was comparable to CT (74% vs 73%, P = 0.649). When analyzing accuracy rates with regard to localization of the bile duct stenosis, the accuracy rate of EUS for proximal vs distal stenosis was significantly higher for distal stenosis (79% vs 57%, P < 0.0001). CONCLUSION: ERCP/IDUS is superior to EUS and CT in providing accurate diagnoses of bile duct strictures of uncertain etiology. Multimodal diagnostics is recommended. PMID:25132767

Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial.

PubMed

Mansour-Ghanaei, Fariborz; Joukar, Farahnaz; Taherzadeh, Zahra; Sokhanvar, Homayoon; Hasandokht, Tolou

2016-06-07

To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to > 3 × the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, > 10 d and/or necessitated surgical or intensive treatment, or contributed to death. PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P < 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P < 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps < 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the naproxen group was significantly lower than that in the placebo (6 patients vs 23 patients, P < 0.01, RRR = 12%, AR = 0.3, 95%CI: 0.2-0.6). Naproxen reduced the PEP in patients with ≥ 3 pancreatic cannulations (P < 0.01, RRR = 25%, AR = 0.1, 95%CI: 0.1-0.4) and an ERCP duration > 40 min (P < 0.01, RRR = 20%, AR = 0.9, 95%CI: 0.4-1.2). Single dose of suppository naproxen administered immediately before ERCP reduces the incidence of PEP.

Complications of Nonoperative Management of High-grade Blunt Hepatic Injuries

DTIC Science & Technology

2005-11-01

cholangiopancreatography (ERCP) and stenting of biliary leaks, and CT scan-guided drainage of hepatic or perihepatic abscesses or biliary collections by...1 B). Stenting was successful in decreasing the biliary leak, but repeat ERCP was required for increased serum bilirubin, pain, and fever...Finally, failure of percutaneous drainage techniques or biliary stenting may require operative intervention. In summary, although patients with high

Effects of melatonin on the acute inflammatory response associated with endoscopic retrograde cholangiopancreatography: A randomized, double-blind, placebo-controlled trial.

PubMed

Hernández-Velázquez, B; Camara-Lemarroy, C R; González-González, J A; García-Compean, D; Monreal-Robles, R; Cordero-Pérez, P; Muñoz-Espinosa, L E

2016-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an acute inflammatory response and melatonin has a variety of immunomodulatory and antioxidant effects studied experimentally in pancreatobiliary pathology. The aim of our study was to evaluate the effects of peri-procedural administration of melatonin on the inflammatory response and lipid peroxidation associated with ERCP. In this proof-of-concept clinical trial, 37 patients with a high probability of choledocholithiasis were randomized to receive peri-procedure (ERCP) melatonin or placebo. We measured the serum concentration of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), lipid peroxidation, amylase, and liver function tests 24h before and after the procedure. We found no pre-procedure or post-procedure differences between the melatonin group or the placebo group (P>.05) in the serum concentrations of TNF-alpha (melatonin: 153.8 vs. 149.4ng/m; placebo: 103.5 vs. 107.3ng/ml), IL-6 (melatonin: 131.8 vs. 133.3ng/ml; placebo: 177.8 vs. 197.8ng/ml), or VEGF (melatonin: 157.3 vs. 157.8pg/ml; placebo: 97.3 vs. 97.8pg/ml), or in relation to lipid peroxidation (melatonin: 39.2 vs. 72.3μg/ml; placebo: 66.4 vs. 90.5μg/ml). After ERCP, a significant decrease in the AST, ALT, and total bilirubin levels was found only in the melatonin group (P<.05). The administration of melatonin was safe and tolerable. Melatonin is safe and tolerable in patients undergoing ERCP, but it does not appear to affect inflammatory cytokine concentrations or lipid peroxidation. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage

PubMed Central

Sayar, Suleyman; Olmez, Sehmus; Avcioglu, Ufuk; Tenlik, Ilyas; Saritas, Bunyamin; Ozdil, Kamil; Altiparmak, Emin; Ozaslan, Ersan

2016-01-01

OBJECTIVE: Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage. METHODS: Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed. RESULTS: Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases. CONCLUSION: ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula. PMID:28058396

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis.

PubMed

Saito, Hirokazu; Kadono, Yoshihiro; Kamikawa, Kentaro; Urata, Atsushi; Imamura, Haruo; Matsushita, Ikuo; Kakuma, Tatsuyuki; Tada, Shuji

2018-02-15

Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts.

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis

PubMed Central

Saito, Hirokazu; Kadono, Yoshihiro; Kamikawa, Kentaro; Urata, Atsushi; Imamura, Haruo; Matsushita, Ikuo; Kakuma, Tatsuyuki; Tada, Shuji

2017-01-01

Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts. PMID:29151506

Increased risk and severity of ERCP-related complications associated with asymptomatic common bile duct stones

PubMed Central

Saito, Hirokazu; Kakuma, Tatsuyuki; Kadono, Yoshihiro; Urata, Atsushi; Kamikawa, Kentaro; Imamura, Haruo; Tada, Shuji

2017-01-01

Background and study aims  Endoscopic removal of asymptomatic common bile duct stones (CBDS) is generally recommended. Although many reports have described the risk of complications in endoscopic retrograde cholangiopancreatography (ERCP), no studies have addressed this problem in the context of asymptomatic CBDS. This study examines the risk of complications arising in ERCP for asymptomatic CBDS. Patients and methods  This retrospective study included 425 patients with naive papilla who underwent therapeutic ERCP for choledocholithiasis at 2 institutions in Japan for 2 years. The risk of complications was examined in patients who were divided into the asymptomatic and symptomatic CBDS groups. We used propensity score analysis to adjust for confounding effects. Results  Complications were observed in 32 (7.5 %) of the 425 patients. Of the 358 patients with symptomatic CBDS, 14 patients (3.9 %) had complications. In contrast, of the 67 patients with asymptomatic CBDS, 18 patients (26.9 %) had complications. Propensity score analysis revealed that asymptomatic CBDS was a significant risk factor, with a significantly higher incidence of complications compared with symptomatic CBDS (odds ratio, 5.3). Moderate to severe complications were observed in 15 of 18 patients (83.3 %) in the asymptomatic CBDS group, with significantly more moderate to severe complications than those in the symptomatic CBDS (odds ratio, 6.7). Conclusions  Asymptomatic CBDS carried a high risk of ERCP-related complications, and these were often more severe. In asymptomatic CBDS, endoscopic treatment should be carefully performed after considering the patient’s background, and detailed explanation of its possible complications should be given to patients in advance. PMID:28879226

Endoscopic ultrasound-guided choledochoduodenostomy after a failed or impossible ERCP.

PubMed

Mora Soler, Ana María; Álvarez Delgado, Alberto; Piñero Pérez, María Concepción; Velasco-Guardado, Antonio; Marcos Prieto, Héctor; Rodríguez Pérez, Antonio

2018-05-01

endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous trans-hepatic biliary drainage (PTBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). this is a retrospective description of six cases of endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUCD), as well as the clinical characteristics, endoscopic procedure, complications and monitoring. all cases had malignant distal biliary obstruction. The procedure was concluded with good drainage in four out of six patients. Two late complications were recorded that were caused by stent migration and there were no deaths related with the procedure. The average monitoring period was six months. EUCD can be considered as a valid therapeutic choice in some selected cases and when performed by a team of expert endoscopists in cases of failed ERCP drainage or as an alternative to PTBD. However, the procedure has some associated complications.

Endoscopic treatment of bile duct complications after orthotopic liver transplantation.

PubMed

Polese, L; Cillo, U; Brolese, A; Boccagni, P; Neri, D; Bassi, D; Erroi, F; Zanus, G; D'Amico, D F; Norberto, L

2007-01-01

To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who have undergone ortotopic liver transplantation (OLT). We reviewed data from 42 consecutive patients who underwent ERCP for biliary complications after OLT over an 8-year period, in particular recording indications and success of the treatment after a mean of 17 months follow-up. Cholangiograms performed in 33/42 patients (79%) displayed anastomotic strictures in 17 patients (52%), bile duct stones in 8 (24%), both bile duct stones and an anastomotic stricture in 2 (6%), papillary stenosis in 1 (3%), and anastomotic biliary leakage in 1 (3%). In contrast, the contrastogram was normal in four patients (12%). Stone extraction was completed in 9/10 patients (90%) with a mean of 1.2 sessions, while stricture dilation was achieved in 12/19 patients (63%) after a mean of 1.7 sessions, by stent positioning (n = 7), balloon dilation (n = 4), or Soehendra dilator (n = 1). Both biliary leakage and papillary stenosis were cured by ERCP. Only one procedure-related complication -- severe pancreatitis (2.4%) -- was observed and no mortality. ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures.

Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile.

PubMed

Minami, Tomoyuki; Sasaki, Tamito; Serikawa, Masahiro; Ishigaki, Takashi; Murakami, Yoshiaki; Chayama, Kazuaki

2014-09-01

No consensus has yet been reached regarding the utility of antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). However, there has been little discussion of potential adverse effects of antibiotic use. This study investigated the impact of antibiotic prophylaxis on overall levels of bacterial infiltration of the biliary tract and the prevalence of drug-resistance among that population. Ninety-three patients, from whom intraoperative bile samples were collected after performing ERCP, were assigned to either an antibiotic-prophylaxis group (AP, n = 58) or a no-antibiotic-prophylaxis group (NAP, n = 35). Detection rates of biliary bacteria and antibiotic resistance were determined for each group. Multivariate analysis was also performed to identify risk factors for the development of drug-resistant biliary bacteria. The bile contamination rate was 37.1% for the NAP group and 55.2% for the AP group (P = 0.09). Drug-resistant bacteria were found in 5.7% of the NAP group and 29.3% of the AP group (P = 0.006). Biliary drainage and antibiotic prophylaxis for ERCP were identified as risk factors for the presence of drug-resistant bacteria. Administration of antibiotic prophylaxis prior to ERCP can be a risk factor for the selection of drug-resistant bacteria in the biliary tract. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation.

PubMed

Kuo, P C; Lewis, W D; Stokes, K; Pleskow, D; Simpson, M A; Jenkins, R L

1994-08-01

Biliary complications (BC) remain a significant cause of morbidity and mortality after orthotopic liver transplantation (OLT). In an effort to determine the incidence of BC after OLT and the success of management options, 157 hepatic transplants performed from January 1987 to July 1991 were reviewed. The incidence of BC was 25 percent, with a one year mortality rate of 43.5 percent compared with 23.4 percent for patients in a control group (p < 0.05). Most BC occurring before postoperative day 30 presented as leaks, with a one year mortality rate of 50 percent (p < 0.03 versus control group). Biliary complications presenting after postoperative day 30 presented as strictures, with a one year mortality rate of 36.8 percent (p = NS versus control group). Endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC), and operative treatment were analyzed to determine relative patency rates after intervention for BC. The analysis showed that ERCP and PTHC were equivalent, with a one year patency rate of 45 percent. Operative treatment had a patency rate of 89 percent (p < 0.05 compared to ERCP and PTHC). The results from ERCP and PTHC may be useful for delineation of rejection versus BC after OLT. However, operative treatment is significantly more effective for definitive treatment of BC after OLT.

Novel ex vivo model for hands-on teaching of and training in EUS-guided biliary drainage: creation of "Mumbai EUS" stereolithography/3D printing bile duct prototype (with videos).

PubMed

Dhir, Vinay; Itoi, Takao; Fockens, Paul; Perez-Miranda, Manuel; Khashab, Mouen A; Seo, Dong Wan; Yang, Ai Ming; Lawrence, Khek Yu; Maydeo, Amit

2015-02-01

EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. Prospective observational feasibility study. Tertiary referral center. Twenty endosonographers attending an interventional EUS workshop. A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement). Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. Small number of participants. The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

The importance of ERCP for the surgical tactic in haemorrhagic necrotizing pancreatitis (preliminary report).

PubMed

Gebhardt, C; Riemann, J F; Lux, G

1983-03-01

In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery, we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past 3 months. The results in, to date, ten patients, all of whom survived their severe illness, revealed four different morphological findings of importance for the surgical tactic. 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. 2. Contrast medium leaks via a ductal fistula: left resection, including the removal of the fistulous area, must be done. 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesions, resulting in drainage of the necrotic cavity into the bowel, permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERCP.

Implementation of remote video auditing with feedback and compliance for manual-cleaning protocols of endoscopic retrograde cholangiopancreatography endoscopes.

PubMed

Armellino, Donna; Cifu, Kelly; Wallace, Maureen; Johnson, Sherly; DiCapua, John; Dowling, Oonagh; Jacobs, Mitchel; Browning, Susan

2018-05-01

A pilot initiative to assess the use of remote video auditing in monitoring compliance with manual-cleaning protocols for endoscopic retrograde cholangiopancreatography (ERCP) endoscopes was performed. Compliance with manual-cleaning steps following the initiation of feedback was measured. A video feed of the ERCP reprocessing room was provided to remote auditors who scored items of an ERCP endoscope manual-cleaning checklist. Compliance feedback was provided in the form of reports and reeducation. Outcomes were reported as checklist compliance. The use of remote video auditing to document manual processing is a feasible approach and feedback and reeducation increased manual-cleaning compliance from 53.1% (95% confidence interval, 34.7-71.6) to 98.9% (95.0% confidence interval, 98.1-99.6). Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Successful endoscopic therapy of traumatic bile leaks.

PubMed

Spinn, Matthew P; Patel, Mihir K; Cotton, Bryan A; Lukens, Frank J

2013-01-01

Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP) after traumatic bile duct injury secondary to blunt (motor vehicle accident) or penetrating (gunshot) trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%). The mean duration of follow-up was 85.6 days (range 54-175 days). There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.

Endoductal tissue sampling of biliary strictures through endoscopic retrograde cholangiopan creatography (ERCP).

PubMed

Pugliese, V; Antonelli, G; Vincenti, M; Gatteschi, B

1997-01-01

Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures. Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serous complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy. This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducta, if previous cytology was negative.

Measuring the value of endoscopic retrograde cholangiopancreatography activity: an opportunity to stratify endoscopists on the basis of their value.

PubMed

Parihar, Vikrant; Moran, Carthage; Maheshwari, Pardeep; Cheriyan, Danny; O'Toole, Aoibhlinn; Murray, Frank; Patchett, Stephen E; Harewood, Gavin C

2018-07-01

As finite healthcare resources come under pressure, the value of physician activity is assuming increasing importance. The value in healthcare can be defined as patient health outcomes achieved per monetary unit spent. Even though some attempts have been made to quantify the value of clinician activity, there is little in the medical literature describing the importance of endoscopists' activity. This study aimed to characterize the value of endoscopic retrograde cholangiopancreatography (ERCP) performance of five gastroenterologists. We carried out a retrospective-prospective cohort study using the databases of patients undergoing ERCP between September 2014 and March 2017. We collected data from 1070 patients who underwent ERCP comparing value among the ERCPists at index ERCP. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure, T is the duration of procedure and C is the adjusted for complexity level. Quality and complexity were derived on a 1-4 Likert scale on the basis of American Society for Gastrointestinal Endoscopy criteria; time was recorded (in min) from intubation to extubation. Endoscopist time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized. In total, 590 procedures were analysed: 465 retrospectively over 24 months and 125 prospectively over 6 months. There was a 32% variation in the value of endoscopist activity in a more substantial retrospective cohort, with an even more considerable 73% variation in a smaller prospective arm. In an analysis of greater than 1000 ERCPs by a small cohort of experienced ERCPists, there was a wide variation in the value of endoscopist activity. Although the precision of estimating procedural costs needs further refinement, these findings show the ability to stratify ERCPists on the basis of the value their activity. As healthcare costs are scrutinized more closely, such value measurements are likely to become more relevant.

Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.

PubMed

Zhang, Rongchun; Luo, Hui; Pan, Yanglin; Zhao, Lina; Dong, Junqiang; Liu, Zhiguo; Wang, Xiangping; Tao, Qin; Lu, Guohua; Guo, Xuegang

2015-10-01

Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking. To investigate the DBR rate in patients with recurrent CBDS after ERCP. A prospective case-control study. A tertiary center. During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded. Standard barium meal examination, MRCP, and enhanced abdominal CT. DBR. Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences. Small sample size. DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. ( NCT02329977.) Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ERCP outside the operating room: Is ketamine not only a “rescue drug”?

PubMed Central

Fabbri, Lea Paola; Nucera, Maria; Marsili, Massimo; Al Malyan, Mohamed; Becchi, Chiara

2012-01-01

Summary Background Endoscopic retrograde cholangiopancreatography ERCP is a painful and long procedure requiring transient deep analgesia and conscious sedation. An ideal anaesthetic that guarantees a rapid and smooth induction, good quality of maintenance, lack of adverse effects and rapid recovery is still lacking. This study aimed to compare safety and efficacy of a continuous infusion of low dose remifentanil plus ketamine combined with propofol in comparison to the standard regimen dose of remifentanil plus propofol continuous infusion during ERCP. Material/Methods 322 ASAI-III patients, 18–85 years old and scheduled for planned ERCP were randomized. Exclusion criteria were a predictable difficult airway, drug allergy, and ASA IV–V patients. We evaluated Propofol 1 mg/kg/h plus Remifentanil 0.25 μg/kg/min (GR) vs. Propofol 1 mg/kg/h plus Ketamine 5 μg/kg/min and Remifentanil 0.1 μg/kg/min (GK). Main outcome measures were respiratory depression, nausea/vomiting, quality of intraoperative conditions, and discharge time. P≤0.05 was statistically significant (95% CI). Results Respiratory depression was observed in 25 patients in the GR group compared to 9 patients in the GK group (p=0.0035). ERCP was interrupted in 9 cases of GR vs. no cases in GK; patients ventilated without any complication. Mean discharge time was 20±5 min in GK and 35±6 min in GR (p=0.0078) and transfer to the ward delayed because of nausea and vomiting in 30 patients in GR vs. 5 patients in GK (p=0.0024). Quality of intraoperative conditions was rated highly satisfactory in 92% of GK vs. 67% of GR (p=0.028). Conclusions The drug combination used in GK confers clinical advantages because it avoids deep sedation, maintains adequate analgesia with conscious sedation, and achieves lower incidence of postprocedural nausea and vomiting with shorter discharge times. PMID:22936194

Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population.

PubMed

Troendle, David M; Abraham, Omana; Huang, Rong; Barth, Bradley A

2015-01-01

Risk factors for the development of post-ERCP pancreatitis (PEP) have not been identified in the pediatric population. It remains unclear what constitutes appropriate prophylaxis in this patient population. To assess the prevalence and severity of PEP in the pediatric population and identify factors associated with developing PEP and to evaluate the effect of prophylactic pancreatic duct stenting in high-risk patients. Retrospective analysis of an ERCP database at a single large pediatric center. Academic center. A total of 432 ERCPs performed on 313 patients younger than 19 years of age from January 2004 to October 2013. ERCP for any indication. Rates and severity of PEP, preprocedural and procedural risk factors for the development of PEP, and the effect of pancreatic stents on preventing PEP in high-risk patients. PEP occurred after 47 procedures (prevalence, 10.9%). Thirty-four cases were mild, 9 were moderate, and 4 were severe. There was no mortality. On multiple logistic analysis, pancreatic duct injection (P<.0001; odds ratio 30.8; 95% confidence interval [CI], 9.1-103.9) and pancreatic sphincterotomy (P<.01; OR 3.8; 95% CI, 1.6-9.8) were positively associated with PEP. A history of chronic pancreatitis was negatively associated with PEP (P<.05; OR 0.37; 95% CI, 0.15-0.93). On subset analysis, placing a prophylactic pancreatic stent was associated with significantly increased rates of PEP in patients with pancreatic duct injection compared with those who had no attempt at stent placement (P<.01). Two patients with severe pancreatitis had prophylactic pancreatic stents in place. Retrospective investigation. In the pediatric population, pancreatic duct injection and pancreatic sphincterotomy are associated with significantly increased rates of PEP, whereas a history of chronic pancreatitis is negatively associated. Prophylactic pancreatic stenting is associated with higher rates of PEP in high-risk patients and does not eliminate severe PEP. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video).

PubMed

Brauer, Brian C; Chen, Yang K; Fukami, Norio; Shah, Raj J

2009-09-01

When conventional ERCP methods fail because of periampullary or ductal obstruction, EUS-guided cholangiopancreatography (EUS-CP) may aid in pancreaticobiliary access. To report our experience when using single-operator EUS-CP. An academic tertiary-referral center. Consecutive patients undergoing EUS-CP were prospectively identified. These patients had undergone failed attempt(s) at therapeutic ERCP. A data sheet was used to record indications, reasons for failed ERCP, EUS-CP visualization of the duct of interest, transpapillary or transenteric intervention, clinical follow-up, and complications. Technical success was decompression of the duct of interest. Clinical success was resolution of jaundice or a > or = 50% reduction in pain or narcotics, as applicable. Between February 2003 and June 2007, EUS-CP was attempted in 20 patients (11 men, 9 women; mean [SD] age 58 +/- 14.9 years). Indications included jaundice (n = 8), biliary stones (n = 3), chronic pancreatitis (n = 6), acute pancreatitis (n = 2), and papillary stenosis (n = 1). Reasons for failed ERCP included periampullary mass (n = 8), intradiverticular papillae (n = 4), and pancreatic duct (PD) stricture (n = 7) or stone (n = 1). Technical success was achieved in 18 of 20 patients (90%). Biliary decompression was obtained in 11 of 12 patients (92%) (7 transpapillary and 4 transenteric-transcholedochal). Pancreatic decompression was obtained in 7 of 8 patients (88%) (3 transpapillary, 4 transgastric). On follow-up, clinical improvement was noted in 15 of 20 patients (70%). For treatment of pain associated with chronic pancreatitis, pain scores decreased by a mean of 1.75 (P = .18). Complications (in 2 of 20 [10%]) included perforation (n = 1) and respiratory failure (n = 1). A single-center nonrandomized observational study with a small patient population. At our academic referral center, single-operator EUS-CP provided decompression of obstructed ducts and may be performed after a failed attempt at conventional ERCP during the same endoscopic session.

[Antibiotic prophylaxis in gastrointestinal endoscopy--recommendations of the Austrian Society of Gastroenterology and Hepatology].

PubMed

Wewalka, F; Kapral, C; Brownstone, E; Homoncik, M; Renner, F

2010-10-01

The recommendations of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) for antibiotic prophylaxis in gastrointestinal endoscopy of the year 2002 have been updated in accord with the recently published guidelines of the American Society of Gastrointestinal Endoscopy (ASGE) and the American Heart Association (AHA). Antibiotic prophylaxis for any endoscopic intervention to prevent infectious endocarditis is no longer necessary. Moreover, the prophylactic use of antibiotics for ERCP without biliary obstruction and ERCP with obstruction and a likelihood of complete drainage is no longer recommended. For ERCP with obstruction and anticipated incomplete drainage, a full course of antibiotics should be administered to prevent cholangitis. For the prevention of local infections antibiotics are useful prior to endoscopic puncturing, contrasting or drainage of cystic lesions as well as just before application of a PEG tube. In cirrhotic patients with GI bleeding antibiotic prophylaxis should be started as early as possible and be administered for several days. © Georg Thieme Verlag KG Stuttgart · New York.

Profile and predictors of bile infection in patients undergoing laparoscopic cholecystectomy.

PubMed

Mahafzah, Azmi M; Daradkeh, Salam S

2009-08-01

To study the bacteriological profile, and to determine predictors of bile infection and septic complications following laparoscopic cholecystectomy. This cross-sectional study reviewed 1248 laparoscopic cholecystectomy cases performed between January 1994 and December 2007 by one surgical team at the Jordan University Hospital, Amman, Jordan. Bile cultures were performed for all patients and statistical analysis was performed on culture results and postoperative complications as well as, on the possible predictors of bile infection including age, gender, associated diseases, preoperative retrograde cholangiopancreatography (ERCP), and indications for surgery. Uncomplicated gallstone disease was diagnosed in 993 patients (79.6%), 221 patients (17.7%) had acute cholecystitis, and 34 patients (2.7%) had jaundice. Associated morbidities were present in 513 patients (41.1%), preoperative ERCP was performed for 132 patients (10.6%), and postoperative septic complications developed in 25 patients (2%). Bile culture was positive in 250 patients (20%), 134 (53.6%) of whom had gram negative bacteria, 73 (29.2%) had gram positive bacteria, and 43 (17.2%) had mixed cultures. The chi-square test has shown that positive bile culture is significantly associated with age, gender, preoperative ERCP, associated morbidities, and complicated gallbladder disease, whereas multinomial regression analysis has shown that age and preoperative ERCP were the only significant predictors of bile infection. Bile infection commonly complicates gallstone disease, and it can be influenced by age and preoperative endoscopic interventions, but it does not influence the occurrence of postoperative septic complications.

Pancreatits after endoscopic retrograde cholangio-pancreatography

PubMed Central

Abdel Aziz, Ayman M; Lehman, Glen A

2007-01-01

Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving non-selected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance. PMID:17569133

[The Management of Common Bile Duct Stones].

PubMed

Park, Chang Hwan

2018-05-25

Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10-20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.

Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography.

PubMed

Chen, Lu; Xia, Lu; Lu, Yi; Bie, Like; Gong, Biao

2017-01-01

Periampullary diverticulum (PAD) is frequently encountered in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate the association of PAD with pancreaticobiliary diseases as well as the impact of PAD on the technical success of ERCP and different methods of bile duct stone extraction. A total of 1489 cases of patients with PAD were identified from 6390 patients who underwent ERCP. These patients were compared with 1500 controls without PAD in terms of biliary stone formation, technical success, and complications of ERCP. Patients with PAD had increased prevalence of bile duct stones, gallstones, and cholangitis (P<0.01). Successful cannulation rates were similar in the PAD and the control group (98.59 vs. 99.07%, P=0.225). The incidence of complications did not differ between the PAD and the control group. Successful stone removal rate of endoscopic sphincterotomy (EST) was lower in the PAD group than in the control group (83.53 vs. 94.31%, P=0.005). In patients with PAD, the rate of successful stone removal was lower in the EST group than in the endoscopic papillary balloon dilation (EPBD) and EPBD combined with limited EST (ESBD) group. The rates of complications were similar among different treatments (EST, EPBD, or ESBD) in patients with PAD. PAD is associated with bile duct stones, gallstones, and cholangitis. In addition, PAD should not be considered a barrier to a successful cannulation. Moreover, EST is less effective than EPBD and ESBD in patients with PAD, whereas EST, EPBD, and ESBD are equally safe in patients with PAD.

[Diagnostic performance of biliary ultrasound vs. magnetic resonance cholangiogram in patients with recurrent biliary obstruction.].

PubMed

Chávez-Valencia, V; Espinosa-Ortega, H F; Espinoza-Peralta, D; Arce-Salinas, C A

2009-01-01

Obstructive jaundice in patients with previous cholecystectomy requires a precise diagnosis. In the diagnostic algorithm, biliary ultrasound (BUS) and magnetic resonance cholangiogram (MRC) are used, although the accuracy of each method is unknown in our setting. No previous comparison of US and MRC in subjects with cholecystectomy has been made. To determine diagnostic accuracy of BUS and MRC in patients with recurrent biliary obstruction. Patients with endoscopic retrograde cholangiopacreatography (ERCP) demonstrating recurrent biliary obstruction by stones were included. All patients underwent BUS and MRC. We determined the diagnostic performance of each image study compared with ERCP. Twenty-seven patients with a mean age of 62.9 +/- 17.3 years-old were included. Sensitivity and specificity of BUS were 0.12 and 0.58, respectively. Figures for MRC were 0.88 and 0.82. Diagnostic agreement between ERCP and MRC was k= 0.66 whereas BUS had a k of only 0.26. MRC had good diagnostic performance for recurrent choledocolithiasis. BUS demonstrated lower accuracy compared with previous reports, so should not be considered in the initial approach of recurrent choledocus obstruction.

Early endoscopic treatment of blunt traumatic pancreatic injury.

PubMed

Björnsson, Bergthor; Kullman, Eric; Gasslander, Thomas; Sandström, Per

2015-01-01

Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

Benign Biliary Strictures and Leaks.

PubMed

Devière, Jacques

2015-10-01

The major causes of benign biliary strictures include surgery, chronic pancreatitis, primary sclerosing cholangitis, and autoimmune cholangitis. Biliary leaks mainly occur after surgery and, rarely, abdominal trauma. These conditions may benefit from a nonsurgical approach in which endoscopic retrograde cholangiopancreatography (ERCP) plays a pivotal role in association with other minimally invasive approaches. This approach should be evaluated for any injury before deciding about the method for repair. ERCP, associated with peroral cholangioscopy, plays a growing role in characterizing undeterminate strictures, avoiding both unuseful major surgeries and palliative options that might compromise any further management. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of Endoscopic Sphincterotomy for Suspected Sphincter of Oddi Dysfunction on Pain-Related Disability Following Cholecystectomy

PubMed Central

Cotton, Peter B.; Durkalski, Valerie; Romagnuolo, Joseph; Pauls, Qi; Fogel, Evan; Tarnasky, Paul; Aliperti, Giuseppe; Freeman, Martin; Kozarek, Richard; Jamidar, Priya; Wilcox, Mel; Serrano, Jose; Brawman-Mintzer, Olga; Elta, Grace; Mauldin, Patrick; Thornhill, Andre; Hawes, Robert; Wood-Williams, April; Orrell, Kyle; Drossman, Douglas; Robuck, Patricia

2015-01-01

IMPORTANCE Abdominal pain after cholecystectomy is common and may be attributed to sphincter of Oddi dysfunction. Management often involves endoscopic retrograde cholangiopancreatography (ERCP) with manometry and sphincterotomy. OBJECTIVE To determine whether endoscopic sphincterotomy reduces pain and whether sphincter manometric pressure is predictive of pain relief. DESIGN, SETTING, AND PATIENTS Multicenter, sham-controlled, randomized trial involving 214 patients with pain after cholecystectomy without significant abnormalities on imaging or laboratory studies, and no prior sphincter treatment or pancreatitis randomly assigned (August 6, 2008-March 23, 2012) to undergo sphincterotomy or sham therapy at 7 referral medical centers. One-year follow-up was blinded. The final follow-up visit was March 21, 2013. INTERVENTIONS After ERCP, patients were randomized 2:1 to sphincterotomy (n = 141) or sham (n = 73) irrespective of manometry findings. Those randomized to sphincterotomy with elevated pancreatic sphincter pressures were randomized again (1:1) to biliary or to both biliary and pancreatic sphincterotomies. Seventy-two were entered into an observational study with conventional ERCP managemeny. MAIN OUTCOMES AND MEASURES Success of treatment was defined as less than 6 days of disability due to pain in the prior 90 days both at months 9 and 12 after randomization, with no narcotic use and no further sphincter intervention. RESULTS Twenty-seven patients (37%; 95%CI, 25.9%-48.1%) in the sham treatment group vs 32 (23%; 95%CI, 15.8%-29.6%) in the sphincterotomy group experienced successful treatment (adjusted risk difference, −15.6%; 95% CI, −28.0% to −3.3%; P = .01). Of the patients with pancreatic sphincter hypertension, 14 (30%; 95% CI, 16.7%-42.9%) who underwent dual sphincterotomy and 10 (20%; 95% CI, 8.7%-30.5%) who underwent biliary sphincterotomy alone experienced successful treatment. Thirty-seven treated patients (26%; 95% CI,19%-34%) and 25 patients (34%; 95% CI, 23%-45%) in the sham group underwent repeat ERCP interventions (P = .22). Manometry results were not associated with the outcome. No clinical subgroups appeared to benefit from sphincterotomy more than others. Pancreatitis occurred in 15 patients (11%) after primary sphincterotomies and in 11 patients (15%) in the sham group. Of the nonrandomized patients in the observational study group, 5 (24%; 95%CI, 6%-42%) who underwent biliary sphincterotomy, 12 (31%; 95%CI, 16%-45%) who underwent dual sphincterotomy, and 2 (17%; 95%CI, 0%-38%) who did not undergo sphincterotomy had successful treatment. CONCLUSIONS AND RELEVANCE In patients with abdominal pain after cholecystectomy undergoing ERCP with manometry, sphincterotomy vs sham did not reduce disability due to pain. These findings do not support ERCP and sphincterotomy for these patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: 00688662 PMID:24867013

Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers.

PubMed

Thomas, Miriam; Howell, Douglas A; Carr-Locke, David; Mel Wilcox, C; Chak, Amitabh; Raijman, Isaac; Watkins, James L; Schmalz, Michael J; Geenen, Joseph E; Catalano, Marc F

2007-09-01

PD and common bile duct (CBD) stones often require mechanical lithotripsy (ML) at ERCP for successful extraction. The frequency and spectrum of complications is not well described in the literature. To describe the frequency and spectrum of complications of ML. A comprehensive retrospective review of cases requiring ML of large or resistant PC and/or CBD stones using a 46-point data questionnaire on type(s) of complication, treatment attempted, and success of treatment. The study involved 7 tertiary referral centers with 712 ML cases (643 biliary and 69 pancreatic). Overall incidence of complications were: 4-4% (31/712); 23/643 biliary, 8/69 pancreatic; 21 single, 10 multiple. Biliary complications: trapped (TR)/broken (BR) basket (N = 11), wire fracture (FX) (N = 8), broken (BR) handle (N = 7), perforation/duct injury (N = 3). Pancreatic complications: TR/BR basket (N = 7), wire FX (N = 4), BR handle (N = 5), pancreatic duct leak (N = 1). Endoscopic intervention successfully treated complications in 29/31 cases (93.5%). Biliary group treatments: sphincterotomy (ES) extension (N = 7), electrohydraulic lithotripsy (EHL) (N = 11), stent (N = 3), per-oral Soehendra lithotripsy (N = 8), surgery (N = 1), extracorporeal lithotripsy (N = 5), and dislodge stones/change basket (N = 4). Pancreatic group treatments: ES extension (N = 3), EHL (N = 2), stent (N = 5), Soehendra lithotriptor (N = 4), dislodge stones/change basket (N = 2), extracorporeal lithotripsy (ECL) (N = 1), surgery (N = 1). Perforated viscus patient died at 30 days. The majority of ML in expert centers involved the bile duct. The complication rate of pancreatic ML is threefold greater than biliary lithotripsy. The most frequent complication of biliary and pancreatic ML is trapped/broken baskets. Extension of ES and EHL are the most frequently utilized treatment options.

Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis.

PubMed

Vaysse, Thibaut; Boytchev, Isabelle; Antoni, Guillemette; Croix, Damien Sainte; Choury, André Daniel; Laurent, Valérie; Pelletier, Gilles; Buffet, Catherine; Bou-Farah, Rita; Carbonnel, Franck

2016-11-01

There is still uncertainty regarding the efficacy and optimal modalities of extracorporeal shock wave lithotripsy (ESWL) in the treatment of chronic pancreatitis. The aims of the present study were to assess the safety and the efficacy of ESWL, either alone or followed by therapeutic endoscopic retrograde cholangiopancreatography (adjuvant ERCP) and to determine predictive factors of efficacy, in a real-life setting. This study included all consecutive patients who underwent an ESWL in a single University Hospital between 2001 and 2012. The indication for ESWL was obstructive stone(s) of the main pancreatic duct resulting in either painful chronic pancreatitis or recurrent acute pancreatitis. Success was defined by resolution of pain, no analgesic treatment, no acute pancreatitis and no surgical treatment for chronic pancreatitis 6 months after the ESWL. One hundred and forty-six patients were studied; 6/146 (4%) had a complication of ESWL. Among the 132 patients in whom follow-up was completed, 91 (69%) had an adjuvant ERCP. After 6 months of follow-up, 100/132 (76%) patients achieved success. In multivariate analysis, the single significant predictive factor of the success of the ESWL treatment was chronic pain (p = 0.03). Patients who had chronic pain and needed opioid treatment had less chance of success than patients without chronic pain (OR 95%CI 0.31 [0.07-1.14]). We found no difference in the success rates between patients who underwent adjuvant ERCP and those who had ESWL only (p = 0.93). This study shows that the ESWL is a safe and effective treatment for patients with chronic pancreatitis and obstructive stones within the main pancreatic duct. Systematic association with therapeutic ERCP appears to provide no additional benefit and is therefore not recommended.

Success of single-balloon enteroscopy in patients with surgically altered anatomy.

PubMed

Kurzynske, Frank C; Romagnuolo, Joseph; Brock, Andrew S

2015-08-01

Single-balloon enteroscopy (SBE) was introduced in 2007 to diagnose and treat small-bowel disorders. No study to date has evaluated SBE in patients with surgically altered anatomy outside of ERCP. To evaluate the efficacy, yield, and safety of SBE in patients with surgically altered anatomy. Retrospective study. Tertiary-care academic medical center. All patients with altered surgical anatomy who underwent SBE at the Medical University of South Carolina from July 2007 to September 2013. SBE. Diagnostic yield, therapeutic yield, technical success, and adverse events. A total of 48 patients met inclusion criteria. Mean age was 56 years (77% female). Eleven patients underwent single-balloon PEG placement, 8 single-balloon ERCP, 22 non-PEG/non-ERCP anterograde SBE, and 7 retrograde SBE. Previous surgeries included Roux-en-Y gastric bypass (n=26), small-intestine resection (n=6), colon resection (n=5), Whipple procedure (n=4), choledochojejunostomy (n=3), hepaticojejunostomy (n=1), Billroth I (n=1), Billroth II (n=1), and Puestow procedure (n=1). Procedural indications were PEG tube placement (n=11), choledocholithiasis (n=2), biliary stricture (n=2), obstructive jaundice (n=1), cholangitis (n=1), ampullary mass (n=1), sphincter of Oddi dysfunction (n=1), anemia and/or bleeding (n=15), abdominal pain (n=9), radiologic evidence of obstruction (n=3), and Peutz-Jeghers syndrome (n=2). The technical success rate was 73% in single-balloon PEG placement, 88% in single-balloon ERCP, 82% in other anterograde SBEs, and 86% in retrograde SBEs. No intraprocedural or postprocedural adverse events were observed. Single center, retrospective study. SBE is safe and effective in patients with surgically altered anatomy. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Malpractice claims for endoscopy

PubMed Central

Hernandez, Lyndon V; Klyve, Dominic; Regenbogen, Scott E

2013-01-01

AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374  794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70  730  101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation. PMID:23596540

Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals.

PubMed

Lawrence, Christopher; Romagnuolo, Joseph; Payne, K Mark; Hawes, Robert H; Cotton, Peter B

2010-09-01

Benign biliary strictures are typically managed endoscopically whereby an increasing size or number of plastic stents is placed at ERCP. Stents are often changed every 3 to 4 months based on the known median patency of a single biliary stent, but patency data for multiple biliary stents are lacking. To assess the incidence of occlusion-free survival of multiple plastic biliary stents and the rate of premature occlusion if left in longer than 6 months. Retrospective. Tertiary-care medical center (Charleston, SC). Consecutive patients who received multiple plastic stents for benign nonhilar biliary strictures from 1994 to 2008 were identified. Exchange of multiple plastic biliary stents within 6 months (group 1) or 6 months or longer (group 2) after placement. Symptomatic stent occlusion. Seventy-nine patients with nonhilar extrahepatic benign biliary stricture underwent 125 ERCPs with multiple plastic biliary stents. Stents were scheduled for removal/exchange within 6 months in 52 patients (86 ERCPs) compared with after 6 months in 22 patients (26 ERCPs). The median interval between multiple stent placement and removal/exchange was 90 days for group 1 and 242 days for group 2. Premature stent occlusion occurred in 4 of 52 (7.7%) patients in group 1 versus 1 of 22 (4.5%) in group 2, with significantly longer occlusion-free survival in group 2 (log-rank P < .0001). Retrospective study at a single tertiary referral center. Multiple plastic biliary stents for benign nonhilar strictures were associated with a low rate of premature symptomatic stent occlusion at more than 6 months and a longer occlusion-free survival. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Do Surgeons and Gastroenterologists Describe Endoscopic Retrograde Cholangiopancreatography Differently? A Qualitative Study.

PubMed

Boehler, Margaret L; Roberts, Nicole; Sanfey, Hilary; Mellinger, John

2016-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure performed by both surgeons and gastroenterologists. There is controversy in the field regarding the training necessary to perform ERCP. Widely disparate requisite volumes of experience to achieve proficiency have been published by representatives of each specialty. The basis for these differences has not been fully explored, with particular reference to the cognitive mindset of the different specialties. Structured cognitive task analytic interviews were conducted with 7 expert gastroenterologists and 4 expert surgeons from 4 institutions, each of whom performs ERCP as a common procedure in their clinical practice. A qualitative analysis and grounded theory approach was used, focusing specifically on duct cannulation as a critical procedural element. Transcripts were analyzed using Atlas.ti software. The qualitative analysis of 11 transcripts identified 173 unique codes from a total of 653 quotes. In all, 5 themes were found to describe the codes: judgment, teaching, techniques, principles, and equipment. Significant differences were noted between gastroenterologists and surgeons across these themes. Gastroenterologists placed emphasis on issues of judgment including rationale, and emphasized explanation and clarification in teaching. Surgeons placed more emphasis on use of visual cues, and emphasized technique and equipment nuances. The data suggest that gastroenterologists deconstruct ERCP competence based on application of rules and rationale through reflection. Surgeons focus more on visual and tactile cues in task deconstruction, and may be more likely to measure proficiency based on technical response to such cues. Based on this study, it is proposed that both specialties might have complementary roles in training therapeutic endoscopists. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Correlation of CBD/CHD angulation with recurrent cholangitis in patients treated with ERCP.

PubMed

Chong, Charing Cn; Chiu, Philip Wy; Tan, Teresa; Teoh, Anthony Yb; Lee, Kit Fai; Ng, Enders Kwok Wai; Lai, Paul Bs; Lau, James Yw

2016-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) for bile duct stone extraction has a major role in the treatment of cholangitis. It is well known that certain risk factors predispose to recurrence of such stones. The aims of this study were to evaluate the correlation between angulation of the common bile duct (CBD), right hepatic duct (RHD), and left hepatic duct (LHD) with recurrent cholangitic attacks and to elucidate other risk factors that may be associated with these attacks. This is retrospective study included 62 patients who had undergone therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones. Their medical records were followed until May 1, 2009. The RHD, LHD, and CBD angulation and CBD diameter were measured on cholangiography prior to any endoscopic procedures. Among these 62 patients, 6 (9.7 %) had recurrence of cholangitis. Both angles of the RHD and the CBD were significantly smaller in the group with recurrence (P = 0.001, P = 0.004). A CBD angle ≤ 130(o) and RHD angle ≤ 125(o) were found to be significantly associated with an increased risk of recurrence (RR = 10.526, P = 0.033; RR = 24.97, P = 0.008) in multivariate analysis. Cholecystectomy was not a protective factor against recurrence of cholangitis (P = 0.615). Angulation of the CBD (≤ 130°) and RHD (≤ 125°) on ERCP are independent risk factors for recurrent cholangitis. Further prospective studies using these data may be warranted for a more accurate estimation and verification of the risk factors predisposing to recurrent cholangitis.

Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

PubMed Central

Wang, Fei; Xu, Boming; Li, Quanpeng; Zhang, Xiuhua; Jiang, Guobing; Ge, Xianxiu; Nie, Junjie; Zhang, Xiuyun; Wu, Ping; Ji, Jie; Miao, Lin

2016-01-01

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is challenging. Results of ERCP in those patients varied. The aim of our study was to evaluate the safety and effectiveness of various endoscopes-assisted ERCP in patients with surgically altered anatomy. Fifty-two patients with Billroth II reconstruction (group A), 20 patients with subtotal or total gastrectomy with Roux-en-Y anastomosis (group B), 25 patients with pancreatoduodenectomy or Roux-en-Y hepaticojejunostomy reconstruction (group C) were included. Gastroscope, duodenoscope, colonoscope, and double-balloon enteroscope were used. The endoscope insertion success rate of groups A, B, C was 96.2% (50/52), 85.0% (17/20), 80% (20/25), respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.068). The mean insertion time was 36.7, 68.4, and 84.0 minutes, respectively. One-way ANOVA showed that the insertion time of group C was significantly longer than that of groups B and C (both P <0.001). The endoscopic cannulation success rates of groups A, B, C were 90%, 82.4%, and 100%, respectively. χ2 test showed that there was no significant difference between the 3 groups (P = 0.144). The mean cannulation time was 19.4, 28.1, and 20.4 minutes, respectively. One-way ANOVA showed that the cannulation time of group B was longer than that of groups A and C (P <0.001, P = 0.001, respectively). In total, 74 patients with successful biliary cannulation achieved the therapeutic goal; thus, the clinical success rate was 76.3% (74/97). Our study showed that ERCP in patients with surgically altered anatomy was safe and feasible. PMID:28033284

Influence of bolt tightening torque, wire size, and component reuse on wire fixation in circular external fixation.

PubMed

Wosar, Marc A; Marcellin-Little, Denis J; Roe, Simon C

2002-01-01

To evaluate the effects of bolt torque, wire size, and component reuse on the ability to maintain wire tension in 3 external skeletal fixation systems. Biomechanical study. Yield strength in tension of 1.0-, 1.2-, 1.5-, and 1.6-mm-diameter wires, and yield strength in torque of Hofmann Small Bone Fixation (SBF) cannulated and slotted bolts and IMEX regular and miniature bolts were determined on a testing machine. The minimum bolt tightening torque needed to prevent wire slippage at clinically recommended wire tensions was determined. Components were tested 10 times, and loads at slippage were recorded. The IMEX system required a mean of 8 Nm of bolt tightening torque to maintain 900 N (1.6-mm wires). The SBF system required a mean of 3 Nm bolt torque to maintain 300 N (1.0-mm wires) and 5 Nm to maintain 600 N (1.2-mm wires). The SBF cannulated bolt required 9 Nm of torque to maintain 900 N (1.5-mm wires). The SBF slotted bolts could only maintain 800 N before yield. The IMEX miniature system required a mean bolt torque of 1.1 Nm to maintain 300 N. The cannulated and slotted bolts from both manufacturers failed to maintain 70% of initial wire tension after 7 and 4 uses, respectively. The IMEX systems and the SBF system using 1.0- and 1.2-mm wires could maintain clinically recommended wire tension safely. Only the IMEX system could maintain clinically recommended wire tension safely using 1.5- or 1.6-mm wires. The SBF system using 1.0- and 1.2-mm wires and the IMEX system using all wire sizes can maintain clinically relevant wire tension. The SBF system using 1.5-mm wires could not. Cannulated and slotted bolts should not be used more than 6 and 3 times, respectively. Nuts should not be reused. Copyright 2002 by The American College of Veterinary Surgeons

Model-Based Testability Assessment and Directed Troubleshooting of Shuttle Wiring Systems

NASA Technical Reports Server (NTRS)

Deb, Somnath; Domagala, Chuck; Shrestha, Roshan; Malepati, Venkatesh; Cavanaugh, Kevin; Patterson-Hine, Ann; Sanderfer, Dwight; Cockrell, Jim; Norvig, Peter (Technical Monitor)

2000-01-01

We have recently completed a pilot study on the Space shuttle wiring system commissioned by the Wiring Integrity Research (WIRe) team at NASA Ames Research Center, As the space shuttle ages, it is experiencing wiring degradation problems including arcing, chaffing insulation breakdown and broken conductors. A systematic and comprehensive test process is required to thoroughly test and quality assure (QA) the wiring systems. The NASA WIRe team recognized the value of a formal model based analysis for risk-assessment and fault coverage analysis. However. wiring systems are complex and involve over 50,000 wire segments. Therefore, NASA commissioned this pilot study with Qualtech Systems. Inc. (QSI) to explore means of automatically extracting high fidelity multi-signal models from wiring information database for use with QSI's Testability Engineering and Maintenance System (TEAMS) tool.

A review of wiring system safety in space power systems

NASA Technical Reports Server (NTRS)

Stavnes, Mark W.; Hammoud, Ahmad N.

1993-01-01

Wiring system failures have resulted from arc propagation in the wiring harnesses of current aerospace vehicles. These failures occur when the insulation becomes conductive upon the initiation of an arc. In some cases, the conductive path of the carbon arc track displays a high enough resistance such that the current is limited, and therefore may be difficult to detect using conventional circuit protection. Often, such wiring failures are not simply the result of insulation failure, but are due to a combination of wiring system factors. Inadequate circuit protection, unforgiving system designs, and careless maintenance procedures can contribute to a wiring system failure. This paper approaches the problem with respect to the overall wiring system, in order to determine what steps can be taken to improve the reliability, maintainability, and safety of space power systems. Power system technologies, system designs, and maintenance procedures which have led to past wiring system failures will be discussed. New technologies, design processes, and management techniques which may lead to improved wiring system safety will be introduced.

A case of biliary Fascioliasis by Fasciola gigantica in Turkey.

PubMed

Goral, Vedat; Senturk, Senem; Mete, Omer; Cicek, Mutallib; Ebik, Berat; Kaya, Beşir

2011-03-01

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.

An incidental case of biliary fascioliasis mimicking cholangiocellular carcinoma.

PubMed

Şenateş, Ebubekir; Doğan, Abdullah; Şenates, Banu Erkalma; Bodakçi, Erdal; Bekçibasi, Muhammet

2014-12-01

Fascioliasis is a zoonotic infestation caused by Fasciola hepatica that usually attacks mammals, such as goats, sheep and cattle. The parasites can infect humans via freshwater plants contaminated with encysted metacercariae. In the acute phase, which involves hepatic invasion, the disease may present with abdominal pain, mild fever and hepatomegaly. In the chronic phase, the parasites settle into the biliary tracts, and then cause cholangitis and cholestasis. Sometimes, the disease may mimic malignancies, creating a mass appearance. Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and treatment method because it allows simultaneous diagnosis and treatment. Here, we present a 44-year-old female patient who presented to our hospital with complaints of abdominal pain, nausea, vomiting, anorexia and weight loss. After diagnostic investigations with laboratory and imaging methods, she was initially hospitalized with a preliminary diagnosis of cholangiocellular carcinoma (CCC). However, after a full work-up, the patient was diagnosed with Fasciola hepatica via ERCP and parasites were extracted with ERCP at the same time and then treated with a single dose of triclabendazole 10 mg/kg. Two months later, the clinical status of the patient had improved markedly, with resolution of all symptoms and all laboratory and imaging tests returning to within normal limits.

Results of a phase I-II study on intraductal confocal microscopy (IDCM) in patients with common bile duct (CBD) stenosis.

PubMed

Giovannini, M; Bories, E; Monges, G; Pesenti, C; Caillol, F; Delpero, J R

2011-07-01

Confocal endomicroscopy is an emergent technique and allows real optical biopsies in the gastrointestinal (GI) tract. The aim of this study was to evaluate a new intraductal confocal miniprobe in patients with a normal common bile duct (CBD) or with a suspicion of a malignant stenosis (cholangiocarcinoma). Thirty-seven patients (23 males) underwent endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stone removal (7 cases) or bile duct stenosis (30 cases). Intraductal confocal microscopy (IDCM) was performed during the ERCP using a probe-based confocal laser endomicroscopy (pCLE) technique. IDCM was done with the CholangioFlex probe with Cellvizio (Mauna Kea Technologies, Paris, France). The depth of penetration of theCholangioFlex probe was 40-70 μm and magnification was 400×. Images were reviewed by an experienced pathologist in GI disease and compared to ERCP findings, CBD biopsies performed during ERCP or EUS, and in 15 patients to the resected specimen (Wipple resection). No complications related to the CholangioFlex insertion occurred after the ERCP. Good images were obtained in 33 patients. Final histology diagnosis was a normal CBD in 7 cases, 23 malignant stenoses (4 ampullary carcinomas, 13 cholangiocarcinomas, and 6 pancreatic cancer), and 7 inflammatory stenoses (4 chronic pancreatitis, 1 stenosis of hepaticojejunal anastomosis, 1 postcholecystectomy CBD stenosis, and 1 primary sclerosing cholangitis). IDCM of a normal CBD showed a thin black band (<20 μm), normal vessels (thin and regular), and no visible glands. IDCM of malignant strictures revealed irregular vessels with lack of contrast in the CBD wall, large black band (>20 μm), and an aggregate of irregular black cells (black clumps). These aspects were seen in all malignant stenoses and none were seen in benign or normal CBD. The presence of irregular vessels, large black bands, and black clumps seen with confocal laser microscopy enabled prediction of neoplasia with an accuracy rate of 86%, sensitivity of 83%, and specificity of 75%. The respective numbers for standard histopathology were 53, 65, and 53%. This phase I-II study on IDCM showed that IDCM is feasible. This new technique will open a new door for optical biopsy of the CBD.

Autonomous diagnostics and prognostics of signal and data distribution systems

NASA Astrophysics Data System (ADS)

Blemel, Kenneth G.

2001-07-01

Wiring is the nervous system of any complex system and is attached to or services nearly every subsystem. Damage to optical wiring systems can cause serious interruptions in communication, command and control systems. Electrical wiring faults and failures due to opens, shorts, and arcing probably result in adverse effects to the systems serviced by the wiring. Abnormalities in a system usually can be detected by monitoring some wiring parameter such as vibration, data activity or power consumption. This paper introduces the mapping of wiring to critical functions during system engineering to automatically define the Failure Modes Effects and Criticality Analysis. This mapping can be used to define the sensory processes needed to perform diagnostics during system engineering. This paper also explains the use of Operational Modes and Criticality Effects Analysis in the development of Sentient Wiring Systems as a means for diagnostic, prognostics and health management of wiring in aerospace and transportation systems.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

MedlinePlus

... Process Research Training & Career Development Funded Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

Current Status of Percutaneous Transhepatic Biliary Drainage in Palliation of Malignant Obstructive Jaundice: A Review

PubMed Central

Chandrashekhara, SH; Gamanagatti, S; Singh, Anuradha; Bhatnagar, Sushma

2016-01-01

Malignancies leading to obstructive jaundice present too late to perform surgery with a curative intent. Due to inexorably progressing hyperbilirubinemia with its consequent deleterious effects, drainage needs to established even in advanced cases. Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) are widely used palliative procedures each with its own merits and lacunae. With the current state-of-the-art PTBD technique consequent upon procedural and hardware improvement, it is equaling ERCP regarding technical success and complications. In addition, there is a reduction in immediate procedure-related mortality with proven survival benefit. Nonetheless, it is the only imminent lifesaving procedure in cholangitis and sepsis. PMID:27803558

Photovoltaic system with improved AC connections and method of making same

DOEpatents

Cioffi, Philip Michael; Todorovic, Maja Harfman; Herzog, Michael Scott; Korman, Charles Steven; Doherty, Donald M.; Johnson, Neil Anthony

2018-02-13

An alternating current (AC) harness for a photovoltaic (PV) system includes a wire assembly having a first end and a second end, the wire assembly having a plurality of lead wires, and at least one AC connection module positioned at a location along a length of the wire assembly between the first end and the second end. Further, the at least one AC connection module includes a first connection terminal electrically coupled to the plurality of lead wires of the wire assembly and constructed to electrically couple the wire assembly with an output of a first PV module of the PV system. The at least one AC connection module also includes a second connection terminal electrically coupled to the plurality of lead wires of the wire assembly and constructed to electrically couple the wire assembly with an output of a second PV module of the PV system.

Traumatic bile leaks from blunt liver injury in children: a multidisciplinary and minimally invasive approach to management.

PubMed

Kulaylat, Afif N; Stokes, Audrey L; Engbrecht, Brett W; McIntyre, J Steele; Rzucidlo, Susan E; Cilley, Robert E

2014-03-01

Selective non-operative management (NOM) of hemodynamically stable pediatric patients with blunt hepatic trauma is the standard of care. Traumatic bile leaks (TBL) are a potential complication following liver injury. The use of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of TBL is described in adults, but limited in the pediatric literature. We report our experience with a multidisciplinary and minimally invasive approach to the management of TBL. This was an IRB-approved 13-year retrospective review (January 1999-December 2012) of an institutional pediatric trauma registry; 294 patients (≤ 17 years old) sustained blunt hepatic injury. Those with TBL were identified. Patient demographics, mechanism of injury, management strategy and outcomes were reviewed. Eleven patients were identified with TBL. Hepatobiliary iminodiacetic scan (HIDA) was diagnostic. Combinations of peri-hepatic drain placement, ERCP with biliary stenting and/or sphincterotomy were performed with successful resolution of TBL in all cases. No child required surgical repair or reconstruction of the leak. Cholangitis developed in one child. There were no long-term complications. A multidisciplinary and minimally invasive approach employing peri-hepatic external drainage catheters and ERCP with sphincterotomy and stenting of the ampulla is a safe and effective management strategy for TBL in children. © 2014.

Assessment of patient dose and radiogenic risks during endoscopic retrograde cholangiopancreatography.

PubMed

Sulieman, A; Elzaki, M; Alkhorayef, M; Babikir, E; Abuzaid, M; Dalton, A; Bradley, D

2016-11-01

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive technique that has been used for over 30 years in the diagnosis and management of pancreaticobiliary disorders. The objectives of this study were to evaluate the patient entrance surface air kerma doses (ESAK) and estimate the organ and effective doses during ERCP in three hospitals in Khartoum. A total of 55 patients were examined in three hospitals in Khartoum state, Sudan. Calibrated thermoluinescent dosimeters (TLD) were used to measure patients' ESAK. Organ and effective doses were estimated using National Radiological Protection Board (NRPB) software. The overall mean of ESAK for all ERCP procedures was 42.4mGy. The mean patient ESAK in Fedail (A), Soba (B) and Ibn sena (C) hospitals were 26.7mGy, 26.0mGy and 72.4mGy, respectively. The effective doses in three hospitals were 1.60, 1.56 and 2.67mSv in that order and the overall mean effective dose was 1.94mSv. Patient radiation doses vary widely among the hospitals. Patient ESAK is low compared to previous studies in the light of the current practice. Patient dose was decreased significantly in the last two decades. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Effectiveness of the Rectal Administration of Low-dose Diclofenac for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis.

PubMed

Okuno, Mitsuru; Shiroko, Junko; Taguchi, Daisuke; Yamaguchi, Kimihiro; Takada, Jun; Imai, Susumu; Sato, Hiroyuki; Thanabashi, Shinobu

2018-03-30

Objective A 50-100-mg rectal dose of nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac or indomethacin) has been shown to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, this is higher than the recommended 25-mg dose that is commonly administered to Japanese patients. The objective of this study was to evaluate the safety and efficacy of 25-mg rectal dose of diclofenac in preventing PEP. Methods Between January 2016 and March 2017, a total of 147 patients underwent ERCP with or without the rectal administration of diclofenac (25 mg) 20 min before the procedure. A retrospective analysis was conducted to evaluate the efficacy and safety of this dose in preventing PEP. Results Thirteen patients (8.8%) developed PEP: 3 patients (4.1%) in the diclofenac group and 10 (13.7%) in the control group (p=0.0460). After ERCP, there were no cases of gastrointestinal hemorrhage, ulceration, acute renal failure, or death. A multivariate logistic regression analysis revealed that the non-administration of rectal diclofenac was a risk factor for PEP (odds ratio=3.530; 95% confidence interval=1.017-16.35; p=0.0468). Conclusions A 25-mg rectal dose of diclofenac might prevent PEP.

Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique.

PubMed

Kaffes, Arthur J; Sriram, Parupudi V J; Rao, Guduru V; Santosh, Darisetti; Reddy, D Nageshwar

2005-11-01

Pre-cutting techniques have been used to gain biliary access at the expense of an increased complication rate. This may be because of the multiple attempts to achieve cannulation by using standard methods before pre-cutting and causing excess edema and papillary trauma. There are limited data on the early use of pre-cutting techniques. We performed a prospective study of the early introduction of needle-knife techniques in patients with difficult biliary cannulation. Standard biliary cannulation was attempted with a sphincterotome and a guidewire. If this failed within 10 minutes or if there were more than 5 pancreatic cannulations, the needle-knife technique was used. Either a standard method of pre-cutting (below-upward) from the papillary orifice or the modified technique of pre-cutting (above-downward), stopping short of the papillary orifice, was adopted, as per the discretion of the endoscopist. If pre-cutting failed, the cannulation was reattempted 24 to 48 hours later. A total of 346 therapeutic biliary ERCP procedures were performed between April and August 2003. Of these, 70 patients (20%) (mean age, 54 years; 38 men) underwent needle-knife pre-cut sphincterotomy (16 with the standard technique). In 58 patients (83%), the procedure was successful with the initial pre-cutting, making the total success at initial ERCP 334/346 (96.5%). Nine patients in whom pre-cut failed, returned for a second-attempt ERCP, with 7 completed successfully. The total success rate of pre-cutting was 65/70 (93%). The overall success rate of biliary cannulation, after two ERCP attempts, was 341/346 (98.5%). Six patients had mild bleeding, and one had mild pancreatitis. There was no difference in these complications between the two types of pre-cut techniques. The early use of needle knife for difficult biliary cannulation is safe and effective, irrespective of the technique used.

30 CFR 75.705-11 - Use of grounded messenger wires; ungrounded systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Use of grounded messenger wires; ungrounded....705-11 Use of grounded messenger wires; ungrounded systems. Solely for purposes of grounding ungrounded high-voltage power systems, grounded messenger wires used to suspend the cables of such systems...

30 CFR 75.705-11 - Use of grounded messenger wires; ungrounded systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Use of grounded messenger wires; ungrounded....705-11 Use of grounded messenger wires; ungrounded systems. Solely for purposes of grounding ungrounded high-voltage power systems, grounded messenger wires used to suspend the cables of such systems...

49 CFR 393.28 - Wiring systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 5 2011-10-01 2011-10-01 false Wiring systems. 393.28 Section 393.28 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY... NECESSARY FOR SAFE OPERATION Lamps, Reflective Devices, and Electrical Wiring § 393.28 Wiring systems...

49 CFR 393.28 - Wiring systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 5 2013-10-01 2013-10-01 false Wiring systems. 393.28 Section 393.28 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY... NECESSARY FOR SAFE OPERATION Lamps, Reflective Devices, and Electrical Wiring § 393.28 Wiring systems...

49 CFR 393.28 - Wiring systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 5 2012-10-01 2012-10-01 false Wiring systems. 393.28 Section 393.28 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY... NECESSARY FOR SAFE OPERATION Lamps, Reflective Devices, and Electrical Wiring § 393.28 Wiring systems...

49 CFR 393.28 - Wiring systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false Wiring systems. 393.28 Section 393.28 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY... NECESSARY FOR SAFE OPERATION Lamps, Reflective Devices, and Electrical Wiring § 393.28 Wiring systems...

30 CFR 77.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2010 CFR

2010-07-01

... pilot check wires. 77.902-2 Section 77.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Approved ground check systems not employing pilot check wires. Ground check systems not employing pilot check wires shall be approved by the Secretary only after it has been determined that the system...

30 CFR 77.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2011 CFR

2011-07-01

... pilot check wires. 77.902-2 Section 77.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Approved ground check systems not employing pilot check wires. Ground check systems not employing pilot check wires shall be approved by the Secretary only after it has been determined that the system...

30 CFR 77.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pilot check wires. 77.902-2 Section 77.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Approved ground check systems not employing pilot check wires. Ground check systems not employing pilot check wires shall be approved by the Secretary only after it has been determined that the system...

30 CFR 77.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pilot check wires. 77.902-2 Section 77.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Approved ground check systems not employing pilot check wires. Ground check systems not employing pilot check wires shall be approved by the Secretary only after it has been determined that the system...

30 CFR 77.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pilot check wires. 77.902-2 Section 77.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Approved ground check systems not employing pilot check wires. Ground check systems not employing pilot check wires shall be approved by the Secretary only after it has been determined that the system...

46 CFR 129.340 - Cable and wiring.

Code of Federal Regulations, 2011 CFR

2011-10-01

... buildup of condensation. (b) Each cable and wire must— (1) Have stranded copper conductors with sufficient... Power Sources and Distribution Systems § 129.340 Cable and wiring. (a) If individual wires, rather than cables, are used in systems operating at a potential of greater than 50 volts, the wire and associated...

46 CFR 129.340 - Cable and wiring.

Code of Federal Regulations, 2013 CFR

2013-10-01

... buildup of condensation. (b) Each cable and wire must— (1) Have stranded copper conductors with sufficient... Power Sources and Distribution Systems § 129.340 Cable and wiring. (a) If individual wires, rather than cables, are used in systems operating at a potential of greater than 50 volts, the wire and associated...

46 CFR 129.340 - Cable and wiring.

Code of Federal Regulations, 2014 CFR

2014-10-01

... buildup of condensation. (b) Each cable and wire must— (1) Have stranded copper conductors with sufficient... Power Sources and Distribution Systems § 129.340 Cable and wiring. (a) If individual wires, rather than cables, are used in systems operating at a potential of greater than 50 volts, the wire and associated...

46 CFR 129.340 - Cable and wiring.

Code of Federal Regulations, 2012 CFR

2012-10-01

... buildup of condensation. (b) Each cable and wire must— (1) Have stranded copper conductors with sufficient... Power Sources and Distribution Systems § 129.340 Cable and wiring. (a) If individual wires, rather than cables, are used in systems operating at a potential of greater than 50 volts, the wire and associated...

A Vibrating Wire System For Quadrupole Fiducialization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wolf, Zachary

2010-12-13

A vibrating wire system is being developed to fiducialize the quadrupoles between undulator segments in the LCLS. This note provides a detailed analysis of the system. The LCLS will have quadrupoles between the undulator segments to keep the electron beam focused. If the quadrupoles are not centered on the beam axis, the beam will receive transverse kicks, causing it to deviate from the undulator axis. Beam based alignment will be used to move the quadrupoles onto a straight line, but an initial, conventional alignment must place the quadrupole centers on a straight line to 100 {micro}m. In the fiducialization stepmore » of the initial alignment, the position of the center of the quadrupole is measured relative to tooling balls on the outside of the quadrupole. The alignment crews then use the tooling balls to place the magnet in the tunnel. The required error on the location of the quadrupole center relative to the tooling balls must be less than 25 {micro}m. In this note, we analyze a system under construction for the quadrupole fiducialization. The system uses the vibrating wire technique to position a wire onto the quadrupole magnetic axis. The wire position is then related to tooling balls using wire position detectors. The tooling balls on the wire position detectors are finally related to tooling balls on the quadrupole to perform the fiducialization. The total 25 {micro}m fiducialization error must be divided between these three steps. The wire must be positioned onto the quadrupole magnetic axis to within 10 {micro}m, the wire position must be measured relative to tooling balls on the wire position detectors to within 15 {micro}m, and tooling balls on the wire position detectors must be related to tooling balls on the quadrupole to within 10 {micro}m. The techniques used in these three steps will be discussed. The note begins by discussing various quadrupole fiducialization techniques used in the past and discusses why the vibrating wire technique is our method of choice. We then give an overview of the measurement system showing how the vibrating wire is positioned onto the quadrupole axis, how the wire position detectors locate the wire relative to tooling balls without touching the wire, and how the tooling ball positions are all measured. The novel feature of this system is the vibrating wire which we discuss in depth. We analyze the wire dynamics and calculate the expected sensitivity of the system. The note should be an aid in debugging the system by providing calculations to compare measurements to.« less

30 CFR 77.704-11 - Use of grounded messenger wires; ungrounded systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Use of grounded messenger wires; ungrounded... AREAS OF UNDERGROUND COAL MINES Grounding § 77.704-11 Use of grounded messenger wires; ungrounded systems. Solely for purposes of grounding ungrounded high-voltage power systems, grounded messenger wires...

30 CFR 77.704-11 - Use of grounded messenger wires; ungrounded systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Use of grounded messenger wires; ungrounded... AREAS OF UNDERGROUND COAL MINES Grounding § 77.704-11 Use of grounded messenger wires; ungrounded systems. Solely for purposes of grounding ungrounded high-voltage power systems, grounded messenger wires...

Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study

PubMed Central

Salet, Nèwel; Bremmer, Rolf H; Verhagen, Marc A M T; Ekkelenkamp, Vivian E; Hansen, Bettina E; de Jonge, Pieter J F; de Man, Rob A

2018-01-01

Objective To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation. Study design Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome. Setting 62 Dutch hospitals. Participants 45 848 unique gastrointestinal patients discharged in 2015. Main outcome measure A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor–patient counselling. Results Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%. Conclusion This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients. PMID:29496668

NASA wiring for space applications program test results

NASA Astrophysics Data System (ADS)

Stavnes, Mark; Hammoud, Ahmad

1995-11-01

The electrical power wiring tests results from the NASA Wiring for Space Applications program are presented. The goal of the program was to develop a base for the building of a lightweight, arc track-resistant electrical wiring system for aerospace applications. This new wiring system would be applied to such structures as pressurized modules, trans-atmospheric vehicles, LEO/GEO environments, and lunar and Martian environments. Technological developments from this program include the fabrication of new insulating materials, the production of new wiring constructions, an improved system design, and an advanced circuit protection design.

Development of termination and utilization concepts for flat conductor cables. Volume 3: Cost study comparison, flat versus round conductor cable

NASA Technical Reports Server (NTRS)

1972-01-01

A cost study comparing flat conductor cable (FCC) with small-gage wire (SGW) and conventional round conductor cable (RCC) is presented. This study was based on a vehicle wiring system consisting of 110,000 ft of conventional RCC equally divided between AWG sizes 20,22, and 24 using MIL-W-81044-type wire and MIL-C-26500 circular connectors. Basic cost data were developed on a similar-sized commercial jet airplane wiring system on a previous company R&D program in which advanced wiring techniques were carried through equivalent installations on an airplane mockup; and on data developed on typical average bundles during this program. Various cost elements included were engineering labor, operations (manufacturing) labor, material costs, and cost impact on payload. Engineering labor includes design, wiring system integration, wiring diagrams and cable assembly drawings, wire installations, and other related supporting functions such as the electronic data processing for the wiring. Operations labor includes mockup, tooling and production planning, fabrication, assembly, installation, and quality control cost impact on payload is the conversion of wiring system weight variations through use of different wiring concepts to program payload benefits in terms of dollars.

Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice

PubMed Central

Gupta, Mamta; Pai, Radha R.; Dileep, Devi; Gopal, Sandeep; Shenoy, Suresh

2013-01-01

Background: Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Cytological techniques including bile aspiration and biliary brushings have become the initial diagnostic modality. Aim: The aim of this study is to evaluate the role of endoscopic biliary tract cytology as a diagnostic tool in the evaluation of extrahepatic cholestatic jaundice. Materials and Methods: A total of 56 biliary tract specimens including 34 bile aspirations and 22 biliary brushings from 41 consecutive patients who had presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) were assessed by cytological examination. The smears prepared were analyzed for standard cytological features. Results: Cytologic diagnosis was adenocarcinoma in 13 (31.7%) cases, atypical in 2 (4.9%), reactive in 3 (7.3%) and benign changes in 19 (46.3%) cases. 4 (9.8%) cases were non-diagnostic. Serum bilirubin was significantly elevated in the malignant group. Biliary stricture was the most common finding on ERCP (68.3%). On cytological examination, presence of solitary, intact atypical cells, enlarged nuclei, irregular nuclear membrane, coarse chromatin and nucleoli were important cytologic criteria for differentiating malignant from benign biliary specimens. Conclusions: Regular use of bile cytology and brushings during ERCP evaluation of extrahepatic cholestatic jaundice is invaluable in obtaining a morphologic diagnosis. A systematic approach, use of strict cytomorphologic criteria and inclusion of significant atypia as malignant diagnosis may improve the sensitivity. PMID:24130407

Risk models for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP): smoking and chronic liver disease are predictors of protection against PEP.

PubMed

DiMagno, Matthew J; Spaete, Joshua P; Ballard, Darren D; Wamsteker, Erik-Jan; Saini, Sameer D

2013-08-01

We investigated which variables independently associated with protection against or development of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and severity of PEP. Subsequently, we derived predictive risk models for PEP. In a case-control design, 6505 patients had 8264 ERCPs, 211 patients had PEP, and 22 patients had severe PEP. We randomly selected 348 non-PEP controls. We examined 7 established- and 9 investigational variables. In univariate analysis, 7 variables predicted PEP: younger age, female sex, suspected sphincter of Oddi dysfunction (SOD), pancreatic sphincterotomy, moderate-difficult cannulation (MDC), pancreatic stent placement, and lower Charlson score. Protective variables were current smoking, former drinking, diabetes, and chronic liver disease (CLD, biliary/transplant complications). Multivariate analysis identified seven independent variables for PEP, three protective (current smoking, CLD-biliary, CLD-transplant/hepatectomy complications) and 4 predictive (younger age, suspected SOD, pancreatic sphincterotomy, MDC). Pre- and post-ERCP risk models of 7 variables have a C-statistic of 0.74. Removing age (seventh variable) did not significantly affect the predictive value (C-statistic of 0.73) and reduced model complexity. Severity of PEP did not associate with any variables by multivariate analysis. By using the newly identified protective variables with 3 predictive variables, we derived 2 risk models with a higher predictive value for PEP compared to prior studies.

Predictive factors for outcomes of patients undergoing endoscopic therapy for bile leak after hepatobiliary surgery.

PubMed

Yabe, Shuntaro; Kato, Hironari; Mizukawa, Sho; Akimoto, Yutaka; Uchida, Daisuke; Seki, Hiroyuki; Tomoda, Takeshi; Matsumoto, Kazuyuki; Yamamoto, Naoki; Horiguchi, Shigeru; Tsutsumi, Koichiro; Okada, Hiroyuki

2017-05-01

Endoscopic procedures are used as first-line treatment for bile leak after hepatobiliary surgery. Advances have been made in endoscopic techniques and devices, but few reports have described the effectiveness of endoscopic procedures and the management principles based on severity of bile leak. We evaluated the effectiveness of an endoscopic procedure for the treatment of bile leak after hepatobiliary surgery. Fifty-eight patients underwent an endoscopic procedure for suspected bile leak after hepatobiliary surgery; the presence of bile leak on endoscopic retrograde cholangiopancreatography (ERCP) was evaluated retrospectively. Two groups were created based on bile leak severity at ERCP. We defined success as follows: technical, successful placement of the plastic stent at the intended bile duct; clinical, improvement in symptoms of bile leak; and eventual, disappearance of bile leak at ERCP. We evaluated several factors that influenced the success of the endoscopic procedure and the differences between bile leak severity. Success rates were as follows: technical, 90%; clinical, 79%; and eventual, 71%. Median interval between first endoscopic procedure and achievement of eventual success was 135 days (IQR, 86-257 days). Bile leak severity was the only independent factor associated with eventual success (P = 0.01). Endoscopic therapy is safe and effective for postoperative bile leak. Bile leak severity is the most important factor influencing successful endoscopic therapy. © 2016 Japan Gastroenterological Endoscopy Society.

Diagnostic significance of pancreas divisum in early life.

PubMed

Shukri, N; Wasa, M; Hasegawa, T; Okada, A

2000-02-01

Pancreas divisum (PD) is a congenital anomaly in which the ventral and dorsal pancreatic ducts fails to fuse in the early fetal period. This anomaly has been known to rarely cause recurrent pancreatitis and to require surgical intervention. With the recent advances in image diagnostic procedures, an increasing incidence of this anomaly has been recognized in the pediatric age group. Seven cases of PD were encountered in our institution between 1978 and 1998. Six were female and one was male, with a mean age of 8 years. All cases were diagnosed to have PD by endoscopic retrograde pancreatography (ERCP) or operative pancreatography. One case (14.3%) had PD associated with a bout of pancreatitis and was operated on by transduodenal papilloplasty, but recurrent bouts of pancreatitis led to the performance of longitudinal pancreaticojejunostomy (Puestow procedure). Six cases (85.7%) were found to have PD as an incidental finding during operation for congenital dilatation of the bile ducts (CDBD), however, 2 cases (33.3%) out of the 6 developed pancreatitis in a later stage and ERCP was effective in their follow-up assessment. One benefited from conservative treatment while the other needed transduodenal papilloplasty along with pancreatoductoplasty. Imaging procedures (ERCP or operative pancreatography) revealed complete PD in 3 cases (42.9%), and incomplete PD in 4 cases (57.1%), however, there was no clinically significant difference between the groups.

30 CFR 77.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2011 CFR

2011-07-01

... wires; approval by the Secretary. 77.803-2 Section 77.803-2 Mineral Resources MINE SAFETY AND HEALTH... check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires shall be approved by the Secretary only if it is determined that the system...

30 CFR 77.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... wires; approval by the Secretary. 77.803-2 Section 77.803-2 Mineral Resources MINE SAFETY AND HEALTH... check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires shall be approved by the Secretary only if it is determined that the system...

30 CFR 77.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2013 CFR

2013-07-01

... wires; approval by the Secretary. 77.803-2 Section 77.803-2 Mineral Resources MINE SAFETY AND HEALTH... check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires shall be approved by the Secretary only if it is determined that the system...

30 CFR 77.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2014 CFR

2014-07-01

... wires; approval by the Secretary. 77.803-2 Section 77.803-2 Mineral Resources MINE SAFETY AND HEALTH... check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires shall be approved by the Secretary only if it is determined that the system...

30 CFR 77.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2012 CFR

2012-07-01

... wires; approval by the Secretary. 77.803-2 Section 77.803-2 Mineral Resources MINE SAFETY AND HEALTH... check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires shall be approved by the Secretary only if it is determined that the system...

An Obstacle Alerting System for Agricultural Application

NASA Technical Reports Server (NTRS)

DeMaio, Joe

2003-01-01

Wire strikes are a significant cause of helicopter accidents. The aircraft most at risk are aerial applicators. The present study examines the effectiveness of a wire alert delivered by way of the lightbar, a GPS-based guidance system for aerial application. The alert lead-time needed to avoid an invisible wire is compared with that to avoid a visible wire. A flight simulator was configured to simulate an agricultural application helicopter. Two pilots flew simulated spray runs in fields with visible wires, invisible wires, and no wires. The wire alert was effective in reducing wire strikes. A lead-time of 3.5 sec was required for the alert to be effective. The lead- time required was the same whether the pilot could see the wire or not.

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

Endoscopic ultrasound-guided biliary drainage

PubMed Central

Chavalitdhamrong, Disaya; Draganov, Peter V

2012-01-01

Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure. PMID:22363114

[Spontaneous liver rupture in a patient with choledocholithiasis resolved by ERCP].

PubMed

Bahena-Aponte, Jesús A; Ramírez de Aguilar, Guillermo; Torres Carrillo, Juan Carlos; Espino Urbina, Luis; Sánchez González, Jesús A

2016-01-01

We present the case of a 34 years old female patient who presents with abdominal pain and elevated total and direct bilirrubins, so she underwent ERCP Reporting: a) successful sphincterotomy without complications, b) choledocholithias is endoscopically resolved, c) secondary cholangitis. She developed significant abdominal pain at 72 h, with hypovolemic shock and peritoneal irritation. She was taken to the surgery, finding a grade III liver laceration. This one was resolved with liver raffia and packing, during the same operative time cholecystectomy was performed. A second look was performed at 24 h, achieving adequate control of bleeding after placing hemostatic (Nexstat®). The patient developed a subdiaphragmatic abscess which needed drainage by another laparotomy. After which the patient had a satisfactory evolution, so she was discharged.

Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

PubMed

Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

1977-05-09

Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

30 CFR 75.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Approved ground check systems not employing pilot check wires. 75.902-2 Section 75.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... employing pilot check wires. Ground check systems not employing pilot check wires will be approved only if...

30 CFR 75.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Approved ground check systems not employing pilot check wires. 75.902-2 Section 75.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... employing pilot check wires. Ground check systems not employing pilot check wires will be approved only if...

Pre-wired systems prove their worth.

PubMed

2012-03-01

The 'new generation' of modular wiring systems from Apex Wiring Solutions have been specified for two of the world's foremost teaching hospitals - the Royal London and St Bartholomew's Hospital, as part of a pounds sterling 1 billion redevelopment project, to cut electrical installation times, reduce on-site waste, and provide a pre-wired, factory-tested, power and lighting system. HEJ reports.

ERCP

MedlinePlus

... dye, or drug used during the procedure Bleeding Hole (perforation) of the bowel Inflammation of the pancreas ( ... or severe bloating Bleeding from the rectum or black stools Fever above 100°F (37.8°C) ...

SpaceWire Data Handling Demonstration System

NASA Astrophysics Data System (ADS)

Mills, S.; Parkes, S. M.; O'Gribin, N.

2007-08-01

The SpaceWire standard was published in 2003 with the aim of providing a standard for onboard communications, defining the physical and data link layers of an interconnection, in order to improve reusability, reliability and to reduce the cost of mission development. The many benefits which it provides mean that it has already been used in a number of missions, both in Europe and throughout the world. Recent work by the SpaceWire community has included the development of higher level protocols for SpaceWire, such as the Remote Memory Access Protocol (RMAP) which can be used for many purposes, including the configuration of SpaceWire devices. Although SpaceWire has become very popular, the various ways in which it can be used are still being discovered, as are the most efficient ways to use it. At the same time, some in the space industry are not even aware of SpaceWire's existence. This paper describes the SpaceWire Data Handling Demonstration System that has been developed by the University of Dundee. This system simulates an onboard data handling network based on SpaceWire. It uses RMAP for all communication, and so demonstrates how SpaceWire and standardised higher level protocols can be used onboard a spacecraft. The system is not only a good advert for those who are unfamiliar with the benefits of SpaceWire, it is also a useful tool for those using SpaceWire to test ideas.

Adjustable Bracket For Entry Of Welding Wire

NASA Technical Reports Server (NTRS)

Gilbert, Jeffrey L.; Gutow, David A.

1993-01-01

Wire-entry bracket on welding torch in robotic welding system provides for adjustment of angle of entry of welding wire over range of plus or minus 30 degrees from nominal entry angle. Wire positioned so it does not hide weld joint in view of through-the-torch computer-vision system part of robot-controlling and -monitoring system. Swiveling bracket also used on nonvision torch on which wire-feed-through tube interferes with workpiece. Angle simply changed to one giving sufficient clearance.

30 CFR 75.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pilot check wires. 75.902-2 Section 75.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... employing pilot check wires. Ground check systems not employing pilot check wires will be approved only if... ground continuity is broken. ...

30 CFR 75.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pilot check wires. 75.902-2 Section 75.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... employing pilot check wires. Ground check systems not employing pilot check wires will be approved only if... ground continuity is broken. ...

30 CFR 75.902-2 - Approved ground check systems not employing pilot check wires.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pilot check wires. 75.902-2 Section 75.902-2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... employing pilot check wires. Ground check systems not employing pilot check wires will be approved only if... ground continuity is broken. ...

Endoscopic Ultrasound-guided Bilio-pancreatic Drainage

PubMed Central

Giovannini, Marc; Bories, Erwan; Téllez-Ávila, Félix I.

2012-01-01

The echoendoscopic biliary drainage is an option to treat obstructive jaundices when endoscopic retrograde cholangiopancreatography (ERCP) drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear sectorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimension on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonografic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampullary diverticula and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Diathermic dilatation of the puncturing tract is required using a 6-Fr cystostome and a plastic or metal stent is introducted. The techincal success of hepaticogastrostomy is near 98%, and complications are present in 20%: pneumoperitoneum, choleperitoneum, infection and stent disfunction. To prevent bile leakage, we have used the 2-stent techniques. The first stent introduced was a long uncovered metal stent (8 or 10 cm) and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92%, and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 14%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general guideline to safer procedure execution. The ideal approach for pancreatic pseudocyst (PPC) puncture combines endos-copy with real time endosonography using an interventional echoendoscope. Several authors have described the use of endoscopic ultrasound (EUS) longitudinal scanners for guidance of transmural puncture and drainage procedures. The same technique could be used to access a dilated pancreatic duct in cases in which the duct cannot be drained by conventional ERCP because of complete obstruction. PMID:24949349

Passive-bending, short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients.

PubMed

Yamauchi, Hiroshi; Kida, Mitsuhiro; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Tokunaga, Shuko; Takezawa, Miyoko; Imaizumi, Hiroshi; Koizumi, Wasaburo

2015-02-07

To evaluate short-type-single-balloon enteroscope (SBE) with passive-bending, high-force transmission functions for endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis. Short-type SBE with this technology (SIF-Y0004-V01; working length, 1520 mm; channel diameter, 3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis. The rate of reaching the blind end, time required to reach the blind end, diagnostic and therapeutic success rates, and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology (SIF-Y0004; working length, 1520 mm; channel diameter, 3.2 mm) in 25 patients. The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004 (P = 0.59). The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004 (16 min vs 24 min, P = 0.04). The diagnostic success rate was 93% with SIF-Y0004-V01 and 84% with SIF-Y0004 (P = 0.17). The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004 (P = 0.68). The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004 (P = 0.50). The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group (P = 0.723). The incidence of pancreatitis was 0% in the SIF-Y0004-V01 group and 5.9% in the SIF-Y0004 group (P > 0.999). The incidence of gastrointestinal perforation was 2.0% (1/50) in the SIF-Y0004-V01 group and 2.9% (1/34) in the SIF-Y0004 group (P > 0.999). SIF-Y0004-V01 is useful for ERCP in patients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.

30 CFR 75.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2011 CFR

2011-07-01

... wires; approval by the Secretary. 75.803-2 Section 75.803-2 Mineral Resources MINE SAFETY AND HEALTH... Underground High-Voltage Distribution § 75.803-2 Ground check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires will be approved only if it...

30 CFR 75.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... wires; approval by the Secretary. 75.803-2 Section 75.803-2 Mineral Resources MINE SAFETY AND HEALTH... Underground High-Voltage Distribution § 75.803-2 Ground check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires will be approved only if it...

30 CFR 75.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2012 CFR

2012-07-01

... wires; approval by the Secretary. 75.803-2 Section 75.803-2 Mineral Resources MINE SAFETY AND HEALTH... Underground High-Voltage Distribution § 75.803-2 Ground check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires will be approved only if it...

30 CFR 75.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2013 CFR

2013-07-01

... wires; approval by the Secretary. 75.803-2 Section 75.803-2 Mineral Resources MINE SAFETY AND HEALTH... Underground High-Voltage Distribution § 75.803-2 Ground check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires will be approved only if it...

30 CFR 75.803-2 - Ground check systems not employing pilot check wires; approval by the Secretary.

Code of Federal Regulations, 2014 CFR

2014-07-01

... wires; approval by the Secretary. 75.803-2 Section 75.803-2 Mineral Resources MINE SAFETY AND HEALTH... Underground High-Voltage Distribution § 75.803-2 Ground check systems not employing pilot check wires; approval by the Secretary. Ground check systems not employing pilot check wires will be approved only if it...

Influence of bracket-slot design on the forces released by superelastic nickel-titanium alignment wires in different deflection configurations.

PubMed

Nucera, Riccardo; Gatto, Elda; Borsellino, Chiara; Aceto, Pasquale; Fabiano, Francesca; Matarese, Giovanni; Perillo, Letizia; Cordasco, Giancarlo

2014-05-01

To evaluate how different bracket-slot design characteristics affect the forces released by superelastic nickel-titanium (NiTi) alignment wires at different amounts of wire deflection. A three-bracket bending and a classic-three point bending testing apparatus were used to investigate the load-deflection properties of one superelastic 0.014-inch NiTi alignment wire in different experimental conditions. The selected NiTi archwire was tested in association with three bracket systems: (1) conventional twin brackets with a 0.018-inch slot, (2) a self-ligating bracket with a 0.018-inch slot, and (3) a self-ligating bracket with a 0.022-inch slot. Wire specimens were deflected at 2 mm and 4 mm. Use of a 0.018-inch slot bracket system, in comparison with use of a 0.022-inch system, increases the force exerted by the superelastic NiTi wires at a 2-mm deflection. Use of a self-ligating bracket system increases the force released by NiTi wires in comparison with the conventional ligated bracket system. NiTi wires deflected to a different maximum deflection (2 mm and 4 mm) release different forces at the same unloading data point (1.5 mm). Bracket design, type of experimental test, and amount of wire deflection significantly affected the amount of forces released by superelastic NiTi wires (P<.05). This phenomenon offers clinicians the possibility to manipulate the wire's load during alignment.

Basic EMC (Electromagnetic compatibility) technology advancement for C3 systems. Volume 4D: Modeling crosstalk in balanced twisted pairs

NASA Astrophysics Data System (ADS)

Koopman, D. A.; Paul, C. R.

1984-08-01

Electrical devices (computers, radar systems, communication radios, etc.) are interconnected by wires on most present systems. Electromagnetic fields produced by the excitation of these wires will cause unintentional coupling of signals onto nearby wires. This undesired electromagnetic coupling is termed crosstalk. It is important to be able to determine whether these crosstalk signals will cause the devices at the ends of the wires to malfunction. Wires are often grouped together in cable bundles or harnesses. The close proximity of wires in these bundles enhances the possibility that the crosstalk levels will be sufficiently large to cause malfunctions. The ability to predict crosstalk levels and the means to control crosstalk when it causes a problem are important to optimum system design. It interference of this type is allowed to surface during final system tests, a costly and time consuming retrofit of the wiring or the addition of filters and other interference control measures may be required.

Design and implementation of wire tension measurement system for MWPCs used in the STAR iTPC upgrade

DOE PAGES

Wang, Xu; Shen, Fuwang; Wang, Shuai; ...

2017-04-06

The STAR experiment at RHIC is planning to upgrade the Time Projection Chamber which lies at the heart of the detector. We have designed an instrument to measure the tension of the wires in the multi-wire proportional chambers (MWPCs) which will be used in the TPC upgrade. The wire tension measurement system causes the wires to vibrate and then it measures the fundamental frequency of the oscillation via a laser based optical platform. The platform can scan the entire wire plane, automatically, in a single run and obtain the wire tension on each wire with high precision. In this paper,more » the details about the measurement method and the system setup will be described. In addition, the test results for a prototype MWPC to be used in the STAR-iTPC upgrade will be presented.« less

Design and implementation of wire tension measurement system for MWPCs used in the STAR iTPC upgrade

NASA Astrophysics Data System (ADS)

Wang, Xu; Shen, Fuwang; Wang, Shuai; Feng, Cunfeng; Li, Changyu; Lu, Peng; Thomas, Jim; Xu, Qinghua; Zhu, Chengguang

2017-07-01

The STAR experiment at RHIC is planning to upgrade the Time Projection Chamber which lies at the heart of the detector. We have designed an instrument to measure the tension of the wires in the multi-wire proportional chambers (MWPCs) which will be used in the TPC upgrade. The wire tension measurement system causes the wires to vibrate and then it measures the fundamental frequency of the oscillation via a laser based optical platform. The platform can scan the entire wire plane, automatically, in a single run and obtain the wire tension on each wire with high precision. In this paper, the details about the measurement method and the system setup will be described. In addition, the test results for a prototype MWPC to be used in the STAR-iTPC upgrade will be presented.

The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma.

PubMed

Wolf, A; Bernhardt, J; Patrzyk, M; Heidecke, C-D

2005-05-01

Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%. Using medical records over the past 5 years, we investigated when and in what circumstances endoscopic retrograde cholangiopancreaticography (ERCP) was used in the diagnosis and treatment of pancreas injuries after blunt abdominal trauma. Penetrating injuries were not taken into consideration. An ERCP was performed on a total of five patients with suspected injuries to the pancreas after blunt abdominal trauma. No duct participation could be determined in three of the patients with a first degree pancreatic lesion. A 44-year-old woman sustained severe internal and external injuries after a traffic accident. Because of the nature of her injuries, pancreatic left resection with splenectomy was necessary. After the operation, a pancreatic fistula diagnosed. The ductus pancreaticus (DP) was successfully treated by stenting with the use of endoscopic retrograde pancreaticography. A 24-year old woman was kicked in the epigastrium by a horse. On the day after the incident, she complained of increasing pain in the upper abdomen, and she had elevated amylase and lipase levels. Computed tomography scan showed free fluid. Less than 48 h after the accident, ERCP was performed and a leakage in the DP in the head-body region (fourth degree) was identified. We placed a stent, and during the subsequent laparoscopy the omental bursa was flushed out and a drainage laid. After 14 days, the patient was sent home. We removed the drainage 4 weeks after the accident, and the stent after 12 weeks. The major advantage of the prompt retrograde discription of the pancreatobiliary system after an accident in which pancreas involvement is suspected is the more precise assessment of the extent of the injuries. If a stent is placed in the same session, it is possible to carry out definitive and interventional treatment.

Interchip link system using an optical wiring method.

PubMed

Cho, In-Kui; Ryu, Jin-Hwa; Jeong, Myung-Yung

2008-08-15

A chip-scale optical link system is presented with a transmitter/receiver and optical wire link. The interchip link system consists of a metal optical bench, a printed circuit board module, a driver/receiver integrated circuit, a vertical cavity surface-emitting laser/photodiode array, and an optical wire link composed of plastic optical fibers (POFs). We have developed a downsized POF and an optical wiring method that allows on-site installation with a simple annealing as optical wiring technologies for achieving high-density optical interchip interconnection within such devices. Successful data transfer measurements are presented.

A One Chip Hardened Solution for High Speed SpaceWire System Implementations. Session: Components

NASA Technical Reports Server (NTRS)

Marshall, Joseph R.; Berger, Richard W.; Rakow, Glenn P.

2007-01-01

An Application Specific Integrated Circuit (ASIC) that implements the SpaceWire protocol has been developed in a radiation hardened 0.25 micron CMOS technology. This effort began in March 2003 as a joint development between the NASA Goddard Space Flight Center (GSFC) and BAE Systems. The BAE Systems SpaceWire ASIC is comprised entirely of reusable core elements, many of which are already flight-proven. It incorporates a router with 4 SpaceWire ports and two local ports, dual PC1 bus interfaces, a microcontroller, 32KB of internal memory, and a memory controller for additional external memory use. The SpaceWire cores are also reused in other ASICs under development. The SpaceWire ASIC is planned for use on the Geostationary Operational Environmental Satellites (GOES)-R, the Lunar Reconnaissance Orbiter (LRO) and other missions. Engineering and flight parts have been delivered to programs and users. This paper reviews the SpaceWire protocol and those elements of it that have been built into the current and next SpaceWire reusable cores and features within the core that go beyond the current standard and can be enabled or disabled by the user. The adaptation of SpaceWire to BAE Systems' On Chip Bus (OCB) for compatibility with the other reusable cores will be reviewed and highlighted. Optional configurations within user systems and test boards will be shown. The physical implementation of the design will be described and test results from the hardware will be discussed. Application of this ASIC and other ASICs containing the SpaceWire cores and embedded microcontroller to Plug and Play and reconfigurable implementations will be described. Finally, the BAE Systems roadmap for SpaceWire developments will be updated, including some products already in design as well as longer term plans.

Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics.

PubMed

Humphries, Romney M; Yang, Shuan; Kim, Stephen; Muthusamy, Venkatara Raman; Russell, Dana; Trout, Alisa M; Zaroda, Teresa; Cheng, Quen J; Aldrovandi, Grace; Uslan, Daniel Zachary; Hemarajata, Peera; Rubin, Zachary Aaron

2017-10-01

Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. An outbreak investigation was performed when 9 patients with blaOXA-232 carbapenem-resistant K. pneumoniae infections were identified at a tertiary care hospital. The investigation included 2 case-control studies, review of duodenoscope reprocessing procedures, and culture of devices. Carbapenem-resistant Enterobacteriacieae (CRE) isolates were evaluated with polymerase chain reaction analysis for carbapenemase genes, and isolates with the blaOXA-232 gene were subjected to whole-genome sequencing and chromosome single-nucleotide polymorphism analysis. On recognition of ERCP as a key risk factor for infection, targeted patient notification and CRE screening cultures were performed. Molecular testing ultimately identified 17 patients with blaOxa-232 carbapenem-resistant K. pneumoniae isolates, including 9 with infections, 7 asymptomatic carriers who had undergone ERCP, and 1 additional patient who had been hospitalized in India and was probably the initial carrier. Two case-control studies established a point-source outbreak associated with 2 specific duodenoscopes. A field investigation of the use, reprocessing, and storage of deuodenoscopes did not identify deviations from US Food and Drug Administration or manufacturer recommendations for reprocessing. This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers' guidelines.

Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis.

PubMed

Mohammad Alizadeh, Amir H; Abbasinazari, Mohammad; Hatami, Behzad; Abdi, Saeed; Ahmadpour, Forozan; Dabir, Shideh; Nematollahi, Aida; Fatehi, Samira; Pourhoseingholi, Mohammad A

2017-03-01

NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP). In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure. Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively). Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group.

A comparative study of wireless and wired sensors networks for deficit irrigation management

NASA Astrophysics Data System (ADS)

Torres Sánchez, Roque; Domingo Miguel, Rafael; Valles, Fulgencio Soto; Perez-Pastor, Alejandro; Lopez Riquelme, Juan Antonio; Blanco Montoya, Victor

2016-04-01

In recent years, the including of sensors in the context of agricultural water management, has received an increasing interest for the establishment of irrigation strategies, such as regulated deficit irrigation (RDI). These strategies allow a significant improvement of crop water productivity (marketable yield / water applied), especially in woody orchards. The application of these deficit irrigation strategies, requires the monitoring of variables related to the orchard, with the purpose of achieving an efficiently irrigation management, since it is necessary to know the soil and plant water status to achieve the level of water deficit desired in each phenological stage. These parameters involve the measurements of soil and plant parameters, by using appropriate instrumentation devices. Traditional centralized instrumentation systems include soil matric potential, water content and LVDT sensors which information is stored by dataloggers with a wired connection to the sensors. Nowadays, these wired systems are being replaced by wireless ones due, mainly, to cost savings in wiring and labor. These technologies (WSNs) allow monitoring a wide variety of parameters in orchards with high density of sensors using discrete and autonomous nodes in the trees or soil places where it is necessary, without using wires. In this paper we present a trial in a cherry crop orchard, with different irrigation strategies where both a wireless and a wired system have been deployed with the aim of obtaining the best criteria on how to select the most suitable technology in future agronomic monitoring systems. The first stage of this study includes the deploying of nodes, wires, dataloggers and the installation of the sensors (same for both, wired and wireless systems). This stage was done during the first 15 weeks of the trial. Specifically, 40 MPS6 soil matric potential, 20 Enviroscan water content and 40 (LVDT and band) dendometers were installed in order to cover the experimental irrigation trials: Control, Severe deficit, Moderate Deficit, Low Deficit and Traditional irrigation, with 4 repetitions (2 wired and 2 wireless) each one. The main goals were: (i) the ability of WSN for monitoring areas with high density of information, (ii) advantages and disadvantages compared to traditional wired instrumentation, (iii) energy sizing for autonomous operation of WSNs, (iv), strategies for deploying nodes to ensure the robustness of WSN. The main conclusions were: i) The WSNs need less time to be installed than the wired systems, ii) the WSNs is easier to install than the wired one because of the absence of wired links, iii) the advantage of WSNs is increased with high density of measure points, iv) the maintenance is higher in WSNs than the wired centralized systems, v) the acquisition costs is similar in both systems, vi) the installation costs is higher in Wired systems than WSNs, vii) the quality of data is similar in both systems although the data in WSNs are sooner available than wired, viii) the data robustness are higher in wired systems than WSN because of solar panel and battery lacks of WSN nodes. This work has been funded by the Ministerio de Economia y Competitividad AGL2013-49047-C2-1R.

A New Flying Wire System for the Tevatron

NASA Astrophysics Data System (ADS)

Blokland, Willem; Dey, Joseph; Vogel, Greg

1997-05-01

A new Flying Wires system replaces the old system to enhance the analysis of the beam emittance, improve the reliability, and handle the upcoming upgrades of the Tevatron. New VME data acquisition modules and timing modules allow for more bunches to be sampled more precisely. The programming language LabVIEW, running on a Macintosh computer, controls the VME modules and the nuLogic motion board that flies the wires. LabVIEW also analyzes and stores the data, and handles local and remote commands. The new system flies three wires and fits profiles of 72 bunches to a gaussian function within two seconds. A new console application operates the flying wires from any control console. This paper discusses the hardware and software setup, the capabilities and measurement results of the new Flying Wires system.

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Signal wires on pole line and aerial cable. 236.71... Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on... pole or other support. Signal wire shall not interfere with, or be interfered by, other wires on the...

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Signal wires on pole line and aerial cable. 236.71... Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on... pole or other support. Signal wire shall not interfere with, or be interfered by, other wires on the...

Beam Position and Phase Monitor - Wire Mapping System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Watkins, Heath A; Shurter, Robert B.; Gilpatrick, John D.

2012-04-10

The Los Alamos Neutron Science Center (LANSCE) deploys many cylindrical beam position and phase monitors (BPPM) throughout the linac to measure the beam central position, phase and bunched-beam current. Each monitor is calibrated and qualified prior to installation to insure it meets LANSCE requirements. The BPPM wire mapping system is used to map the BPPM electrode offset, sensitivity and higher order coefficients. This system uses a three-axis motion table to position the wire antenna structure within the cavity, simulating the beam excitation of a BPPM at a fundamental frequency of 201.25 MHz. RF signal strength is measured and recorded formore » the four electrodes as the antenna position is updated. An effort is underway to extend the systems service to the LANSCE facility by replacing obsolete electronic hardware and taking advantage of software enhancements. This paper describes the upgraded wire positioning system's new hardware and software capabilities including its revised antenna structure, motion control interface, RF measurement equipment and Labview software upgrades. The main purpose of the wire mapping system at LANSCE is to characterize the amplitude response versus beam central position of BPPMs before they are installed in the beam line. The wire mapping system is able to simulate a beam using a thin wire and measure the signal response as the wire position is varied within the BPPM aperture.« less

49 CFR 236.73 - Open-wire transmission line; clearance to other circuits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.73 Open-wire transmission...

49 CFR 236.73 - Open-wire transmission line; clearance to other circuits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.73 Open-wire transmission...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2013 CFR

2013-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2014 CFR

2014-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2012 CFR

2012-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.73 - Open-wire transmission line; clearance to other circuits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.73 Open-wire transmission...

BAE Systems Radiation Hardened SpaceWire ASIC and Roadmap

NASA Technical Reports Server (NTRS)

Berger, Richard; Milliser, Myrna; Kapcio, Paul; Stanley, Dan; Moser, David; Koehler, Jennifer; Rakow, Glenn; Schnurr, Richard

2006-01-01

An Application Specific Integrated Circuit (ASIC) that implements the SpaceWire protocol has been developed in a radiation hardened 0.25 micron CMOS, technology. This effort began in March 2003 as a joint development between the NASA Goddard Space Flight Center (GSFC) and BAE Systems. The BAE Systems SpaceWire ASlC is comprised entirely of reusable core elements, many of which are already flight-proven. It incorporates a 4-port SpaceWire router with two local ports, dual PC1 bus interfaces, a microcontroller, 32KB of internal memory, -and a memory controller for additional external memory use. The SpaceWire ASlC is planned for use on both the Geostationary Operational Environmental Satellites (GOES)-R and the Lunar Reconnaissance Orbiter (LRO). Engineering parts have already been delivered to both programs. This paper discusses the SpaceWire protocol and those elements of it that have been built into the current SpaceWire reusable core. There are features within the core that go beyond the current standard that can be enabled or disabled by the user and these will be described. The adaptation of SpaceWire to BAE Systems' On Chip Bus (OCB) for compatibility with the other reusable cores will be discussed. Optional configurations within user systems will be shown. The physical imp!ementation of the design will be described and test results from the hardware will be discussed. Finally, the BAE Systems roadmap for SpaceWire developments will be discussed, including some products already in design as well as longer term plans.

Pentoxifylline Treatment in Acute Pancreatitis (AP)

ClinicalTrials.gov

2018-02-21

Acute Pancreatitis (AP); Gallstone Pancreatitis; Alcoholic Pancreatitis; Post-ERCP/Post-procedural Pancreatitis; Trauma Acute Pancreatitis; Hypertriglyceridemia Acute Pancreatitis; Idiopathic (Unknown) Acute Pancreatitis; Medication Induced Acute Pancreatitis; Cancer Acute Pancreatitis; Miscellaneous (i.e. Acute on Chronic Pancreatitis)

[Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

PubMed

Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

2017-10-01

Background  In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods  To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results  Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion  For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

Wire-bonder-assisted integration of non-bondable SMA wires into MEMS substrates

NASA Astrophysics Data System (ADS)

Fischer, A. C.; Gradin, H.; Schröder, S.; Braun, S.; Stemme, G.; van der Wijngaart, W.; Niklaus, F.

2012-05-01

This paper reports on a novel technique for the integration of NiTi shape memory alloy wires and other non-bondable wire materials into silicon-based microelectromechanical system structures using a standard wire-bonding tool. The efficient placement and alignment functions of the wire-bonding tool are used to mechanically attach the wire to deep-etched silicon anchoring and clamping structures. This approach enables a reliable and accurate integration of wire materials that cannot be wire bonded by traditional means.

Method and system for controlling chemical reactions between superconductors and metals in superconducting cables

DOEpatents

Shen, Tengming

2016-11-15

A method, system, and apparatus for fabricating a high-strength Superconducting cable comprises pre-oxidizing at least one high-strength alloy wire, coating at least one Superconducting wire with a protective layer, and winding the high-strength alloy wire and the Superconducting wire to form a high-strength Superconducting cable.

Method and system for controlling chemical reactions between superconductors and metals in superconducting cables

DOEpatents

Shen, Tengming

2018-01-02

A method, system, and apparatus for fabricating a high-strength Superconducting cable comprises pre-oxidizing at least one high-strength alloy wire, coating at least one Superconducting wire with a protective layer, and winding the high-strength alloy wire and the Superconducting wire to form a high-strength Superconducting cable.

System and method for evaluating a wire conductor

DOEpatents

Panozzo, Edward; Parish, Harold

2013-10-22

A method of evaluating an electrically conductive wire segment having an insulated intermediate portion and non-insulated ends includes passing the insulated portion of the wire segment through an electrically conductive brush. According to the method, an electrical potential is established on the brush by a power source. The method also includes determining a value of electrical current that is conducted through the wire segment by the brush when the potential is established on the brush. The method additionally includes comparing the value of electrical current conducted through the wire segment with a predetermined current value to thereby evaluate the wire segment. A system for evaluating an electrically conductive wire segment is also disclosed.

A prospective group sequential study evaluating a new type of fully covered self-expandable metal stent for the treatment of benign biliary strictures (with video).

PubMed

Poley, Jan-Werner; Cahen, Djuna L; Metselaar, Herold J; van Buuren, Henk R; Kazemier, Geert; van Eijck, Casper H J; Haringsma, Jelle; Kuipers, Ernst J; Bruno, Marco J

2012-04-01

Fully-covered self expandable metal stents (fcSEMSs) are an alternative to progressive plastic stenting for the treatment of benign biliary strictures (BBS) with the prospect of a higher treatment efficacy and the need for fewer ERCPs, thereby reducing the burden for patients and possibly costs. Key to this novel treatment is safe stent removal. To investigate the feasibility and safety of stent removal of a fcSEMS with a proximal retrieval lasso: a long wire thread integrated in the proximal ends of the wire mesh that hangs freely in the stent lumen. Pulling it enables gradual removal of the stent inside-out. A secondary aim was success of stricture resolution. Non-randomized, prospective follow-up study with 3 sequential cohorts of 8 patients with BBS. Academic tertiary referral center. Eligible patients had strictures either postsurgical (post-cholecystectomy (LCx) or liver transplantation (OLT)), due to chronic pancreatitis (CP), or papillary stenosis (PF). Strictures had to be located at least 2 cm below the liver hilum. All patients had one plastic stent in situ across the stricture and had not undergone previous treatment with either multiple plastic stents or fcSEMS. The first cohort of patients underwent stent placement for 2 months, followed by 3 months if the stricture had not resolved. The second and third cohort started with 3 months and 4 months, respectively, both followed by another 4 months if indicated. Treatment success was defined by stricture resolution at cholangiography, the ability to pass an inflated extraction balloon and clinical follow-up (at least 6 months). safety of stent removal. Secondary outcomes were complications and successful stricture resolution. A total of 23 patients (11 female; 20-67 yrs) were eligible for final analysis. One patient developed a malignant neuroendocrine tumor in the setting of CP. Strictures were caused by CP (13), OLT (6), LCx (3) and PF (1). In total 39 fcSEMS were placed and removed. Removals were easy and without complications. Transient pain after insertion was common (13 of 23/56%) but was easily managed by analgesics in all patients. Other complications were cholecystitis (1), cholangitis due to stent migration (1, stent replaced) or stent clogging (2, managed endoscopically) and worsening of CP (2). In these patients, the fcSEMS was removed and replaced after pancreatic sphincterotomy and PD stent placement. Median follow-up was 15 months (range 11-25). Overall treatment success was 61% (14/23); in the CP group 46%, in the remaining patients 80% (p = 0.11). Patients with stricture resolution after removal of the first stent (n = 7; success 6/7) showed a trent towards a more sustained treatment success than patients who needed a 2nd stent placement (n = 16; success 8/16); p = 0.12). Small number of patients with regard to secondary outcomes. Removal of a new type of fcSEMS with a proximal retrieval lasso in patients with BBS proved easy and uncomplicated. Treatment success for CP strictures was higher compared to what is known from results of progressive plastic stenting protocols. For other indications treatment success was comparable to progressive plastic stenting, but with the prospect of fewer ERCP procedures. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

47 CFR 36.341 - Cable and wire facilities expenses-Account 6410 (Class B telephone companies); Accounts 6411...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Cable and wire facilities expenses-Account 6410... Operating Expenses and Taxes Cable and Wire Facilities Expenses § 36.341 Cable and wire facilities expenses... network cable, aerial wire, and conduit systems. (b) The general method of separating cable and wire...

47 CFR 36.341 - Cable and wire facilities expenses-Account 6410 (Class B telephone companies); Accounts 6411...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Cable and wire facilities expenses-Account 6410... Operating Expenses and Taxes Cable and Wire Facilities Expenses § 36.341 Cable and wire facilities expenses... network cable, aerial wire, and conduit systems. (b) The general method of separating cable and wire...

Magnetorheological fluid based automotive steer-by-wire systems

NASA Astrophysics Data System (ADS)

Ahmadkhanlou, Farzad; Washington, Gregory N.; Bechtel, Stephen E.; Wang, Yingru

2006-03-01

The idea of this paper is to design a Magnetorheological (MR) fluid based damper for steer-by-wire systems to provide sensory feedback to the driver. The advantages of using MR fluids in haptic devices stem from the increase in transparency gained from the lightweight semiactive system and controller implementation. The performance of MR fluid based steer-by wire system depends on MR fluid model and specifications, MR damper geometry, and the control algorithm. All of these factors are addressed in this study. The experimental results show the improvements in steer-by-wire by adding force feedback to the system.

14 CFR 121.1111 - Electrical wiring interconnection systems (EWIS) maintenance program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Electrical wiring interconnection systems... Airworthiness and Safety Improvements § 121.1111 Electrical wiring interconnection systems (EWIS) maintenance program. (a) Except as provided in paragraph (f) of this section, this section applies to transport...

46 CFR 110.25-1 - Plans and information required for new construction.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-line wiring diagram of the power system, supported, by cable lists, panelboard summaries, and other... computed operating loads for each condition of operation. (c) Elementary and isometric or deck wiring plans...) Manual alarm system; and (11) Supervised patrol system. (d) Deck wiring or schematic plans of power...

A Simulation Study on Take-Off and Landing Dynamics of the Aircraft of a Fly-By-Wire Control System

DTIC Science & Technology

1993-01-07

L:V,"DIN G DYN;AMICS OF THE AIRCRAFT OF A FLY-BY-WIRE CONTROL SYSTEM by Y achang Feng, Gang Chert, Peiqiong Li 93-00985 Distribution unlimit ed. FASTC...FLY-BY-WIRE CONTROL SYSTEM By: Yachang Feng, Gang Chen, Peiqiong- Li English pages: 17 Source: Hangkon, Xuebao, Vol. 12, No. 6, June, 1991; pp. 252-258...Landing Dynamics of the Aircraft of a Fly-By-Wire Control System Beijing University of Aeronautics and Astronautics Yachang FENG, Gang CHEN and Peiqiong Li

Endoscopic retrograde cholangio pancreatography (ERCP) - series (image)

MedlinePlus

... small intestine, also called the duodenum. The common bile duct carries bile from the liver to the duodenum, and enters ... sometimes pass from the gallbladder into the common bile duct, and block the flow of bile into ...

International space station wire program

NASA Technical Reports Server (NTRS)

May, Todd

1995-01-01

Hardware provider wire systems and current wire insulation issues for the International Space Station (ISS) program are discussed in this viewgraph presentation. Wire insulation issues include silicone wire contamination, Tefzel cold temperature flexibility, and Russian polyimide wire insulation. ISS is a complex program with hardware developed and managed by many countries and hundreds of contractors. Most of the obvious wire insulation issues are known by contractors and have been precluded by proper selection.

Diagnosis and management of pancreaticopleural fistula.

PubMed

Tay, Clifton Ming; Chang, Stephen Kin Yong

2013-04-01

Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.

Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California

PubMed Central

Kahaleh, Michel; Artifon, Everson LA; Perez-Miranda, Manuel; Gaidhane, Monica; Rondon, Carlos; Itoi, Takao; Giovannini, Marc

2015-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary and pancreatic drainage. While ERCP is successful in about 95% of cases, a small subset of cases are unsuccessful due to altered anatomy, peri-ampullary pathology, or malignant obstruction. Endoscopic ultrasound-guided drainage is a promising technique for biliary, pancreatic and recently gallbladder decompression, which provides multiple advantages over percutaneous or surgical biliary drainage. Multiple retrospective and some prospective studies have shown endoscopic ultrasound-guided drainage to be safe and effective. Based on the currently reported literature, regardless of the approach, the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%. endoscopic ultrasound-guided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic endoscopy PMID:25624708

Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy.

PubMed

Tsutsumi, Koichiro; Kato, Hironari; Tomoda, Takeshi; Matsumoto, Kazuyuki; Sakakihara, Ichiro; Yamamoto, Naoki; Noma, Yasuhiro; Sonoyama, Takayuki; Okada, Hiroyuki; Yamamoto, Kazuhide

2012-12-07

Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice. Recently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective, even in patients with surgically altered anatomies. On the other hand, endoscopic partial stent-in-stent (PSIS) placement of self-expandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible, safe and effective. We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success. This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization, even in patients with surgically altered anatomies.

Modeling data for pancreatitis in presence of a duodenal diverticula using logistic regression

NASA Astrophysics Data System (ADS)

Dineva, S.; Prodanova, K.; Mlachkova, D.

2013-12-01

The presence of a periampullary duodenal diverticulum (PDD) is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers reported that the diverticulum had something to do with the incidence of pancreatitis. The aim of this study is to investigate if the presence of duodenal diverticula predisposes to the development of a pancreatic disease. A total 3966 patients who had undergone ERCP were studied retrospectively. They were divided into 2 groups-with and without PDD. Patients with a duodenal diverticula had a higher rate of acute pancreatitis. The duodenal diverticula is a risk factor for acute idiopathic pancreatitis. A multiple logistic regression to obtain adjusted estimate of odds and to identify if a PDD is a predictor of acute or chronic pancreatitis was performed. The software package STATISTICA 10.0 was used for analyzing the real data.

NASA wiring for space applications program

NASA Technical Reports Server (NTRS)

Schulze, Norman

1995-01-01

An overview of the NASA Wiring for Space Applications Program and its relationship to NASA's space technology enterprise is given in viewgraph format. The mission of the space technology enterprise is to pioneer, with industry, the development and use of space technology to secure national economic competitiveness, promote industrial growth, and to support space missions. The objectives of the NASA Wiring for Space Applications Program is to improve the safety, performance, and reliability of wiring systems for space applications and to develop improved wiring technologies for NASA flight programs and commercial applications. Wiring system failures in space and commercial applications have shown the need for arc track resistant wiring constructions. A matrix of tests performed versus wiring constructions is presented. Preliminary data indicate the performance of the Tensolite and Filotex hybrid constructions are the best of the various candidates.

Acquisition of Turbulence Data Using the DST Group Constant-Temperature Hot-Wire Anemometer System

DTIC Science & Technology

2015-10-01

fluctuations in the low-speed wind tunnel at DST Group. The use of both single- wire and crossed- wire (2 wire ) probes is described. Areas covered include a...fluid-flow studies, including testing of models of aircraft, ships and submarines in wind and water tunnels. Hot- wire anemometers and associated hot...spectra of velocity fluctuations in the low-speed wind tunnel at DST Group. The use of both single- wire and crossed- wire (2 wires ) probes is

Operation and force analysis of the guide wire in a minimally invasive vascular interventional surgery robot system

NASA Astrophysics Data System (ADS)

Yang, Xue; Wang, Hongbo; Sun, Li; Yu, Hongnian

2015-03-01

To develop a robot system for minimally invasive surgery is significant, however the existing minimally invasive surgery robots are not applicable in practical operations, due to their limited functioning and weaker perception. A novel wire feeder is proposed for minimally invasive vascular interventional surgery. It is used for assisting surgeons in delivering a guide wire, balloon and stenting into a specific lesion location. By contrasting those existing wire feeders, the motion methods for delivering and rotating the guide wire in blood vessel are described, and their mechanical realization is presented. A new resistant force detecting method is given in details. The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire. The driving torque for rotating the guide wire is developed at different positions. Using the CT reconstruction image and extracted vessel paths, the path equation of the blood vessel is obtained. Combining the shapes of the guide wire outside the blood vessel, the whole bending equation of the guide wire is obtained. That is a risk criterion in the delivering process. This process can make operations safer and man-machine interaction more reliable. A novel surgery robot for feeding guide wire is designed, and a risk criterion for the system is given.

49 CFR 236.76 - Tagging of wires and interference of wires or tags with signal apparatus.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INSTRUCTIONS GOVERNING THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.76 Tagging of...

49 CFR 236.76 - Tagging of wires and interference of wires or tags with signal apparatus.

Code of Federal Regulations, 2014 CFR

2014-10-01

... INSTRUCTIONS GOVERNING THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.76 Tagging of...

49 CFR 236.76 - Tagging of wires and interference of wires or tags with signal apparatus.

Code of Federal Regulations, 2013 CFR

2013-10-01

... INSTRUCTIONS GOVERNING THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.76 Tagging of...

Filter line wiring designs in aircraft

NASA Astrophysics Data System (ADS)

Rowe, Richard M.

1990-10-01

The paper presents a harness design using a filter-line wire technology and appropriate termination methods to help meet high-energy radiated electromagnetic field (HERF) requirements for protection against the adverse effects of EMI on electrical and avionic systems. Filter-line interconnect harnessing systems discussed consist of high-performance wires and cables; when properly wired they suppress conducted and radiated EMI above 100 MHz. Filter-line termination devices include backshell adapters, braid splicers, and shield terminators providing 360-degree low-impedance terminations and enhancing maintainability of the system.

Characteristics of coated copper wire specimens using high frequency ultrasonic complex vibration welding equipments.

PubMed

Tsujino, J; Ihara, S; Harada, Y; Kasahara, K; Sakamaki, N

2004-04-01

Welding characteristic of thin coated copper wires were studied using 40, 60, 100 kHz ultrasonic complex vibration welding equipments with elliptical to circular vibration locus. The complex vibration systems consisted of a longitudinal-torsional vibration converter and a driving longitudinal vibration system. Polyurethane coated copper wires of 0.036 mm outer diameter and copper plates of 0.3 mm thickness and the other dimension wires were used as welding specimens. The copper wire part is completely welded on the copper substrate and the insulated coating material is driven from welded area to outsides of the wire specimens by high frequency complex vibration.

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Protection of insulated wire; splice in underground wire. 236.74 Section 236.74 Transportation Other Regulations Relating to Transportation (Continued..., AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Protection of insulated wire; splice in underground wire. 236.74 Section 236.74 Transportation Other Regulations Relating to Transportation (Continued..., AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.76 - Tagging of wires and interference of wires or tags with signal apparatus.

Code of Federal Regulations, 2010 CFR

2010-10-01

... with signal apparatus. 236.76 Section 236.76 Transportation Other Regulations Relating to... wires and interference of wires or tags with signal apparatus. Each wire shall be tagged or otherwise so... apparatus. [49 FR 3384, Jan. 26, 1984] Inspections and Tests; All Systems ...

49 CFR 236.76 - Tagging of wires and interference of wires or tags with signal apparatus.

Code of Federal Regulations, 2011 CFR

2011-10-01

... with signal apparatus. 236.76 Section 236.76 Transportation Other Regulations Relating to... wires and interference of wires or tags with signal apparatus. Each wire shall be tagged or otherwise so... apparatus. [49 FR 3384, Jan. 26, 1984] Inspections and Tests; All Systems ...

Mapping the Galvanic Corrosion of Three Metals Coupled with a Wire Beam Electrode: The Influence of Temperature and Relative Geometrical Position.

PubMed

Ju, Hong; Yang, Yuan-Feng; Liu, Yun-Fei; Liu, Shu-Fa; Duan, Jin-Zhuo; Li, Yan

2018-02-28

The local electrochemical properties of galvanic corrosion for three coupled metals in a desalination plant were investigated with three wire-beam electrodes as wire sensors: aluminum brass (HAl77-2), titanium (TA2), and 316L stainless steel (316L SS). These electrodes were used with artificial seawater at different temperatures. The potential and current-density distributions of the three-metal coupled system are inhomogeneous. The HAl77-2 wire anodes were corroded in the three-metal coupled system. The TA2 wires acted as cathodes and were protected; the 316L SS wires acted as secondary cathodes. The temperature and electrode arrangement have important effects on the galvanic corrosion of the three-metal coupled system. The corrosion current of the HAl77-2 increased with temperature indicating enhanced anode corrosion at higher temperature. In addition, the corrosion of HAl77-2 was more significant when the HAl77-2 wires were located in the middle of the coupled system than with the other two metal arrangement styles.

Mapping the Galvanic Corrosion of Three Metals Coupled with a Wire Beam Electrode: The Influence of Temperature and Relative Geometrical Position

PubMed Central

Liu, Yun-Fei; Liu, Shu-Fa; Duan, Jin-Zhuo

2018-01-01

The local electrochemical properties of galvanic corrosion for three coupled metals in a desalination plant were investigated with three wire-beam electrodes as wire sensors: aluminum brass (HAl77-2), titanium (TA2), and 316L stainless steel (316L SS). These electrodes were used with artificial seawater at different temperatures. The potential and current–density distributions of the three-metal coupled system are inhomogeneous. The HAl77-2 wire anodes were corroded in the three-metal coupled system. The TA2 wires acted as cathodes and were protected; the 316L SS wires acted as secondary cathodes. The temperature and electrode arrangement have important effects on the galvanic corrosion of the three-metal coupled system. The corrosion current of the HAl77-2 increased with temperature indicating enhanced anode corrosion at higher temperature. In addition, the corrosion of HAl77-2 was more significant when the HAl77-2 wires were located in the middle of the coupled system than with the other two metal arrangement styles. PMID:29495617

Palliation: Hilar cholangiocarcinoma

PubMed Central

Goenka, Mahesh Kr; Goenka, Usha

2014-01-01

Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise. PMID:25232449

Non-traumatic perforation of common hepatic duct: Case report and review of literature HP.

PubMed

Atwez, Abdelaziz; Augustine, Matthew; Nottingham, James M

2017-01-01

Non-traumatic biliary perforation other than the gallbladder is extremely rare and most commonly seen in children in association with congenital biliary anomalies. We present a rare case of choledocholithiasis that progressed to spontaneous perforation of the common hepatic duct probably from ischemic necrosis caused by impaction of large biliary stones. A 62-year-old female presented with diarrhea and jaundice. She was found to have two 2.5cm stones in the common hepatic duct. Stones could not be extracted by ERCP, and placement of biliary stent was done to restore patency. The patient was lost to follow up and returned after three months with a new onset of similar symptoms. At that time ERCP and a stent change were done without resolution of the symptoms. Patient then underwent an open exploration and was found to have a free perforation in the lateral aspect of the common hepatic duct just at the bifurcation of the right and left hepatic radicals. Through this perforation stones were both extracted and cholangiogram showed free flow with the distal biliary stent. The stent was nowhere near the site of perforation which appeared to be caused by pressure necrosis from the impacted stones. Impacted stones in the biliary tree need to be extracted to avoid pressure necrosis and spontaneous perforation. ERCP and stent placement should be used only as temporizing measures to manage the acute obstructive phase. Definitive surgical intervention must follow initial biliary decompression to extract the impacted biliary stones and avoid complications. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction.

PubMed

Lee, Jae Min; Lee, Sang Hyub; Jang, Dong Kee; Chung, Kwang Hyun; Park, Jin Myung; Paik, Woo Hyun; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong-Tae

2016-03-01

Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction.

A US Multicenter Study of Safety and Efficacy of Fully Covered Self-Expandable Metallic Stents in Benign Extrahepatic Biliary Strictures.

PubMed

Saxena, Payal; Diehl, David L; Kumbhari, Vivek; Shieh, Frederick; Buscaglia, Jonathan M; Sze, Wilson; Kapoor, Sumit; Komanduri, Srinadh; Nasr, John; Shin, Eun Ji; Singh, Vikesh; Lennon, Anne Marie; Kalloo, Anthony N; Khashab, Mouen A

2015-11-01

Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges. The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS. A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded. A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57% were males. Stricture resolution occurred in 81% of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7%) was the most common complication, followed by stent occlusion (4.9%), cholangitis (4.1%), and pancreatitis (3.3%). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis. Majority of BBS can be successfully managed with 1-2 consecutive FCSEMS with stent dwell time of 6 months.

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery

PubMed Central

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. PMID:24705194

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery.

PubMed

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study.

PubMed

Karim, Sherko Abdullah Molah; Abdulla, Karzan Seerwan; Abdulkarim, Qalandar Hussein; Rahim, Fattah Hama

2018-04-01

Pancreaticoduodenectomy (PD) is one of the most difficult and complex surgery that carries a high rate of major complications, including delayed gastric emptying (DGE), pancreatic fistula, bleeding, intra-abdominal collection, and pulmonary complications. In this study, we have tried to demonstrate the outcomes, and rates of complications from patients who had undergone this procedure by our surgical team. This retrospective study has been constructed on 98 patients who underwent pancreaticoduodenectomy from May 2010 to November 2017 in three different hospitals of the Sulaimanyah governorate in the Kurdistan region of Iraq by the same surgical team. Data was collected from the medical records of patients. A preoperative work up had done for all patients, including those who are necessary for anesthesia fitness and those for staging assessment. None of the operated patients received any types of neoadjuvant therapy. Out of all 98 patients who underwent PD, the most common complication was wound infection (23.5%), followed by pancreatic leak (21.4%). The pulmonary complication rate was 17.3%, while the intra-abdominal collection rate was 12.2%. In 12.2% of our patients we faced postoperative bleeding, with five patients having to be reopened for this reason. About 77.3% of patients that underwent preoperative ERCP had difficult bile duct dissection. There was an association between preoperative ERCP and difficult bile duct dissection (P Value < 0.001). Outcomes of our surgical team compared to the published data of some other centers. Preoperative ERCP seems to make difficulty in bile duct dissection during PD. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Successful endoscopic removal of a rare, large impacted pancreatic duct stone using grasping forceps: A case report with video.

PubMed

Liu, Qin; Wang, Yiping; Zeng, Hongze; Hu, Bing

2018-04-01

As a main complication of chronic pancreatitis (CP), pancreatic duct stones (PDSs) are often associated with ductal obstruction resulting in increasing intraductal and parenchymal pressure and long-lasting pain. There are many methods for removing PDSs. However, for large stones, it is technically difficult to remove them entirely by endoscopic retrograde cholangiopancreatography (ERCP). A 57-year-old man presented with a chief complaint of severe epigastric pain radiating to his back 3 or 4 times annually for 2 years. The abdominal computed tomography scan revealed dilation of the proximal pancreatic duct with an irregular high-density calcification shadow located at the head of the pancreas. A pancreatic stent was placed initially by ERCP to relieve epigastric pain and alleviate symptom. Repeated ERCP was subsequently performed 2 months later to extract the impacted large pancreatic stone. By using grasping forceps, the huge coralloid stone (272 × 0 mm) was successfully extracted in an en bloc manner. Then, a 7-French × 5 cm plastic pancreatic stent was placed for 2 weeks. The patient was free of any pancreatic pain during the 2-year follow-up. Generally, for large or impacted pancreatic stones, endoscopic removal is technically difficult to achieve. Pancreatic stenting can be an effective method of alleviating abdominal pain and facilitating subsequent endoscopic lithoextraction. Extraction of large stones with grasping forceps can be an alternative approach instead of extracorporeal shock wave lithotripsy or surgery when stones are impacted at the papilla's orifice and partially protruding into the duodenal lumen.

75 FR 7557 - Airworthiness Directives; The Boeing Company Model 767 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... shorts in many systems, including the spar fuel shut off valve, oxygen mask deployment, and burned wires... and wire bundles, causing shorts in many systems, including the spar fuel shut off valve, oxygen mask... and wire bundles, causing shorts in many systems, including the spar fuel shut off valve, oxygen mask...

75 FR 68245 - Airworthiness Directives; McDonnell Douglas Corporation Model MD-90-30 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... shutoff system wiring. This proposed AD was prompted by a possible latent failure in the fire handle... engine fuel fire shutoff handle is activated. Separating the fire handle shutoff system wiring will... handle shutoff system wiring. FAA's Determination We are proposing this AD because we evaluated all the...

Operational environments for electrical power wiring on NASA space systems

NASA Technical Reports Server (NTRS)

Stavnes, Mark W.; Hammoud, Ahmad N.; Bercaw, Robert W.

1994-01-01

Electrical wiring systems are used extensively on NASA space systems for power management and distribution, control and command, and data transmission. The reliability of these systems when exposed to the harsh environments of space is very critical to mission success and crew safety. Failures have been reported both on the ground and in flight due to arc tracking in the wiring harnesses, made possible by insulation degradation. This report was written as part of a NASA Office of Safety and Mission Assurance (Code Q) program to identify and characterize wiring systems in terms of their potential use in aerospace vehicles. The goal of the program is to provide the information and guidance needed to develop and qualify reliable, safe, lightweight wiring systems, which are resistant to arc tracking and suitable for use in space power applications. This report identifies the environments in which NASA spacecraft will operate, and determines the specific NASA testing requirements. A summary of related test programs is also given in this report. This data will be valuable to spacecraft designers in determining the best wiring constructions for the various NASA applications.

The construction technique of the high granularity and high transparency drift chamber of MEG II

NASA Astrophysics Data System (ADS)

Chiarello, G.; Chiri, C.; Corvaglia, A.; Grancagnolo, F.; Miccoli, A.; Panareo, M.; Pinto, C.; Spedicato, M.; Tassielli, G. F.

2017-07-01

The MEG experiment searches for the charged lepton flavor violating decay, μ +→ e+γ. MEG has already determined the world best upper limit on the branching ratio BR<4.2× 10-13 at 90% CL. An upgrade of the whole detector has been approved to obtain a substantial increase in sensitivity. Currently MEG is in upgrade phases, this phase involves all the detectors. The new positron tracker is a single volume, full stereo, small cells drift chamber (DCH) co-axial to the beam line. It is composed of 10 concentric layers and each single drift cell is approximately square 7 mm side, with a 20 μ m gold plated W sense wire surrounded by 40 μ m and 50 μ m silver plated Al field wires in a ratio of 5:1, about 12,000 wires. Due to the high wire density (12 wires/cm2), the use of the classical feed-through technique as wire anchoring system could hardly be implemented and therefore it was necessary to develop new wiring strategies. The number of wires and the stringent requirements on the precision of their position and on the uniformity of the wire mechanical tension impose the use of an automatic system to operate the wiring procedures. This wiring robot, designed and built at the INFN Lecce and University of Salento laboratories, consists of: ṡ a semiautomatic wiring machine with a high precision on wire mechanical tensioning (better than 0.5 g) and on wire positioning (20 μ m) for simultaneous wiring of multiwire layers; ṡ a contact-less infrared laser soldering tool; ṡ an automatic handling system for storing and transporting the multi-wire layers. The drift chamber is currently under construction at INFN and should be completed by the end of summer 2017 to be then delivered to PSI for commissioning.

A wire scanner system for characterizing the BNL energy recovery LINAC beam position monitor system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michnoff R.; Biscardi, C.; Cerniglia, P.

2012-04-15

A stepper motor controlled wire scanner system has recently been modified to support testing of the Brookhaven National Laboratory (BNL) Collider-Accelerator department's Energy Recovery Linac (ERL) beam position monitor (BPM) system. The ERL BPM consists of four 9.33 mm diameter buttons mounted at 90 degree spacing in a cube with 1.875 inch inside diameter. The buttons were designed by BNL and fabricated by Times Microwave Systems. Libera brilliance single pass BPM electronic modules with 700 MHz bandpass filter, manufactured by Instrumentation Technologies, will be used to measure the transverse beam positions at 14 locations around the ERL. The wire scannermore » assembly provides the ability to measure the BPM button response to a pulsed wire, and evaluate and calibrate the Libera position measurement electronics. A description of the wire scanner system and test result data will be presented.« less

In-Situ Wire Damage Detection System

NASA Technical Reports Server (NTRS)

Williams, Martha; Roberson, Luke; Tate, Lanetra; Smith, Trent; Gibson, Tracy; Medelius, Pedro; Jolley, Scott

2012-01-01

An In-Situ Wire Damage Detection System (ISWDDS) has been developed that is capable of detecting damage to a wire insulation, or a wire conductor, or to both. The system will allow for realtime, continuous monitoring of wiring health/integrity and reduce the number of false negatives and false positives while being smaller, lighter in weight, and more robust than current systems. The technology allows for improved safety and significant reduction in maintenance hours for aircraft, space vehicles, satellites, and other critical high-performance wiring systems for industries such as energy production and mining. The integrated ISWDDS is comprised of two main components: (1) a wire with an innermost core conductor, an inner insulation film, a conductive layer or inherently conductive polymer (ICP) covering the inner insulation film, an outermost insulation jacket; and (2) smart connectors and electronics capable of producing and detecting electronic signals, and a central processing unit (CPU) for data collection and analysis. The wire is constructed by applying the inner insulation films to the conductor, followed by the outer insulation jacket. The conductive layer or ICP is on the outer surface of the inner insulation film. One or more wires are connected to the CPU using the smart connectors, and up to 64 wires can be monitored in real-time. The ISWDDS uses time domain reflectometry for damage detection. A fast-risetime pulse is injected into either the core conductor or conductive layer and referenced against the other conductor, producing transmission line behavior. If either conductor is damaged, then the signal is reflected. By knowing the speed of propagation of the pulse, and the time it takes to reflect, one can calculate the distance to and location of the damage.

A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli.

PubMed

Ross, Andrew S; Baliga, Christopher; Verma, Punam; Duchin, Jeffrey; Gluck, Michael

2015-09-01

Because of their complex design, duodenoscopes have been long recognized to be difficult to fully disinfect and may play a role in transmission of bacteria between patients. Recent reports of duodenoscope-associated carbapenem-resistant enterobacteriaceae transmission have confirmed these suspicions. An outbreak of a multidrug resistant strain of Escherichia coli was recently reported at our institution. Herein we report the results of our investigation and the process improvements that we deployed in an effort to contain the outbreak. A full investigation into the environment, endoscopists, infection control practices, high-level disinfection process as well as endoscopes was undertaken in conjunction with the local county health authority and the Centers for Disease Control and Prevention. Duodenoscopes were cultured and quarantined for 48 hours until negative cultures were obtained. Ergonomic changes were made to the endoscope reprocessing area, duodenoscopes were returned for routine maintenance, and surveillance cultures were obtained from all patients undergoing ERCP. Between November 2012 and August 2013, 32 patients were found to harbor 1 of 2 clonal strains of multidrug-resistant E coli, all of whom had undergone ERCP or duodenoscopy. A total of 1149 ERCPs were performed during this time period. Seven patients died within 31 days of the organism being identified in culture, 16 patients died overall by March 2015. The exact contribution of E coli to death is unclear because most patients had underlying late-stage malignancy or other severe medical comorbidities. No breach in high-level disinfection protocol or infection control practices was identified. The clonal strain of E coli was identified in culture on 4 of 8 duodenoscopes, 3 of which required critical repairs despite lack of obvious malfunction. The defect rate in high-level disinfection of duodenoscopes was 2% over a 1-year period. The implemented quality improvements, subsequent to which 1625 ERCPs have been performed, were successful in halting the outbreak. The existing manufacturer-recommended high-level disinfection protocols for duodenoscopes are inadequate. Although the ultimate solution may be a design change to the instrument, the timeline for such a change appears long and potentially difficult to exact. In the interim, a reliable method to ensure that bacterial pathogens are not present on the duodenoscope after high-level disinfection is needed. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

PubMed

Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

2014-06-01

In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

Electromagnetic interference in intraoperative monitoring of motor evoked potentials and a wireless solution.

PubMed

Farajidavar, Aydin; Seifert, Jennifer L; Delgado, Mauricio R; Sparagana, Steven; Romero-Ortega, Mario I; Chiao, J-C

2016-02-01

Intraoperative neurophysiological monitoring (IONM) is utilized to minimize neurological morbidity during spine surgery. Transcranial motor evoked potentials (TcMEPs) are principal IONM signals in which the motor cortex of the subject is stimulated with electrical pulses and the evoked potentials are recorded from the muscles of interest. Currently available monitoring systems require the connection of 40-60 lengthy lead wires to the patient. These wires contribute to a crowded and cluttered surgical environment, and limit the maneuverability of the surgical team. In this work, it was demonstrated that the cumbersome wired system is vulnerable to electromagnetic interference (EMI) produced by operating room (OR) equipment. It was hypothesized that eliminating the lengthy recording wires can remove the EMI induced in the IONM signals. Hence, a wireless system to acquire TcMEPs was developed and validated through bench-top and animal experiments. Side-by-side TcMEPs acquisition from the wired and wireless systems in animal experiments under controlled conditions (absence of EMI from OR equipment) showed comparable magnitudes and waveforms, thus demonstrating the fidelity in the signal acquisition of the wireless solution. The robustness of the wireless system to minimize EMI was compared with a wired-system under identical conditions. Unlike the wired-system, the wireless system was not influenced by the electromagnetic waves from the C-Arm X-ray machine and temperature management system in the OR. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Xu; Shen, Fuwang; Wang, Shuai

The STAR experiment at RHIC is planning to upgrade the Time Projection Chamber which lies at the heart of the detector. We have designed an instrument to measure the tension of the wires in the multi-wire proportional chambers (MWPCs) which will be used in the TPC upgrade. The wire tension measurement system causes the wires to vibrate and then it measures the fundamental frequency of the oscillation via a laser based optical platform. The platform can scan the entire wire plane, automatically, in a single run and obtain the wire tension on each wire with high precision. In this paper,more » the details about the measurement method and the system setup will be described. In addition, the test results for a prototype MWPC to be used in the STAR-iTPC upgrade will be presented.« less

Characterization System of Multi-pixel Array TES Microcalorimeter

NASA Astrophysics Data System (ADS)

Yoshimoto, Shota; Maehata, Keisuke; Mitsuda, Kazuhisa; Yamanaka, Yoshihiro; Sakai, Kazuhiro; Nagayoshi, Kenichiro; Yamamoto, Ryo; Hayashi, Tasuku; Muramatsu, Haruka

We have constructed characterization system for 64-pixel array transition-edge sensor (TES) microcalorimeter using a 3He-4He dilution refrigerator (DR) with the cooling power of 60 µW at a temperature of 100 mK. A stick equipped with 384 of Manganin wires was inserted into the refrigerator to perform characteristic measurements of 64-pixel array TES microcalorimeter and superconducting quantum interference device (SQUID) array amplifiers. The stick and Manganin wires were thermally anchored at temperatures of 4 and 1 K with sufficient thermal contact. The cold end of the Manganin wires were thermally anchored and connected to CuNi clad NbTi wires at 0.7 K anchor. Then CuNi clad NbTi wires were wired to connectors placed on the holder mounted on the cold stage attached to the base plate of the mixing chamber. The heat flow to the cold stage through the installed wires was estimated to be 0.15 µW. In the operation test the characterization system maintained temperature below 100 mK.

49 CFR 236.57 - Shunt and fouling wires.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

49 CFR 236.73 - Open-wire transmission line; clearance to other circuits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Open-wire transmission line; clearance to other..., AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.73 Open-wire transmission line; clearance to other circuits. Open-wire transmission line operating at voltage of 750 volts or...

49 CFR 236.73 - Open-wire transmission line; clearance to other circuits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Open-wire transmission line; clearance to other..., AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.73 Open-wire transmission line; clearance to other circuits. Open-wire transmission line operating at voltage of 750 volts or...

49 CFR 236.57 - Shunt and fouling wires.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Shunt and fouling wires. 236.57 Section 236.57...: All Systems Track Circuits § 236.57 Shunt and fouling wires. (a) Except as provided in paragraph (b) of this section, shunt wires and fouling wires hereafter installed or replaced shall consist of at...

47 CFR 68.213 - Installation of other than “fully protected” non-system simple customer premises wiring.

Code of Federal Regulations, 2010 CFR

2010-10-01

... only to “unprotected” premises wiring used with simple installations of wiring for up to four line residential and business telephone service. More complex installations of wiring for multiple line services... requirements, for installation and maintenance of wiring on the subscriber's side of the demarcation point...

Crewmember repairing the Regenerative Carbon Dioxide Removal System wiring.

NASA Technical Reports Server (NTRS)

1992-01-01

Mission Pilot Ken Bowersox, busy at work on the wiring harness for the Regenerative Carbon Dioxide Removal System located under the mid deck floor. Photo shows Bowersox splicing wires together to 'fool' a faulty sensor that caused the 'air conditioner' to shut down.

Calibration, Data Acquisition, and Post Analysis of Turbulent Fluid Flow in a Calibration Jet Using Hot-wire Anemometry

NASA Technical Reports Server (NTRS)

Moreno, Michelle

2004-01-01

The Turbine Branch concentrates on the following areas: Computational Fluid Dynamics (CFD), and implementing experimental procedures to obtain physical modeling data. Hot-wire Anemometry is a valuable tool for obtaining physical modeling data. Hot-wire Anemometry is likely to remain the principal research tool for most turbulent air/gas flow studies. The Hot-wire anemometer consists of a fine wire heated by electric current. When placed in a fluid stream, the hot-wire loses heat to the fluid by forced convection. In forced convection, energy transfer is due to molecular motion imposed by an extraneous force moving fluid parcels. When the hot-wire is in "equilibrium", the rate of heat input to the wire is equal to the rate of heat loss at the wire ends. The equality between heat input and heat loss is the basis for King s equation, which relates the electrical parameters of the hot-wire to the flow parameters of the fluid. Hot-wire anemometry is based on convective heat transfer from a heated wire element placed in a fluid flow. Any change in the fluid flow condition that affects the heat transfer from the heated element will be detected virtually instantaneously by a constant-temperature Hot-wire anemometry system. The system implemented for this research is the IFA 300. The system is a fully-integrated, thermal anemometer-based system that measures mean and fluctuating velocity components in air, water, and other fluids. It also measures turbulence and makes localized temperature measurements. A constant-temperature anemometer is a bridge and amplifier circuit that controls a tiny wire at constant temperature. As a fluid flow passes over the heated sensor, the amplifier senses the bridge off-balance and adjusts the voltage to the top of the bridge, keeping the bridge in balance. The voltage on top of the bridge can then be related to the velocity of the flow. The bridge voltage is sensitive to temperature as well as velocity and so the built-in thermocouple circuit can be attached to a thermocouple that can measure the fluid temperature. Additional information is included in the original extended abstract.

Anatomical Variations of the Biliary Tree Found with Endoscopic Retrograde Cholagiopancreatography in a Referral Center in Southern Iran.

PubMed

Taghavi, Seyed Alireza; Niknam, Ramin; Alavi, Seyed Ehsan; Ejtehadi, Fardad; Sivandzadeh, Gholam Reza; Eshraghian, Ahad

2017-10-01

BACKGROUND Anatomical variations in the biliary system have been proven to be of clinical importance. Awareness of the pattern of these variations in a specific population may help to prevent and manage biliary injuries during surgical and endoscopic procedures. Knowledge of the biliary anatomy will be also of great help in planning the drainage of adequate percentage of liver parenchyma in endoscopic or radiological procedures. METHODS All consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) from April 2013 to April 2015 at Nemazee Hospital, a referral center in the south of Iran, were included in this cross-sectional study. The patients with previous hepatic or biliary surgery, liver injury or destructive biliary disease were excluded from the study. All ERCPs were reviewed by two expert gastroenterologists in this field. The disagreed images by the two gastroenterologists were excluded. Huang classification was used for categorizing the different structural variants of the biliary tree, and the frequency of each variant was recorded. RESULTS Totally, 362 patients (181 men and 181 women) were included in the study. 163 patients (45%) had type A1 Huang classification (right dominant), which was the most prevalent type among our patients. 55% of them had non-right dominant anatomy. The result of the Chi-square test revealed that there was no statistically significant difference between the men and women regarding the anatomical variations (p = 0.413). CONCLUSION The anatomical variation in the biliary system among Iranian patients is comparable to other regions of the world. Significant proportions of our patients are non-right dominant and may need bilateral biliary drainage.

Development of automatic through-insulation welding for microelectric interconnections

NASA Technical Reports Server (NTRS)

Arnett, J. C.

1972-01-01

The capability to automatically route, remove insulation from, and weld small-diameter solid conductor wire is presented. This would facilitate the economical small-quantity production of complex miniature electronic assemblies. An engineering model of equipment having this capability was developed and evaluated. Whereas early work in the use of welded magnet wire interconnections was concentrated on opposed electrode systems, and generally used heat to melt the wire insulation, the present method is based on a concentric electrode system and a wire feed system which splits the insulation by application of pressure prior to welding. The work deals with the design, fabrication, and evaluation testing of an improved version of this concentric electrode system. Two different approaches to feeding the wire to the concentric electrodes were investigated. It was concluded that the process is feasible for the interconnection of complex miniature electronic assemblies.

75 FR 60667 - Airworthiness Directives; Learjet Inc. Model 45 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

.... This proposed AD would require a general visual inspection for damage of wiring (including chafing... result in a short circuit and the loss of systems associated with the wiring (including fire suppression..., which could result in the loss of systems associated with the wiring (including fire suppression...

Monitoring and evaluation of wire mesh forming life

NASA Astrophysics Data System (ADS)

Enemuoh, Emmanuel U.; Zhao, Ping; Kadlec, Alec

2018-03-01

Forming tables are used with stainless steel wire mesh conveyor belts to produce variety of products. The forming tables will typically run continuously for several days, with some hours of scheduled downtime for maintenance, cleaning and part replacement after several weeks of operation. The wire mesh conveyor belts show large variation in their remaining life due to associated variations in their nominal thicknesses. Currently the industry is dependent on seasoned operators to determine the replacement time for the wire mesh formers. The drawback of this approach is inconsistency in judgements made by different operators and lack of data knowledge that can be used to develop decision making system that will be more consistent with wire mesh life prediction and replacement time. In this study, diagnostic measurements about the health of wire mesh former is investigated and developed. The wire mesh quality characteristics considered are thermal measurement, tension property, gage thickness, and wire mesh wear. The results show that real time thermal sensor and wear measurements would provide suitable data for the estimation of wire mesh failure, therefore, can be used as a diagnostic parameter for developing structural health monitoring (SHM) system for stainless steel wire mesh formers.

The Influence of Pd-Doped Au Wire Bonding on HAZ Microstructure and Looping Profile in Micro-Electromechanical Systems (MEMS) Packaging

NASA Astrophysics Data System (ADS)

Ismail, Roslina; Omar, Ghazali; Jalar, Azman; Majlis, Burhanuddin Yeop

2015-07-01

Wire bonding processes has been widely adopted in micro-electromechanical systems (MEMS) packaging especially in biomedical devices for the integration of components. In the first process sequence in wire bonding, the zone along the wire near the melted tips is called the heat-affected zone (HAZ). The HAZ plays an important factor that influenced the looping profiles of wire bonding process. This paper investigates the effect of dopants on microstructures in the HAZ. One precent palladium (Pd) was added to the as-drawn 4N gold wire and annealed at 600°C. The addition of Pd was able to moderate the grain growth in the HAZ by retarding the heat propagation to the wire. In the formation of the looping profile, the first bending point of the looping is highly associated with the length of the HAZ. The alloyed gold wire (2N gold) has a sharp angle at a distance of about 30 m from the neck of the wire with a measured bending radius of about 40 mm and bending angle of about 40° clockwise from vertical axis, while the 4N gold wire bends at a longer distance. It also shows that the HAZ for 4N gold is longer than 2N gold wire.

47 CFR 32.2321 - Customer premises wiring.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Instructions for Balance Sheet Accounts § 32.2321... 232, Station Connections, inside wiring subclass. (b) Embedded Customer Premises Wiring is that...

47 CFR 32.2321 - Customer premises wiring.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Instructions for Balance Sheet Accounts § 32.2321... 232, Station Connections, inside wiring subclass. (b) Embedded Customer Premises Wiring is that...

Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma.

PubMed

Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kudo, Taiki; Taya, Yoko A; Kawahata, Shuhei; Kubota, Yoshimasa; Kubo, Kimitoshi; Eto, Kazunori; Ehira, Nobuyuki; Yamato, Hiroaki; Onodera, Manabu; Sakamoto, Naoya

2016-05-10

To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma. In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage. In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage. The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.

Does rectal indomethacin eliminate the need for prophylactic pancreatic stent placement in patients undergoing high-risk ERCP? Post hoc efficacy and cost-benefit analyses using prospective clinical trial data.

PubMed

Elmunzer, B Joseph; Higgins, Peter D R; Saini, Sameer D; Scheiman, James M; Parker, Robert A; Chak, Amitabh; Romagnuolo, Joseph; Mosler, Patrick; Hayward, Rodney A; Elta, Grace H; Korsnes, Sheryl J; Schmidt, Suzette E; Sherman, Stuart; Lehman, Glen A; Fogel, Evan L

2013-03-01

A recent large-scale randomized controlled trial (RCT) demonstrated that rectal indomethacin administration is effective in addition to pancreatic stent placement (PSP) for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk cases. We performed a post hoc analysis of this RCT to explore whether rectal indomethacin can replace PSP in the prevention of PEP and to estimate the potential cost savings of such an approach. We retrospectively classified RCT subjects into four prevention groups: (1) no prophylaxis, (2) PSP alone, (3) rectal indomethacin alone, and (4) the combination of PSP and indomethacin. Multivariable logistic regression was used to adjust for imbalances in the prevalence of risk factors for PEP between the groups. Based on these adjusted PEP rates, we conducted an economic analysis comparing the costs associated with PEP prevention strategies employing rectal indomethacin alone, PSP alone, or the combination of both. After adjusting for risk using two different logistic regression models, rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP. Economic analysis revealed that indomethacin alone was a cost-saving strategy in 96% of Monte Carlo trials. A prevention strategy employing rectal indomethacin alone could save approximately $150 million annually in the United States compared with a strategy of PSP alone, and $85 million compared with a strategy of indomethacin and PSP. This hypothesis-generating study suggests that prophylactic rectal indomethacin could replace PSP in patients undergoing high-risk ERCP, potentially improving clinical outcomes and reducing healthcare costs. A RCT comparing rectal indomethacin alone vs. indomethacin plus PSP is needed.

Management guidelines for gallstone pancreatitis. Are the targets achievable?

PubMed

Sanjay, Pandanaboyana; Yeeting, Sim; Whigham, Carole; Judson, Hannah K; Kulli, Christoph; Polignano, Francesco M; Tait, Iain S

2009-01-08

Current management of gallstone pancreatitis in a university hospital. Comparison of current management of gallstone pancreatitis with recommendations in national guidelines. Tertiary care centre in Scotland. One-hundred consecutive patients admitted with gallstone pancreatitis. All patients that presented with gallstone pancreatitis over a 4-year period were audited retrospectively. Data were collated for radiological diagnosis within 48 hours, ERCP within 72 hours, CT at 6-10 days, and use of high-dependency or intensive therapy units in severe gallstone pancreatitis, and definitive treatment of gallstone pancreatitis within 2 weeks as recommended in national guidelines. Forty-six patients had severe gallstone pancreatitis and 54 patients mild pancreatitis. Etiology was established within 48 hours in 92 patients. Six (13.0%) out of the patients with severe gallstone pancreatitis were managed in a high dependency unit. Fifteen (32.6%) patients with severe gallstone pancreatitis underwent CT within 6-10 days of admission. Four (8.7%) of the 46 patients with severe gallstone pancreatitis had urgent ERCP (less than 72 hours). Overall 22/100 patients unsuitable for surgery underwent endoscopic sphincterotomy as definitive treatment. Seventy-eight patients had surgery, with 40 (51.3%) of these patients undergoing an index admission cholecystectomy, and 38 (48.7%) patients were discharged for interval cholecystectomy. Overall 81 patients with gallstone pancreatitis had definitive therapy during the index to same admission (cholecystectomy or sphincterotomy). Two (5.3%) patients were readmitted whilst awaiting interval cholecystectomy: one with acute cholecystitis and one with acute pancreatitis. There were no mortalities in this cohort. This study has highlighted difficulties in implementation of national guidelines, as the use of critical care, timing of ERCP and CT, and definitive treatment prior to discharge did not concur with national targets for gallstone pancreatitis.

Cholecystectomy Reduces Recurrent Pancreatitis and Improves Survival After Endoscopic Sphincterotomy.

PubMed

Young, Shih-Hao; Peng, Yen-Ling; Lin, Xi-Hsuan; Chen, Yung-Tai; Luo, Jiing-Chyuan; Wang, Yen-Po; Hou, Ming-Chih; Lee, Fa-Yauh

2017-02-01

The aim of this study was to assess whether cholecystectomy can decrease the recurrent pancreatitis in the elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) and successful clearance of bile duct (BD) stones after gallstone-related acute pancreatitis. We analyzed data from National Health Insurance Research Database of Taiwan. Elderly patients (age ≧70 years old) who had gallstone-related acute pancreatitis and underwent successful EST with BD stones clearance were eligible for enrollment. This nationwide, population-based, propensity score (PS)-matched cohort study involved two cohorts: (1) patients who underwent cholecystectomy after ERCP with BD stone clearance as study group and (2) those who adopted wait-and-see strategy (without cholecystectomy) after ERCP with BD stone clearance as control group. The primary and secondary endpoints were recurrent acute pancreatitis and all-cause mortality, respectively. During the study period, a total of 670 elderly patients (male 291, female 379) with a mean age of 79.1 was enrolled for analysis after PS matching. The incidence rate of recurrent acute pancreatitis was 12.39 per 1000 person-years in the cholecystectomy cohort and 23.94 per 1000 person-years in the PS-matched control cohort. The risk of recurrent acute pancreatitis was significantly lower in the cholecystectomy cohort (HR, 0.56; 95 % confidence interval [CI], 0.34-0.91; P = 0.021). The HR for all-cause mortality among the cholecystectomy cohort was 0.75 (95 % CI, 0.59-0.95; P = 0.016) compared with the control cohort. Cholecystectomy decreased the subsequent recurrent acute pancreatitis and the all-cause mortality in elderly patients with EST and clearance of BD stones after gallstone-related acute pancreatitis.

Treatment and outcome of traumatic biliary injuries in children.

PubMed

Soukup, Elizabeth S; Russell, Katie W; Metzger, Ryan; Scaife, Eric R; Barnhart, Douglas C; Rollins, Michael D

2014-02-01

Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome. We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002-2012. Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4-15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage. Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections. © 2014.

Printed wiring board system programmer's manual

NASA Technical Reports Server (NTRS)

Brinkerhoff, C. D.

1973-01-01

The printed wiring board system provides automated techniques for the design of printed circuit boards and hybrid circuit boards. The system consists of four programs: (1) the preprocessor program combines user supplied data and pre-defined library data to produce the detailed circuit description data; (2) the placement program assigns circuit components to specific areas of the board in a manner that optimizes the total interconnection length of the circuit; (3) the organizer program assigns pin interconnections to specific board levels and determines the optimal order in which the router program should attempt to layout the paths connecting the pins; and (4) the router program determines the wire paths which are to be used to connect each input pin pair on the circuit board. This document is intended to serve as a programmer's reference manual for the printed wiring board system. A detailed description of the internal logic and flow of the printed wiring board programs is included.

46 CFR 129.340 - Cable and wiring.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Cable and wiring. 129.340 Section 129.340 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OFFSHORE SUPPLY VESSELS ELECTRICAL INSTALLATIONS Power Sources and Distribution Systems § 129.340 Cable and wiring. (a) If individual wires, rather than...

Design and fabrication of a three-finger prosthetic hand using SMA muscle wires

NASA Astrophysics Data System (ADS)

Simone, Filomena; York, Alexander; Seelecke, Stefan

2015-03-01

Bio-inspired hand-like gripper systems based on shape memory alloy (SMA) wire actuation have the potential to enable a number of useful applications in, e.g., the biomedical field or industrial assembly systems. The inherent high energy density makes SMA solutions a natural choice for systems with lightweight, low noise and high force requirements, such as hand prostheses or robotic systems in a human/machine environment. The focus of this research is the development, design and realization of a SMA-actuated prosthetic hand prototype with three fingers. The use of thin wires (100 μm diameter) allows for high cooling rates and therefore fast movement of each finger. Grouping several small wires mechanically in parallel allows for high force actuation. To save space and to allow for a direct transmission of the motion to each finger, the SMA wires are attached directly within each finger, across each phalanx. In this way, the contraction of the wires will allow the movement of the fingers without the use of any additional gears. Within each finger, two different bundles of wires are mounted: protagonist ones that create bending movement and the antagonist ones that enable stretching of each phalanx. The resistance change in the SMA wires is measured during actuation, which allows for monitoring of the wire stroke and potentially the gripping force without the use of additional sensors. The hand is built with modern 3D-printing technologies and its performance while grasping objects of different size and shape is experimentally investigated illustrating the usefulness of the actuator concept.

Combustibility of Electrical Wire and Cable for Rail Rapid Transit Systems. Volume 1. Flammability.

DOT National Transportation Integrated Search

1983-05-01

The objective of this study was to examine the flammability of wires and cables used in rapid rail transit systems. The overall goal of the study was to quantify the fire properties of wires and cables in a manner so that the relative fire hazards co...

Combustibility of Electrical Wire and Cable for Rail Rapid Transit Systems. Volume 2. Toxicity.

DOT National Transportation Integrated Search

1983-05-01

The objective of this study was to examine the flammability of wires and cables used in rapid rail transit systems. The overall goal of the study was to quantify the fire properties of wires and cables in a manner so that the relative fire hazards co...

78 FR 22802 - Airworthiness Directives; the Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... indication system and wiring on each engine; and repetitive operational checks of that installation to detect... wiring. Installation of a second locking gearbox 754 work-hours x $85 per hour = $0 $64,090 system. $64... proposed AD would require replacing certain relays and relay sockets, and doing wiring changes. For certain...

Interceptive Beam Diagnostics - Signal Creation and Materials Interactions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Plum, Michael; Spallation Neutron Source, Oak Ridge National Laboratory, P.O. Box 2008, Oak Ridge, TN

2004-11-10

The focus of this tutorial will be on interceptive beam diagnostics such as wire scanners, screens, and harps. We will start with an overview of the various ways beams interact with materials to create signals useful for beam diagnostics systems. We will then discuss the errors in a harp or wire scanner profile measurement caused by errors in wire position, number of samples, and signal errors. Finally we will apply our results to two design examples-the SNS wire scanner system and the SNS target harp.

Durability Evaluation of a Thin Film Sensor System With Enhanced Lead Wire Attachments on SiC/SiC Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Lei, Jih-Fen; Kiser, J. Douglas; Singh, Mrityunjay; Cuy, Mike; Blaha, Charles A.; Androjna, Drago

2000-01-01

An advanced thin film sensor system instrumented on silicon carbide (SiC) fiber reinforced SiC matrix ceramic matrix composites (SiC/SiC CMCs), was evaluated in a Mach 0.3 burner rig in order to determine its durability to monitor material/component surface temperature in harsh environments. The sensor system included thermocouples in a thin film form (5 microns thick), fine lead wires (75 microns diameter), and the bonds between these wires and the thin films. Other critical components of the overall system were the heavy, swaged lead wire cable (500 microns diameter) that contained the fine lead wires and was connected to the temperature readout, and ceramic attachments which were bonded onto the CMCs for the purpose of securing the lead wire cables, The newly developed ceramic attachment features a combination of hoops made of monolithic SiC or SiC/SiC CMC (which are joined to the test article) and high temperature ceramic cement. Two instrumented CMC panels were tested in a burner rig for a total of 40 cycles to 1150 C (2100 F). A cycle consisted of rapid heating to 1150 C (2100 F), a 5 minute hold at 1150 C (2100 F), and then cooling down to room temperature in 2 minutes. The thin film sensor systems provided repeatable temperature measurements for a maximum of 25 thermal cycles. Two of the monolithic SiC hoops debonded during the sensor fabrication process and two of the SiC/SiC CMC hoops failed during testing. The hoops filled with ceramic cement, however, showed no sign of detachment after 40 thermal cycle test. The primary failure mechanism of this sensor system was the loss of the fine lead wire-to-thin film connection, which either due to detachment of the fine lead wires from the thin film thermocouples or breakage of the fine wire.

46 CFR 183.340 - Cable and wiring requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... requirements. (a) If individual wires, rather than cable, are used in systems greater than 50 volts, the wire must be in conduit. (b) All cable and wire must: (1) Have stranded copper conductors with sufficient... constant representing the resistance of copper). I=Load current, in amperes. L=length of conductor from...

46 CFR 183.340 - Cable and wiring requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... requirements. (a) If individual wires, rather than cable, are used in systems greater than 50 volts, the wire must be in conduit. (b) All cable and wire must: (1) Have stranded copper conductors with sufficient... constant representing the resistance of copper). I=Load current, in amperes. L=length of conductor from...

46 CFR 183.340 - Cable and wiring requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... requirements. (a) If individual wires, rather than cable, are used in systems greater than 50 volts, the wire must be in conduit. (b) All cable and wire must: (1) Have stranded copper conductors with sufficient... constant representing the resistance of copper). I=Load current, in amperes. L=length of conductor from...

46 CFR 183.340 - Cable and wiring requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... requirements. (a) If individual wires, rather than cable, are used in systems greater than 50 volts, the wire must be in conduit. (b) All cable and wire must: (1) Have stranded copper conductors with sufficient... constant representing the resistance of copper). I=Load current, in amperes. L=length of conductor from...

Digital Systems Validation Handbook. Volume 2

DTIC Science & Technology

1989-02-01

power. 2. A grid of wires, solid sheet, or foil. 3. A wire from circuit to grounding block or case. 4. A wire from circuit to structure. 5. Shield...RETURN. (11) 1. Structure, for power, fault, and "discrete" circuits. 2. A grid of wires, solid sheet, or foil. 3. A wire from circuit load back to...TV (14) Television TWTD (13) Thin Wire Time Domain TX (5) Transmit U.K. (13,141 United Kingdom U.S. (14) United States UART (15) Universal Asynchronous

["Cholethorax" revealing injury to the common bile duct after celioscopic cholecystectomy].

PubMed

Lehur, P A; Guiberteau-Canfrère, V; Bury, A; Cloarec, D; Le Borgne, J

1992-01-01

The case-report describes the unusual formation of a bilious pleural effusion or "cholethorax" revealing a common bile duct injury secondary to laparoscopic cholecystectomy. Pleural drainage led to a diagnostic ERCP. Subsequently a Roux en Y hepatico-jejunostomy allowed a satisfactory outcome.

Eye lens exposure to medical staff during endoscopic retrograde cholangiopancreatography.

PubMed

Zagorska, A; Romanova, K; Hristova-Popova, J; Vassileva, J; Katzarov, K

2015-11-01

The paper presents a study of the radiation doses to eye lens of medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in a busy gastroenterology department. For each procedure the dose equivalent to the eye, exposure time, dose rate, Kerma Area Product and fluoroscopy time were recorded. Measurements were performed for a period of two months in four main positions of the operating staff, and then extrapolated to estimate annual doses. The fluoroscopy time per ERCP procedure varied between 1.0 min and 28.8 min, with a mean value of 4.6 min. The calculated mean eye dose per procedure varied between 34.9 μSv and 93.3 μSv. The results demonstrated that if eye protection is not used, annual doses to the eye lens of the gastroenterologist performing the procedure and the anesthesiologist can exceed the dose limit of 20 mSv per year. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

[Surgical treatment of choledocholithiasis in a patient with situs inversus totalis: a case report and literature review].

PubMed

Morales-Rodríguez, Jerson Francisco; Corina Cotillo, Estefania; Moreno-Loaiza, Oscar

2017-07-26

Situs inversus totalis (SIT) is a rare condition, in which there is transposition of the thoraco-abdominal organs. This situation leads to diagnostic and therapeutic difficulties in patients with acute surgical abdomen. The objective of this report is to present the case of a patient who presented with colonic pain in the epigastrium and left hypochondrium, in which the diagnosis of SIT, cholelithiasis and choledocholithiasis was reached after the respective imaging studies. Once the diagnosis was made, treatment was performed through retrograde endoscopic cholangiopancreatography (ERCP) and subsequent surgical exploration of bile ducts. Both procedures were failed due to technical difficulties generated by the patient's condition. In conclusion, in spite of the report of successful cases in the literature of ERCP and surgical treatment of the biliary tract in SIT, there may be situations that do not allow a successful approach, so meticulous surgical planning and the use of support methods are necessary In the management of these patients.

Elective laparoscopic cholecystectomy for surgical trainees: predictive factors of operative time.

PubMed

Haji, A; Khan, A; Haq, A; Ribeiro, B

2009-08-01

To determine pre-operative criteria to predict duration and technical difficulty of laparoscopic cholecystectomies that will aid in identifying patients suitable for training lists. A prospective analysis of 835 consecutive patients who underwent laparoscopic cholecystectomies. Data collected included patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (ES), duration of surgery (from skin incision to skin closure), peri-operative and postoperative complications and histological gallbladder wall thickness. Post-operative complications were seen in 3% (n=20). Overall open conversion rate was 2%. The mean duration of surgery was 78.76 +/- 1.75 minutes. Age, ERCP and ES were not independent predictors of a long operation time. However, a positive correlation was seen with histological gallbladder wall thickness and duration of surgery (p=0.001). The mean operating time for gallbladder wall thickness < 3 mm was 72.1 +/- 1.62 minutes whereas that for > 3 mm thickness was 83.3 +/- 2.05 minutes (p=<0.001). Gallbladder wall thickness can be used as an independent predictor of a long operation time.

Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center.

PubMed

Soh, Jae Seung; Yang, Dong-Hoon; Lee, Sang Soo; Lee, Seohyun; Bae, Jungho; Byeon, Jeong-Sik; Myung, Seung-Jae; Yang, Suk-Kyun

2015-09-01

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

Next Generation Wiring

NASA Technical Reports Server (NTRS)

Medelius, Petro; Jolley, Scott; Fitzpatrick, Lilliana; Vinje, Rubiela; Williams, Martha; Clayton, LaNetra; Roberson, Luke; Smith, Trent; Santiago-Maldonado, Edgardo

2007-01-01

Wiring is a major operational component on aerospace hardware that accounts for substantial weight and volumetric space. Over time wire insulation can age and fail, often leading to catastrophic events such as system failure or fire. The next generation of wiring must be reliable and sustainable over long periods of time. These features will be achieved by the development of a wire insulation capable of autonomous self-healing that mitigates failure before it reaches a catastrophic level. In order to develop a self-healing insulation material, three steps must occur. First, methods of bonding similar materials must be developed that are capable of being initiated autonomously. This process will lead to the development of a manual repair system for polyimide wire insulation. Second, ways to initiate these bonding methods that lead to materials that are similar to the primary insulation must be developed. Finally, steps one and two must be integrated to produce a material that has no residues from the process that degrades the insulating properties of the final repaired insulation. The self-healing technology, teamed with the ability to identify and locate damage, will greatly improve reliability and safety of electrical wiring of critical systems. This paper will address these topics, discuss the results of preliminary testing, and remaining development issues related to self-healing wire insulation.

LANSCE-R WIRE-SCANNER ANALOG FRONT-END ELECTRONICS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gruchalla, Michael E.

2011-01-01

A new AFE is being developed for the new LANSCE-R wire-scanner systems. The new AFE is implemented in a National Instruments Compact RIO (cRIO) module installed a BiRa 4U BiRIO cRIO chassis specifically designed to accommodate the cRIO crate and all the wire-scanner interface, control and motor-drive electronics. A single AFE module provides interface to both X and Y wire sensors using true DC coupled transimpedance amplifiers providing collection of the wire charge signals, real-time wire integrity verification using the normal dataacquisition system, and wire bias of 0V to +/-50V. The AFE system is designed to accommodate comparatively long macropulsesmore » (>1ms) with high PRF (>120Hz) without the need to provide timing signals. The basic AFE bandwidth is flat from true DC to 50kHz with a true first-order pole at 50kHz. Numeric integration in the cRIO FPGA provides real-time pulse-to-pulse numeric integration of the AFE signal to compute the total charge collected in each macropulse. This method of charge collection eliminates the need to provide synchronization signals to the wire-scanner AFE while providing the capability to accurately record the charge from long macropulses at high PRF.« less

Flexible endoscopes: structure and function. The suction and biopsy channel.

PubMed

Holland, P

2001-01-01

Flexible endoscopes are complex medical instruments that are easily damaged. To maintain the flexible endoscope in optimum working condition, the user must have a thorough understanding of the structure and function of the instrument. This is the second in a series of articles presenting an in-depth look at the care and handling of the flexible endoscope. The first article discussed the air and water system. This article will focus specifically on the suction and biopsy channel system. The flexible endoscope is constructed of several systems that operate simultaneously to produce a highly technical, yet effective diagnostic and therapeutic medical device. These systems include the air and water system, the suction or operating channel system, the mechanical system, the endoscopic retrograde cholangiopancreatography (ERCP) elevator system, the optical system, and the electrical system. A review of the internal and external structure of the flexible endoscope and the functions of the channel system, including infection control issues, potential problems and evaluation, and prevention of minor problems to avoid expensive repairs, will be addressed.

Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery.

PubMed

Oh, You Na; Ha, Keong Jun; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

2015-08-01

Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA) was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578), major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99), minor wound complications (3.6% vs. 2.0%, p=0.279), or mediastinitis (0.8% vs. 1.0%, p=1.00). Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068). The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

Description and Flight Test Results of the NASA F-8 Digital Fly-by-Wire Control System

NASA Technical Reports Server (NTRS)

1975-01-01

A NASA program to develop digital fly-by-wire (DFBW) technology for aircraft applications is discussed. Phase I of the program demonstrated the feasibility of using a digital fly-by-wire system for aircraft control through developing and flight testing a single channel system, which used Apollo hardware, in an F-8C airplane. The objective of Phase II of the program is to establish a technology base for designing practical DFBW systems. It will involve developing and flight testing a triplex digital fly-by-wire system using state-of-the-art airborne computers, system hardware, software, and redundancy concepts. The papers included in this report describe the Phase I system and its development and present results from the flight program. Man-rated flight software and the effects of lightning on digital flight control systems are also discussed.

Second NASA Workshop on Wiring for Space Applications

NASA Technical Reports Server (NTRS)

1994-01-01

This document contains the proceedings of the Second NASA Workshop on Wiring for Space Applications held at NASA LeRC in Cleveland, OH, 6-7 Oct. 1993. The workshop was sponsored by NASA Headquarters Code QW Office of Safety and Mission Quality, Technical Standards Division and hosted by NASA LeRC, Power Technology Division, Electrical Components and Systems Branch. The workshop addressed key technology issues in the field of electrical power wiring for space applications. Speakers from government, industry, and academia presented and discussed topics on arc tracking phenomena, wiring system design, insulation constructions, and system protection. Presentation materials provided by the various speakers are included in this document.

NEMA wire and cable standards development programs

NASA Astrophysics Data System (ADS)

Baird, Robert W.

1994-01-01

The National Electrical Manufacturers Association (NEMA) is the nation's largest trade association for manufacturers of electrical equipment. Its member companies produce components, end-use equipment and systems for the generation, transmission, distribution, control and use of electricity. The wire and cable division is presented in 6 sections: building wire and cable, fabricated conductors, flexible cords, high performance wire and cable, magnet wire, and power and control cable. Participating companies are listed.

Large scale generation of micro-droplet array by vapor condensation on mesh screen piece

PubMed Central

Xie, Jian; Xu, Jinliang; He, Xiaotian; Liu, Qi

2017-01-01

We developed a novel micro-droplet array system, which is based on the distinct three dimensional mesh screen structure and sintering and oxidation induced thermal-fluid performance. Mesh screen was sintered on a copper substrate by bonding the two components. Non-uniform residue stress is generated along weft wires, with larger stress on weft wire top location than elsewhere. Oxidation of the sintered package forms micro pits with few nanograsses on weft wire top location, due to the stress corrosion mechanism. Nanograsses grow elsewhere to show hydrophobic behavior. Thus, surface-energy-gradient weft wires are formed. Cooling the structure in a wet air environment nucleates water droplets on weft wire top location, which is more “hydrophilic” than elsewhere. Droplet size is well controlled by substrate temperature, air humidity and cooling time. Because warp wires do not contact copper substrate and there is a larger conductive thermal resistance between warp wire and weft wire, warp wires contribute less to condensation but function as supporting structure. The surface energy analysis of drops along weft wires explains why droplet array can be generated on the mesh screen piece. Because the commercial material is used, the droplet system is cost effective and can be used for large scale utilization. PMID:28054635

Large scale generation of micro-droplet array by vapor condensation on mesh screen piece.

PubMed

Xie, Jian; Xu, Jinliang; He, Xiaotian; Liu, Qi

2017-01-05

We developed a novel micro-droplet array system, which is based on the distinct three dimensional mesh screen structure and sintering and oxidation induced thermal-fluid performance. Mesh screen was sintered on a copper substrate by bonding the two components. Non-uniform residue stress is generated along weft wires, with larger stress on weft wire top location than elsewhere. Oxidation of the sintered package forms micro pits with few nanograsses on weft wire top location, due to the stress corrosion mechanism. Nanograsses grow elsewhere to show hydrophobic behavior. Thus, surface-energy-gradient weft wires are formed. Cooling the structure in a wet air environment nucleates water droplets on weft wire top location, which is more "hydrophilic" than elsewhere. Droplet size is well controlled by substrate temperature, air humidity and cooling time. Because warp wires do not contact copper substrate and there is a larger conductive thermal resistance between warp wire and weft wire, warp wires contribute less to condensation but function as supporting structure. The surface energy analysis of drops along weft wires explains why droplet array can be generated on the mesh screen piece. Because the commercial material is used, the droplet system is cost effective and can be used for large scale utilization.

Large scale generation of micro-droplet array by vapor condensation on mesh screen piece

NASA Astrophysics Data System (ADS)

Xie, Jian; Xu, Jinliang; He, Xiaotian; Liu, Qi

2017-01-01

We developed a novel micro-droplet array system, which is based on the distinct three dimensional mesh screen structure and sintering and oxidation induced thermal-fluid performance. Mesh screen was sintered on a copper substrate by bonding the two components. Non-uniform residue stress is generated along weft wires, with larger stress on weft wire top location than elsewhere. Oxidation of the sintered package forms micro pits with few nanograsses on weft wire top location, due to the stress corrosion mechanism. Nanograsses grow elsewhere to show hydrophobic behavior. Thus, surface-energy-gradient weft wires are formed. Cooling the structure in a wet air environment nucleates water droplets on weft wire top location, which is more “hydrophilic” than elsewhere. Droplet size is well controlled by substrate temperature, air humidity and cooling time. Because warp wires do not contact copper substrate and there is a larger conductive thermal resistance between warp wire and weft wire, warp wires contribute less to condensation but function as supporting structure. The surface energy analysis of drops along weft wires explains why droplet array can be generated on the mesh screen piece. Because the commercial material is used, the droplet system is cost effective and can be used for large scale utilization.

PCACE- PERSONAL COMPUTER AIDED CABLING ENGINEERING

NASA Technical Reports Server (NTRS)

Billitti, J. W.

1994-01-01

A computerized interactive harness engineering program has been developed to provide an inexpensive, interactive system which is designed for learning and using an engineering approach to interconnection systems. PCACE is basically a database system that stores information as files of individual connectors and handles wiring information in circuit groups stored as records. This directly emulates the typical manual engineering methods of data handling, thus making the user interface to the program very natural. Data files can be created, viewed, manipulated, or printed in real time. The printed ouput is in a form ready for use by fabrication and engineering personnel. PCACE also contains a wide variety of error-checking routines including connector contact checks during hardcopy generation. The user may edit existing harness data files or create new files. In creating a new file, the user is given the opportunity to insert all the connector and harness boiler plate data which would be part of a normal connector wiring diagram. This data includes the following: 1) connector reference designator, 2) connector part number, 3) backshell part number, 4) cable reference designator, 5) cable part number, 6) drawing revision, 7) relevant notes, 8) standard wire gauge, and 9) maximum circuit count. Any item except the maximum circuit count may be left blank, and any item may be changed at a later time. Once a file is created and organized, the user is directed to the main menu and has access to the file boiler plate, the circuit wiring records, and the wiring records index list. The organization of a file is such that record zero contains the connector/cable boiler plate, and all other records contain circuit wiring data. Each wiring record will handle a circuit with as many as nine wires in the interface. The record stores the circuit name and wire count and the following data for each wire: 1) wire identifier, 2) contact, 3) splice, 4) wire gauge if different from standard, 5) wire/group type, 6) wire destination, and 7) note number. The PCACE record structure allows for a wide variety of wiring forms using splices and shields, yet retains sufficient structure to maintain ease of use. PCACE is written in TURBO Pascal 3.0 and has been implemented on IBM PC, XT, and AT systems under DOS 3.1 with a memory of 512K of 8 bit bytes, two floppy disk drives, an RGB monitor, and a printer with ASCII control characters. PCACE was originally developed in 1983, and the IBM version was released in 1986.

Study on nondestructive detection system based on x-ray for wire ropes conveyer belt

NASA Astrophysics Data System (ADS)

Miao, Changyun; Shi, Boya; Wan, Peng; Li, Jie

2008-03-01

A nondestructive detection system based on X-ray for wire ropes conveyer belt is designed by X-ray detection technology. In this paper X-ray detection principle is analyzed, a design scheme of the system is presented; image processing of conveyer belt is researched and image processing algorithms are given; X-ray acquisition receiving board is designed with the use of FPGA and DSP; the software of the system is programmed by C#.NET on WINXP/WIN2000 platform. The experiment indicates the system can implement remote real-time detection of wire ropes conveyer belt images, find faults and give an alarm in time. The system is direct perceived, strong real-time and high accurate. It can be used for fault detection of wire ropes conveyer belts in mines, ports, terminals and other fields.

76 FR 10215 - Airworthiness Directives; Learjet Inc. Model 45 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-24

... above. This AD requires a general visual inspection for damage of wiring (including chafing, pinched... the pilot and copilot circuit breaker panels caused by a short circuit between chafed wiring and the... misrouted wires, which could result in a short circuit and the loss of systems associated with the wiring...

Systems Engineering Approach To Ground Combat Vehicle Survivability In Urban Operations

DTIC Science & Technology

2016-09-01

extinguishing system (AFES), which uses fire wires to detect the presence of fires. The detection of fire automatically triggers the activation of the fire...corresponding wires and connection points also means that it can be more difficult for engineers to integrate distributed architecture systems onto...command signals to the missile via wires trailing behind the missile or via RF signals. See Figure 29 for an illustration of CLOS guidance. Since CLOS

Energetics and electronic properties of Pt wires of different topologies on monolayer MoSe{sub 2}

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jamdagni, Pooja, E-mail: j.poojaa1228@gmail.com; Ahluwalia, P. K.; Kumar, Ashok

2016-05-23

The energetics and electronic properties of different topology of Pt wires including linear, zigzag and ladder structures on MoSe{sub 2} monolayer have been investigated in the framework of density functional theory (DFT). The predicted order of stability of Pt wire on MoSe{sub 2} monolayer is found to be: linear > ladder > zigzag. Pt wires induce states near the Fermi level of MoSe{sub 2} that results into metallic characteristics of Pt-wire/MoSe{sub 2} assembled system. Valence band charge density signifies most of the contribution from Pt atoms near the Fermi energy of assembled wire/MoSe{sub 2} system. These findings are expected tomore » be important for the fabrication of devices based on MoSe{sub 2} layers for flexible nanoelectronics.« less

Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

PubMed Central

Osoegawa, Takashi; Motomura, Yasuaki; Akahoshi, Kazuya; Higuchi, Naomi; Tanaka, Yoshimasa; Hisano, Terumasa; Itaba, Souichi; Gibo, Junya; Yamada, Mariko; Kubokawa, Masaru; Sumida, Yorinobu; Akiho, Hirotada; Ihara, Eikichi; Nakamura, Kazuhiko

2012-01-01

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth II gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing, selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth II reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth II reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth II reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth II anastomosis. CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy. PMID:23239923

Advanced wiring technique and hardware application: Airplane and space vehicle

NASA Technical Reports Server (NTRS)

Ernst, H. L.; Eichman, C. D.

1972-01-01

An advanced wiring system is described which achieves the safety/reliability required for present and future airplane and space vehicle applications. Also, present wiring installation techniques and hardware are analyzed to establish existing problem areas. An advanced wiring system employing matrix interconnecting unit, plug to plug trunk bundles (FCC or ribbon cable) is outlined, and an installation study presented. A planned program to develop, lab test and flight test key features of these techniques and hardware as a part of the SST technology follow-on activities is discussed.

A biomechanical comparison of three sternotomy closure techniques.

PubMed

Cohen, David J; Griffin, Lanny V

2002-02-01

A biomechanical study of three sternotomy closure techniques (figure-of-eight stainless-steel wires, Pectofix Dynamic Sternal Fixation [DSF] stainless-steel plates, and figure-of-eight stainless-steel cables) was conducted to compare strength and stiffness variables in three clinically relevant loading modes (anterior-posterior shear, longitudinal shear, and lateral distraction). All tests were conducted on polyurethane foam sternal models that simulate the properties of cancellous bone. Each model was divided longitudinally and reconstructed using one of the sternotomy closure repair techniques. Tests were performed using a materials testing system that applies a continuously increasing amount of force in one direction to the model until it catastrophically breaks. A total of six trials of each fixation type in each of three test groups were prepared and tested, for a total of 54 tests. Strength and stiffness variables as well as a post-yield analysis of failure were evaluated. Sternums repaired using the DSF plate system are a more rigid construct than sternums repaired using the stainless-steel wires or cables in the distraction and transverse shear modes and they are not significantly different from sternums repaired with wires or cables in the longitudinal shear mode. The DSF plate system offers a 25% improvement in resistance to failure (yield) compared to wires when a transverse shear force is applied to the model. The cable system had a higher resistance to failure than the wires in all modes although the differences were not statistically significant. Additionally, the DSF plate system provides substantial reduction of the implant's cutting into the sternal model under loading as evidenced by the post-yield displacement when compared with either cables or wires for the distraction and longitudinal shear modes. For the transverse shear mode, the cables or wires would completely fail at the load for which cutting begins for the DSF. Both the DSF plate system and the stainless-steel cable system offer important advantages over figure-of-eight wire for sternal closure.

Cable Bundle Wire Derating

NASA Technical Reports Server (NTRS)

Lundquist, Ray A.; Leidecker, Henning

1998-01-01

The allowable operating currents of electrical wiring when used in the space vacuum environment is predominantly determined by the maximum operating temperature of the wire insulation. For Kapton insulated wire this value is 200 C. Guidelines provided in the Goddard Space Flight Center (GSFC) Preferred Parts List (PPL) limit the operating current of wire within vacuum to ensure the maximum insulation temperature is not exceeded. For 20 AWG wire, these operating parameters are: 3.7 amps per wire, bundle of 15 or more wires, 70 C environment, and vacuum of 10(exp -5) torr or less. To determine the behavior and temperature of electrical wire at different operating conditions, a thermal vacuum test was performed on a representative electrical harness of the Hubble Space Telescope (HST) power distribution system. This paper describes the test and the results.

Droplet monitoring probe

NASA Technical Reports Server (NTRS)

Baughman, J. R.; Thys, P. C.

1973-01-01

A droplet monitoring system is disclosed for analysis of mixed-phase fluid flow in development of gas turbines. The system uses a probe comprising two electrical wires spaced a known distance apart and connected at one end to means for establishing a dc potential between the wires. A drop in the fluid stream momentarily contacting both wires simultaneously causes and electrical signal which is amplified, detected and counted.

77 FR 58424 - Drucker, Inc., DynaMotive Energy Systems Corp., and Gate to Wire Solutions, Inc., Order of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Drucker, Inc., DynaMotive Energy Systems Corp., and Gate to Wire Solutions, Inc., Order of Suspension of Trading September 18, 2012. It appears to the... that there is a lack of current and accurate information concerning the securities of Gate to Wire...

Virtual Instrument Systems in Reality (VISIR) for Remote Wiring and Measurement of Electronic Circuits on Breadboard

ERIC Educational Resources Information Center

Tawfik, M.; Sancristobal, E.; Martin, S.; Gil, R.; Diaz, G.; Colmenar, A.; Peire, J.; Castro, M.; Nilsson, K.; Zackrisson, J.; Hakansson, L.; Gustavsson, I.

2013-01-01

This paper reports on a state-of-the-art remote laboratory project called Virtual Instrument Systems in Reality (VISIR). VISIR allows wiring and measuring of electronic circuits remotely on a virtual workbench that replicates physical circuit breadboards. The wiring mechanism is developed by means of a relay switching matrix connected to a PCI…

The 80 kV electrostatic wire septum for AmPS

NASA Astrophysics Data System (ADS)

Vanderlinden, A.; Bijleveld, J. H. M.; Rookhuizen, H. Boer; Bruinsma, P. J. T.; Heine, E.; Lassing, P.; Prins, E.

The characteristics of the wire septum for the Amsterdam Pulse Stretcher (AmPS) are summarized. In the extraction process of the AmPS the extracted beam is intercepted from the circulating beam by the 1 m long electrostatic wire septum. For a bending angle of 4.4 mrad, the maximum anode voltage is 80 kV. The system developed consists of a wire spacing of 0.65 mm between tungsten wires of 50 micrometers diameter. Stainless steel spring wires, bent in a half cylindrical carrier, stretch the septum wires two by two. Prototype tests were successful up to an anode voltage of 120 kV.

Mountain Plains Learning Experience Guide: Electrical Wiring. Course: Electrical Wiring Rough-In.

ERIC Educational Resources Information Center

Arneson, R.; And Others

One of two individualized courses included in an electrical wiring curriculum, this course covers electrical installations that are generally hidden within the structure. The course is comprised of four units: (1) Outlet and Switch Boxes, (2) Wiring, (3) Service Entrance, and (4) Signal and Low Voltage Systems. Each unit begins with a Unit…

Transport electron through a quantum wire by side-attached asymmetric quantum-dot rings

NASA Astrophysics Data System (ADS)

Rostami, A.; Zabihi, S.; Rasooli S., H.; Seyyedi, S. K.

2011-12-01

The electronic conductance at zero temperature through a quantum wire with side-attached asymmetric quantum ring (as a scatter system) is theoretically studied using the non-interacting Anderson tunneling Hamiltonian method. We show that the asymmetric configuration of QD- scatter system strongly impresses the amplitude and spectrum of quantum wire nanostructure transmission characteristics. It is shown that whenever the balanced number of quantum dots in two rings is substituted by unbalanced scheme, the number of forbidden mini-bands in quantum wire conductance increases and QW-nanostructure electronic conductance contains rich spectral properties due to appearance of the new anti-resonance and resonance points in spectrum. Considering the suitable gap between nano-rings can strengthen the amplitude of new resonant peaks in the QW conductance spectrum. The proposed asymmetric quantum ring scatter system idea in this paper opens a new insight on designing quantum wire nano structure for given electronic conductance.

Design of power cable grounding wire anti-theft monitoring system

NASA Astrophysics Data System (ADS)

An, Xisheng; Lu, Peng; Wei, Niansheng; Hong, Gang

2018-01-01

In order to prevent the serious consequences of the power grid failure caused by the power cable grounding wire theft, this paper presents a GPRS based power cable grounding wire anti-theft monitoring device system, which includes a camera module, a sensor module, a micro processing system module, and a data monitoring center module, a mobile terminal module. Our design utilize two kinds of methods for detecting and reporting comprehensive image, it can effectively solve the problem of power and cable grounding wire box theft problem, timely follow-up grounded cable theft events, prevent the occurrence of electric field of high voltage transmission line fault, improve the reliability of the safe operation of power grid.

Crystal-Phase Quantum Wires: One-Dimensional Heterostructures with Atomically Flat Interfaces.

PubMed

Corfdir, Pierre; Li, Hong; Marquardt, Oliver; Gao, Guanhui; Molas, Maciej R; Zettler, Johannes K; van Treeck, David; Flissikowski, Timur; Potemski, Marek; Draxl, Claudia; Trampert, Achim; Fernández-Garrido, Sergio; Grahn, Holger T; Brandt, Oliver

2018-01-10

In semiconductor quantum-wire heterostructures, interface roughness leads to exciton localization and to a radiative decay rate much smaller than that expected for structures with flat interfaces. Here, we uncover the electronic and optical properties of the one-dimensional extended defects that form at the intersection between stacking faults and inversion domain boundaries in GaN nanowires. We show that they act as crystal-phase quantum wires, a novel one-dimensional quantum system with atomically flat interfaces. These quantum wires efficiently capture excitons whose radiative decay gives rise to an optical doublet at 3.36 eV at 4.2 K. The binding energy of excitons confined in crystal-phase quantum wires is measured to be more than twice larger than that of the bulk. As a result of their unprecedented interface quality, these crystal-phase quantum wires constitute a model system for the study of one-dimensional excitons.

A Software Suite for Testing SpaceWire Devices and Networks

NASA Astrophysics Data System (ADS)

Mills, Stuart; Parkes, Steve

2015-09-01

SpaceWire is a data-handling network for use on-board spacecraft, which connects together instruments, mass-memory, processors, downlink telemetry, and other on-board sub-systems. SpaceWire is simple to implement and has some specific characteristics that help it support data-handling applications in space: high-speed, low-power, simplicity, relatively low implementation cost, and architectural flexibility making it ideal for many space missions. SpaceWire provides high-speed (2 Mbits/s to 200 Mbits/s), bi-directional, full-duplex data-links, which connect together SpaceWire enabled equipment. Data-handling networks can be built to suit particular applications using point-to-point data-links and routing switches. STAR-Dundee’s STAR-System software stack has been designed to meet the needs of engineers designing and developing SpaceWire networks and devices. This paper describes the aims of the software and how those needs were met.

Heartbeat-based error diagnosis framework for distributed embedded systems

NASA Astrophysics Data System (ADS)

Mishra, Swagat; Khilar, Pabitra Mohan

2012-01-01

Distributed Embedded Systems have significant applications in automobile industry as steer-by-wire, fly-by-wire and brake-by-wire systems. In this paper, we provide a general framework for fault detection in a distributed embedded real time system. We use heartbeat monitoring, check pointing and model based redundancy to design a scalable framework that takes care of task scheduling, temperature control and diagnosis of faulty nodes in a distributed embedded system. This helps in diagnosis and shutting down of faulty actuators before the system becomes unsafe. The framework is designed and tested using a new simulation model consisting of virtual nodes working on a message passing system.

Heartbeat-based error diagnosis framework for distributed embedded systems

NASA Astrophysics Data System (ADS)

Mishra, Swagat; Khilar, Pabitra Mohan

2011-12-01

Distributed Embedded Systems have significant applications in automobile industry as steer-by-wire, fly-by-wire and brake-by-wire systems. In this paper, we provide a general framework for fault detection in a distributed embedded real time system. We use heartbeat monitoring, check pointing and model based redundancy to design a scalable framework that takes care of task scheduling, temperature control and diagnosis of faulty nodes in a distributed embedded system. This helps in diagnosis and shutting down of faulty actuators before the system becomes unsafe. The framework is designed and tested using a new simulation model consisting of virtual nodes working on a message passing system.

Cable Bundle Wire Derating

NASA Technical Reports Server (NTRS)

Lundquist, Ray A.; Leidecker, Henning

1999-01-01

The allowable operating currents of electrical wiring when used in the space vacuum environment is predominantly determined by the maximum operating temperature of the wire insulation. For Kapton insulated wire this value is 200 degree C. Guidelines provided in the Goddard Space Flight Center (GSFC) Preferred Parts List (PPL) limit the operating current of wire within vacuum to ensure the maximum insulation temperature is not exceeded. For 20 AWG wire, these operating parameters are: (1) 3.7 amps per wire (2) bundle of 15 or more wires (3) 70 C environment (4) vacuum of 10(exp -5) torr or less To determine the behavior and temperature of electrical wire at different operating conditions, a thermal vacuum test was performed on a representative electrical harness of the Hubble Space Telescope (HST) power distribution system. This paper describes the test and the results.

Cable Bundle Wire Derating

NASA Technical Reports Server (NTRS)

Lundquist, Ray A.; Leidecker, Henning

1998-01-01

The allowable operating currents of electrical wiring when used in the space vacuum environment is predominantly determined by the maximum operating temperature of the wire insulation. For Kapton insulated wire this value is 200 C. Guidelines provided in the Goddard Space Flight Center (GSFC) Preferred Parts List (PPL) limit the operating current of wire within vacuum to ensure the maximum insulation temperature is not exceeded. For 20 AWG wire, these operating parameters are: (1) 3.7 amps per wire; (2) bundle of 15 or more wires; (3) 70 C environment: and (4) vacuum of 10(exp -5) torr or less. To determine the behavior and temperature of electrical wire at different operating conditions, a thermal vacuum test was performed on a representative electrical harness of the Hubble Space Telescope (HST) power distribution system. This paper describes the test and the results.

Wire rope tension control of hoisting systems using a robust nonlinear adaptive backstepping control scheme.

PubMed

Zhu, Zhen-Cai; Li, Xiang; Shen, Gang; Zhu, Wei-Dong

2018-01-01

This paper concerns wire rope tension control of a double-rope winding hoisting system (DRWHS), which consists of a hoisting system employed to realize a transportation function and an electro-hydraulic servo system utilized to adjust wire rope tensions. A dynamic model of the DRWHS is developed in which parameter uncertainties and external disturbances are considered. A comparison between simulation results using the dynamic model and experimental results using a double-rope winding hoisting experimental system is given in order to demonstrate accuracy of the dynamic model. In order to improve the wire rope tension coordination control performance of the DRWHS, a robust nonlinear adaptive backstepping controller (RNABC) combined with a nonlinear disturbance observer (NDO) is proposed. Main features of the proposed combined controller are: (1) using the RNABC to adjust wire rope tensions with consideration of parameter uncertainties, whose parameters are designed online by adaptive laws derived from Lyapunov stability theory to guarantee the control performance and stability of the closed-loop system; and (2) introducing the NDO to deal with uncertain external disturbances. In order to demonstrate feasibility and effectiveness of the proposed controller, experimental studies have been conducted on the DRWHS controlled by an xPC rapid prototyping system. Experimental results verify that the proposed controller exhibits excellent performance on wire rope tension coordination control compared with a conventional proportional-integral (PI) controller and adaptive backstepping controller. Copyright © 2017 ISA. All rights reserved.

KIM-1 interface adapter to 3-wire teletype systems

NASA Technical Reports Server (NTRS)

Burhans, R. W.

1976-01-01

The KIM-1 circuit designed for use with a full duplex isolated 4 terminal system is described. Operation of the circuit with a 3 wire system in conjunction with a single +5v supply interface is discussed.

Preliminary Design of an Autonomous Amphibious System

DTIC Science & Technology

2016-09-01

changing vehicle dynamics will require innovative new autonomy algorithms. The developed software architecture, drive-by- wire kit, and supporting...COMMUNICATIONS ARCHITECTURE .................................................12 3.3 DRIVE-BY- WIRE DESIGN...SOFTWARE MATURATION PLANS ......................................................17 4.2 DRIVE-BY- WIRE PLANNED REFINEMENT

75 FR 60614 - Airworthiness Directives; The Boeing Company Model 747-400, 747-400D, and 747-400F Series Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... source outside the FQIS to the densitometer wiring from causing failure of the FQIS densitometer... wiring of the other systems as a result of implementing the actions required by this AD. Boeing requests... are implemented, then no further actions are required to separate the FQIS wire from the wiring of...

Strength of cerclage fixation systems: a biomechanical study.

PubMed

Incavo, S J; Difazio, F; Wilder, D

1990-11-01

This study examined the load to failure ratio and stiffness of eight different cerclage techniques commonly used in the clinical management of fractures. For a single-loop cerclage, titanium cable was the strongest, while stainless steel wire secured with a commercial tightener was the weakest (P < 0.05). When a single-loop configuration is necessary (i.e. trochanteric attachment) a cable system is superior to cerclage wiring. A double-wrap of either cable or wire was considerably stronger than any single-wrap cerclage technique and stronger than two cerclage wires (P < 0.05). Copyright © 1990. Published by Elsevier Ltd.

A Comparison of Zero Mean Strain Rotating Beam Fatigue Test Methods for Nitinol Wire

NASA Astrophysics Data System (ADS)

Norwich, Dennis W.

2014-07-01

Zero mean strain rotating beam fatigue testing has become the standard for comparing the fatigue properties of Nitinol wire. Most commercially available equipment consists of either a two-chuck or a chuck and bushing system, where the wire length and center-to-center axis distance determine the maximum strain on the wire. For the two-chuck system, the samples are constrained at either end of the wire, and both chucks are driven at the same speed. For the chuck and bushing system, the sample is constrained at one end in a chuck and rides freely in a bushing at the other end. These equivalent systems will both be herein referred to as Chuck-to-Chuck systems. An alternate system uses a machined test block with a specific radius to guide the wire at a known strain during testing. In either system, the test parts can be immersed in a temperature-controlled fluid bath to eliminate any heating effect created in the specimen due to dissipative processes during cyclic loading (cyclic stress induced the formation of martensite) Wagner et al. ( Mater. Sci. Eng. A, 378, p 105-109, 1). This study will compare the results of the same starting material tested with each system to determine if the test system differences affect the final results. The advantages and disadvantages of each system will be highlighted and compared. The factors compared will include ease of setup, operator skill level required, consistency of strain measurement, equipment test limits, and data recovery and analysis. Also, the effect of test speed on the test results for each system will be investigated.

DNA G-Wire Formation Using an Artificial Peptide is Controlled by Protease Activity.

PubMed

Usui, Kenji; Okada, Arisa; Sakashita, Shungo; Shimooka, Masayuki; Tsuruoka, Takaaki; Nakano, Shu-Ichi; Miyoshi, Daisuke; Mashima, Tsukasa; Katahira, Masato; Hamada, Yoshio

2017-11-16

The development of a switching system for guanine nanowire (G-wire) formation by external signals is important for nanobiotechnological applications. Here, we demonstrate a DNA nanostructural switch (G-wire <--> particles) using a designed peptide and a protease. The peptide consists of a PNA sequence for inducing DNA to form DNA-PNA hybrid G-quadruplex structures, and a protease substrate sequence acting as a switching module that is dependent on the activity of a particular protease. Micro-scale analyses via TEM and AFM showed that G-rich DNA alone forms G-wires in the presence of Ca 2+ , and that the peptide disrupted this formation, resulting in the formation of particles. The addition of the protease and digestion of the peptide regenerated the G-wires. Macro-scale analyses by DLS, zeta potential, CD, and gel filtration were in agreement with the microscopic observations. These results imply that the secondary structure change (DNA G-quadruplex <--> DNA/PNA hybrid structure) induces a change in the well-formed nanostructure (G-wire <--> particles). Our findings demonstrate a control system for forming DNA G-wire structures dependent on protease activity using designed peptides. Such systems hold promise for regulating the formation of nanowire for various applications, including electronic circuits for use in nanobiotechnologies.

Computer-assisted design of flux-cored wires

NASA Astrophysics Data System (ADS)

Dubtsov, Yu N.; Zorin, I. V.; Sokolov, G. N.; Antonov, A. A.; Artem'ev, A. A.; Lysak, V. I.

2017-02-01

The algorithm and description of the AlMe-WireLaB software for the computer-assisted design of flux-cored wires are introduced. The software functionality is illustrated with the selection of the components for the flux-cored wire, ensuring the acquisition of the deposited metal of the Fe-Cr-C-Mo-Ni-Ti-B system. It is demonstrated that the developed software enables the technologically reliable flux-cored wire to be designed for surfacing, resulting in a metal of an ordered composition.

Gallbladder and cystic duct absence. An infrequent malformation in laparoscopic surgery.

PubMed

Cabajo Caballero, M A; Martin del Olmo, J C; Blanco Alvarez, J I; Atienza Sanchez, R

1997-05-01

Gallbladder absence is an infrequent anomaly normally accompanied by lack of the cystic duct. Of unknown etiology, in general it is accepted to be a congenital malformation. A male patient (age 59) diagnosed with nonfunctional symptomatic scleroatrophic gallbladder by echography and ERCP was operated on using a laparoscopic approach. Gallbladder and cystic absence was diagnosed during the procedure. A new case of gallbladder and cystic duct absence, diagnosed by laparoscopy, is presented. This type of extrahepatic bile duct malformation is quite rare, but it must be taken into account due to the generalization of laparoscopic surgery in biliar pathology because of the high risk of serious lesions to the hepatocholedochal system.

Molecular Spintronics: Theory of Spin-Dependent Electron Transport in Fe/BDT/Fe Molecular Wire Systems

NASA Astrophysics Data System (ADS)

Dalgleish, Hugh; Kirczenow, George

2004-03-01

Metal/Molecule/Metal junction systems forming molecular wires are currently the focus of intense study. Recently, spin-dependent electron transport in molecular wires with magnetic Ni electrodes has been studied theoretically, and spin-valve effects have been predicted.* Here we explore theoretically another magnetic molecular wire system, namely, ferromagnetic Fe nano-contacts bridged with 1,4-benzene-dithiolate (BDT). We estimate the essential structural and electronic parameters for this system based on ab initio density functional calculations (DFT) for some simple model systems involving thiol groups and Fe clusters as well as semi-empirical considerations and the known electronic structure of bulk Fe. We then use Lippmann-Schwinger and Green's function techniques together with the Landauer formalism to study spin-dependent transport. *E. G. Emberly and G. Kirczenow, Chem. Phys. 281, 311 (2002); R. Pati, L. Senapati, P.M. Ajayan and S.K. Nayak, Phys. Rev. B68, 100407 (2003).

Flywheel system using wire-wound rotor

DOEpatents

Chiao, Edward Young; Bender, Donald Arthur; Means, Andrew E.; Snyder, Philip K.

2016-06-07

A flywheel is described having a rotor constructed of wire wound onto a central form. The wire is prestressed, thus mitigating stresses that occur during operation. In another aspect, the flywheel incorporates a low-loss motor using electrically non-conducting permanent magnets.

Characterization and application of Shape Memory Alloy wires for micro and meso positioning systems

NASA Astrophysics Data System (ADS)

Khan, Afzal

The properties of Shape Memory Alloy (SMA) wires are determined by experimentation, and previously used experimental equipment contributes to measurement errors in data. In this study, various characterization experiments are designed and carried out using a precision characterization instrument for shape memory alloy wires to determine the properties and parameters of the alloy. These experiments demonstrate the behavior of SMA wires under different thermal and loading conditions as they occur in actuation applications. As SMA wires go through phase transformation, a significant amount of contraction force is produced. This actuation force has been used in bias spring actuators and differential actuators. In this dissertation, the force generated during the twinning of martensite is used to actuate positioning systems with small displacements at the micrometer level. A micropositioning system is designed and tested that has a positioning accuracy of about +/-0.15 mum. A relation between the current input and the displacement output is determined for the specific preload. The transformation force generated during the phase change from martensite to austenite is used as an actuation force for a second positioning system that uses linear bearing with a displacement range of about a millimeter. This positioning system actuated with a single nitinol wire and guided by symmetric parallel diaphragm flexures, was designed and tested. The actuation is repeatable to about +/-15 mum with variation of about +/-5 mum in postion at steady temperature.

Third NASA Workshop on Wiring for Space Applications

NASA Technical Reports Server (NTRS)

Hammoud, Ahmad (Compiler); Stavnes, Mark (Compiler)

1995-01-01

This workshop addressed key technology issues in the field of electrical power wiring for space applications, and transferred information and technology related to space wiring for use in government and commercial applications. Speakers from space agencies, U.S. Federal labs, industry, and academia presented program overviews and discussed topics on arc tracking phenomena, advancements in insulation materials and constructions, and new wiring system topologies.

Safe Emergency Evacuation From Tall Structures

NASA Technical Reports Server (NTRS)

Stephan, E. S.

1984-01-01

Emergency egress system allows people to be evacuated quickly from tall structures. New emergency system applicable to rescues from fires in tall hotels and other buildings. System consists of basket on slide wire. Basket descends by gravity on sloped slide wire staked to ground.

77 FR 33129 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... modify the fuel quantity indication system (FQIS) wiring or fuel tank systems to prevent development of..., 2012 (77 FR 12506). That NPRM proposed to require modifying the fuel quantity indication system wiring or fuel tank systems to prevent development of an ignition source inside the center fuel tank. That...

14 CFR 25.1713 - Fire protection: EWIS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Electrical Wiring Interconnection Systems (EWIS) § 25.1713... used during emergency procedures must be fire resistant. (c) Insulation on electrical wire and electrical cable, and materials used to provide additional protection for the wire and cable, installed in...

Wire winding increases lifetime of oxide coated cathodes

NASA Technical Reports Server (NTRS)

Kerslake, W.; Vargo, D.

1965-01-01

Refractory-metal heater base wound with a thin refractory metal wire increases the longevity of oxide-coated cathodes. The wire-wound unit is impregnated with the required thickness of metal oxide. This cathode is useful in magnetohydrodynamic systems and in electron tubes.

Radiographic evaluation of pancreatico-jejunal shunts.

PubMed Central

Miller, E W; Goldberg, H I; Goldberg, S B; Shapiro, H

1976-01-01

This paper describes opacification and identification of two surgically constructed pancreatico-jujunal shunts. A fibreoptic panendoscope was used with retrograde injection via the ampulla of Vater (ERCP). This procedure makes possible more accurate anatomical evaluation and so more precise clinical appraisal of both pre- and post-surgical states. Images Fig. 1 Fig. 2 PMID:955500

Pancreatic Calculus Causing Biliary Obstruction: Endoscopic Therapy for a Rare Initial Presentation of Chronic Pancreatitis.

PubMed

Shetty, Anurag J; Pai, C Ganesh; Shetty, Shiran; Balaraju, Girisha

2015-09-01

Biliary obstruction in chronic calcific pancreatitis (CCP) is often caused by inflammatory or fibrotic strictures of the bile duct, carcinoma of head of pancreas or less commonly by compression from pseudocysts. Pancreatic calculi causing ampullary obstruction and leading to obstructive jaundice is extremely rare. The medical records of all patients with CCP or biliary obstruction who underwent endoscopic retrograde cholangiopancreatography (ERCP) over 4 years between 2010-2014 at Kasturba Medical College, Manipal were analyzed. Five patients of CCP with impacted pancreatic calculi at the ampulla demonstrated during ERCP were identified. All 5 presented with biliary obstruction and were incidentally detected to have CCP when evaluated for the same; 3 patients had features of cholangitis. All the patients were managed successfully by endoscopic papillotomy and extraction of pancreatic calculi from the ampulla with resolution of biliary obstruction. Pancreatic calculus causing ampullary obstruction, though very rare, should be considered as a possibility in patients with CCP complicated by biliary obstruction. Endoscopic therapy is affective in the resolution of biliary obstruction in such patients.

Management of Pancreatic Calculi: An Update.

PubMed

Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

2016-11-15

Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.

Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy

PubMed Central

Jiang, Yuan-Hui; Zhang, An-Hong; Zhou, Shao-Jun

2017-01-01

Abstract Rationale: Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood. Patient concerns: A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016. Diagnoses: Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD). Interventions: During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate. Outcomes: After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse. Lessons: This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as “pancreatogenic choledocholithiasis,” and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause. PMID:29145338

Endoscopic duodenal perforation: surgical strategies in a regional centre

PubMed Central

2014-01-01

Background Duodenal perforation is an uncommon complication of endoscopic retrograde cholangio-pancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy. Most are minor perforations that settle with conservative management. A few perforations however result in life-threatening retroperitoneal necrosis and require surgical intervention. There is a relative paucity of references specifically describing the surgical interventions required for this eventuality. Methods Five cases of iatrogenic duodenal perforation were ascertained between 2002 and 2007 at Cairns Base Hospital. Clinical features were analyzed and compared, with reference to a review of ERCP at that institution for the years 2005/2006. Results One patient recovered with conservative management. Of the other four, one died after initial laparotomy. The other three survived, undergoing multiple procedures and long inpatient stays. Conclusions Iatrogenic duodenal perforation with retroperitoneal necrosis is an uncommon complication of endoscopy, but when it does occur it is potentially life-threatening. Early recognition may lead to a better outcome through earlier intervention, although a protracted course with multiple procedures should be anticipated. A number of surgical techniques may need to be employed according to the individual circumstances of the case. PMID:24461069

Exposure and risk analysis to particulate matter, metals, and polycyclic aromatic hydrocarbon at different workplaces in Argentina.

PubMed

Colman Lerner, Jorge Esteban; Elordi, Maria Lucila; Orte, Marcos Agustin; Giuliani, Daniela; de Los Angeles Gutierrez, Maria; Sanchez, EricaYanina; Sambeth, Jorge Enrique; Porta, Atilio Andres

2018-03-01

In order to estimate air quality at work environments from small and medium-sized enterprises (SMEs), we determined both the concentration of particulate matter (PM 10 and PM 2.5 ) and the presence of polycyclic aromatic hydrocarbons (PAHs), as the heavy metals in the composition of the particulate matter. Three SMEs located in the city of La Plata, Argentina, were selected: an electromechanical repair and car painting center (ERCP), a sewing work room (SWR), and a chemical analysis laboratory (CAL). The results evidenced high levels of PM exceeding the limits allowed by the USEPA and the presence of benzo(k)fluoranthene in all the analyzed sites and benzo(a)pyrene in the most contaminated site (ERCP). Regarding metals, the presence of Cd, Ni, Cu, Pb, and Mn, mainly in the fraction of PM 2.5 , in the same workplace was found. As far as risk assessment at all the workplaces surveyed is concerned, risk values for contracting cancer throughout life for exposed workers (LCR) did not comply with the parameters either of USEPA or of WHO (World Health Organization).

NASA requirements and applications environments for electrical power wiring

NASA Technical Reports Server (NTRS)

Stavnes, Mark W.; Hammoud, Ahmad N.

1992-01-01

Serious problems can occur from insulation failures in the wiring harnesses of aerospace vehicles. In most recorded incidents, the failures have been identified to be the result of arc tracking, the propagation of an arc along wiring bundles through degradation of insulation. Propagation of the arc can lead to the loss of the entire wiring harness and the functions which it supports. While an extensive database of testing for arc track resistant wire insulations has been developed for aircraft applications, the counterpart requirements for spacecraft are very limited. The electrical, thermal, mechanical, chemical, and operational requirements for specification and testing of candidate wiring systems for spacecraft applications is presented.

Apollo display and keyboard unit (DSKY) used on F-8 DFBW

NASA Technical Reports Server (NTRS)

1996-01-01

The display and keyboard (DSKY) unit used on the F-8 Digital Fly-By-Wire (DFBW) aircraft during Phase I of the fly-by-wire program. Warning lights are in the upper left section, displays in the upper right, and the keyboard is in the lower section. The Apollo flight-control system used in Phase I of the DFBW program had been used previously on the Lunar Module and was incredibly reliable. The DSKY was one element of the system. Also part of the fly-by-wire control system was the inertial platform. Both the computer and the inertial platform required a cooling system that used liquid nitrogen to keep the system within temperature limits. Should the primary flight control system fail, a backup system using three analog computers would automatically take over. The F-8 DFBW had no manual backup. The F-8 Digital Fly-By-Wire (DFBW) flight research project validated the principal concepts of all-electric flight control systems now used on nearly all modern high-performance aircraft and on military and civilian transports. The first flight of the 13-year project was on May 25, 1972, with research pilot Gary E. Krier at the controls of a modified F-8C Crusader that served as the testbed for the fly-by-wire technologies. The project was a joint effort between the NASA Flight Research Center, Edwards, California, (now the Dryden Flight Research Center) and Langley Research Center. It included a total of 211 flights. The last flight was December 16, 1985, with Dryden research pilot Ed Schneider at the controls. The F-8 DFBW system was the forerunner of current fly-by-wire systems used in the space shuttles and on today's military and civil aircraft to make them safer, more maneuverable, and more efficient. Electronic fly-by-wire systems replaced older hydraulic control systems, freeing designers to design aircraft with reduced in-flight stability. Fly-by-wire systems are safer because of their redundancies. They are more maneuverable because computers can command more frequent adjustments than a human pilot can. For airliners, computerized control ensures a smoother ride than a human pilot alone can provide. Digital-fly-by-wire is more efficient because it is lighter and takes up less space than the hydraulic systems it replaced. This either reduces the fuel required to fly or increases the number of passengers or pounds of cargo the aircraft can carry. Digital fly-by-wire is currently used in a variety of aircraft ranging from F/A-18 fighters to the Boeing 777. The DFBW research program is considered one of the most significant and most successful NASA aeronautical programs since the inception of the agency. F-8 aircraft were built originally for the U.S. Navy by LTV Aerospace of Dallas, Texas. The aircraft had a wingspan of 35 feet, 2 inches; was 54 feet, 6 inches long; and was powered by a Pratt & Whitney J57 turbojet engine.

Magnetization reversal modes in fourfold Co nano-wire systems

NASA Astrophysics Data System (ADS)

Blachowicz, T.; Ehrmann, A.

2015-09-01

Magnetic nano-wire systems are, as well as other patterned magnetic structures, of special interest for novel applications, such as magnetic storage media. In these systems, the coupling between neighbouring magnetic units is most important for the magnetization reversal process of the complete system, leading to a variety of magnetization reversal mechanisms. This article examines the influence of the magnetic material on hysteresis loop shape, coercive field, and magnetization reversal modes. While iron nano-wire systems exhibit flat or one-step hysteresis loops, systems consisting of cobalt nano-wires show hysteresis loops with several longitudinal steps and transverse peaks, correlated to a rich spectrum of magnetization reversal mechanisms. We show that changing the material parameters while the system geometry stays identical can lead to completely different hysteresis loops and reversal modes. Thus, especially for finding magnetic nano-systems which can be used as quaternary or even higher-order storage devices, it is rational to test several materials for the planned systems. Apparently, new materials may lead to novel and unexpected behaviour - and can thus result in novel functionalities.

Image Capture and Display Based on Embedded Linux

NASA Astrophysics Data System (ADS)

Weigong, Zhang; Suran, Di; Yongxiang, Zhang; Liming, Li

For the requirement of building a highly reliable communication system, SpaceWire was selected in the integrated electronic system. There was a need to test the performance of SpaceWire. As part of the testing work, the goal of this paper is to transmit image data from CMOS camera through SpaceWire and display real-time images on the graphical user interface with Qt in the embedded development platform of Linux & ARM. A point-to-point mode of transmission was chosen; the running result showed the two communication ends basically reach a consensus picture in succession. It suggests that the SpaceWire can transmit the data reliably.

Application of vision measurements for modal analysis of wires for the purpose of overhead transmission lines monitoring

NASA Astrophysics Data System (ADS)

Mendrok, Krzysztof; Dworakowski, Ziemowit; Holak, Krzysztof; Kohut, Piotr

2017-05-01

Overhead transmission power lines are still one of the crucial elements of electro-energetic system. There are obvious advantages of using overhead transmission in the distribution of electricity. The amount of energy transported through a power line is determined by the distance between the wire and the ground or other objects placed beneath it (eg. trees). This distance is not fixed and depends on the overhang of the wire. This, in turn, is determined by many factors such as ambient temperature, humidity, precipitation, the value of current flowing through the wire. In order to optimize the wires electrical load, the monitoring of that overhang is required. One way to measure it is the non-contact measurement by vision system. It has the advantage, that using high-speed cameras respectively it also allows for vibration measurement and analysis of dynamic performance. That is very important while the wires are susceptible to the influence of wind, and the resulting vibrations interfere with the correct measurement of the overhang. The paper presents the results of vision measurements of the system vibrations and modal analysis carried out on their basis. The study was conducted on a specially made laboratory stand.

49 CFR 236.108 - Insulation resistance tests, wires in trunking and cables.

Code of Federal Regulations, 2014 CFR

2014-10-01

... cables. 236.108 Section 236.108 Transportation Other Regulations Relating to Transportation (Continued... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES... Insulation resistance tests, wires in trunking and cables. (a) Insulation resistance of wires and cables...

49 CFR 236.108 - Insulation resistance tests, wires in trunking and cables.

Code of Federal Regulations, 2012 CFR

2012-10-01

... cables. 236.108 Section 236.108 Transportation Other Regulations Relating to Transportation (Continued... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES... Insulation resistance tests, wires in trunking and cables. (a) Insulation resistance of wires and cables...

49 CFR 236.108 - Insulation resistance tests, wires in trunking and cables.

Code of Federal Regulations, 2013 CFR

2013-10-01

... cables. 236.108 Section 236.108 Transportation Other Regulations Relating to Transportation (Continued... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES... Insulation resistance tests, wires in trunking and cables. (a) Insulation resistance of wires and cables...

Fine-Filament MgB2 Superconductor Wire

NASA Technical Reports Server (NTRS)

Cantu, Sherrie

2015-01-01

Hyper Tech Research, Inc., has developed fine-filament magnesium diboride (MgB2) superconductor wire for motors and generators used in turboelectric aircraft propulsion systems. In Phase I of the project, Hyper Tech demonstrated that MgB2 multifilament wires (<10 micrometers) could reduce alternating current (AC) losses that occur due to hysteresis, eddy currents, and coupling losses. The company refined a manufacturing method that incorporates a magnesium-infiltration process and provides a tenfold enhancement in critical current density over wire made by a conventional method involving magnesium-boron powder mixtures. Hyper Tech also improved its wire-drawing capability to fabricate fine multifilament strands. In Phase II, the company developed, manufactured, and tested the wire for superconductor and engineering current density and AC losses. Hyper Tech also fabricated MgB2 rotor coil packs for a superconducting generator. The ultimate goal is to enable low-cost, round, lightweight, low-AC-loss superconductors for motor and generator stator coils operating at 25 K in next-generation turboelectric aircraft propulsion systems.

Dissipation-driven phase transitions in superconducting wires

NASA Astrophysics Data System (ADS)

Lobos, Alejandro; Iucci, Aníbal; Müller, Markus; Giamarchi, Thierry

2010-03-01

Narrow superconducting wires with diameter dξ0 (where ξ0 is the bulk superconducting coherence length) are quasi-1D systems in which fluctuations of the order parameter strongly affect low-temperature properties. Indeed, fluctuations cause the magnitude of the order parameter to temporarily vanish at some point along the wire, allowing its phase to slip by 2π, and to produce finite resistivity for all temperatures below Tc. In this work, we show that a weak coupling to a diffusive metallic film reinforces superconductivity in the wire through a quench of phase fluctuations. We analyze the effective phase-only action of the system by a perturbative renormalization-group and a self-consistent variational approach to obtain the critical points and phases at T=0. We predict a quantum phase transition towards a superconducting phase with long-range order as a function of the wire stiffness and coupling to the metal. Finally we discuss implications for the DC resistivity of the wire.

Inelastic fingerprints of hydrogen contamination in atomic gold wire systems

NASA Astrophysics Data System (ADS)

Frederiksen, Thomas; Paulsson, Magnus; Brandbyge, Mads

2007-03-01

We present series of first-principles calculations for both pure and hydrogen contaminated gold wire systems in order to investigate how such impurities can be detected. We show how a single H atom or a single H2 molecule in an atomic gold wire will affect forces and Au-Au atom distances under elongation. We further determine the corresponding evolution of the low-bias conductance as well as the inelastic contributions from vibrations. Our results indicate that the conductance of gold wires is only slightly reduced from the conductance quantum G0 = 2e2/h by the presence of a single hydrogen impurity, hence making it difficult to use the conductance itself to distinguish between various configurations. On the other hand, our calculations of the inelastic signals predict significant differences between pure and hydrogen contaminated wires, and, importantly, between atomic and molecular forms of the impurity. A detailed characterization of gold wires with a hydrogen impurity should therefore be possible from the strain dependence of the inelastic signals in the conductance.

Surgical Success in Chronic Pancreatitis: Sequential Endoscopic Retrograde Cholangiopancreatography and Surgical Longitudinal Pancreatojejunostomy (Puestow Procedure).

PubMed

Ford, Kathryn; Paul, Anu; Harrison, Phillip; Davenport, Mark

2016-06-01

Introduction Chronic pancreatitis (CP) can be a cause of recurrent, severe, disabling abdominal pain in children. Surgery has been suggested as a useful therapy, although experience is limited and the results unpredictable. We reviewed our experience of a two-stage protocol-preliminary endoscopic retrograde cholangiopancreatography (ERCP) and duct stenting, and if symptoms resolved, definitive surgical decompression by longitudinal pancreatojejunostomy (LPJ) (Puestow operation). Patients and Methods This is a single-center, retrospective review of children with established CP who underwent an LPJ between February 2002 and September 2012. A questionnaire was completed (incorporating visual analog scale pain and lifestyle scores) to assess functional outcome. Data are expressed as median (range). Results In this study, eight (M:F ratio of 4:4) children underwent an LPJ and one female child had a more limited pancreatojejunostomy anastomosis following preliminary ERCP and stent placement where possible. Diagnoses included hereditary pancreatitis (n = 3), idiopathic or structural pancreatitis (n = 5), and duct stricture following radiotherapy (n = 1). Median duct diameter presurgery was 5 (4-11) mm. Endoscopic placement of a Zimmon pancreatic stent was possible in six with relief of symptoms in all. Median age at definitive surgery was 11 (range, 7-17) years with a median postoperative stay of 9 (range, 7-12) days and a follow-up of 6 (range, 0.5-12) years. All children reported markedly reduced episodes of pain postprocedure. One developed diabetes mellitus, while three had exocrine deficiency (fecal elastase < 200 µg/g) requiring enzyme supplementation. The child with limited LPJ had symptomatic recurrence and required restenting and further surgery to widen the anastomosis to become pain free. Conclusion ERCP and stenting provide a therapeutic trial to assess possible benefit of a definitive duct drainage procedure. LPJ-the modified Puestow operation was safe and complication-free with good medium-term relief of symptoms. We were not able to identify a consistent etiology-associated outcome. Georg Thieme Verlag KG Stuttgart · New York.

Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

PubMed Central

Lu, Jiong; Cheng, Yao; Xiong, Xian-Ze; Lin, Yi-Xin; Wu, Si-Jia; Cheng, Nan-Sheng

2012-01-01

AIM: To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones. METHODS: Four databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011, were searched to identify all randomized controlled trials (RCTs). Data were extracted from the studies by two independent reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, number of procedures per patient, length of hospital stay, total operative time, hospitalization charges, patient acceptance and quality of life scores. RESULTS: Seven eligible RCTs [five trials (n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC + laparoscopic common bile duct exploration (LCBDE); two trials (n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE], composed of 787 patients in total, were included in the final analysis. The meta-analysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) = -0.10, 95% confidence intervals (CI): -0.24 to 0.04, P = 0.17], postoperative morbidity (RR = 0.79, 95% CI: 0.58 to 1.10, P = 0.16), mortality (RR = 2.19, 95% CI: 0.33 to 14.67, P = 0.42), conversion to other procedures (RR = 1.21, 95% CI: 0.54 to 2.70, P = 0.39), length of hospital stay (MD = 0.99, 95% CI: -1.59 to 3.57, P = 0.45), total operative time (MD = 12.14, 95% CI: -1.83 to 26.10, P = 0.09). Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management. CONCLUSION: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient’s condition, operator’s expertise and local resources should be taken into account in making treatment decisions. PMID:22791952

Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents: a meta-analysis.

PubMed

Khan, Muhammad Ali; Baron, Todd H; Kamal, Faisal; Ali, Bilal; Nollan, Richard; Ismail, Mohammad Kashif; Tombazzi, Claudio; Artifon, Everson L A; Repici, Alessandro; Khashab, Mouen A

2017-07-01

Background and study aims  There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method  Searches in several databases identified studies including ≥ 10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence. Pooled risk ratios (RRs) comparing CSEMSs with MPS were calculated for stricture resolution, stricture recurrence, and adverse events. Pooled difference in means was calculated to compare number of endoscopic retrograde cholangiopancreatographies (ERCPs) in each group.  Results  The meta-analysis included 22 studies with 1298 patients. Weighted pooled rate for BBS resolution with CSEMS was 83 % (95 % confidence limits [95 %CLs] 78 %, 87 %; I 2  = 72 %). On meta-regression analysis, resolution in chronic pancreatitis patients and post-orthotopic liver transplant patients were significant predictors of heterogeneity. Weighted pooled rate for stricture recurrence with CSEMSs was 16 % (11 %, 22 %). Overall rate of adverse events requiring intervention and/or hospitalization was 15 %. Four randomized controlled trials with 213 patients compared CSEMSs with MPS: the pooled RRs for stricture resolution, recurrence, and adverse events were 1.07 (0.97, 1.18), 0.88 (0.48, 1.63), and 1.16 (0.71, 1.88), respectively with no heterogeneity. Pooled difference in means for number of ERCPs was - 1.71 ( - 2.33, - 1.09) in favor of CSEMS. Conclusions  CSEMSs appear to have excellent efficacy in BBS management. They are as effective as MPS but require fewer ERCPs to achieve clinical success. © Georg Thieme Verlag KG Stuttgart · New York.

A space release/deployment system actuated by shape memory wires

NASA Astrophysics Data System (ADS)

Fragnito, Marino; Vetrella and, Sergio

2002-11-01

In this paper, the design of an innovative hold down/release and deployment device actuated by shape memory wires, to be used for the first time for the S MA RT microsatellite solar wings is shown. The release and deployment mechanisms are actuated by a Shape Memory wire (Nitinol), which allows a complete symmetrical and synchronous release, in a very short time, of the four wings in pairs. The hold down kinematic mechanism is preloaded to avoid vibration nonlinearities and unwanted deployment at launch. The deployment mechanism is a simple pulley system. The stiffness of the deployed panel-hinge system needs to be dimensioned in order to meet the on-orbit requirement for attitude control. One-way roller clutches are used to keep the panel at the desired angle during the mission. An ad hoc software has been developed to simulate both the release and deployment operations, coupling the SMA wire behavior with the system mechanics.

Energy dissipation of composite multifilamentary superconductors for high-current ramp-field magnet applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gung, C.Y.

1993-01-01

Energy dissipation, which is also called AC loss, of a composite multifilamentary superconducting wire is one of the most fundamental concerns in building a stable superconducting magnet. Characterization and reduction of AC losses are especially important in designing a superconducting magnet for generating transient magnetic fields. The goal of this thesis is to improve the understanding of AC-loss properties of superconducting wires developed for high-current ramp-field magnet applications. The major tasks include: (1) building an advanced AC-loss measurement system, (2) measuring AC losses of superconducting wires under simulated pulse magnet operations, (3) developing an analytical model for explaining the newmore » AC-loss properties found in the experiment, and (4) developing a computational methodology for comparing AC losses of a superconducting wire with those of a cable for a superconducting pulse magnet. A new experimental system using an isothermal calorimetric method was designed and constructed to measure the absolute AC losses in a composite superconductor. This unique experimental setup is capable of measuring AC losses of a brittle Nb{sub 3}Sn wire carrying high AC current in-phase with a large-amplitude pulse magnetic field. Improvements of the accuracy and the efficiency of this method are discussed. Three different types of composite wire have been measured: a Nb{sub 3}Sn modified jelly-roll (MJR) internal-tin wire used in a prototype ohmic heating coil, a Nb{sub 3}Sn internal-tin wire developed for a fusion reactor ohmic heating coil, and a NbTi wire developed for the magnets in a particle accelerator. The cross sectional constructions of these wires represent typical commercial wires manufactured for pulse magnet applications.« less

Deformable 3D-2D registration for guiding K-wire placement in pelvic trauma surgery

NASA Astrophysics Data System (ADS)

Goerres, J.; Jacobson, M.; Uneri, A.; de Silva, T.; Ketcha, M.; Reaungamornrat, S.; Vogt, S.; Kleinszig, G.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

2017-03-01

Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories ( 10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4º in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking / navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet / outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.

Apparatus for disintegrating kidney stones

NASA Technical Reports Server (NTRS)

Angulo, E. D. (Inventor)

1984-01-01

The useful life of the wire probe in an ultrasonic kidney stone disintegration instrument is enhanced and prolonged by attaching the wire of the wire probe to the tip of an ultrasonic transducer by means of a clamping arrangement. Additionally, damping material is applied to the wire probe in the form of a damper tube through which the wire probe passes in the region adjacent the transducer tip. The damper tube extends outwardly from the transducer tip a predetermined distance, terminating in a resilient soft rubber joint. Also, the damper tube is supported intermediate its length by a support member. The damper system thus acts to inhibit lateral vibrations of the wire in the region of the transducer tip while providing little or no damping to the linear vibrations imparted to the wire by the transducer.

A reliability analysis tool for SpaceWire network

NASA Astrophysics Data System (ADS)

Zhou, Qiang; Zhu, Longjiang; Fei, Haidong; Wang, Xingyou

2017-04-01

A SpaceWire is a standard for on-board satellite networks as the basis for future data-handling architectures. It is becoming more and more popular in space applications due to its technical advantages, including reliability, low power and fault protection, etc. High reliability is the vital issue for spacecraft. Therefore, it is very important to analyze and improve the reliability performance of the SpaceWire network. This paper deals with the problem of reliability modeling and analysis with SpaceWire network. According to the function division of distributed network, a reliability analysis method based on a task is proposed, the reliability analysis of every task can lead to the system reliability matrix, the reliability result of the network system can be deduced by integrating these entire reliability indexes in the matrix. With the method, we develop a reliability analysis tool for SpaceWire Network based on VC, where the computation schemes for reliability matrix and the multi-path-task reliability are also implemented. By using this tool, we analyze several cases on typical architectures. And the analytic results indicate that redundancy architecture has better reliability performance than basic one. In practical, the dual redundancy scheme has been adopted for some key unit, to improve the reliability index of the system or task. Finally, this reliability analysis tool will has a directive influence on both task division and topology selection in the phase of SpaceWire network system design.

Tips of the dual-lumen microcatheter-facilitated reverse wire technique in percutaneous coronary interventions for markedly angulated bifurcated lesions.

PubMed

Nomura, Tetsuya; Kikai, Masakazu; Hori, Yusuke; Yoshioka, Kenichi; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Sugimoto, Takeshi; Keira, Natsuya; Tatsumi, Tetsuya

2018-04-01

In practical settings of percutaneous coronary intervention (PCI), we sometimes encounter difficulty in introducing a guidewire (GW) to the markedly angulated side branch (SB), and the reverse wire technique is considered as a last resort to overcome such a situation. We analyzed 12 cases that underwent PCI with dual-lumen microcatheter-facilitated reverse wire technique between January 2013 and July 2016. We retrospectively investigated the lesion's characteristics and the details of the PCI procedures, and discussed tips about the use of this technique. The SB that exhibits both a smaller take-off angle and a larger carina angle is considered to be the most suitable candidate for this technique. The first step of this technique involves the delivery of the reverse wire system to the target bifurcation. However, most cases exhibit significant stenosis proximal to the bifurcation, which often hampers the delivery of the reverse wire system. Because the sharply curved reverse wire system is easier to pass the stenosis as compared to the roundly curved system, we recommend a sharp curve should be adopted for this technique. On the other hand, it is sure that device delivery is much easier on the GW with a round curve as compared to that with a sharp curve. Therefore, it is important to modify the details of this procedure on a case-by-case basis according to the lesion's characteristics.

Self-organization of mesoscopic silver wires by electrochemical deposition.

PubMed

Zhong, Sheng; Koch, Thomas; Walheim, Stefan; Rösner, Harald; Nold, Eberhard; Kobler, Aaron; Scherer, Torsten; Wang, Di; Kübel, Christian; Wang, Mu; Hahn, Horst; Schimmel, Thomas

2014-01-01

Long, straight mesoscale silver wires have been fabricated from AgNO3 electrolyte via electrodeposition without the help of templates, additives, and surfactants. Although the wire growth speed is very fast due to growth under non-equilibrium conditions, the wire morphology is regular and uniform in diameter. Structural studies reveal that the wires are single-crystalline, with the [112] direction as the growth direction. A possible growth mechanism is suggested. Auger depth profile measurements show that the wires are stable against oxidation under ambient conditions. This unique system provides a convenient way for the study of self-organization in electrochemical environments as well as for the fabrication of highly-ordered, single-crystalline metal nanowires.

[Current strategy in PCI for CTO].

PubMed

Asakura, Yasushi

2011-02-01

Recently, CTO PCI has come into wide use all over the world and it has been standardized. The 1st step is an antegrade approach using single wire. The 2nd strategy would be parallel wire technique. And the next would be a retrograde approach. In this method, retrograde wiring with Corsair is done at first. If it is successful, externalization is established using 300 cm wire, and this system is able to provide strong back-up support. If it fails, reverse CART technique is the next step. IVUS guided wiring is a last resort. The 2nd wire is manipulated with IVUS guidance. Now, initial success rate is more than 90% with these methods.

A Review of Gas-Cooled Reactor Concepts for SDI Applications

DTIC Science & Technology

1989-08-01

710 program .) Wire- Core Reactor (proposed by Rockwell). The wire- core reactor utilizes thin fuel wires woven between spacer wires to form an open...reactor is based on results of developmental studies of nuclear rocket propulsion systems. The reactor core is made up of annular fuel assemblies of...XE Addendum to Volume II. NERVA Fuel Development , Westinghouse Astronuclear Laboratory, TNR-230, July 15’ 1972. J I8- Rover Program Reactor Tests

46 CFR 111.30-19 - Buses and wiring.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Buses and wiring. 111.30-19 Section 111.30-19 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-19 Buses and wiring. (a) General. Each bus must meet the requirements of...

46 CFR 111.30-19 - Buses and wiring.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Buses and wiring. 111.30-19 Section 111.30-19 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-19 Buses and wiring. (a) General. Each bus must meet the requirements of...

46 CFR 111.30-19 - Buses and wiring.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Buses and wiring. 111.30-19 Section 111.30-19 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-19 Buses and wiring. (a) General. Each bus must meet the requirements of...

46 CFR 111.30-19 - Buses and wiring.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Buses and wiring. 111.30-19 Section 111.30-19 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-19 Buses and wiring. (a) General. Each bus must meet the requirements of...

77 FR 9518 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

...) Installation of New Relay and Wiring Bundle Within 72 months after the effective date of this AD: Change the... and temperature control system (CACTCS). This AD requires doing certain wiring changes, installing a new relay and necessary wiring in the CACTCS, and performing an operational test of the cooling pack...

Aluminum Lithium Alloy 2195 Fusion Welding Improvements with New Filler Wire

NASA Technical Reports Server (NTRS)

Russell, Carolyn; Bjorkman, Gerry; McCool, Carolyn (Technical Monitor)

2000-01-01

A viewgraph presentation outlines NASA Marshall Space Flight Center, Lockheed Martin Michoud Space Systems, and McCook Metals' development an aluminum-copper weld filler wire for fusion welding 2195 aluminum lithium. The aluminum-copper based weld filler wire has been identified as B218, which is the result of six years of weld filler wire development funded by NASA, Lockheed Martin, and McCook Metals. The Super Lightweight External Tank for the NASA Space Shuttle Program consists of 2195 welded with 4043 aluminum-silicon weld filler wire. The B218 filler wire chemistry was developed to produce enhanced 2195 weld and repair weld mechanical properties. An initial characterization of the B218 weld filler wire was performed consisting of initial weld and repair weld evaluation comparing B218 and 4043. The testing involved room temperature and cryogenic tensile testing along with fracture toughness testing. B218 weld filler wire proved to produce enhanced initial and repair weld tensile and fracture properties over 4043. B218 weld filler wire has proved to be a superior weld filler wire for welding 2195 and other aluminum lithium alloys over 4043.

Measurement of the geometric parameters of power contact wire based on binocular stereovision

NASA Astrophysics Data System (ADS)

Pan, Xue-Tao; Zhang, Ya-feng; Meng, Fei

2010-10-01

In the electrified railway power supply system, electric locomotive obtains power from the catenary's wire through the pantograph. Under the action of the pantograph, combined with various factors such as vibration, touch current, relative sliding speed, load, etc, the contact wire will produce mechanical wear and electrical wear. Thus, in electrified railway construction and daily operations, the geometric parameters such as line height, pull value, the width of wear surface must be under real-timely and non-contact detection. On the one hand, the safe operation of electric railways will be guaranteed; on the other hand, the wire endurance will be extended, and operating costs reduced. Based on the characteristics of the worn wires' image signal, the binocular stereo vision technology was applied for measurement of contact wire geometry parameters, a mathematical model of measurement of geometric parameters was derived, and the boundaries of the wound wire abrasion-point value were extracted by means of sub-pixel edge detection method based on the LOG operator with the least-squares fitting, thus measurements of the wire geometry parameters were realized. Principles were demonstrated through simulation experiments, and the experimental results show that the detection methods presented in this paper for measuring the accuracy, efficiency and convenience, etc. are close to or superior to the traditional measurements, which has laid a good foundation for the measurement system of geometric parameters for the contact wire of the development of binocular vision.

Interface for the rapid analysis of liquid samples by accelerator mass spectrometry

DOEpatents

Turteltaub, Kenneth; Ognibene, Ted; Thomas, Avi; Daley, Paul F; Salazar Quintero, Gary A; Bench, Graham

2014-02-04

An interface for the analysis of liquid sample having carbon content by an accelerator mass spectrometer including a wire, defects on the wire, a system for moving the wire, a droplet maker for producing droplets of the liquid sample and placing the droplets of the liquid sample on the wire in the defects, a system that converts the carbon content of the droplets of the liquid sample to carbon dioxide gas in a helium stream, and a gas-accepting ion source connected to the accelerator mass spectrometer that receives the carbon dioxide gas of the sample in a helium stream and introduces the carbon dioxide gas of the sample into the accelerator mass spectrometer.

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems.

PubMed

Glover, Jack L; Hudson, Lawrence T

2016-06-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in a US national aviation security standard.

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems

PubMed Central

Glover, Jack L.; Hudson, Lawrence T.

2016-01-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in a US national aviation security standard. PMID:27499586

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems

NASA Astrophysics Data System (ADS)

Glover, Jack L.; Hudson, Lawrence T.

2016-06-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in an international aviation security standard.

Polymer Chemistry

NASA Technical Reports Server (NTRS)

Williams, Martha; Roberson, Luke; Caraccio, Anne

2010-01-01

This viewgraph presentation describes new technologies in polymer and material chemistry that benefits NASA programs and missions. The topics include: 1) What are Polymers?; 2) History of Polymer Chemistry; 3) Composites/Materials Development at KSC; 4) Why Wiring; 5) Next Generation Wiring Materials; 6) Wire System Materials and Integration; 7) Self-Healing Wire Repair; 8) Smart Wiring Summary; 9) Fire and Polymers; 10) Aerogel Technology; 11) Aerogel Composites; 12) Aerogels for Oil Remediation; 13) KSC's Solution; 14) Chemochromic Hydrogen Sensors; 15) STS-130 and 131 Operations; 16) HyperPigment; 17) Antimicrobial Materials; 18) Conductive Inks Formulations for Multiple Applications; and 19) Testing and Processing Equipment.

Gallbladder Diseases - Multiple Languages

MedlinePlus

... Cantonese dialect) (繁體中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) Portuguese (português) Russian (Русский) Somali ( ... हिन्दी (Hindi) Bilingual PDF Health Information Translations Japanese (日本語) Expand Section ERCP (Endoscopic Retrograde Cholangiopancreatography) - 日本語 ( ...

A NASA/Industry/University Partnership for Development of Dual-Use Vibration Isolation Technology

NASA Technical Reports Server (NTRS)

Tinker, Michael L.

1994-01-01

A partnership is described that was formed as a result of a NASA university grant for the study of wire rope vibration isolation systems. Vibration isolators of this type are currently used in the Space Shuttle Orbiter and engine test facility, and have potential application in the international space station and other space vehicles. Wire rope isolators were considered for use on the Hubble Space Telescope and the military has used wire rope technology extensively. The desire of the wire rope industry to expand sales in commercial markets coupled with results of the prior NASA funded study, led to the formation of a partnership including NASA, the university involved in the research grant, and a small company that designs wire rope systems. Goals include the development of improved mathematical models and a designers handbook to facilitate the use of the new modeling tools.

Apparatus and method supporting wireless access to multiple security layers in an industrial control and automation system or other system

DOEpatents

Chen, Yu-Gene T.

2013-04-16

A method includes receiving a message at a first wireless node. The first wireless node is associated with a first wired network, and the first wired network is associated with a first security layer. The method also includes transmitting the message over the first wired network when at least one destination of the message is located in the first security layer. The method further includes wirelessly transmitting the message for delivery to a second wireless node when at least one destination of the message is located in a second security layer. The second wireless node is associated with a second wired network, and the second wired network is associated with the second security layer. The first and second security layers may be associated with different security paradigms and/or different security domains. Also, the message could be associated with destinations in the first and second security layers.

A Potential Pitfall in the Use of the Monorail System for Carotid Stenting

PubMed Central

Pereira, E.; Birnbaum, L.

2006-01-01

Summary The use of EPDs seems to be necessary for safe CAS. Though the monorail system may offer advantages for a single operator, we caution its use with certain aortic arch anatomies. In such anatomies, using an OTW system or at least a 300 cm filter wire or devices that support wire extension will remedy some complications, such as the loss of the guiding sheath. As in our case, the added advantage of a 300 cm filter wire enabled us to avoid a poor outcome or an emergency vascular surgery. PMID:20569594

A potential pitfall in the use of the monorail system for carotid stenting. A technical case report.

PubMed

Pereira, E; Birnbaum, L

2006-12-15

The use of EPDs seems to be necessary for safe CAS. Though the monorail system may offer advantages for a single operator, we caution its use with certain aortic arch anatomies. In such anatomies, using an OTW system or at least a 300 cm filter wire or devices that support wire extension will remedy some complications, such as the loss of the guiding sheath. As in our case, the added advantage of a 300 cm filter wire enabled us to avoid a poor outcome or an emergency vascular surgery.

Aging Aircraft 2005, The Joint NASA/FAA/DOD Conference on Aging Aircraft, Decision algorithms for Electrical Wiring Interconnect Systems (EWIS)Fault Detection

DTIC Science & Technology

2005-02-03

Aging Aircraft 2005 The 8th Joint NASA /FAA/DOD Conference on Aging Aircraft Decision Algorithms for Electrical Wiring Interconnect Systems (EWIS...SUBTITLE Aging Aircraft 2005, The 8th Joint NASA /FAA/DOD Conference on Aging Aircraft, Decision algorithms for Electrical Wiring Interconnect...UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) NASA Langley Research Center, 8W. Taylor St., M/S 190 Hampton, VA 23681 and NAVAIR

KSC-07pd3632

NASA Image and Video Library

2007-12-14

KENNEDY SPACE CENTER, FLA. -- On Launch Pad 39A, technicians overlook wires and monitoring equipment that will be used to validate the circuit on the test wiring from the electrical harness in space shuttle Atlantis' aft main engine compartment connected with the engine cut-off system. The test wiring leads from the tail mast on the mobile launcher platform to the interior where the Time Domain Reflectometry, or TDR, test equipment will be located to test the sensor system. Photo credit: NASA/Kim Shiflett

Steady-state analysis of a faulted three-phase four-wire system supplying induction motors with neutrals connected and other single-phase line-to-neutral loads

NASA Technical Reports Server (NTRS)

Wood, M. E.

1980-01-01

Four wire Wye connected ac power systems exhibit peculiar steady state fault characteristics when the fourth wire of three phase induction motors is connected. The loss of one phase of power source due to a series or shunt fault results in currents higher than anticipated on the remaining two phases. A theoretical approach to compute the fault currents and voltages is developed. A FORTRAN program is included in the appendix.

Electrodynamic Tethers. 1: Power Generator in LEO. 2: Thrust for Propulsion and Power Storage

NASA Technical Reports Server (NTRS)

Mccoy, J. E.

1984-01-01

An electrodynamic tether consists of a long insulated wire in space whose orbital motion cuts across lines of magnetic flux to produce an induce voltage that in typical low orbits averages about 200 v/km. Such a system should be capable of generating substantial electrical power, at the expense of IXB drag acting on its orbital energy. If a reverse current is driven against the induced voltage, the system should act as a motor producing IXB thrust. A reference system was designed, capable of generating 20 KW of power into an electrical load located anywhere along the wire at the expense of 2.6N (20,000 J/sec) drag on the wire. In an ideal system, the conversion between mechanical and electrical energy would reach 100% efficiency. In the actual system part of the 20 KW is lost to internal resistance of the wire, plasma and ionosphere, while the drag force is increased by residual air drag. The 20 KW PMG system as designed is estimated to provide 18.7 KW net power to the load at total drag loss of 20.4 KJ/sec, or an overall efficiency of 92%. Similar systems using heavier wire appear capable of producing power levels in excess of 1 Megawatt at voltages of 2-4 KV, with conversion efficiency between mechanical and electrical power better than 95%. The hollow cathode based system should be readily reversible from generator to motor operation by driving a reverse current using onboard power.

An EEG (electroencephalogram) recording system with carbon wire electrodes for simultaneous EEG-fMRI (functional magnetic resonance imaging) recording

PubMed Central

Negishi, Michiro; Abildgaard, Mark; Laufer, Ilan; Nixon, Terry; Constable, Robert Todd

2008-01-01

Simultaneous EEG-fMRI (Electroencephalography-functional Magnetic Resonance Imaging) recording provides a means for acquiring high temporal resolution electrophysiological data and high spatial resolution metabolic data of the brain in the same experimental runs. Carbon wire electrodes (not metallic EEG electrodes with carbon wire leads) are suitable for simultaneous EEG-fMRI recording, because they cause less RF (radio-frequency) heating and susceptibility artifacts than metallic electrodes. These characteristics are especially desirable for recording the EEG in high field MRI scanners. Carbon wire electrodes are also comfortable to wear during long recording sessions. However, carbon electrodes have high electrode-electrolyte potentials compared to widely used Ag/AgCl (silver/silver-chloride) electrodes, which may cause slow voltage drifts. This paper introduces a prototype EEG recording system with carbon wire electrodes and a circuit that suppresses the slow voltage drift. The system was tested for the voltage drift, RF heating, susceptibility artifact, and impedance, and was also evaluated in a simultaneous ERP (event-related potential)-fMRI experiment. PMID:18588913

46 CFR 111.105-17 - Wiring methods for hazardous locations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Wiring methods for hazardous locations. 111.105-17... ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Hazardous Locations § 111.105-17 Wiring methods for... made with dust-tight cable entrance seals approved for the installation. [CGD 94-108, 61 FR 28284, June...

Randomized comparison of the magnetic navigation system vs. standard wires in the treatment of bifurcations.

PubMed

Ramcharitar, Steve; van der Giessen, Willem J; van der Ent, Martin; Serruys, Patrick W; van Geuns, Robert Jan

2011-06-01

Aims Randomly compare the magnetic navigation system (MNS) to standard guidewire techniques in managing bifurcating lesions. Methods and results Thirty-one consecutive patients with bifurcating lesions were randomized to cross the bifurcating vessels prior to treatment and thereafter the struts of deployed stents with either magnetic or standard guidewires. Crossing success, crossing/fluoroscopy times, and contrast media usage were directly compared. Similar times were noted in both the magnetic wire crossings (median, IQR; 68 s, 45-138 s vs. 59 s, 32-133 s) and fluoroscopic times (median, IQR; 62 s, 44-135 s vs. 55 s, 27-133 s) when compared with standard conventional wires passage through the deployed struts. The MNS successful crossings were 30/31 (96.8%) compared with 28/31 (90.0%) observed with the standard wires. Two previously failed standard wire cases were successfully crossed with magnetic guidewires. Conclusion In contemporary stented bifurcations, the MNS achieved equivalent crossing/fluoroscopy times through deployed stents struts and may be useful in salvaging failed standard wire cases.

Integrated Electrical Wire Insulation Repair System

NASA Technical Reports Server (NTRS)

Williams, Martha; Jolley, Scott; Gibson, Tracy; Parks, Steven

2013-01-01

An integrated system tool will allow a technician to easily and quickly repair damaged high-performance electrical wire insulation in the field. Low-melt polyimides have been developed that can be processed into thin films that work well in the repair of damaged polyimide or fluoropolymer insulated electrical wiring. Such thin films can be used in wire insulation repairs by affixing a film of this low-melt polyimide to the damaged wire, and heating the film to effect melting, flow, and cure of the film. The resulting repair is robust, lightweight, and small in volume. The heating of this repair film is accomplished with the use of a common electrical soldering tool that has been modified with a special head or tip that can accommodate the size of wire being repaired. This repair method can furthermore be simplified for the repair technician by providing replaceable or disposable soldering tool heads that have repair film already "loaded" and ready for use. The soldering tool heating device can also be equipped with a battery power supply that will allow its use in areas where plug-in current is not available

Amplification of Reynolds number dependent processes by wave distortion. [acoustic instability of liquid propellant rocket engines

NASA Technical Reports Server (NTRS)

Ventrice, M. B.; Fang, J. C.; Purdy, K. R.

1975-01-01

A system using a hot-wire transducer as an analog of a liquid droplet of propellant was employed to investigate the ingredients of the acoustic instability of liquid-propellant rocket engines. It was assumed that the combustion process was vaporization-limited and that the combustion chamber was acoustically similar to a closed-closed right-circular cylinder. Before studying the hot-wire closed-loop system (the analog system), a microphone closed-loop system, which used the response of a microphone as the source of a linear feedback exciting signal, was investigated to establish the characteristics of self-sustenance of acoustic fields. Self-sustained acoustic fields were found to occur only at resonant frequencies of the chamber. In the hot-wire closed-loop system, the response of hot-wire anemometer was used as the source of the feedback exciting signal. The self-sustained acoustic fields which developed in the system were always found to be harmonically distorted and to have as their fundamental frquency a resonant frequency for which there also existed a second resonant frequency which was approximately twice the fundamental frequency.

Development of automatic pre-tracking system for fillet weld based on laser trigonometry

NASA Astrophysics Data System (ADS)

Shen, Xiaoqin; Yu, Fusheng

2005-01-01

In this paper, an automatic fillet weld pre-tracking system for welding the work piece of lorry back boards with several bend in haul automobile is developed basing on laser trigonometry. The optical measuring head based on laser-PSD trigonometry is used as position sensor. It is placed in front of the traveling direction of welding wire to get the distances from welding wire to the two side boards of the welding lines, upper board and bottom board of the fillet weld respectively. A chip of AT89S52 is used as the micro controller in this system. The AC servomotors, ball-screws and straight guide rails constitute the sliding table to take welding wire move. The laser-PSD sensors pass through the vertical board, upper board and bottom board of the fillet weld when welding wire moves and then get the distance. The laser-PSD sensors output the analog signals. After A/D conversion, the digital signal is input into AT89S52 and calculated. Then the information of the position and lateral deviation of the welding wire when welding a certain position are gotten to control welding wires. So the weld pre-tracking for welding the work piece with long distance and large bend in haul automobile is realized. The position information is input into EEPROM to be saved for short time after handled by AT89S52. The information is as the welding position information as well as the speed adjusting data of the welding wire when it welds the several bend of the work piece. The practice indicates that this system has high pre-tracking precision, good anti-disturb ability, excellent reliability, easy operating ability and good adaptability to the field of production.

The mechatronic design of a fast wire scanner in IHEP U-70 accelerator

NASA Astrophysics Data System (ADS)

Baranov, V. T.; Makhov, S. S.; Savin, D. A.; Terekhov, V. I.

2016-10-01

This paper presents the mechatronic design of a fast wire scanner based on a servomotor. The design of the wire scanner is motivated by the need to measure the transverse profile of the high power proton and carbon beams at the IHEP U-70 accelerator. This paper formulates the requirements to the fast wire scanner system for the high intensity proton beam at the U-70 accelerator. The results on the design of electro-mechanical device for the wire scanner with a wire traveling speed 10-20 m/s are presented. The solution consists in a brushless servomotor and standard motor control electronics. High radiation levels in the accelerator enclosure dictate the use of a resolver as the position feedback element.

Shape memory alloy heat engines and energy harvesting systems

DOEpatents

Browne, Alan L; Johnson, Nancy L; Shaw, John Andrew; Churchill, Christopher Burton; Keefe, Andrew C; McKnight, Geoffrey P; Alexander, Paul W; Herrera, Guillermo A; Yates, James Ryan; Brown, Jeffrey W

2014-09-30

A heat engine includes a first rotatable pulley and a second rotatable pulley spaced from the first rotatable pulley. A shape memory alloy (SMA) element is disposed about respective portions of the pulleys at an SMA pulley ratio. The SMA element includes a first wire, a second wire, and a matrix joining the first wire and the second wire. The first wire and the second wire are in contact with the pulleys, but the matrix is not in contact with the pulleys. A timing cable is disposed about respective portions of the pulleys at a timing pulley ratio, which is different than the SMA pulley ratio. The SMA element converts a thermal energy gradient between the hot region and the cold region into mechanical energy.

Welding wire pressure sensor assembly

NASA Technical Reports Server (NTRS)

Morris, Timothy B. (Inventor); Milly, Peter F., Sr. (Inventor); White, J. Kevin (Inventor)

1994-01-01

The present invention relates to a device which is used to monitor the position of a filler wire relative to a base material being welded as the filler wire is added to a welding pool. The device is applicable to automated welding systems wherein nonconsumable electrode arc welding processes are utilized in conjunction with a filler wire which is added to a weld pool created by the electrode arc. The invention senses pressure deviations from a predetermined pressure between the filler wire and the base material, and provides electrical signals responsive to the deviations for actuating control mechanisms in an automatic welding apparatus so as to minimize the pressure deviation and to prevent disengagement of the contact between the filler wire and the base material.

Mechanization of and experience with a triplex fly-by-wire backup control system

NASA Technical Reports Server (NTRS)

Lock, W. P.; Petersen, W. R.; Whitman, G. B.

1976-01-01

A redundant three axis analog control system was designed and developed to back up a digital fly by wire control system for an F-8C airplane. The mechanization and operational experience with the backup control system, the problems involved in synchronizing it with the primary system, and the reliability of the system are discussed. The backup control system was dissimilar to the primary system, and it provided satisfactory handling through the flight envelope evaluated. Limited flight tests of a variety of control tasks showed that control was also satisfactory when the backup control system was controlled by a minimum displacement (force) side stick. The operational reliability of the F-8 digital fly by wire control system was satisfactory, with no unintentional downmodes to the backup control system in flight. The ground and flight reliability of the system's components is discussed.

[Contrast of Z-Pinch X-Ray Yield Measure Technique].

PubMed

Li, Mo; Wang, Liang-ping; Sheng, Liang; Lu, Yi

2015-03-01

Resistive bolometer and scintillant detection system are two mainly Z-pinch X-ray yield measure techniques which are based on different diagnostic principles. Contrasting the results from two methods can help with increasing precision of X-ray yield measurement. Experiments with different load material and shape were carried out on the "QiangGuang-I" facility. For Al wire arrays, X-ray yields measured by the two techniques were largely consistent. However, for insulating coating W wire arrays, X-ray yields taken from bolometer changed with load parameters while data from scintillant detection system hardly changed. Simulation and analysis draw conclusions as follows: (1) Scintillant detection system is much more sensitive to X-ray photons with low energy and its spectral response is wider than the resistive bolometer. Thus, results from the former method are always larger than the latter. (2) The responses of the two systems are both flat to Al plasma radiation. Thus, their results are consistent for Al wire array loads. (3) Radiation form planar W wire arrays is mainly composed of sub-keV soft X-ray. X-ray yields measured by the bolometer is supposed to be accurate because of the nickel foil can absorb almost all the soft X-ray. (4) By contrast, using planar W wire arrays, data from scintillant detection system hardly change with load parameters. A possible explanation is that while the distance between wires increases, plasma temperature at stagnation reduces and spectra moves toward the soft X-ray region. Scintillator is much more sensitive to the soft X-ray below 200 eV. Thus, although the total X-ray yield reduces with large diameter load, signal from the scintillant detection system is almost the same. (5) Both Techniques affected by electron beams produced by the loads.

Fast wire per wire X-ray data acquisition system for time-resolved small angle scattering experiments

NASA Astrophysics Data System (ADS)

Epstein, A.; Briquet-Laugier, F.; Sheldon, S.; Boulin, C.

2000-04-01

Most of the X-ray multi-wire gas detectors used at the EMBL Hamburg outstation for time-resolved studies of biological samples are readout, using the delay line method. The main disadvantage of such readout systems is their event rate limitation introduced by the delay line and the required time to digital conversion step. They also lack the possibility to deal with multiple events. To overcome these limitations, a new approach for the complete readout system was introduced. The new linear detection system is based on the wire per wire approach where each individual wire is associated to preamplifier/discriminator/counter electronics channel. High-density, front-end electronics were designed around a fast current sensitive preamplifier. An eight-channel board was designed to include the preamplifiers-discriminators and the differential ECL drivers output stages. The detector front-end consists of 25 boards directly mounted inside the detector assembly. To achieve a time framing resolution as short as 10 /spl mu/s, very fast histogramming is required. The only way to implement this for a high number of channels (200 in our case) is by using a distributed system. The digital part of the system consists of a crate controller, up to 16 acquisition boards (capable of handling fast histogramming for up to 32-channels each) and an optical-link board (based on the Cypress "Hot-Link" chip set). Both the crate controller and the acquisition boards are based on a standard RISC microcontroller (IDT R3081) plug-in board. At present, a dedicated CAMAC module which we developed is used to interface the digital front-end acquisition crate to the host via the optical link.

Preliminary system design study for a digital fly-by-wire flight control system for an F-8C aircraft

NASA Technical Reports Server (NTRS)

Seacord, C. L.; Vaughn, D. K.

1976-01-01

The design of a fly-by-wire control system having a mission failure probability of less than one millionth failures per flight hour is examined. Emphasis was placed on developing actuator configurations that would improve the system performance, and consideration of the practical aspects of sensor/computer and computer/actuator interface implementation. Five basic configurations were defined as appropriate candidates for the F-8C research aircraft. Options on the basic configurations were included to cover variations in flight sensors, redundancy levels, data transmission techniques, processor input/output methods, and servo actuator arrangements. The study results can be applied to fly by wire systems for transport aircraft in general and the space shuttle.

Stationary drag photocurrent caused by strong effective running wave in quantum wires: Quantization of current

NASA Astrophysics Data System (ADS)

Entin, M. V.; Magarill, L. I.

2010-02-01

The stationary current induced by a strong running potential wave in one-dimensional system is studied. Such a wave can result from illumination of a straight quantum wire with special grating or spiral quantum wire by circular-polarized light. The wave drags electrons in the direction correlated with the direction of the system symmetry and polarization of light. In a pure system the wave induces minibands in the accompanied system of reference. We study the effect in the presence of impurity scattering. The current is an interplay between the wave drag and impurity braking. It was found that the drag current is quantized when the Fermi level gets into energy gaps.

A numerical simulation of tooth movement by wire bending.

PubMed

Kojima, Yukio; Fukui, Hisao

2006-10-01

In orthodontic treatment, wires are bent and attached to teeth to move them via elastic recovery. To predict how a tooth will move, the initial force system produced from the wire is calculated. However, the initial force system changes as the tooth moves and may not be used to predict the final tooth position. The purpose of this study was to develop a comprehensive mechanical, 3-dimensional, numerical model for predicting tooth movement. Tooth movements produced by wire bending were simulated numerically. The teeth moved as a result of bone remodeling, which occurs in proportion to stress in the periodontal ligament. With an off-center bend, a tooth near the bending position was subjected to a large moment and tipped more noticeably than the other teeth. Also, a tooth far from the bending position moved slightly in the mesial or the distal direction. With the center V-bend, when the second molar was added as an anchor tooth, the tipping angle and the intrusion of the canine increased, and movement of the first molar was prevented. When a wire with an inverse curve of Spee was placed in the mandibular arch, the calculated tendency of vertical tooth movements was the same as the measured result. In these tooth movements, the initial force system changed as the teeth moved. Tooth movement was influenced by the size of the root surface area. Tooth movements produced by wire bending could be estimated. It was difficult to predict final tooth positions from the initial force system.

Metal muscles and nerves—a self-sensing SMA-actuated hand concept

NASA Astrophysics Data System (ADS)

Simone, F.; Rizzello, G.; Seelecke, S.

2017-09-01

Bio-inspired hand-like grippers actuated by Shape Memory Alloy (SMA) wires represent an emerging new technology with potential applications in many different fields, ranging from industrial assembly processes to biomedical systems. The inherently high energy density makes SMAs a natural choice for compact, lightweight, and silent actuator systems capable of producing a high amount of work, such as hand prostheses or robotic systems in industrial human/machine environments. In this work, a concept for a compact and versatile gripping system is developed, in which SMA wires are implemented as antagonistic muscles actuating an artificial hand with three fingers. In order to combine high gripping force with sufficient actuation speed, the muscle implementation pursues a multi-wire concept with several 0.1 mm diameter NiTi wires connected in parallel, in order to increase the surface-to-volume ratio for accelerated cooling. The paper starts with an illustration of the design concept of an individual 3-phalanx-finger, along with kinematic considerations for optimal placement of SMA wires. Three identical fingers are subsequently fabricated via 3D printing and assembled into a hand-like gripper. The maximum displacement of each finger phalanx is measured, and an average phalanxes dynamic responsiveness is evaluated. SMA self-sensing is documented by experiments relating the wires change in resistance to the finger motion. Several finger force measurements are also performed. The versatility of the gripper is finally documented by displaying a variety of achievable grasping configurations.

Structural Properties of Single-Strand Orthodontic Wires from a Proposed Alternative Standard Flexure Test.

DTIC Science & Technology

1984-01-01

structural system the orthodontic appliance consists intraorally of bands or bonded pads and the attached brackets , the arch wires, the ligatures, and any...RD-Ali5B 994 STRUCTURAL PROPERTIES OF SINGLE-STRAND ORTHODONTIC i/i WIRES FROM A PROPOSED__(U) AIR FORCE INST OF TECH WRIGHT-PATTERSON RFB OH M L... Orthodontic Wires From A Proposed Alternative - Standard Flexure Test 6. PERPOMING o1. REPORT NUMBER AUTNOR(e) I. CONTRACT O& GRANT NUMUER(a) Marion L

An interactive wire-wrap board layout program

NASA Technical Reports Server (NTRS)

Schlutsmeyer, A.

1987-01-01

An interactive computer-graphics-based tool for specifying the placement of electronic parts on a wire-wrap circuit board is presented. Input is a data file (currently produced by a commercial logic design system) which describes the parts used and their interconnections. Output includes printed reports describing the parts and wire paths, parts counts, placement lists, board drawing, and a tape to send to the wire-wrap vendor. The program should reduce the engineer's layout time by a factor of 3 to 5 as compared to manual methods.

Powerplexer

NASA Technical Reports Server (NTRS)

Woods, J. M. (Inventor)

1973-01-01

An electrical power distribution system is described for use in providing different dc voltage levels. A circuit is supplied with DC voltage levels and commutates pulses for timed intervals onto a pair of distribution wires. The circuit is driven by a command generator which places pulses on the wires in a timed sequence. The pair of wires extend to voltage strippers connected to the various loads. The voltage strippers each respond to the pulse dc levels on the pair of wires and form different output voltages communicated to each load.

Graphics enhanced computer emulation for improved timing-race and fault tolerance control system analysis. [of Centaur liquid-fuel booster

NASA Technical Reports Server (NTRS)

Szatkowski, G. P.

1983-01-01

A computer simulation system has been developed for the Space Shuttle's advanced Centaur liquid fuel booster rocket, in order to conduct systems safety verification and flight operations training. This simulation utility is designed to analyze functional system behavior by integrating control avionics with mechanical and fluid elements, and is able to emulate any system operation, from simple relay logic to complex VLSI components, with wire-by-wire detail. A novel graphics data entry system offers a pseudo-wire wrap data base that can be easily updated. Visual subsystem operations can be selected and displayed in color on a six-monitor graphics processor. System timing and fault verification analyses are conducted by injecting component fault modes and min/max timing delays, and then observing system operation through a red line monitor.

Problems with aging wiring in Naval aircraft

NASA Technical Reports Server (NTRS)

Campbell, Frank J.

1994-01-01

The Navy is experiencing a severe aircraft electrical wiring maintenance problem as a result of the extensive use of an aromatic polyimide insulation that is deteriorating at a rate that was unexpected when this wire was initially selected. This problem has significantly affected readiness, reliability, and safety and has greatly increased the cost of ownership of Naval aircraft. Failures in wire harnesses have exhibited arcing and burning that will propagate drastically, to the interruption of many electrical circuits from a fault initiated by the failure of deteriorating wires. There is an urgent need for a capability to schedule aircraft rewiring in an orderly manner with a logically derived determination of which aircraft have aged to the point of absolute necessity. Excessive maintenance was demonstrated to result from the accelerated aging due to the parameters of moisture, temperature, and strain that exist in the Naval Aircraft environment. Laboratory studies have demonstrated that MIL-W-81381 wire insulation when aged at high humidities followed the classical Arrhenius thermal aging relationship. In an extension of the project a multifactor formula was developed that is now capable of predicting life under varying conditions of these service parameters. An automated test system has also been developed to analyze the degree of deterioration that has occurred in wires taken from an aircraft in order to obtain an assessment of remaining life. Since it is both physically and financially impossible to replace the wiring in all the Navy's aircraft at once, this system will permit expedient scheduling so that those aircraft that are most probable to have wiring failure problems can be overhauled first.

Causes of failure with Szabo technique - an analysis of nine cases.

PubMed

Jain, Rajendra Kumar; Padmanabhan, T N C; Chitnis, Nishad

2013-01-01

The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Causes of failure with Szabo technique – An analysis of nine cases

PubMed Central

Jain, Rajendra Kumar; Padmanabhan, T.N.C.; Chitnis, Nishad

2013-01-01

Objective The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. Methods and results From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. Conclusion This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. PMID:23809379

Correlating electronic transport to atomic structures in self-assembled quantum wires.

PubMed

Qin, Shengyong; Kim, Tae-Hwan; Zhang, Yanning; Ouyang, Wenjie; Weitering, Hanno H; Shih, Chih-Kang; Baddorf, Arthur P; Wu, Ruqian; Li, An-Ping

2012-02-08

Quantum wires, as a smallest electronic conductor, are expected to be a fundamental component in all quantum architectures. The electronic conductance in quantum wires, however, is often dictated by structural instabilities and electron localization at the atomic scale. Here we report on the evolutions of electronic transport as a function of temperature and interwire coupling as the quantum wires of GdSi(2) are self-assembled on Si(100) wire-by-wire. The correlation between structure, electronic properties, and electronic transport are examined by combining nanotransport measurements, scanning tunneling microscopy, and density functional theory calculations. A metal-insulator transition is revealed in isolated nanowires, while a robust metallic state is obtained in wire bundles at low temperature. The atomic defects lead to electron localizations in isolated nanowire, and interwire coupling stabilizes the structure and promotes the metallic states in wire bundles. This illustrates how the conductance nature of a one-dimensional system can be dramatically modified by the environmental change on the atomic scale. © 2012 American Chemical Society

Needleless electrospinning with twisted wire spinneret

NASA Astrophysics Data System (ADS)

Holopainen, Jani; Penttinen, Toni; Santala, Eero; Ritala, Mikko

2015-01-01

A needleless electrospinning setup named ‘Needleless Twisted Wire Electrospinning’ was developed. The polymer solution is electrospun from the surface of a twisted wire set to a high voltage and collected on a cylindrical collector around the wire. Multiple Taylor cones are simultaneously self-formed on the downward flowing solution. The system is robust and simple with no moving parts aside from the syringe pump used to transport the solution to the top of the wire. The structure and process parameters of the setup and the results on the preparation of polyvinyl pyrrolidone (PVP), hydroxyapatite (HA) and bioglass fibers with the setup are presented. PVP fiber sheets with areas of 40 × 120 cm2 and masses up to 1.15 g were prepared. High production rates of 5.23 g h-1 and 1.40 g h-1 were achieved for PVP and HA respectively. The major limiting factor of the setup is drying of the polymer solution on the wire during the electrospinning process which will eventually force to interrupt the process for cleaning of the wire. Possible solutions to this problem and other ways to develop the setup are discussed. The presented system provides a simple way to increase the production rate and area of fiber sheet as compared with the conventional needle electrospinning.

Performance of Continuous Quantum Thermal Devices Indirectly Connected to Environments

NASA Astrophysics Data System (ADS)

González, J.; Alonso, Daniel; Palao, José

2016-04-01

A general quantum thermodynamics network is composed of thermal devices connected to the environments through quantum wires. The coupling between the devices and the wires may introduce additional decay channels which modify the system performance with respect to the directly-coupled device. We analyze this effect in a quantum three-level device connected to a heat bath or to a work source through a two-level wire. The steady state heat currents are decomposed into the contributions of the set of simple circuits in the graph representing the master equation. Each circuit is associated with a mechanism in the device operation and the system performance can be described by a small number of circuit representatives of those mechanisms. Although in the limit of weak coupling between the device and the wire the new irreversible contributions can become small, they prevent the system from reaching the Carnot efficiency.

Research of x-ray nondestructive detector for high-speed running conveyor belt with steel wire ropes

NASA Astrophysics Data System (ADS)

Wang, Junfeng; Miao, Changyun; Wang, Wei; Lu, Xiaocui

2008-03-01

An X-ray nondestructive detector for high-speed running conveyor belt with steel wire ropes is researched in the paper. The principle of X-ray nondestructive testing (NDT) is analyzed, the general scheme of the X-ray nondestructive testing system is proposed, and the nondestructive detector for high-speed running conveyor belt with steel wire ropes is developed. The hardware of system is designed with Xilinx's VIRTEX-4 FPGA that embeds PowerPC and MAC IP core, and its network communication software based on TCP/IP protocol is programmed by loading LwIP to PowerPC. The nondestructive testing of high-speed conveyor belt with steel wire ropes and network transfer function are implemented. It is a strong real-time system with rapid scanning speed, high reliability and remotely nondestructive testing function. The nondestructive detector can be applied to the detection of product line in industry.

Design of measuring system for wire diameter based on sub-pixel edge detection algorithm

NASA Astrophysics Data System (ADS)

Chen, Yudong; Zhou, Wang

2016-09-01

Light projection method is often used in measuring system for wire diameter, which is relatively simpler structure and lower cost, and the measuring accuracy is limited by the pixel size of CCD. Using a CCD with small pixel size can improve the measuring accuracy, but will increase the cost and difficulty of making. In this paper, through the comparative analysis of a variety of sub-pixel edge detection algorithms, polynomial fitting method is applied for data processing in measuring system for wire diameter, to improve the measuring accuracy and enhance the ability of anti-noise. In the design of system structure, light projection method with orthogonal structure is used for the detection optical part, which can effectively reduce the error caused by line jitter in the measuring process. For the electrical part, ARM Cortex-M4 microprocessor is used as the core of the circuit module, which can not only drive double channel linear CCD but also complete the sampling, processing and storage of the CCD video signal. In addition, ARM microprocessor can complete the high speed operation of the whole measuring system for wire diameter in the case of no additional chip. The experimental results show that sub-pixel edge detection algorithm based on polynomial fitting can make up for the lack of single pixel size and improve the precision of measuring system for wire diameter significantly, without increasing hardware complexity of the entire system.

The Effects of Operational Parameters on a Mono-wire Cutting System: Efficiency in Marble Processing

NASA Astrophysics Data System (ADS)

Yilmazkaya, Emre; Ozcelik, Yilmaz

2016-02-01

Mono-wire block cutting machines that cut with a diamond wire can be used for squaring natural stone blocks and the slab-cutting process. The efficient use of these machines reduces operating costs by ensuring less diamond wire wear and longer wire life at high speeds. The high investment costs of these machines will lead to their efficient use and reduce production costs by increasing plant efficiency. Therefore, there is a need to investigate the cutting performance parameters of mono-wire cutting machines in terms of rock properties and operating parameters. This study aims to investigate the effects of the wire rotational speed (peripheral speed) and wire descending speed (cutting speed), which are the operating parameters of a mono-wire cutting machine, on unit wear and unit energy, which are the performance parameters in mono-wire cutting. By using the obtained results, cuttability charts for each natural stone were created on the basis of unit wear and unit energy values, cutting optimizations were performed, and the relationships between some physical and mechanical properties of rocks and the optimum cutting parameters obtained as a result of the optimization were investigated.

B218 Weld Filler Wire Characterization for Al-Li Alloy 2195

NASA Technical Reports Server (NTRS)

Bjorkman, Gerry; Russell, Carolyn

2000-01-01

NASA Marshall Space Flight Center, Lockheed Martin Space Systems- Michoud Operations, and McCook Metals have developed an aluminum-copper weld filler wire for fusion welding aluminum lithium alloy 2195. The aluminum-copper based weld filler wire has been identified as B218, a McCook Metals designation. B218 is the result of six years of weld filler wire development funded by NASA, Lockheed Martin, and McCook Metals. The filler wire chemistry was developed to produce enhanced 2195 weld and repair weld mechanical properties over the 4043 aluminum-silicon weld filler wire, which is currently used to weld 2195 on the Super Lightweight External Tank for the NASA Space Shuttle Program. An initial characterization was performed consisting of a repair weld evaluation using B218 and 4043 weld filler wires. The testing involved room temperature and cryogenic repair weld tensile testing along with fracture toughness testing. From the testing, B218 weld filler wire produce enhanced repair weld tensile strength, ductility, and fracture properties over 4043. B218 weld filler wire has proved to be a superior weld filler wire for welding aluminum lithium alloy 2195 over 4043.

A Novel Two-Wire Fast Readout Approach for Suppressing Cable Crosstalk in a Tactile Resistive Sensor Array

PubMed Central

Wu, Jianfeng; Wang, Yu; Li, Jianqing; Song, Aiguo

2016-01-01

For suppressing the crosstalk problem due to wire resistances and contacted resistances of the long flexible cables in tactile sensing systems, we present a novel two-wire fast readout approach for the two-dimensional resistive sensor array in shared row-column fashion. In the approach, two wires are used for every driving electrode and every sampling electrode in the resistive sensor array. The approach with a high readout rate, though it requires a large number of wires and many sampling channels, solves the cable crosstalk problem. We also verified the approach’s performance with Multisim simulations and actual experiments. PMID:27213373

Investigation of factors affecting the heater wire method of calibrating fine wire thermocouples

NASA Technical Reports Server (NTRS)

Keshock, E. G.

1972-01-01

An analytical investigation was made of a transient method of calibrating fine wire thermocouples. The system consisted of a 10 mil diameter standard thermocouple (Pt, Pt-13% Rh) and an 0.8 mil diameter chromel-alumel thermocouple attached to a 20 mil diameter electrically heated platinum wire. The calibration procedure consisted of electrically heating the wire to approximately 2500 F within about a seven-second period in an environment approximating atmospheric conditions at 120,000 feet. Rapid periodic readout of the standard and fine wire thermocouple signals permitted a comparison of the two temperature indications. An analysis was performed which indicated that the temperature distortion at the heater wire produced by the thermocouple junctions appears to be of negligible magnitude. Consequently, the calibration technique appears to be basically sound, although several practical changes which appear desirable are presented and discussed. Additional investigation is warranted to evaluate radiation effects and transient response characteristics.

Pull-pull position control of dual motor wire rope transmission.

PubMed

Guo, Quan; Jiao, Zongxia; Yan, Liang; Yu, Qian; Shang, Yaoxing

2016-08-01

Wire rope transmission is very efficient because of the small total moving object mass. The wire rope could only transmit pulling force. Therefore it has to be kept in a tightened state during transmission; in high speed applications the dynamic performance depends on the rope's stiffness, which can be adjusted by the wire rope tension. To improve the system dynamic performance output, this paper proposes a novel pull-pull method based on dual motors connected by wire ropes, for precise, high speed position control applications. The method can regulate target position and wire rope tension simultaneously. Wire ropes remain in a pre-tightening state at all times, which prevents the influence of elasticity and reduces the position tracking error in the changing direction process. Simulations and experiments were conducted; the results indicate that both position precision and superior dynamic performance can be synchronously achieved. The research is relevant to space craft precision pointing instruments.

Prediction of multi performance characteristics of wire EDM process using grey ANFIS

NASA Astrophysics Data System (ADS)

Kumanan, Somasundaram; Nair, Anish

2017-09-01

Super alloys are used to fabricate components in ultra-supercritical power plants. These hard to machine materials are processed using non-traditional machining methods like Wire cut electrical discharge machining and needs attention. This paper details about multi performance optimization of wire EDM process using Grey ANFIS. Experiments are designed to establish the performance characteristics of wire EDM such as surface roughness, material removal rate, wire wear rate and geometric tolerances. The control parameters are pulse on time, pulse off time, current, voltage, flushing pressure, wire tension, table feed and wire speed. Grey relational analysis is employed to optimise the multi objectives. Analysis of variance of the grey grades is used to identify the critical parameters. A regression model is developed and used to generate datasets for the training of proposed adaptive neuro fuzzy inference system. The developed prediction model is tested for its prediction ability.

46 CFR 183.340 - Cable and wiring requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... a manner as to avoid chafing and other damage. The use of plastic tie wraps must be limited to... requirements. (a) If individual wires, rather than cable, are used in systems greater than 50 volts, the wire... current carrying capacity for the circuit in which they are used; (2) Be installed in a manner to avoid or...

46 CFR 120.340 - Cable and wiring requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... chafing and other damage. The use of plastic tie wraps must be limited to bundling or retention of... wires, rather than cables, are used in systems greater than 50 volts, the wire must be in conduit. (b... for the circuit in which they are used; (2) Be installed in a manner to avoid or reduce interference...

Wire-Guide Manipulator For Automated Welding

NASA Technical Reports Server (NTRS)

Morris, Tim; White, Kevin; Gordon, Steve; Emerich, Dave; Richardson, Dave; Faulkner, Mike; Stafford, Dave; Mccutcheon, Kim; Neal, Ken; Milly, Pete

1994-01-01

Compact motor drive positions guide for welding filler wire. Drive part of automated wire feeder in partly or fully automated welding system. Drive unit contains three parallel subunits. Rotations of lead screws in three subunits coordinated to obtain desired motions in three degrees of freedom. Suitable for both variable-polarity plasma arc welding and gas/tungsten arc welding.

Effects of Ionizing Radiation and Restraint Stress on Activity, Avoidance Conditioning, and Stomach Ulcers in Albino Rats.

DTIC Science & Technology

1984-03-01

surrounded the rat. The ends of the screen wire tube were twisted and secured with galvanized wire. Care was taken to wrap the screen wire tight so that...function. In N. R. DiLuzio and R. Paoletti (eds.). The reticuloendothelial system and atherosclerosis : Advances in experimental medicine and biology, pp

75 FR 70150 - Airworthiness Directives; McDonnell Douglas Corporation Model MD-11 and MD-11F Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... installation of hardware. Boeing stated that the original NPRM implies that only wiring changes would be required; installation of brackets and supporting hardware, however, are required in addition to the wiring... tail tank fuel system, a wiring change, and corrective actions if necessary. That NPRM was prompted by...

46 CFR 111.95-7 - Wiring of boat winch components.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Wiring of boat winch components. 111.95-7 Section 111.95... SYSTEMS-GENERAL REQUIREMENTS Electric Power-Operated Boat Winches § 111.95-7 Wiring of boat winch... electric installation from all sources of potential. The switch must be in series with and on the supply...

Micromagnetic simulations of anisotropies in coupled and uncoupled ferromagnetic nanowire systems.

PubMed

Blachowicz, T; Ehrmann, A

2013-01-01

The influence of a variation of spatial relative orientations onto the coupling dynamics and subsequent magnetic anisotropies was modeled in ferromagnetic nanowires. The wires were analyzed in the most elementary configurations, thus, arranged in pairs perpendicular to each other, leading to one-dimensional (linear) and zero-dimensional (point-like) coupling. Different distances within each elementary pair of wires and between the pairs give rise to varying interactions between parallel and perpendicular wires, respectively. Simulated coercivities show an exchange of easy and hard axes for systems with different couplings. Additionally, two of the systems exhibit a unique switching behavior which can be utilized for developing new functionalities.

Risk management in fly-by-wire systems

NASA Technical Reports Server (NTRS)

Knoll, Karyn T.

1993-01-01

A general description of various types of fly-by-wire systems is provided. The risks inherent in digital flight control systems, like those used in the Space Shuttle, are identified. The results of a literature survey examining risk management methods in use throughout the aerospace industry are presented. The applicability of these methods to the Space Shuttle program is discussed.

14 CFR 25.1717 - Circuit protective devices: EWIS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Electrical Wiring Interconnection Systems (EWIS) § 25.1717 Circuit protective devices: EWIS. Electrical wires and cables must be designed and...

Breakdown dynamics of electrically exploding thin metal wires in vacuum

NASA Astrophysics Data System (ADS)

Sarkisov, G. S.; Caplinger, J.; Parada, F.; Sotnikov, V. I.

2016-10-01

Using a two-frame intensified charge coupled device (iCCD) imaging system with a 2 ns exposure time, we observed the dynamics of voltage breakdown and corona generation in experiments of fast ns-time exploding fine Ni and stainless-steel (SS) wires in a vacuum. These experiments show that corona generation along the wire surface is subjected to temporal-spatial inhomogeneity. For both metal wires, we observed an initial generation of a bright cathode spot before the ionization of the entire wire length. This cathode spot does not expand with time. For 25.4 μm diameter Ni and SS wire explosions with positive polarity, breakdown starts from the ground anode and propagates to the high voltage cathode with speeds approaching 3500 km/s or approximately one percent of light speed.

Ultrasonic Device for Assessing the Quality of a Wire Crimp

NASA Technical Reports Server (NTRS)

Yost, William T. (Inventor); Perey, Daniel F. (Inventor); Cramer, Karl E. (Inventor)

2015-01-01

A system for determining the quality of an electrical wire crimp between a wire and ferrule includes an ultrasonically equipped crimp tool (UECT) configured to transmit an ultrasonic acoustic wave through a wire and ferrule, and a signal processor in communication with the UECT. The signal processor includes a signal transmitting module configured to transmit the ultrasonic acoustic wave via an ultrasonic transducer, signal receiving module configured to receive the ultrasonic acoustic wave after it passes through the wire and ferrule, and a signal analysis module configured to identify signal differences between the ultrasonic waves. The signal analysis module is then configured to compare the signal differences attributable to the wire crimp to a baseline, and to provide an output signal if the signal differences deviate from the baseline.

Intraoperative Ultrasound to Assess for Pancreatic Duct Injuries

DTIC Science & Technology

2015-04-01

cholecystocholangiopancreatography is often nondiagnostic, gastroenterologists may not be available for endoscopic retrograde cholangiopancreatography (ERCP...10MHz.We use the SonoSite MicroMaxx SLT 10-5 MHz 52mm broadband linear array intraoperative US probe ( FUJIFILM SonoSite, Inc., Bothell, WA). The duct...Intraoperative US Availability Is gastroenterology available? Is the fluoroscopic and endoscopic equipment available? Is MRCP available? Is a

XV-15 Tilt Rotor fly-by-wire collective control demonstrator development specifications

NASA Technical Reports Server (NTRS)

Meuleners, R. J.

1981-01-01

A fly by wire system in the collective control system for XV-15 Tilt Rotor Research Aircraft was evaluated. The collective control system was selected because it requires a system tracking accuracy between right and left rotors of approximately 0.1%. The performance characteristics of the collectors axel provide typical axis control response data. The demonstrator is bread boarded as a dual system instead of the triplex system.

[Endo-Lap method in the management of biliary lithiasis (gallbladder and common bile duct)].

PubMed

Filip, V; Georgescu, St; Stanciu, C; Bălan, Gh; Târcoveanu, E; Neacşu, C N; Cîrdei, C; Drug, V L

2004-01-01

To present the results of the biliary endoscopic approach (ERCP) followed by laparoscopic cholecystectomy (LC) in the management of biliary lithiasis (gallbladder and common bile duct--CBD). From 1997 to March 2003 37 patients with biliary lithiasis were treated by endoscopic sphincterotomy (ES) with stone extraction, followed after 24-48 hours by LC. The indications for ERCP were presence of an obstructive jaundice (n=32) and a dilated CBD at the ultrasound examination (n=5). Selective biliary cannulation was obtained in 35 (94.6%) cases, in all of them with successful papillotomy. Stones were found in all patients. CBD clearances for calculi (from 1 to 8) was obtained in 33 of 35 patients (94.3%), the rest of 2 being managed by open laparotomy. Antibiotics were administrated in all patients. Laparoscopic cholecystectomy was performed after 24-48 hours, with one conversion (3%). Postoperative morbidity was 12.1%: 2 transitory pancreatic reactions and 2 wound infections. Endo-Lap method is a useful management alternative for combined gallbladder and CBD lithiasis. It has all the advantages of the two mini-invasive procedures (fast recovery, short hospitalization, low costs) and a less postoperative morbidity in patients with high risk.

Endoscopic Gallbladder Drainage for Acute Cholecystitis

PubMed Central

Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

2015-01-01

Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

Management of Pancreatic Calculi: An Update

PubMed Central

Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

2016-01-01

Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy. PMID:27784844

Ballooning of the papilla during contrast injection: the semaphore of a choledochocele.

PubMed

Kim, M H; Myung, S J; Lee, S K; Yoo, B M; Seo, D W; Lee, M H; Jung, S A; Kim, Y S; Min, Y I

1998-09-01

Choledochocele is a rare abnormality involving the intramural segment of the common bile duct. ERCP is essential to demonstrate a choledochocele. The aim of this study was to investigate the duodenoscopic and cholangiographic findings during ERCP. Over a 4-year period, 17 symptomatic patients (8 men, 9 women; age range 45 to 83 years) were identified as having choledochoceles. The diagnosis of choledochocele was made by both duodenoscopic and cholangiographic findings. As a characteristic duodenoscopic finding, the enlarged bulging papilla was noted in 8 patients (47%), whereas a normal-appearing papilla was noted in 9 patients (53%) before the injection of contrast media. However, in all 17 patients progressive enlargement or ballooning of the papilla was noted during contrast injection. The maximum diameter of the choledochocele, determined by cholangiography, was significantly larger (19 +/-4 mm) in patients with initially bulging papilla than in those with normal-appearing papilla (9+/-3 mm) (p < 0.05). Ballooning of the papilla during contrast injection may be a specific duodenoscopic finding for choledochocele. To avoid missing the diagnosis of a choledochocele, especially when it is small, it is important to watch the papilla carefully during contrast injection.

Syntactic methods of shape feature description and its application in analysis of medical images

NASA Astrophysics Data System (ADS)

Ogiela, Marek R.; Tadeusiewicz, Ryszard

2000-02-01

The paper presents specialist algorithms of morphologic analysis of shapes of selected organs of abdominal cavity proposed in order to diagnose disease symptoms occurring in the main pancreatic ducts and upper segments of ureters. Analysis of the correct morphology of these structures has been conducted with the use of syntactic methods of pattern recognition. Its main objective is computer-aided support to early diagnosis of neoplastic lesions and pancreatitis based on images taken in the course of examination with the endoscopic retrograde cholangiopancreatography (ERCP) method and a diagnosis of morphological lesions in ureter based on kidney radiogram analysis. In the analysis of ERCP images, the main objective is to recognize morphological lesions in pancreas ducts characteristic for carcinoma and chronic pancreatitis. In the case of kidney radiogram analysis the aim is to diagnose local irregularity of ureter lumen. Diagnosing the above mentioned lesion has been conducted with the use of syntactic methods of pattern recognition, in particular the languages of shape features description and context-free attributed grammars. These methods allow to recognize and describe in a very efficient way the aforementioned lesions on images obtained as a result of initial image processing into diagrams of widths of the examined structures.

Biliary access in technically difficult biliary cannulation: the mucosal bridge technique

PubMed Central

Thomas, Rebecca; Shah, Suhaila Rizal; Worthley, Christopher S

2009-01-01

Background: The use of precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) facilitates selective bile duct access in difficult procedures. However, it is also associated with high rates of complications. Several techniques for precut sphincterotomy have been described in the literature. This paper reports our experience with a non-needle-knife technique for precut sphincterotomy, namely, the mucosal bridge technique. Methods: We analysed the experience of a single surgical endoscopist at our centre in performing precut sphincterotomies by retrospectively examining information in the database for January 2002 to February 2008, which had been stored prospectively using Endoscribe. Results: The mucosal bridge technique was performed in 16 (3.19%) of 501 patients. Success rates were 75% and 100% after first and second ERCPs, respectively. The failure of initial procedures was caused by bleeding, tissue oedema, poorly visualized papilla or a poorly distensible duodenum and oedematous papilla. There were four cases of complications, which included periductular extravasation of contrast, bleeding, and sepsis in two patients. However, these complications were not a direct consequence of the precut sphincterotomy. Conclusions: The mucosal bridge technique can be used to increase the likelihood of successful bile duct cannulation, thus preventing the need for a second intervention. PMID:19590645

Eye dose to staff involved in interventional and procedural fluoroscopy

NASA Astrophysics Data System (ADS)

McLean, D.; Hadaya, D.; Tse, J.

2016-03-01

In 2011 the International Commission on Radiological Protection (ICRP) lowered the occupational eye dose limit from 150 to 20 mSv/yr [1]. While international jurisdictions are in a process of adopting these substantial changes, medical physicists at the clinical level have been advising medical colleagues on specific situations based on dose measurements. Commissioned and calibrated TLDs mounted in commercially available holders designed to simulate the measurement of Hp(3), were applied to staff involved in x-ray procedures for a one month period. During this period clinical procedure data was concurrently collected and subject to audit. The use or not of eye personal protective equipment (PPE) was noted for all staff. Audits were conducted in the cardiac catheterisation laboratory, the interventional angiography rooms and the procedural room where endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed. Significant levels of occupational dose were recorded in the cardiac and interventional procedures, with maximum reading exceeding the new limit for some interventional radiologists. No significant eye doses were measured for staff performing ERCP procedures. One outcome of the studies was increased use of eye PPE for operators of interventional equipment with increased availability also to nursing staff, when standing in close proximity to the patient during procedures.

Management of pancreatic and duodenal injuries in pediatric patients.

PubMed

Plancq, M C; Villamizar, J; Ricard, J; Canarelli, J P

2000-01-01

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.