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Sample records for physician-controlled wire-guided cannulation

  1. Internal Wire Guide For Gas/Tungsten-Arc Welding

    NASA Technical Reports Server (NTRS)

    Morgan, Gene E.; Dyer, Gerald E.

    1990-01-01

    Wire kept in shielding gas, preventing oxidation. Guide inside gas cup of gas/tungsten-arc welding torch feeds filler wire to weld pool along line parallel to axis of torch. Eliminates problem of how to place and orient torch to provide clearance for external wire guide.

  2. Current situation of endoscopic biliary cannulation and salvage techniques for difficult cases: Current strategies in Japan.

    PubMed

    Yasuda, Ichiro; Isayama, Hiroyuki; Bhatia, Vikram

    2016-04-01

    In the pancreatobiliary session at Endoscopic Forum Japan (EFJ) 2015, current trends of routine biliary cannulation techniques and salvage techniques for difficult biliary cannulation cases were discussed. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. It was concluded that, currently, in Western countries, the wire-guided cannulation (WGC) technique is favored during initial cannulation attempts. However, the conventional technique using an endoscopic retrograde cholangiopancreatography catheter with contrast medium injection is still used as first choice at most Japanese high-volume centers. The WGC technique is used as the second choice at some institutions only. After failed biliary cannulation attempts, the initial salvage option preferred in most centers includes pancreatic guidewire placement, followed by precut techniques as the second salvage choice. Among several precut techniques, the free-hand needle knife sphincterotomy with cutting upwards from the pancreatic duct is most popular. Endoscopic ultrasonography-guided rendezvous technique is also carried out as a final salvage option at select institutions.

  3. Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients

    PubMed Central

    Masci, Enzo; Mangiavillano, Benedetto; Luigiano, Carmelo; Bizzotto, Alessandra; Limido, Eugenio; Cantù, Paolo; Manes, Gianpiero; Viaggi, Paolo; Spinzi, Giancarlo; Radaelli, Franco; Mariani, Alberto; Virgilio, Clara; Alibrandi, Angela; Testoni, Pier Alberto

    2015-01-01

    Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique. Methods: From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut). Results: The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups. Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419 PMID:26528503

  4. Cannulation in the Diseased Aorta

    PubMed Central

    Khoynezhad, Ali; Plestis, Konstadinos A.

    2006-01-01

    The Seldinger technique is a method of femoral cannulation that has been used to establish cardiopulmonary bypass. Reports of cannulation of the ascending aorta for antegrade perfusion using the Seldinger method are anecdotal. To the best of our knowledge, the approach described herein for direct cannulation of the ascending aorta with use of the Seldinger technique for antegrade perfusion has not been previously described in the English-language medical literature. This method is helpful when the surgeon is treating a patient who has a calcified ascending aorta, complicated aortic dissection, calcified femoral vessels, or a diseased thoracoabdominal aorta. In such cases, retrograde perfusion has been associated with severe complications as a result of atheromatous embolization from the descending thoracic aorta. Herein, we describe our approach to cannulation for cardiopulmonary bypass, which entails insertion of an aortic cannula into the ascending aorta by means of the Seldinger technique. A soft-tip guidewire is inserted through an arterial entry catheter that has been used to puncture a hole in the wall of the vessel. Then the aortic cannula is introduced into the vessel, sliding along the guidewire. Guided by transesophageal echocardiography, the tip of the cannula is positioned carefully and is then advanced into the descending aorta. This positioning of the cannula decreases the chance of arterial embolization, thereby improving cerebral protection. If cannulation of the ascending aorta is not feasible, the transverse aortic arch or proximal descending aorta can be used. PMID:17041694

  5. Wire-guided balloon coloplasty--a new treatment for colorectal strictures?

    PubMed Central

    Banerjee, A K; Walters, T K; Wilkins, R; Burke, M

    1991-01-01

    A new technique for dilatation of colorectal anastomotic strictures--wire-guided balloon coloplasty--is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy. Images Figure 1. Figure 2. Figure 3. PMID:2013892

  6. Enhanced nucleic acid amplification with blood in situ by wire-guided droplet manipulation (WDM)

    PubMed Central

    Harshman, Dustin K.; Reyes, Roberto; Park, Tu San; You, David J.; Song, Jae-Young; Yoon, Jeong-Yeol

    2013-01-01

    There are many challenges facing the use of molecular biology to provide pertinent information in a timely, cost effective manner. Wire-guided droplet manipulation (WDM) is an emerging format for conducting molecular biology with unique characteristics to address these challenges. To demonstrate the use of WDM, an apparatus was designed and assembled to automate polymerase chain reaction (PCR) on a reprogrammable platform. WDM minimizes thermal resistance by convective heat transfer to a constantly moving droplet in direct contact with heated silicone oil. PCR amplification of the GAPDH gene was demonstrated at a speed of 8.67 sec/cycle. Conventional PCR was shown to be inhibited by the presence of blood. WDM PCR utilizes molecular partitioning of nucleic acids and other PCR reagents from blood components, within the water-in-oil droplet, to increase PCR reaction efficiency with blood in situ. The ability to amplify nucleic acids in the presence of blood simplifies pre-treatment protocols towards true point-of-care diagnostic use. The 16s rRNA hypervariable regions V3 and V6 were amplified from Klebsiella pneumoniae genomic DNA with blood in situ. The detection limit of WDM PCR was 1 ng/µL or 105 genomes/µL with blood in situ. The application of WDM for rapid, automated detection of bacterial DNA from whole blood may have an enormous impact on the clinical diagnosis of infections in bloodstream or chronic wound/ulcer, and patient safety and morbidity. PMID:24140832

  7. Enhanced nucleic acid amplification with blood in situ by wire-guided droplet manipulation (WDM).

    PubMed

    Harshman, Dustin K; Reyes, Roberto; Park, Tu San; You, David J; Song, Jae-Young; Yoon, Jeong-Yeol

    2014-03-15

    There are many challenges facing the use of molecular biology to provide pertinent information in a timely, cost effective manner. Wire-guided droplet manipulation (WDM) is an emerging format for conducting molecular biology with unique characteristics to address these challenges. To demonstrate the use of WDM, an apparatus was designed and assembled to automate polymerase chain reaction (PCR) on a reprogrammable platform. WDM minimizes thermal resistance by convective heat transfer to a constantly moving droplet in direct contact with heated silicone oil. PCR amplification of the GAPDH gene was demonstrated at a speed of 8.67 s/cycle. Conventional PCR was shown to be inhibited by the presence of blood. WDM PCR utilizes molecular partitioning of nucleic acids and other PCR reagents from blood components, within the water-in-oil droplet, to increase PCR reaction efficiency with blood in situ. The ability to amplify nucleic acids in the presence of blood simplifies pre-treatment protocols towards true point-of-care diagnostic use. The 16s rRNA hypervariable regions V3 and V6 were amplified from Klebsiella pneumoniae genomic DNA with blood in situ. The detection limit of WDM PCR was 1 ng/μL or 10(5)genomes/μL with blood in situ. The application of WDM for rapid, automated detection of bacterial DNA from whole blood may have an enormous impact on the clinical diagnosis of infections in bloodstream or chronic wound/ulcer, and patient safety and morbidity.

  8. Robotic Assisted Cannulation of Occluded Retinal Veins

    PubMed Central

    Meenink, Thijs C. M.; Janssens, Tom; Vanheukelom, Valerie; Naus, Gerrit J. L.; Beelen, Maarten J.; Meers, Caroline; Jonckx, Bart; Stassen, Jean-Marie

    2016-01-01

    Purpose To develop a methodology for cannulating porcine retinal venules using a robotic assistive arm after inducing a retinal vein occlusion using the photosensitizer rose bengal. Methodology Retinal vein occlusions proximal to the first vascular branch point were induced following intravenous injection of rose bengal by exposure to 532nm laser light delivered by slit-lamp or endolaser probe. Retinal veins were cannulated by positioning a glass catheter tip using a robotically controlled micromanipulator above venules with an outer diameter of 80μm or more and performing a preset piercing maneuver, controlled robotically. The ability of a balanced salt (BSS) solution to remove an occlusion by repeat distention of the retinal vein was also assessed. Results Cannulation using the preset piercing program was successful in 9 of 9 eyes. Piercing using the micromanipulator under manual control was successful in only 24 of 52 attempts, with several attempts leading to double piercing. The best location for cannulation was directly proximal to the occlusion. Infusion of BSS did not result in the resolution of the occlusion. Conclusion Cannulation of venules using a robotic microassistive arm can be achieved with consistency, provided the piercing is robotically driven. The model appears robust enough to allow testing of therapeutic strategies aimed at eliminating a retinal vein thrombus and its evolution over time. PMID:27676261

  9. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  10. Cannulation techniques for extracorporeal life support

    PubMed Central

    Pavlushkov, Evgeny; Berman, Marius

    2017-01-01

    The article reviews cannulation strategy for different modes of extracorporeal life support. Technical aspects, pitfalls and complications are discussed for central and peripheral extracorporeal membrane oxygenation (VA, VV, VAV, VVA), biventricular assist device support and extracorporeal CO2 removal. PMID:28275615

  11. A closed-loop pump-driven wire-guided flow jet for ultrafast spectroscopy of liquid samples

    NASA Astrophysics Data System (ADS)

    Picchiotti, Alessandra; Prokhorenko, Valentyn I.; Miller, R. J. Dwayne

    2015-09-01

    We describe the design and provide the results of the full characterization of a closed-loop pump-driven wire-guided flow jet system. The jet has excellent optical quality with a wide range of liquids spanning from alcohol to water based solutions, including phosphate buffers used for biological samples. The thickness of the jet film varies depending on the flow rate between 90 μm and 370 μm. The liquid film is very stable, and its thickness varies only by 0.76% under optimal conditions. Measured transmitted signal reveals a long term optical stability (hours) with a RMS of 0.8%, less than the overall noise of the spectroscopy setup used in our experiments. The closed loop nature of the overall jet design has been optimized for the study of precious biological samples, in limited volumes, to remove window contributions from spectroscopic observables. This feature is particularly important for femtosecond studies in the UV range.

  12. Experimental fluid dynamics of transventricular apical aortic cannulation.

    PubMed

    Fukuda, Ikuo; Yanaoka, Hideki; Inamura, Takao; Minakawa, Masahito; Daitoku, Kazuyuki; Suzuki, Yasuyuki

    2010-03-01

    To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle-image velocimetry in a glass aortic model. Simulated apical cannulation using a 7-mm Sarns Soft-Flow cannula and the newly developed 7-mm apical aortic cannula was compared with standard aortic cannulation. The flow-velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula.

  13. What nephrologists need to know about vascular access cannulation.

    PubMed

    Dinwiddie, Lesley C; Ball, Lynda; Brouwer, Deborah; Doss-McQuitty, Sheila; Holland, Janet

    2013-01-01

    This article describes cannulation events, especially problems, common and rare, minor and major, to aid the nephrologist (and mid-level providers e.g. nurse practitioner and physician's assistant) in decision-making to prevent or treat cannulation-related adverse outcomes. The usual management, potential outcomes, nephrologist intervention, and prevention are discussed and include: assessment of arteriovenous (AV) access and readiness for cannulation; initial cannulation of both arteriovenous fistulas and grafts; needle size and adequacy; needle direction and potential for recirculation; limited cannulation sites/buttonhole; pain and fear of pain; prevention of bleeding; management of infiltrations/extravasations; prevention and management of "one-site-itis"; prevention and management of infection. It concludes with the importance of the medical director as the leader of the continuous quality improvement (CQI) team in preventing/reducing cannulation-related adverse events.

  14. The peripheral cannulation technique in minimally invasive congenital cardiac surgery.

    PubMed

    Vida, Vladimiro L; Tessari, Chiara; Putzu, Alessandro; Tiberio, Ivo; Guariento, Alvise; Gallo, Michele; Stellin, Giovanni

    2016-08-19

    Congenital minimally invasive cardiac surgery has gained wide acceptance thanks to its favorable outcomes. The introduction of peripheral cannulation for cardiopulmonary bypass further reduces surgical trauma by decreasing surgical access and allowing the spectrum of surgical access for the correction of simple congenital heart defects to be widened. Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels, proves to be a safe and effective tool in patients with body weight above 15 kg.

  15. Veno-venous extracorporeal membrane oxygenation: cannulation techniques

    PubMed Central

    Banfi, Carlo; Pozzi, Matteo; Siegenthaler, Nils; Brunner, Marie-Eve; Tassaux, Didier; Obadia, Jean-Francois; Bendjelid, Karim

    2016-01-01

    The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection. While VV-ECMO circuits usually include the cannulation of two vessels (double cannulation) in its classic configuration, the use of a single cannula is now possible for VV-ECMO support. Recently, experienced centers have employed more advanced approaches by cannulating three vessels (triple cannulation) which follows veno-arterio-venous (VAV) or veno-arterio-pulmonary-arterial cannulation (VAPa). However, ‘triple’ cannulation expands the field of application but increases the complexity of ECMO systems. In the present review, the authors focus on the indications for VV-ECMO, patient assessment prior to cannulation, the role of ultrasound-guided vessel puncture, double lumen single bicaval cannulations, and finally triple cannulation in VV-ECMO. PMID:28149575

  16. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults.

    PubMed

    Napp, L Christian; Kühn, Christian; Hoeper, Marius M; Vogel-Claussen, Jens; Haverich, Axel; Schäfer, Andreas; Bauersachs, Johann

    2016-04-01

    Extracorporeal membrane oxygenation (ECMO) has revolutionized treatment of severe isolated or combined failure of lung and heart. Due to remarkable technical development the frequency of use is growing fast, with increasing adoption by interventional cardiologists independent of cardiac surgery. Nevertheless, ECMO support harbors substantial risk such as bleeding, thromboembolic events and infection. Percutaneous ECMO circuits usually comprise cannulation of two large vessels ('dual' cannulation), either veno-venous for respiratory and veno-arterial for circulatory support. Recently experienced centers apply more advanced strategies by cannulation of three large vessels ('triple' cannulation), resulting in veno-veno-arterial or veno-arterio-venous cannulation. While the former intends to improve drainage and unloading, the latter represents a very potent method to provide circulatory and respiratory support at the same time. As such triple cannulation expands the field of application at the expense of increased complexity of ECMO systems. Here, we review percutaneous dual and triple cannulation strategies for different clinical scenarios of the critically ill. As there is no unifying terminology to date, we propose a nomenclature which uses "A" and all following letters for supplying cannulas and all letters before "A" for draining cannulas. This general and unequivocal code covers both dual and triple ECMO cannulation strategies (VV, VA, VVA, VAV). Notwithstanding the technical evolution, current knowledge of ECMO support is mainly based on observational experience and mostly retrospective studies. Prospective controlled trials are urgently needed to generate evidence on safety and efficacy of ECMO support in different clinical settings.

  17. Intravenous cannulation of hens for long-term infusion.

    PubMed

    Hamilton, R M

    1978-12-01

    Intravenous cannulation was performed on the brachial vein of the hen. The cannulation system consisted of a jacket that fitted around the body of the hen. An external sheath passed through the top of the cage, over a small pulley and was counter-weighted with lead. A subcutaneous polyethylene sheath was extended from the wing near the site of cannulation to the mid-point of the back between the wings and into the external sheath. Once the polyethylene cannula was inserted into and attached to the brachial vein, the free end was passed through the subcutaneous sheath, into and through the external sheath, and attached to a syringe or pump. No special post-cannulation care was necessary. The hens were housed in wire cages and received feed and water ad libitum. Twenty-four hens were continuously or intermittently infused for up to 73 days after cannulation.

  18. Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

    PubMed Central

    Harwood, Lori E.; Wilson, Barbara M.; Oudshoorn, Abe

    2016-01-01

    Background Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation. Method This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis. Results Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes. Conclusions Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use. PMID:26985384

  19. Droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling for simpler and faster PCR assay using wire-guided manipulations

    PubMed Central

    2012-01-01

    A computer numerical control (CNC) apparatus was used to perform droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling on a single superhydrophobic surface and a multi-chambered PCB heater. Droplets were manipulated using “wire-guided” method (a pipette tip was used in this study). This methodology can be easily adapted to existing commercial robotic pipetting system, while demonstrated added capabilities such as vibrational mixing, high-speed centrifuging of droplets, simple DNA extraction utilizing the hydrophobicity difference between the tip and the superhydrophobic surface, and rapid thermocycling with a moving droplet, all with wire-guided droplet manipulations on a superhydrophobic surface and a multi-chambered PCB heater (i.e., not on a 96-well plate). Serial dilutions were demonstrated for diluting sample matrix. Centrifuging was demonstrated by rotating a 10 μL droplet at 2300 round per minute, concentrating E. coli by more than 3-fold within 3 min. DNA extraction was demonstrated from E. coli sample utilizing the disposable pipette tip to cleverly attract the extracted DNA from the droplet residing on a superhydrophobic surface, which took less than 10 min. Following extraction, the 1500 bp sequence of Peptidase D from E. coli was amplified using rapid droplet thermocycling, which took 10 min for 30 cycles. The total assay time was 23 min, including droplet centrifugation, droplet DNA extraction and rapid droplet thermocycling. Evaporation from of 10 μL droplets was not significant during these procedures, since the longest time exposure to air and the vibrations was less than 5 min (during DNA extraction). The results of these sequentially executed processes were analyzed using gel electrophoresis. Thus, this work demonstrates the adaptability of the system to replace many common laboratory tasks on a single platform (through re-programmability), in rapid succession (using droplets), and with a high level of

  20. Internal jugular vein cannulation: A comparison of three techniques

    PubMed Central

    Ray, Bikash R; Mohan, Virender K; Kashyap, Lokesh; Shende, Dilip; Darlong, Vanlal M; Pandey, Ravindra K

    2013-01-01

    Context: Ultrasound-guided internal jugular vein (IJV) cannulation is known for increasing success rate and decreasing rate of complications. The ultrasound image can be used as a real time image during cannulation or to prelocate the IJV before attempting cannulation. Aims: This study compares both the ultrasound-guided technique with the classical anatomical landmark technique (central approach) for right IJV cannulation in terms of success rate, complications, and time for cannulation. Settings and Design: A prospective, randomized, observational study was conducted at a tertiary care hospital. Material and Methods: One hundred twenty patients requiring IJV cannulation were included in this study and were randomly allocated in three groups. Number of attempts, success rate, venous access time, catheterization time, and complications were observed in each group. Statistical Analysis Used: Statistical analysis was performed using STATA-9 software. Demographic data were compared using one-way analysis of variance (ANOVA). Nonparametric data were compared using the Kruskall–Wallis test, and multiple comparisons were done applying The Mann–Whitney test for individual pairs of groups. Nominal data were compared by applying the Chi-square test and Fisher exact test. Results: Successful cannulation (≤3 attempt) was achieved in 90.83% of patients without any statistical significant difference between the groups. Venous access time and catheterization time was found to be significantly less in both the ultrasound groups than the anatomical land mark group. Number of attempts and success in first attempt was similar between the groups. Conclusions: Both the ultrasound techniques are found to be better than the anatomical landmark technique. Further, ultrasound-guided prelocation was found to be as effective as ultrasound guided real-time imaging technique for right IJV cannulation. PMID:24106363

  1. [Ultrasound guided radial artery cannulation: procedure description and literature review].

    PubMed

    Carmona Monge, F J; Martínez Lareo, M; Núñez Reiz, A

    2011-01-01

    Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population.

  2. Pre-cannulation lung biopsy shortens ECMO course.

    PubMed

    Lohmann, Pablo; Lee, Timothy C; Kearney, Debra L; Fernandes, Caraciolo J

    2016-07-01

    We describe the clinical course of an infant with respiratory failure who underwent lung biopsy prior to cannulation for undergoing extracorporeal membrane oxygenation (ECMO). Pathology revealed alveolar capillary dysplasia, and ECMO was discontinued. Rapid diagnosis allowed for closure and saved resources. We recommend considering early biopsy in infants with atypical pulmonary hypertension.

  3. Arterial cannulation can hasten the onset of symmetrical peripheral gangrene

    PubMed Central

    Srinivasan, Nataraj M.; Chaudhuri, Souvik

    2011-01-01

    Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula. PMID:25885311

  4. Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla

    PubMed Central

    Wang, Wei; Gong, Biao; Jiang, Wei-Song; Liu, Lei; Bielike, Kouken; Xv, Bin; Wu, Yun-Lin

    2015-01-01

    AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife. METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed. RESULTS: Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301). CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed. PMID:26019460

  5. Force-Based Puncture Detection and Active Position Holding for Assisted Retinal Vein Cannulation*

    PubMed Central

    Gonenc, Berk; Tran, Nhat; Riviere, Cameron N.; Gehlbach, Peter; Taylor, Russell H.; Iordachita, Iulian

    2016-01-01

    Retinal vein cannulation is a demanding procedure proposed to treat retinal vein occlusion by direct therapeutic agent delivery methods. Challenges in identifying the moment of venous puncture, achieving cannulation and maintaining cannulation during drug delivery currently limit the feasibility of the procedure. In this study, we respond to these problems with an assistive system combining a handheld micromanipulator, Micron, with a force-sensing microneedle. The integrated system senses the instant of vein puncture based on measured forces and the position of the needle tip. The system actively holds the cannulation device securely in the vein following cannulation and during drug delivery. Preliminary testing of the system in a dry phantom, stretched vinyl membranes, demonstrates a significant improvement in the total time the needle could be maintained stably inside of the vein. This was especially evident in smaller veins and is attributed to decreased movement of the positioned cannula following venous cannulation. PMID:27127804

  6. Force-Based Puncture Detection and Active Position Holding for Assisted Retinal Vein Cannulation.

    PubMed

    Gonenc, Berk; Tran, Nhat; Riviere, Cameron N; Gehlbach, Peter; Taylor, Russell H; Iordachita, Iulian

    2015-09-01

    Retinal vein cannulation is a demanding procedure proposed to treat retinal vein occlusion by direct therapeutic agent delivery methods. Challenges in identifying the moment of venous puncture, achieving cannulation and maintaining cannulation during drug delivery currently limit the feasibility of the procedure. In this study, we respond to these problems with an assistive system combining a handheld micromanipulator, Micron, with a force-sensing microneedle. The integrated system senses the instant of vein puncture based on measured forces and the position of the needle tip. The system actively holds the cannulation device securely in the vein following cannulation and during drug delivery. Preliminary testing of the system in a dry phantom, stretched vinyl membranes, demonstrates a significant improvement in the total time the needle could be maintained stably inside of the vein. This was especially evident in smaller veins and is attributed to decreased movement of the positioned cannula following venous cannulation.

  7. Femoral cannulation: a safe vascular access option for cardiopulmonary bypass in minimally invasive cardiac surgery.

    PubMed

    Saadat, Siavash; Schultheis, Molly; Azzolini, Anthony; Romero, Joseph; Dombrovskiy, Victor; Odroniec, Karen; Scholz, Peter; Lemaire, Anthony; Batsides, George; Lee, Leonard

    2016-03-01

    Femoral cannulation during cardiopulmonary bypass has become a common approach for many cardiac procedures and serves as an important access option, especially during minimally invasive cardiac surgery. Opponents, however, argue that there is significant risk, including site-specific and overall morbidity, which makes the use of this modality dangerous compared to conventional aortoatrial cannulation techniques. We analyzed our institutional experience to elucidate the safety and efficacy of femoral cannulation. All data were collected from a single hospital's cardiac surgery database. A total of 346 cardiac surgeries were evaluated from September 2012 to September 2013, of which 85/346 (24.6%) utilized a minimally invasive approach. Of the 346 operations performed, 72/346 (20.8%) utilized femoral cannulation while 274/346 (79.2%) used aortoatrial cannulation. Stroke occurred in 1/72 (1.39%) after femoral cannulation, specifically, in a conventional sternotomy patient, while it occurred in 6/274 (2.19%) [p=0.67] after aortoatrial cannulation. When comparing postoperative complications between the femoral cannulation and aortoatrial cannulation groups, the rates of atrial fibrillation [10/72 (13.9%) versus 46/274 (16.8%), p=0.55], renal failure [2/72 (2.78%) versus 11/274 (4.01%), p=0.62], prolonged ventilation time [4/72 (5.56%) versus 27/274 (9.85%), p=0.26] and re-operation for bleeding [3/72 (4.17%) versus 13/274 (4.74%), p=0.84] showed no significant difference. Selective femoral cannulation provides a safe alternative to aortoatrial cannulation for cardiopulmonary bypass and is especially important when performing minimally invasive cardiac surgery. When comparing aortoatrial and femoral cannulation, we found no significant difference in the postoperative complication rates and overall mortality.

  8. Evaluation of dorsal aorta cannulation for immunological studies of grouper (Epinephelus malabaricus).

    PubMed

    Lo, Wan-Yu; Chang, Ching-Fong; Song, Yen-Ling

    2003-04-01

    Blood is often withdrawn to study the immune responses of fish. However, netting, handling and anaesthetising the experimental fish, and drawing blood samples cause severe stress that may alter the effects of immune study protocols and treatments. We evaluated the effect of aorta cannulation, for use in immune studies, on grouper (Epinephelus malabaricus) plasma cortisol, total red and white blood cell counts and phagocytosis. Plasma cortisol increased from 30 to 88 ng/ml 1 day after insertion of the cannula, to a maximum of 951 ng/ml 3 to 5 days after surgery, indicating the groupers were stressed by cannulation and post-cannulation inflammation. Total RBC count decreased, and total WBC count increased after surgery. Following cannulation, the phagocytic index of peripheral blood leukocytes decreased from 100% to 46%. The adverse effects of cannulation were mitigated by continuously immersing groupers in oxytetracycline (OTC), which decreased the recovery period for treated fish. In contrast, OTC-treatment did not markedly improve the recovery of groupers subjected to caudal vessel puncture. Cortisol levels in OTC-treated grouper with caudal vessel puncture were significantly higher than in OTC-treated, cannulated grouper, and remained at a high level until day 13 of the experiment. From day 7 to 13, total RBC and WBC counts in OTC-treated, cannulated groupers were significantly different from those in OTC-treated groupers with caudal vessel puncture. OTC treatment improved the phagocytic index of groupers subjected to caudal vessel puncture, but the phagocytic index was lower than that of groupers subjected to cannulation. Cannulation minimises visual and handling disturbances, and facilitates standardisation of experimental conditions and quick and easy sampling via the dorsal aorta cannula. Therefore, dorsal aorta cannulation minimises the stress of blood sampling and should prove useful for immune studies in fish.

  9. Technique for long-term ileal cannulation in ponies.

    PubMed Central

    Peloso, J G; Schumacher, J; McClure, S R; Crabill, M R; Hanselka, D V; Householder, D D; Potter, G D

    1994-01-01

    A T-cannula was fitted permanently into the ileum of ten mature ponies to quantify the role of the prececal and postileal segments of the digestive tract in equine nutrition studies. The ponies were anesthetized, positioned in left lateral recumbency, and the distal small intestine was exteriorized through a right paralumbar incision. A silastic T-cannula was inserted through a 2-cm longitudinal incision into the lumen of the ileum, on the antimesenteric surface, and sutured to the ileum. The stem of the cannula was exteriorized through a 2-cm circular skin incision, 6 cm caudal to the 16th rib. Nine ponies were alive with functional cannulas after six months. Primary complications associated with cannulation of the ileum were clinical signs of depression and dehydration produced by leakage of intestinal contents around the stem of the cannula. These complications were resolved with fluid and electrolyte therapy. Images Fig. 1. Fig. 2. PMID:7954119

  10. Efficacy of 'radioguided occult lesion localisation' (ROLL) versus 'wire-guided localisation' (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial.

    PubMed

    Postma, E L; Verkooijen, H M; van Esser, S; Hobbelink, M G; van der Schelling, G P; Koelemij, R; Witkamp, A J; Contant, C; van Diest, P J; Willems, S M; Borel Rinkes, I H M; van den Bosch, M A A J; Mali, W P; van Hillegersberg, R

    2012-11-01

    For the management of non-palpable breast cancer, accurate pre-operative localisation is essential to achieve complete resection with optimal cosmetic results. Radioguided occult lesions localisation (ROLL) uses the radiotracer, injected intra-tumourally for sentinel lymph node identification to guide surgical excision of the primary tumour. In a multicentre randomised controlled trial, we determined if ROLL is superior to the standard of care (i.e. wire-guided localisation, WGL) for preoperative tumour localisation. Women (>18 years.) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomised to ROLL or WGL. Patients allocated to ROLL received an intra-tumoural dose of 120 Mbq technetium-99 m nanocolloid. The tumour was surgically removed, guided by gamma probe detection. In the WGL group, ultrasound- or mammography-guided insertion of a hooked wire provided surgical guidance for excision of the primary tumour. Primary outcome measures were the proportion of complete tumour excisions (i.e. with negative margins), the proportion of patients requiring re-excision and the volume of tissue removed. Data were analysed according to intention-to-treat principle. This study is registered at ClinincalTrials.gov, number NCT00539474. In total, 314 patients with 316 invasive breast cancers were enrolled. Complete tumour removal with negative margins was achieved in 140/162 (86 %) patients in the ROLL group versus 134/152 (88 %) patients in the WGL group (P = 0.644). Re-excision was required in 19/162 (12 %) patients in the ROLL group versus 15/152 (10 %) (P = 0.587) in the WGL group. Specimen volumes in the ROLL arm were significantly larger than those in the WGL arm (71 vs. 64 cm(3), P = 0.017). No significant differences were seen in the duration and difficulty of the radiological and surgical procedures, the success rate of the sentinel node procedure, and cosmetic outcomes. In this first

  11. Very quick reverse transcription polymerase chain reaction for detecting 2009 H1N1 influenza A using wire-guide droplet manipulationst.

    PubMed

    You, David J; Tran, Phat L; Kwon, Hyuck-Jin; Patel, Deepa; Yoon, Jeong-Yeol

    2011-01-01

    Reverse transcription polymerase chain reaction (RT-PCR) is currently a gold standard in identifying influenza A virus, especially H1N1 flu. Typical RT-PCR assays take about 1-2 h for thermocycling, and there is a growing need to further speed up the thermocycling to less than 30 min. Additionally, the PCR assay system should be made portable as a point-of-care detection tool. There have been attempts to further speed up the PCR assays by reducing its volume. There have also been attempts to use droplet microfluidics technology to PCR, primarily to automate the PCR enrichment processes and take advantage of its small volume. In all these attempts, heating and cooling is made by conduction heat transfer. Rapid movements of droplets (immersed in oil) over three different temperature zones make very quick PCR possible, as heating/cooling will be made by convection heat transfer, whose heat transfer coefficients are much higher than that of conduction. We used our newly-invented method of wire-guide droplet manipulations towards very quick RT-PCR. Computational fluid dynamics (CFD) simulation of our system revealed that heating/cooling for each temperature change takes 1-4 s for a 10 microL droplet, as compared to >30 s in the other quick PCRs. Theoretically a 30-cycle process can take as short as 13 s x 30 cycles = 6 min 30 s. The entire system was made as a single instrument, with the components made by a milling machine and a rapid prototyping device. No additional equipment and external computers are required. With this newly developed system, 160 bp gene sequence was amplified from 2009 H1N1 influenza A (human origin). The 30-cycle process took as short as 6 min 50 s for a 10 microL droplet (with additional 4 min for reverse transcription). Its product was confirmed by traditional gel electrophoresis, subsequent imaging as well as gene sequencing, which has been very difficult with the other stationary droplet/nanodrop approaches. The proposed system has a

  12. Axillary Versus Femoral Arterial Cannulation During Repair of Type A Aortic Dissection?

    PubMed Central

    Stamou, Sotiris C.; Gartner, Derek; Kouchoukos, Nicholas T.; Lobdell, Kevin W.; Khabbaz, Kamal; Murphy, Edward; Hagberg, Robert C.

    2016-01-01

    Background The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. Methods A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality, and Cox regression hazard ratios were calculated to determine predictors of long-term mortality. Results Operative mortality was not influenced by cannulation site (16% for axillary cannulation vs. 19% for femoral cannulation, p = 0.64). In multivariate logistic regression analysis, hemodynamic instability (p < 0.001) and prolonged cardiopulmonary bypass time (>200 min; p = 0.05) emerged as independent predictors of operative mortality. Stroke rates were comparable between the two techniques (14% for axillary and 17% for femoral cannulation, p = 0.52). Five-year actuarial survival was comparable between the groups (55.1% for axillary and 65.7% for femoral cannulation, p = 0.36). In Cox regression analysis, predictors of long-term mortality were: age (p < 0.001), stroke (p < 0.001), prolonged cardiopulmonary bypass time (p = 0.001), hemodynamic instability (p = 0.002), and renal failure (p = 0.001). Conclusions The outcomes of femoral versus axillary arterial cannulation in patients with acute Type A aortic dissection are comparable. The choice of arterial cannulation site should be individualized based on different patient risk profiles. PMID:28097193

  13. The culture of vascular access cannulation among nurses in a chronic hemodialysis unit.

    PubMed

    Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe; Thompson, Bonita

    2010-01-01

    The native arteriovenous fistula (AVF) is the vascular access of choice for patients on chronic hemodialysis (HD) because of its longevity and lower complication rate. Yet from 2001 to 2004 in Canada, there has been a notable increase in both incident and prevalent central venous catheter (CVC) use with a corresponding decrease in AVF use over the same time period (Moist, Trpeski, Na, & Lok, 2008). A similar trend has been found in other countries (Moist, Chang, Polkinghorne, & McDonald, 2007). There are a number of contributing factors to low AVF use in patients on chronic hemodialysis. While some of these factors may be patient-related, nursing interventions specific to cannulation may be a contributor. To date, little is known about HD nurses' attitudes and experiences regarding cannulation. The purpose of this study was to describe the culture and everyday practices of vascular access cannulation of the AVF from the perspective of the HD nurse. An ethnographic research design was employed, utilizing qualitative methods. Ten HD nurses were interviewed using a semi-structured interview tool, and a number of themes were generated from the interviews. One overarching theme of "perpetual novice" was evident, acknowledging the failure to transition from novice to expert cannulator despite working in HD for a number of years. Other common themes that emerged from the interviews were a) the lack of fistulas, b) the fistula as a "hard sell" to patients, c) the skill of cannulation, and d) the assembly-line approach to care. As a result of a number of factors, HD nurses were unable to acquire the skills necessary to become an expert cannulator. Moreover, the decrease in opportunities to practise cannulation has resulted in wide variation in skill level among HD nurses. To improve cannulation skills and achieve successful cannulation of AV fistulas, HD nurses identified a number of educational strategies that should take place. They also identified the need for an

  14. Force-Sensing Microneedle for Assisted Retinal Vein Cannulation*

    PubMed

    Gonenc, Berk; Gehlbach, Peter; Handa, James; Taylor, Russell H; Iordachita, Iulian

    2014-11-01

    Retinal vein cannulation (RVC) is a challenging procedure proposed for drug delivery into the very small retinal veins. The available glass cannulas for this procedure are both hard to visualize and fragile thereby limiting the feasibility of both robot-assisted and manual RVC approaches. In this study, we develop and test a new force-sensing RVC instrument that can be easily integrated with the existing manual and robotic devices. The tool enables (1) the measurement of the forces required for puncturing retinal veins in vivo and (2) an assistive method to inform the operator of the needle piercing the vessel wall. The fiber Bragg grating based sensor can be inserted into the eye through a small (∅ 0.9 mm) opening and provides a quantitative assessment at the tool tip with a resolution smaller than 0.25 mN. Assessment of forces during vessel penetration in the chorioallantoic membranes of chicken embryos have revealed a consistent sharp drop in tool tip force upon vessel puncture that has been used as a signature to provide auditory feedback to the user to stop needle advancement and begin drug delivery.

  15. Force-Sensing Microneedle for Assisted Retinal Vein Cannulation*

    PubMed Central

    Gonenc, Berk; Gehlbach, Peter; Handa, James; Taylor, Russell H.; Iordachita, Iulian

    2014-01-01

    Retinal vein cannulation (RVC) is a challenging procedure proposed for drug delivery into the very small retinal veins. The available glass cannulas for this procedure are both hard to visualize and fragile thereby limiting the feasibility of both robot-assisted and manual RVC approaches. In this study, we develop and test a new force-sensing RVC instrument that can be easily integrated with the existing manual and robotic devices. The tool enables (1) the measurement of the forces required for puncturing retinal veins in vivo and (2) an assistive method to inform the operator of the needle piercing the vessel wall. The fiber Bragg grating based sensor can be inserted into the eye through a small (∅ 0.9 mm) opening and provides a quantitative assessment at the tool tip with a resolution smaller than 0.25 mN. Assessment of forces during vessel penetration in the chorioallantoic membranes of chicken embryos have revealed a consistent sharp drop in tool tip force upon vessel puncture that has been used as a signature to provide auditory feedback to the user to stop needle advancement and begin drug delivery. PMID:25580178

  16. Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients

    PubMed Central

    Maddali, Madan Mohan; Arun, Venkitaramanan; Wala, Al-Ajmi Ahmed; Al-Bahrani, Maher Jaffer; Jayatilaka, Cheskey Manoj; Nishant, Arora Ram

    2016-01-01

    Background: The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was used for qualitative variables. Results: The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients. Conclusions: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients. PMID:27716688

  17. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network

    PubMed Central

    2013-01-01

    Background Success in deep biliary cannulation via native ampullae of Vater is an accepted measure of competence in ERCP training and practice, yet prior studies focused on predicting adverse events alone, rather than success. Our aim is to determine factors associated with deep biliary cannulation success, with/ without precut sphincterotomy. Methods The ERCP Quality Network is a unique prospective database of over 10,000 procedures by over 80 endoscopists over several countries. After data cleaning, and eliminating previously stented or cut papillae, two multilevel fixed effect multivariate models were used to control for clustering within physicians, to predict biliary cannulation success, with and without allowing “precut” to assist an initially failed cannulation. Results 13018 ERCPs were performed by 85 endoscopists (March 2007 - May 2011). Conventional (without precut) and overall cannulation rates were 89.8% and 95.6%, respectively. Precut was performed in 876 (6.7%). Conventional success was more likely in outpatients (OR 1.21), but less likely in complex contexts (OR 0.59), sicker patients (ASA grade (II, III/V: OR 0.81, 0.77)), teaching cases (OR 0.53), and certain indications (strictures, active pancreatitis). Overall cannulation success (some precut-assisted) was more likely with higher volume endoscopists (> 239/year: OR 2.79), more efficient fluoroscopy practices (OR 1.72), and lower with moderate (versus deeper) sedation (OR 0.67). Conclusion Biliary cannulation success appears influenced by both patient and practitioner factors. Patient- and case-specific factors have greater impact on conventional (precut-free) cannulation success, but volume influences ultimate success; both may be used to select appropriate cases and can help guide credentialing policies. PMID:24112846

  18. Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous.

    PubMed

    Aazami, Mathias Hossain; Gholoobi, Arash; Amini, Shahram; Abdollahi-Moghadam, Alireza; Soltani, Ghassem

    2016-04-01

    Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m(2), representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation.

  19. Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous

    PubMed Central

    Gholoobi, Arash; Amini, Shahram; Abdollahi-Moghadam, Alireza; Soltani, Ghassem

    2016-01-01

    Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m2, representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation. PMID:27127430

  20. Moving beyond the "perpetual novice": understanding the experiences of novice hemodialysis nurses and cannulation of the arteriovenous fistula.

    PubMed

    Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe

    2013-01-01

    Cannulation of the arteriovenous fistula (AVF) is an essential skill for hemodialysis (HD) nurses. With declining rates of AVFs, opportunities to develop expert cannulation skills have become limited. This study explored the concept of perpetual novice and AVF cannulation from the perspective of the novice cannulator. Nine hemodialysis nurses were interviewed using ethnographic methodology. The study identified the interplay between personal and environmental/contextual factors that hindered skill acquisition. Personal attributes identified by participants included HD nurses' approach to learning and previous experience, emotional reaction to stress, and interpersonal relationships with colleagues. Environmental/contextual factors identified as impediments to cannulation skill development included limited learning opportunities, attitudes and demands from patients, unit flow and time pressures, and limitations imposed by the current model of nursing care. This study will be helpful in directing future educational, operational, and supportive interventions for novice HD nurses around cannulation skill development.

  1. Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients

    PubMed Central

    Li, Xiuyan; Fang, Guizhen; Yang, Danhua; Wang, Lanfang; Zheng, Chunmei; Ruan, Longjuan; Wang, Lingcong

    2016-01-01

    Background This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. Material/Methods A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. Results (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (P<0.05). (2) The cannulation duration in the ultrasound group and the palpation group was 8.77±6.33 s and 28.7±26.33 s, respectively (P<0.01). (3) Incidence of hematoma and staxis around stoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). Conclusions Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics. PMID:27397118

  2. Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

    PubMed Central

    Bucsky, Bence S.; Richardt, Doreen; Petersen, Michael; Sievers, Hans H.

    2016-01-01

    Background The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Methods Between January 2003 and December 2015, 235 patients underwent repair of AADA. All patients were evaluated for the type of arterial cannulation (femoral vs. central) for initial bypass. Demographic data and outcome parameters were accessed. Results One hundred and twenty seven (54.0%) were initially cannulated in the central aortic vessels (ascending aorta or subclavian/axillary artery) and 108 (46.0%) in the femoral artery. Patients were comparable between age (62.4±14.4 vs. 62.9±14.4 years, P=0.805), gender (male, 62.2 vs. 69.4%, P=0.152) and previous sternotomy (15.7 vs. 16.7%, P=0.861) between both cannulation groups; while EuroSCORE I (11.5±4.0 vs. 12.7±4.2, P=0.031) and ASA Score (3.5±0.81 vs. 3.8±0.57, P=0.011) were significantly higher in the femoral artery cannulation group. Bypass (249±102 vs. 240±81 min, P=0.474), X-clamp (166±85 vs. 157±67 min, P=0.418) and circulatory arrest time (51.6±28.7 vs. 48.3±21.7 min, P=0.365) were similar between the groups as were lowest temperature (18.1±2.0 vs. 18.1±2.2, P=0.775). Postoperative neurologic deficit and 30-day mortality were comparable between both cannulation groups (11.7 vs. 7.2%, P=0.449 and 20.2 vs. 16.9%, P=0.699, central vs. peripheral cannulation). Multivariate analysis revealed only EuroScore I above 13 as single preoperative predictor for mortality. Conclusions AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. PMID:27563543

  3. HEADPLAY Personal Cinema System Facilitates Intravenous Cannulation in Children: A Randomized Controlled Trial.

    PubMed

    Lim, Evangeline; Fabila, Teddy; Sze Ying, Thong; Tan, Josephine

    2013-01-01

    HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children.

  4. HEADPLAY Personal Cinema System Facilitates Intravenous Cannulation in Children: A Randomized Controlled Trial

    PubMed Central

    Lim, Evangeline; Fabila, Teddy; Sze Ying, Thong; Tan, Josephine

    2013-01-01

    HEADPLAY personal cinema system (PCS) is a portable visual headset/visor through which movie clips may be viewed. We studied the use of HEADPLAY PCS as a distraction tool in facilitating intravenous cannulation in children undergoing anaesthesia. 60 children were enrolled into the study and randomized into 2 groups. EMLA local anaesthetic cream was used to reduce the pain associated with intravenous cannulation. Children in group 1 wore the HEADPLAY visor whereas children in group 2 were subject to conventional distraction therapy. Children were asked to rate their anxiety, pain, and satisfaction scores after intravenous cannulation. Periprocedural anxiety was also determined using the modified Yale Preoperative Anxiety Scale (mYPAS). There were no statistically significant differences in terms of pain and anxiety scores between the 2 groups. Although the satisfaction score of the children in the HEADPLAY PCS group was marginally higher compared to the conventional group, this did not hit statistical significance. 86.6% of children in group 1 reported that they would want to use the visor again for their next intravenous cannulation. We conclude that HEADPLAY PCS is a distraction tool that is acceptable to most children and can contribute towards satisfaction of the intravenous cannulation process in children. PMID:23840223

  5. Technique of right lymphatic duct cannulation for pulmonary lymph collection in an acute porcine model.

    PubMed

    Chuang, G J; Gao, C X; Mulder, D S; Chiu, R C

    1986-12-01

    The pig is an increasingly preferred model for biomedical research, including studies for pulmonary pathophysiology. However, in piglets, the technique for cannulating the right lymphatic duct, which is subject to more anatomical variations and technically more demanding than that in dogs, has not been described. Our technique evolved to enable this collection of porcine lung lymph in acute experiments. The lymphatic ampulla is cannulated via one of the cervical lymphatics. The right lymphatic duct is invariably dorsal to the cranial vena cava and classically leads to the lymphatic ampulla. Yet in 18% of our pigs, cannulation was difficult or not feasible because the lymphatic duct either drained directly into the cranial vena cava at a distance from the lymphatic ampulla, or into the axillary lymph node of the first rib or the caudal deep cervical lymph nodes. Gently squeezing back regurgitated blood in the lymphatic ampulla before tying the suture and frequently withdrawing lymph with a syringe when the flow is small enabled us to collect clear lymph, usually immediately after completing the cannulation. The rate of lymph flow varied widely (1.7 +/- 0.6 ml/hr) and increased when the left atrial pressure was raised. The lymph protein was 2.8 +/- 0.2 g% with lymph/plasma protein ratio at 0.55 +/- 0.04. The anatomical variations encountered in our 34 dissections, as well as the technical maneuvers found to be useful in the successful cannulation and collection of the porcine lung lymph, are described in detail.

  6. Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back.

    PubMed

    Rezayat, Talayeh; Stowell, Jeffrey R; Kendall, John L; Turner, Elizabeth; Fox, J Christian; Barjaktarevic, Igor

    2016-03-01

    Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal "in-plane" technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.

  7. Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back

    PubMed Central

    Rezayat, Talayeh; Stowell, Jeffrey R.; Kendall, John L.; Turner, Elizabeth; Fox, J. Christian; Barjaktarevic, Igor

    2016-01-01

    Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself. PMID:26973755

  8. Sequential Double-Guidewire Technique and Transpancreatic Precut Sphincterotomy for Difficult Biliary Cannulation

    PubMed Central

    Kim, Chang W.; Chang, Jae H.; Kim, Tae H.; Han, Sok W.

    2015-01-01

    Background/Aims: The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK). Patients and Methods: Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed. Results: DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023). Conclusions: Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent. PMID:25672234

  9. Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

    PubMed Central

    Xinopoulos, Dimitrios; Bassioukas, Stefanos P; Kypreos, Dimitrios; Korkolis, Dimitrios; Scorilas, Andreas; Mavridis, Konstantinos; Dimitroulopoulos, Dimitrios; Paraskevas, Emmanouil

    2011-01-01

    AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access. METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate. RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients’ gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases. PMID:21528077

  10. Effects on Subtalar Joint Stress Distribution After Cannulated Screw Insertion at Different Positions and Directions.

    PubMed

    Yuan, Cheng-song; Chen, Wan; Chen, Chen; Yang, Guang-hua; Hu, Chao; Tang, Kang-lai

    2015-01-01

    We investigated the effects on subtalar joint stress distribution after cannulated screw insertion at different positions and directions. After establishing a 3-dimensional geometric model of a normal subtalar joint, we analyzed the most ideal cannulated screw insertion position and approach for subtalar joint stress distribution and compared the differences in loading stress, antirotary strength, and anti-inversion/eversion strength among lateral-medial antiparallel screw insertion, traditional screw insertion, and ideal cannulated screw insertion. The screw insertion approach allowing the most uniform subtalar joint loading stress distribution was lateral screw insertion near the border of the talar neck plus medial screw insertion close to the ankle joint. For stress distribution uniformity, antirotary strength, and anti-inversion/eversion strength, lateral-medial antiparallel screw insertion was superior to traditional double-screw insertion. Compared with ideal cannulated screw insertion, slightly poorer stress distribution uniformity and better antirotary strength and anti-inversion/eversion strength were observed for lateral-medial antiparallel screw insertion. Traditional single-screw insertion was better than double-screw insertion for stress distribution uniformity but worse for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion was slightly worse for stress distribution uniformity than was ideal cannulated screw insertion but superior to traditional screw insertion. It was better than both ideal cannulated screw insertion and traditional screw insertion for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion is an approach with simple localization, convenient operation, and good safety.

  11. Afferent lymphatic cannulation as a model system to study innate immune responses to infection and vaccination.

    PubMed

    Neeland, Melanie R; Meeusen, Els N T; de Veer, Michael J

    2014-03-15

    The afferent lymphatics consist of the cells and immunomodulatory signals that are involved in the early response to peripheral stimuli. Examination of this compartment in both homeostatic and stimulatory conditions permits the analysis of the innate biological pathways responsible for the generation of an adaptive immune response in the lymph node. Afferent lymphatic cannulation is therefore an ideal model system to study cellular migration and antigen dispersal kinetics during infection and vaccination. Utilisation of these lymphatic cannulation models has demonstrated the ability to both increase current understanding of infectious diseases, vaccine delivery systems and has the potential to target effector cells and molecules that may be used as novel therapeutic or vaccine targets.

  12. A Reusable Adapter for Collection of Cerebrospinal Fluid in Chronically Cannulated Goats

    DTIC Science & Technology

    1989-03-03

    cannulas. Additionally, a 4cm area of each bone surface was cleaned. One cannula was positioned dorsal to the ependymal lining of the lateral ventricle...around implantation areas. In addition, blood cell counts remained at normal levels in all cannulated goats. Moreover, hypertensive hydrocephalus did

  13. Cannulation of the extrathoracic left common carotid artery for thoracic aorta operations through left posterolateral thoracotomy.

    PubMed

    Veron, Sebastien; Neri, Eugenio; Buklas, Dimitrios; Pula, Giorgio; Benvenuti, Antonio; Massetti, Massimo; Bizzarri, Federico; Sassi, Carlo

    2004-11-01

    The femoral artery is the usual site of arterial cannulation in thoracic aorta operations through left posterolateral thoracotomy that require cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). The advantage of this perfusion route is in limiting the duration of circulatory arrest. It is associated, however, with the risk of retrograde embolization or, in cases involving aortic dissection, malperfusion of vital organs. To prevent these risks, we have used the extrathoracic left common carotid artery as the perfusion route. From December 1999 to January 2003, we used cannulation of the left extrathoracic common carotid artery in 42 thoracic aorta operations through posterolateral thoracotomy with an open proximal anastomosis technique during DHCA. The indication for thoracic aortic repair was atherosclerotic ulcer in 7 cases, chronic aortic aneurysm in 18, acute type B dissection in 5, and chronic type B dissection in 12. Cannulation of the extrathoracic left common carotid artery was successful in all patients. Postoperative recovery was uneventful, with no cerebrovascular events in all cases. No cannulation-related complications were observed. One patient died from cardiac insufficiency on postoperative day 5. No peripheral neurological deficits (paraplegia or paraparesis) were observed. Postoperative complications included atrial fibrillation in five patients, reoperation to control hemorrhage in six, respiratory insufficiency in nine, and renal insufficiency in six. These results indicate that cannulation of the left extrathoracic common carotid artery is a useful, reliable method for proximal perfusion during CPB in patients undergoing repair of the descending thoracic aorta through left posterolateral thoracotomy. By providing effective perfusion of the brain, this technique can prolong safe DHCA time. Another advantage is the prevention of cerebral emboli, ensuring retrograde flow to the aortic arch.

  14. Incidence of posterior wall penetration during internal jugular vein cannulation: A comparison of two techniques using real-time ultrasound

    PubMed Central

    Srinivasan, Shrikanth; Govil, Deepak; Gupta, Sachin; Patel, Sweta; Jagadeesh, KN; Tomar, Deeksha Singh

    2017-01-01

    Background and Aims: The true incidence of penetration of the posterior wall (through-and-through puncture) of the internal jugular vein (IJV) during cannulation is unknown. This may have implications if there is hematoma formation, penetration and/or inadvertent cannulation of an underlying carotid artery. This study compared the incidence of posterior wall puncture during IJV cannulation using ultrasound guidance versus traditional landmarks-guided technique. Methods: One hundred and seventy adult patients admitted to a gastro-liver Intensive Care Unit who required central venous lines were randomly divided into Group A: IJV cannulation using anatomical landmark-guided technique and Group B: IJV cannulation using real-time ultrasound guidance. In both groups, a second investigator followed the needle path using real-time ultrasound. The incidence of posterior wall puncture, number of attempts for successful cannulation, incidence of inadvertent arterial punctures and occurrence of complications such as hematoma formation and pneumothorax were recorded. Results: Significantly more (37/80, 46%) patients in Group A had posterior wall puncture compared to 19/90 (21%) in Group B. Incidence of arterial puncture was 8/80 (10%) in Group A, 5/90 (5.5%) in Group B. The number of attempts for venous cannulation and hematoma formation was significantly less in Group B. Conclusion: Real-time ultrasound-guided IJV cannulation significantly reduces but does not wholly eliminate the incidence of posterior venous wall penetrations. It also significantly reduces the incidence of inadvertent arterial punctures and number of attempts for successful cannulation.

  15. Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures

    PubMed Central

    Uzun, Metin; Bilen, Fikri Erkal; Eralp, Levent

    2014-01-01

    Objectives: The aim of the treatment of tibial plateau fractures is to obtain a pain-free and fully functional knee with closed reduction, percutaneous cannulated screw fixation and hexapodal external fixator reconstruction for high energy compound upper tibial fractures. Methods: Patients with comminuted tibial plateau fractures underwent closed reduction, percutaneous fixation with cannulated screws, and reconstruction with hexapodal external fixator. The follow-up period was 24 months. Results: The clinical and radiological results were good or excellent. The average knee flexion was 125°. Conclusion: Our results are successful in the initial stage, however, it should be pointed out that during the long term follow-up osteoarthritis may develop leading to worsening of the condition. Level of Evidence IV, Case Series. PMID:24644420

  16. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    PubMed

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

  17. Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation

    PubMed Central

    Jacob, Samuel; MacHannaford, Juan C.; Chamogeorgakis, Themistokles; Gonzalez-Stawinski, Gonzalo V.; Felius, Joost; Rafael, Aldo E.; Malyala, Rajasekhar S.

    2017-01-01

    Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies—such as cardiac transplantation or a left ventricular assist device—can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome. This technique involves cannulation of the subclavian artery and vein. The current case report details our recent experience with this approach in a critically ill patient awaiting cardiac transplantation.

  18. Hemodialysis catheter insertion: is increased PO2 a sign of arterial cannulation? A case report

    PubMed Central

    2014-01-01

    Background Ultrasound-guided Central Venous Catheterization (CVC) for temporary vascular access, preferably using the right internal jugular vein, is widely accepted by nephrologists. However CVC is associated with numerous potential complications, including death. We describe the finding of a rare left-sided partial anomalous pulmonary vein connection during central venous catheterization for continuous renal replacement therapy (CRRT). Case presentation Ultrasound-guided cannulation of a large bore temporary dual-lumen Quinton-Mahurkar catheter into the left internal jugular vein was performed for CRRT initiation in a 66 year old African-American with sepsis-related oliguric acute kidney injury. The post-procedure chest X-ray suggested inadvertent left carotid artery cannulation. Blood gases obtained from the catheter showed high partial pressure of oxygen (PO2) of 140 mmHg and low partial pressure of carbon dioxide (PCO2) of 22 mmHg, suggestive of arterial cannulation. However, the pressure-transduced wave forms appeared venous and Computed Tomography Angiography located the catheter in the left internal jugular vein, but demonstrated that the tip of the catheter was lying over a left pulmonary vein which was abnormally draining into the left brachiocephalic (innominate) vein rather than into the left atrium. Conclusion Although several mechanical complications of dialysis catheters have been described, ours is one of the few cases of malposition into an anomalous pulmonary vein, and highlights a sequential approach to properly identify the catheter location in this uncommon clinical scenario. PMID:25073708

  19. Internal Jugular Vein Cannulation: An Ultrasound-Guided Technique Versus a Landmark-Guided Technique

    PubMed Central

    Turker, Gurkan; Kaya, Fatma Nur; Gurbet, Alp; Aksu, Hale; Erdogan, Cuneyt; Atlas, Ahmet

    2009-01-01

    OBJECTIVES To compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. METHODS A total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. RESULTS The overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups. CONCLUSION The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications. PMID:19841706

  20. The Shape of the Foramen Ovale: A Visualization Aid for Cannulation Procedures.

    PubMed

    Zdilla, Matthew J; Fijalkowski, Kristen M

    2017-03-01

    Several neurosurgical procedures, including rhizotomy for the management of trigeminal neuralgia, cannulate the foramen ovale (FO) to access intracranial structures. Cannulation procedures, including those utilizing neuronavigational technology, are occasionally complicated by anatomical variation of the FO, sometimes resulting in miscannulation and subsequent adverse events. The FO, while commonly thought of as oval-shaped, has also been described as "almond," "banana," "D shape," "pear," and "triangular." Because of the importance of the FO in neurosurgical procedures and the misunderstanding of FO shape, the aim of this study is to objectively describe the shape of the FO and its most likely shape variation. A total of 211 FO were evaluated by geometric morphometric analysis. A consensus shape is presented for the FO. No significant difference was found between the shapes of left- and right-sided FO. The most likely shape variation of the FO occurs as an inverse relationship between the anteromedial-posterolateral and anterolateral-posteromedial aspects of the foramen. The capacity to visualize the average FO shape and understand the most likely shape variance, as illustrated by this report, will aid neurosurgeons in their approach to procedures requiring cannulation of the FO.

  1. Tissue reaction to implants of different metals: a study using guide wires in cannulated screws.

    PubMed

    Devine, D M; Leitner, M; Perren, S M; Boure, L P; Pearce, S G

    2009-10-20

    Cannulated screws, along with guide wires, are typically used for surgical fracture treatment in cancellous bone. Breakage or bending deformation of the guide wire is a clinical concern. Mechanically superior guide wires made of Co-Cr alloys such as MP35N and L605 may reduce the occurrence of mechanical failures when used in combination with conventional (316L stainless steel) cannulated screws. However the possibility of galvanic or crevice corrosion and adverse tissue reaction, exists when using dissimilar materials, particularly in the event that a guide wire breaks, and remains in situ. Therefore, we designed an experiment to determine the tissue reaction to such an in vivo environment. Implant devices were designed to replicate a clinical situation where dissimilar metals can form a galvanic couple. Histological and SEM analyses were used to evaluate tissue response and corrosion of the implants. In this experiment, no adverse in vivo effects were detected from the use of dissimilar materials in a model of a broken guide wire in a cannulated screw.

  2. [Ultrasonic guided cannulation of the axillary vein in intensive care patients].

    PubMed

    Schregel, W; Höer, H; Radtke, J; Cunitz, G

    1994-10-01

    Cannulation of the axillary vein is claimed to be an effective and relatively safe access to the central venous (CV) system [2, 4, 5, 8]. However, anatomical landmarks recommended for venous location (Muskulus pectoralis minor, processus coracoideus) are probably hard to identify in the majority of intensive care (ICU) patients. This investigation evaluated unidirectional 8 MHz Doppler ultrasound (US) in locating the axillary vein. Success rates and complications of this CV access in ICU patients is analysed. METHODS. The experimental design was approved by the local ethical committee (RUB). In 50 patients from our ICU cannulation of the axillary vein was attempted; all were in need of a CV line. Other CV puncture sites (except for the subclavian vein) were associated with contraindications. Patients were placed in a 15 degrees Trendelenburg position (15 exceptions); the arm was abducted to 45 degrees [5, 8]. The course of the axillary vein was located by Doppler US and marked on the skin with a felt pen. Prior to puncture, US intensity was judged by a score ranging from 0 to 4. After skin desinfection, sterile draping, and local anaesthesia, puncture of the axillary vein was attempted. The puncture kit LeaderCath 11,515 (Vygon, Aachen, FRG) was used. When venous blood could be aspirated, the Seldinger guidewire was inserted and the definite catheter placed. The experimental design allowed up to ten punctures, slightly modified in angle and direction of the needle, if puncture of the axillary vein or guide-wire placement failed. The cannulation attempt was classified as unsuccessful in the following cases: malposition, axillary vein not encountered by the puncture needle, guide-wire placement unsuccessful, or if identification and cannulation of the vein lasted more than 20 min. The puncture attempts were evaluated in respect to success rate, time, relation of US intensity to puncture attempts and CV pressure, complications, and malposition. RESULTS. Of the 50

  3. A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model.

    PubMed

    Hardie, Robert J; Sheehan, Nora K

    2016-10-01

    This study describes a lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model. The thoracic duct was cannulated via a left lateral intercostal thoracotomy in 12 cats. Lymphatic fluid was collected for up to 16 days and analyzed on days 3, 9 and 16. The volume collected and duration of cannula patency were recorded. Contrast imaging of the thoracic duct was performed if fluid ceased to flow or at the end of the 16-day study period. In two cats, the cannula became dislodged within 24 h. For the remaining 10 cats, mean daily volume collected was 43.7 mL (median 41.0, range 2.3 to 152.4 mL), and mean duration of cannula patency was 8.2 days (median 6.5, range 3 to 16 days). Contrast imaging revealed that the cannula was patent in three cats, obstructed in two cats, and the thoracic duct had ruptured or had extravasation of contrast outside the duct in five cats. Cytological examination of lymphatic fluid from the three time points revealed normal appearing small lymphocytes (97%) and few (3%) non-degenerate neutrophils, macrophages, eosinophils, and plasma cells. Based on the results of this study, lateral thoracotomy approach for thoracic duct cannulation is a feasible technique for collecting lymphatic fluid in cats. This technique may have application as a model for short-term evaluation of thoracic fluid in cats; however, cannula patency was unpredictable and should be considered when utilizing this technique.

  4. The Mesenteric Lymph Duct Cannulated Rat Model: Application to the Assessment of Intestinal Lymphatic Drug Transport

    PubMed Central

    Trevaskis, Natalie L.; Hu, Luojuan; Caliph, Suzanne M.; Han, Sifei; Porter, Christopher J.H.

    2015-01-01

    The intestinal lymphatic system plays key roles in fluid transport, lipid absorption and immune function. Lymph flows directly from the small intestine via a series of lymphatic vessels and nodes that converge at the superior mesenteric lymph duct. Cannulation of the mesenteric lymph duct thus enables the collection of mesenteric lymph flowing from the intestine. Mesenteric lymph consists of a cellular fraction of immune cells (99% lymphocytes), aqueous fraction (fluid, peptides and proteins such as cytokines and gut hormones) and lipoprotein fraction (lipids, lipophilic molecules and apo-proteins). The mesenteric lymph duct cannulation model can therefore be used to measure the concentration and rate of transport of a range of factors from the intestine via the lymphatic system. Changes to these factors in response to different challenges (e.g., diets, antigens, drugs) and in disease (e.g., inflammatory bowel disease, HIV, diabetes) can also be determined. An area of expanding interest is the role of lymphatic transport in the absorption of orally administered lipophilic drugs and prodrugs that associate with intestinal lipid absorption pathways. Here we describe, in detail, a mesenteric lymph duct cannulated rat model which enables evaluation of the rate and extent of lipid and drug transport via the lymphatic system for several hours following intestinal delivery. The method is easily adaptable to the measurement of other parameters in lymph. We provide detailed descriptions of the difficulties that may be encountered when establishing this complex surgical method, as well as representative data from failed and successful experiments to provide instruction on how to confirm experimental success and interpret the data obtained. PMID:25866901

  5. Percutaneous Cannulated Compression Screw Osteosynthesis in Phalanx Fractures: The Surgical Technique, the Indications, and the Results

    PubMed Central

    Kisch, Tobias; Wenzel, Eike; Mailänder, Peter; Stang, Felix

    2017-01-01

    Objective: Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. Methods: We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Results: Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. Conclusions: The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures. PMID:28293333

  6. Catheter malplacement during central venous cannulation through arm veins in pediatric patients.

    PubMed

    Chaturvedi, Arvind; Bithal, Parmod K; Dash, Harihar; Chauhan, Rajendra S; Mohanty, Bibekanand

    2003-07-01

    For successful catheter placement, central venous cannulation (CVC) through internal jugular vein and subclavian vein has been recommended in both adult and pediatric patients. But it carries a risk of serious complications, such as pneumothorax, carotid, or subclavian artery puncture, which can be life-threatening, particularly in critically ill children. So a prospective study was carried out to determine the success rate of correct catheter tip placement during CVC through antecubital veins in pediatric neurosurgical patients. A total of 200 pediatric patients (age 1-15 years) of either sex were studied. Basilic or cephalic veins of either arm were selected. All the patients were cannulated in the operation room under general anesthesia. Single lumen, proper size catheters (with stillete) were used for cannulation. The catheter was inserted in supine position with the arm abducted at right angle to the body and neck turned ipsilaterally. The length of insertion was determined from cubital fossa to the right second intercostal space. The exact position of the tip of the catheter was confirmed radiologically in ICU. Correct catheter tip placement was achieved in 98 (49%) patients. Multivariate logistic regression analysis of data shows that there was no statistically significant difference among correct and incorrect catheter tip placement in relation to factors including sex, side of cannulation (left or right), and type of vein (basilic or cephalic). The analysis of correct catheter tip placement in relation to age showed that the highest success rate was achieved in children of age group 6 to 10 years (60.2%) followed by 30.6% in the 11 to 15 year group. The lowest success rate of tip placement of only 9.2% was observed in younger children of age 1 to 5 years, which is statistically significant (P = 0.001). Of 102 incorrect placements reported, 37% were in 1 to 5 year age group versus 9.2% correct tip placements. The most common unsatisfactory placements were

  7. Optical wire guided lumpectomy: frequency domain measurements

    NASA Astrophysics Data System (ADS)

    Dayton, A. L.; Keränen, V. T.; Prahl, S. A.

    2009-02-01

    In practice, complete removal of the tumor during a lumpectomy is difficult; the published rates of positive margins range from 10% to 50%. A spherical lumpectomy specimen with tumor directly in the middle may improve the success rate. A light source placed within the tumor may accomplish this goal by creating a sphere surrounding the tumor that can serve as a guide for resection. In an optical phantom and a prophylactic mastectomy specimen, sinusoidally modulated light within the medium was collected by optical fiber(s) at fixed distance(s) from the source and used to measure the optical properties. These optical properties were then used to calculate the distance the light had traveled through the medium. The fiber was coupled to an 830nm diode laser that was modulated at 100, 200 and 300 MHz. A handheld optical probe collected the modulated light and a network analyzer measured the phase lag. This data was used to calculate the distance the light traveled from the emitting fiber tip to the probe. The optical properties were μa = 0.004mm-1 and μ1s = 0.38mm-1 in the phantom. The optical properties for the tissue were μa = 0.005mm-1 and μ1s = 0.20mm-1. The prediction of distance from the source was within 4mm of the actual distance at 30mm in the phantom and within 3mm of the actual distance at 25mm in the tissue. The feasibility of a frequency domain system that makes measurements of local optical properties and then extrapolates those optical properties to make measurements of distance with a separate probe was demonstrated.

  8. 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.

  9. Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes

    PubMed Central

    Field, M L; Al‐Alao, B; Mediratta, N; Sosnowski, A

    2006-01-01

    Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes: (a) repeat surgery, (b) minimally invasive surgery, and (c) cases with diseased vessels such as porcelain, aneurysmal, and dissecting aorta. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the development of closed chest extracorporeal life support, in the form of cardiopulmonary support and extracorporeal membrane oxygenation. With this development have come applications for cardiopulmonary bypass based support outside the traditional cardiac theatre setting, including emergency circulatory support for patients in cardiogenic shock and respiratory support for patients with severely impaired gas exchange. This review summarises the approach to extrathoracic cannulation for the generalist. PMID:16679471

  10. Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: an in-vivo experimental comparison.

    PubMed

    Horn, J; Schlegel, U; Krettek, C; Ito, K

    2005-07-01

    Infection continues to be a problematic complication of fracture treatment, particularly in severe open fractures. The implant design and material as well as implantation technique play an important role in the pathogenesis of local infection. The aim of our study was to determine if the local resistance to infection of a cannulated IM nail is less than that of a solid nail and more similar to that of a hollow nail. In 65 female White Zealand rabbits, the intramedullary cavity was inoculated with matching concentrations of Staphylococcus aureus, and one of the three nails was inserted. The solid nail had a greater than twofold higher resistance to infection (23%) compared to that of the other two nails (hollow, 65%; cannulated, 61%) which was statistically significant (p<0.02). No difference in infection resistance was detected between the hollow slotted and cannulated nail designs (p=1). Although these experimental results may be clinically considered, direct extrapolation to clinical infection rates is ill advised.

  11. Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire.

    PubMed

    Miyamura, Satoshi; Ota, Haruka; Okamoto, Michio; Namba, Jiro; Yamamoto, Koji

    2016-01-01

    Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation.

  12. Characterization of post-surgical alterations in the bile duct-cannulated rat.

    PubMed

    Bachir-Cherif, Dalila; Blum, Denise; Braendli-Baiocco, Annamaria; Chaput, Evelyne; Pacheco, Gonzalo Christiano Duran; Flint, Nicholas; Haiker, Monika; Hoflack, Jean-Christophe; Justies, Nicole; Neff, Rachel; Starke, Volkmar; Steiner, Guido; Tournillac, Charles Alexandre; Singer, Thomas; Ubeaud-Séquier, Geneviève; Schuler, Franz

    2011-08-01

    The bile duct-cannulated (BDC) rat is a standard animal model used in ADME experiments. The aim of this study was to investigate post-surgical alterations that are relevant to ADME investigations in BDC rats compared with sham- and non-operated animals. Water and food intake was reduced in the animals' post-surgery. This led to a lower body weight in operated animals. In BDC animals, aspartate aminotransferase (AST) levels in plasma were transiently elevated and total bile acid levels were reduced. Alpha(1)-acid glycoprotein (AGP) in plasma and the concentration of bile components in bile were elevated. Histopathology showed inflammation in the area of the cannulation between the liver and the small intestine. A microarray-based gene expression and RTq-PCR analysis identified altered expression for several genes involved in drug disposition including the down-regulation of cytochrome P450 enzymes. This led to reduced cytochrome P450 content in the liver and lower metabolic activity in microsomes from BDC and sham-operated rats compared with naïve animals. The results of the study suggest that the post-surgical inflammation leads to physiological changes relevant for drug absorption and disposition. These alterations should be accounted for in the interpretation of ADME studies in BDC animals.

  13. Measuring intravenous cannulation skills of practical nursing students using rubber mannequin intravenous training arms.

    PubMed

    Jones, Robert S; Simmons, Angela; Boykin, Gary L; Stamper, David; Thompson, Jennifer C

    2014-11-01

    This study examined the effectiveness of two training methods for peripheral intravenous (IV) cannulation; one using rubber mannequin IV training arms, and the other consisting of students performing the procedure on each other. Two hundred-sixty Phase II Army Practical Nursing students were randomized into two groups and trained to perform an IV cannulation procedure. All students watched a 12-minute training video covering standard IV placement procedures. Afterward, both groups practiced the procedure for an hour according to their assigned group. Students were then tested on IV placement in a live human arm using a 14-item testing instrument in three trials that were scored pass/fail. There was no difference in the groups' performance of the IV procedure on the first attempt: 51.7% (n = 92) of the human arm group passed the test, and 48.3% (n = 86) of the rubber mannequin group passed the test (p = 0.074). These data suggest that using rubber mannequin IV arms for IV skills training may be just as effective as training students using traditional methods. In addition, using simulation provides an extra benefit of reducing risks associated with learning the procedure on a fellow student.

  14. Treatment of delayed/nonunion of scaphoid waist with Synthes cannulated scaphoid screw and bone graft.

    PubMed

    Inaparthy, P K; Nicholl, J E

    2008-12-01

    Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. Our aim was to conduct a retrospective study looking at the union rate, time to union, and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. This study is a review of a cohort of 30 patients treated with a cannulated Synthes scaphoid screw and corticocancellous bone grafting for scaphoid waist delayed union and nonunion at our center. We achieved 86% overall union rate. The patients with delayed union achieved a 100% union rate. Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting.

  15. Treatment of Delayed/Nonunion of Scaphoid Waist with Synthes Cannulated Scaphoid Screw and Bone Graft

    PubMed Central

    Nicholl, J. E.

    2008-01-01

    Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. Our aim was to conduct a retrospective study looking at the union rate, time to union, and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. This study is a review of a cohort of 30 patients treated with a cannulated Synthes scaphoid screw and corticocancellous bone grafting for scaphoid waist delayed union and nonunion at our center. We achieved 86% overall union rate. The patients with delayed union achieved a 100% union rate. Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting. PMID:18780015

  16. Right Internal Jugular Vein Cannulation: Carotid Artery-directed versus Sternocleidomastoid-directed Methods.

    PubMed

    Yu, Zhao-Yan; Yuan, Ping; Pan, Yang; Zhang, Zhong-Min

    2016-02-01

    The aim of the present study was to explore a simple and safe method for central venous catheterization (CVC) from the right internal jugular vein (RIJV) by comparing carotid artery (CA) positioning with sternocleidomastoid (SCM) positioning. The medical records of patients who underwent CVC between January 2011 and January 2015 were retrospectively reviewed. Central venous catheters were inserted into the RIJV either above the level of the cricoid cartilage using the CA-directed method (419 patients, Group 1) or below the level of the cricoid cartilage using the SCM-directed method (436 patients, Group 2). Success rate and related complications of catheterization were evaluated in the two groups. The total success rate of RIJV cannulation in Group 1 (97.2%) was higher than that in Group 2 (94.5%). Moreover, the success rate at first attempt was significantly higher in Group 1 than in Group 2 (92.4% vs 86.9%). The incidence of hematoma was 1.6 per cent in Group 1 and 3.8 per cent in Group 2. The rate of other complications such as pneumothorax, catheter-related infections, and catheter occlusion did not significantly differ between the groups. In conclusions, CA-directed RIJV cannulation is more effective and simple to perform than the SCM-directed method, and should become the preferred CVC technique in the absence of ultrasound guidance.

  17. Comparative Evaluation of Volatile Anaesthetic Agents for Attenuation of Venous Cannulation Pain: A Prospective, Randomized Controlled Study

    PubMed Central

    Das, Pravin K; Gautam, Sujeet KS; Jaisawal, Parineeta; Kadiyala, Venkat N.; Rambhad, Sonal

    2016-01-01

    Introduction Topical application of volatile anaesthetic agents has been found to attenuate the response to a mechanical stimulus; however, this effect of volatile anaesthetic on perception of pain during venous cannulation is not known. Aim To compare the efficacy of topically administered volatile anaesthetic agents for attenuating venous cannulation pain. Materials and Methods This prospective, randomized, placebo controlled and double blind study was conducted on 120 patients, aged 20-60years. They were of American Society of Anaesthesiologists (ASA) I or II physical status, of either sex, planned for elective surgeries. These patients were randomized into 4 groups, of 30 each. Equipotent doses of halothane (1ml), isoflurane (1.5ml), sevoflurane (2.7ml) and sterile water (2.5ml; Control) were topically administered on the volar surface of forearm wrapped with cotton and aluminium foil; venous cannulation was performed with 18G intravenous cannula after 30 min. These patients were assessed for the incidence and severity of pain upon venous cannulation {visual analog scale (VAS), 0-100mm; 0 = no pain and 100 = worst imaginable pain}. Data were analysed by one-way ANOVA, Chi-square test and Kruskal-Wallis test. The p<0.05 was considered as significant. Results A significant reduction in the incidence of venous cannulation pain was observed in the halothane (79%) group as compared to control (100%; p<0.05), isoflurane (100%; p<0.05) and sevoflurane (100%; p<0.05) groups. The severity of venous cannulation pain as assessed by median (interquartile range, Q1-Q3). VAS scores was reduced in the halothane {10 (10-20); p<0.001}, isoflurane {20 (10-30); p<0.001} and sevoflurane {20 (20-30); p<0.001} groups as compared to the control group {40 (30-40)}; VAS score in the halothane group was significantly less as compared to isoflurane (p<0.05) and sevoflurane (p<0.05) groups. Conclusion Topical application of halothane is most effective in reducing incidence and severity of

  18. Cannulation Strategies in Adult Veno-arterial and Veno-venous Extracorporeal Membrane Oxygenation: Techniques, Limitations, and Special Considerations

    PubMed Central

    Jayaraman, Arun L; Cormican, Daniel; Shah, Pranav; Ramakrishna, Harish

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use. PMID:28074818

  19. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations.

    PubMed

    Jayaraman, Arun L; Cormican, Daniel; Shah, Pranav; Ramakrishna, Harish

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) refers to specific mechanical devices used to temporarily support the failing heart and/or lung. Technological advances as well as growing collective knowledge and experience have resulted in increased ECMO use and improved outcomes. Veno-arterial (VA) ECMO is used in selected patients with various etiologies of cardiogenic shock and entails either central or peripheral cannulation. Central cannulation is frequently used in postcardiotomy cardiogenic shock and is associated with improved venous drainage and reduced concern for upper body hypoxemia as compared to peripheral cannulation. These concerns inherent to peripheral VA ECMO may be addressed through so-called triple cannulation approaches. Veno-venous (VV) ECMO is increasingly employed in selected patients with respiratory failure refractory to more conventional measures. Newer dual lumen VV ECMO cannulas may facilitate extubation and mobilization. In summary, the pathology being addressed impacts the ECMO approach that is deployed, and each ECMO implementation has distinct virtues and drawbacks. Understanding these considerations is crucial to safe and effective ECMO use.

  20. Reentrant cannulation of the small intestine in sheep: cannula and surgical method.

    PubMed

    Ivan, M; Johnston, D W

    1981-04-01

    The function, design and production of a reentrant cannula for the small intestine of sheep and the corresponding surgical procedure are described. The cannula is molded in one piece from polyvinylchloride plastisol. It consists of a curved intestinal tube joined to a stem with an external elliptical ring on the distal end and a perforated flange that encircles the stem above the intestinal tube. A circular perspex valve with two curved channels was made to fit into the interior of the cannula, making it capable of either a "maintenance" or a "collection" function. The cannula was inserted into the proximal duodenum and(or) terminal ileum of sheep via a 5-cm incision on the antimesenteric side of the intestine. The intestine was attached to the cannula by a Dacron straight arterial graft. This reentrant cannulation method does not require an intestinal transection and a mesenteric incision under the transection. Therefore, little damage was done to the blood and nervous system.

  1. Evaluation of Previously Cannulated Radial Arteries as Patent Coronary Artery Bypass Conduits.

    PubMed

    Watson, Timothy; Pope, Adele; van Pelt, Niels; Ruygrok, Peter N

    2015-10-01

    In coronary artery bypass grafting, good-quality conduits are needed to maximize the potential for long-term patency. Revascularization has traditionally been achieved with use of the saphenous vein and the internal thoracic arteries. In recent years, total arterial revascularization with use of the radial arteries has been promoted. Meanwhile, use of the transradial approach for coronary angiography has also increased. The long-term effects of previous cannulation in radial artery bypass grafts are not known. Therefore, we used multidetector computed tomographic angiography to investigate radial-artery graft patency in a small series of patients who had undergone transradial angiography. We found a high patency rate, and we discuss those findings here.

  2. The effect of buttonhole cannulation vs. rope-ladder technique on hemodialysis access patency.

    PubMed

    Chan, Micah R; Shobande, Olatokunbo; Vats, Hemender; Wakeen, Maureen; Meyer, Xinliu; Bellingham, Janet; Astor, Brad C; Yevzlin, Alexander S

    2014-03-01

    The rope-ladder (RL) technique is the most common technique used for cannulation of arteriovenous fistulae (AVF). Buttonhole cannulation (BHC), or constant-site technique, is recommended by the National Kidney Foundation's Kidney Disease Outcome Quality Initiative (NKF/KDOQI) vascular access guidelines. We compared outcomes of primary patency, episodes of bacteremia, access blood flow (Qa), and quality of life (QoL) scores between RL and BHC patients. Using a prospectively collected, vascular access database, a total of 45 prevalent dialysis patients using BHC were compared with 38 patients using the RL technique over a median of 12 months (inter-quartile range: 4-27 months). The two groups did not differ significantly in demographics except that diabetes was more common in those using BHC as compared to rope-ladder (69% vs. 34%; p = 0.002). Risk factors associated with lack of primary patency were age (hazards ratio [HR] = 1.02 per decade; 95% CI: 1.00-1.03; p = 0.04) and female gender (HR = 1.92; 95% CI: 1.08-3.40; p = 0.03). Use of the buttonhole technique was not associated with improved primary patency (HR = 1.22, 95% CI: 0.65-2.28; p = 0.53). Episodes of bacteremia and mean scores from KDQOL-36 did not differ significantly between the groups. This study demonstrates for the first time that BHC use is not associated with improved access patency.

  3. An Endovascular Cannulation Needle with an Internal Wire for the Fragmentation of Thrombi in Retinal Vein Occlusion

    PubMed Central

    Asami, Tetsu; Kaneko, Hiroki; Miyake, Kensaku; Ota, Ichiro; Miyake, Goichiro; Kato, Seiichi; Yasuda, Shunsuke; Iwase, Takeshi; Ito, Yasuki; Terasaki, Hiroko

    2016-01-01

    Purpose We report a newly developed device to fragment thrombi in retinal vein occlusion. Methods The new instrument consists of a 23-gauge (G) pipe and a 37-G needle with an internal wire. A total of 40 porcine eyes were used; 20 eyes for experiments in the branch retinal vein (BRV group) and 20 eyes for experiments in the central retinal vein (CRV group). We placed 25-G 3-port trocars, and core vitrectomy was performed. Another 23-G scleral incision was performed for insertion of the needle. The needle pierced the retinal vein at a distance of three- to four- or one-disc diameters from the optic disc (BRV or CRV group, respectively), and the internal wire was advanced toward the disc. The success rates of needle piercing and cannulation of the internal wire were recorded in each group. In the CRV group, the cannulation was deemed successful when the tip reached inside the optic disc. Real-time optical coherence tomography imaging also was performed using the Zeiss Rescan 700 device in porcine eyes. Histologic examination of the retinal vessel inserted with the internal wire was performed. Results The success rates of needle piercing into the BRV and CRV were 85% and 95%, respectively. The success rates of cannulation of the internal wire into the BRV and CRV were 85% and 0%, respectively. The process of cannulation was recorded successfully with the Rescan 700. Histologic examination showed no damages to the endothelial cell layer. Conclusions The needle and internal wire intended to be used for recanalization of BRV occlusion were successfully pierced and cannulated into the BRV. Translational Relevance This newly developed device could become a treatment modality for retinal vein occlusion to fragment thrombi that present treatment methods cannot reach and remove directly. PMID:27730009

  4. Multiple venous thrombosis complicating central venous cannulation in a non cancer patient - a case report.

    PubMed

    Peters, Ce; Menkiti, Id; Desalu, I; Thomas, Mo

    2013-01-01

    Central venous catheterization is a common procedure for critically ill patients. Like all procedures, it has its complications, one of which is thrombosis. Reports of thrombosis are commoner among cancer patients. We present a 37 year old non cancer patient who developed thrombi in both right and left internal jugular veins, 10 and 13 days respectively after insertion of central venous catheter. This was detected by ultrasound scans of the neck while attempting re-cannulation for parenteral feeding. She also had left lower limb deep venous thrombosis, confirmed by doppler scan, which was managed with low molecular weight heparin and warfarin. The patient was subsequently treated with streptokinase. A repeat scan of the internal jugular veins 4 days after thrombolysis revealed a reduction in size of the thrombi. Symptoms of deep venous thrombosis improved and she was transferred to the wards where she made remarkable improvement. This case illustrates the potential usefulness of ultrasound guided-central line insertion in patients who have had central venous lines inserted previously in order to detect thrombi.

  5. Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

    PubMed Central

    Banfi, Carlo; Pozzi, Matteo; Brunner, Marie-Eve; Rigamonti, Fabio; Murith, Nicolas; Mugnai, Damiano; Obadia, Jean-Francois; Bendjelid, Karim

    2016-01-01

    Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO. PMID:27747024

  6. Robot-assisted retinal vein cannulation with force-based puncture detection: Micron vs. the steady-hand eye robot.

    PubMed

    Gonenc, Berk; Tran, Nhat; Gehlbach, Peter; Taylor, Russell H; Iordachita, Iulian

    2016-08-01

    Retinal vein cannulation is a demanding procedure where therapeutic agents are injected into occluded retina veins. The feasibility of this treatment is limited due to challenges in identifying the moment of venous puncture, achieving cannulation and maintaining it throughout the drug delivery period. In this study, we integrate a force-sensing microneedle with two distinct robotic systems: the handheld micromanipulator Micron, and the cooperatively controlled Steady-Hand Eye Robot (SHER). The sensed tool-to-tissue interaction forces are used to detect venous puncture and extend the robots' standard control schemes with a new position holding mode (PHM) that assists the operator hold the needle position fixed and maintain cannulation for a longer time with less trauma on the vasculature. We evaluate the resulting systems comparatively in a dry phantom, stretched vinyl membranes. Results have shown that modulating the admittance control gain of SHER alone is not a very effective solution for preventing the undesired tool motion after puncture. However, after using puncture detection and PHM the deviation from the puncture point is significantly reduced, by 65% with Micron, and by 95% with SHER representing a potential advantage over freehand for both.

  7. Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation

    PubMed Central

    MacAskill, Mark G.; Watson, David G.; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

    2015-01-01

    Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~ 60% at 12 months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates. PMID:25866325

  8. Axillo-iliac arteriovenous hemodialysis graft creation with an early cannulation device.

    PubMed

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Lopez-Mendez, Alejandra; Gomez-Arcive, Zeniff; Laparra-Escareno, Hugo; Cuen-Ojeda, Cesar; Lizola, Rene; Torres-Machorro, Adriana

    2017-03-01

    Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.

  9. Massive hemothorax due to subclavian vein tear during internal jugular vein cannulation in a 15-year-old boy scheduled for mitral valve replacement

    PubMed Central

    Mishra, Sandeep Kumar; Paulose, Deepak; Kundra, Pankaj; Parida, Satyen

    2015-01-01

    We present an unusual case of life-threatening hemothorax in a 15-year-old boy following subclavian vein tear during internal jugular vein (IJV) cannulation prior to initiation of surgery (mitral valve replacement). Successful IJV cannulation was done in the third attempt. However, we missed the subclavian tear which occurred during the first two initial attempts as there was no clinical evidence suggestive of it at that point of time. This undiagnosed hemothorax led to hemodynamic decompensation requiring high volume and inotropic support to wean the patient off cardiopulmonary bypass. This unusually high requirement of fluid and inotropes required the surgeon to look for noncardiac causes for the hemodynamic disturbance and he noticed a bulge in the right pleura, which on exploration had approximately 1.5 L of collected blood. It was then retrospectively analyzed that the cause of this hemothorax could have been the undue lateral orientation of the needle during IJV cannulation and the advancement of the dilator to its entire length could have injured the subclavian vein. Here, we also would like to discuss the safety precautions to be taken during the cannulation, like the needle orientation and the length to which the dilator must be advanced for safe central venous cannulation. PMID:26712992

  10. Computational Analysis of Pumping Efficacy of a Left Ventricular Assist Device according to Cannulation Site in Heart Failure with Valvular Regurgitation

    PubMed Central

    2016-01-01

    Mitral valve regurgitation (MR) causes blood to flow in two directions during contraction of the left ventricle (LV), that is, forward into the aorta and backward into the left atrium (LA). In aortic valve regurgitation (AR), leakage occurs from the aorta into the LV during diastole. Our objective is to analyze the contribution of a left ventricular assist device (LVAD) to MR and AR for the following two different cannulation sites: from the LA to the aorta (LAAO) and from the LV to the aorta (LVAO). Using a computational method, we simulated three ventricular conditions (normal [HF without valvular regurgitation], 5% MR, and 5% AR) in three groups (control [no LVAD], LAAO, and LVAO). The results showed that LVAD with LAAO cannulation is appropriate for recovery of the MR heart, and the LVAD with LVAO cannulation is appropriate for treating the AR heart. PMID:28115981

  11. Fatigue strength of a wire passing through a cannulated screw: implications for closure of the sternum following cardiac surgery.

    PubMed

    Jutley, R S; Shepherd, D E T; Hukins, D W L

    2003-01-01

    It has been proposed that the incidence of sternal dehiscence can be decreased by passing the wires used for sternotomy closure through cannulated screws. However, there is a potential risk of fatigue failure as a result of the wire moving against the screw, e.g. during coughing and sneezing. The system of cannulated screws and wire was subjected to static tensile testing to failure. Five tests were performed and failure occurred at 388 +/- 34 N (mean +/- SD). Ten cyclic tests were then performed. Sinusoidal loading was applied at 10 Hz with peak forces in the range 10-90 per cent of the static failure force, at a constant load ratio R = 10. The test with the lowest peak force reached run-out at 6 x 10(6) cycles. The others failed by the ends of the wire closures becoming untwisted (one test), the wire fracturing at the twist (three tests) or the wire fracturing at the screw (five tests). However, calculations based on these results suggest that fatigue failure is unlikely to occur as a result of regular breathing or continuous coughing or sneezing.

  12. Subclavian artery cannulation provides better myocardial protection in conventional repair of acute type A aortic dissection: experience from a single medical centre in Taiwan

    PubMed Central

    Hsu, Po-Shun; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Lee, Chung-Yi; Ke, Hong-Yan; Lin, Yi-Chang; Tsai, Chien-Suang; Chen, Jia-Lin

    2016-01-01

    Summary Background Although many reports have detailed the advantages and disadvantages between femoral and subclavian arterial cannulations for acute aortic dissection type A (AADA), the confounding factors caused by disease severity and surgical procedures could not be completely eliminated. We compared femoral and subclavian artery cannulation and report the results for reconstruction of only the ascending aorta. Methods From January 2003 to December 2010, 51 AADA cases involving reconstruction of only the ascending aorta were retrospectively reviewed and categorised on the basis of femoral (n = 26, 51%) or subclavian (n = 25, 49%) arterycannulation. Bentall’s procedures, arch reconstruction and hybrid operations with stent-grafts were all excluded to avoid confounding factors due to dissection severity. Surgical results, postoperative mortality, and short- and mid-term outcomes were compared between the groups. Results Subclavian cannulation had a lower incidence of cerebral and myocardial injury and lower hospital mortality than femoral cannulation (8 vs 34%, p = 0.04). Ventilation duration as well as intensive care unit (ICU) and hospital stay were also shorter with subclavian cannulation. Risk factors for hospital mortality included pre-operative respiratory failure (odds ratio: 12.84), peri-operative cardiopulmonary bypass (CPB) time > 200 minutes (odds ratio: 13.49), postoperative acidosis (pH < 7.2, odds ratio: 88.63), and troponin I > 2.0 ng/ml (odds ratio: 20.08). The overall hospital mortality rate was 21%. The 40 survivors were followed up for three years with survival of 75% at one year and 70% at three years. Conclusions Our results show that subclavian cannulation had a lower incidence of cerebral and myocardial injury as well as better postoperative recovery and lower hospital mortality rates for reconstruction of only the ascending aorta. PMID:27841900

  13. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  14. Back to the roots? Dual cannulation strategy for ambulatory ECMO in adolescent lung transplant candidates: An alternative?

    PubMed

    Schmidt, F; Jack, T; Sasse, M; Mueller, C; Schwerk, N; Bobylev, D; Beerbaum, P; Koeditz, H

    2017-03-01

    Bridging critically ill pediatric patients to lung transplantation still remains a major challenge. Although still controversial, within the last 5 years, ECMO has been increasingly used as a bridge to lung transplantation concept in adult and pediatric patients with acceptable outcomes. The outstanding developments in the field of extracorporeal devices and the introduction of awake ECMO concepts with the avoidance of mechanical ventilation have led to a real paradigm shift in the ICU management of pretransplant candidates with severe respiratory failure. Therefore, ECMO is no longer seen as a contraindication for lung transplantation at least at our center. Nevertheless, how to bridge these patients on ECMO still remains controversial. Thus, we introduced an ambulatory ECMO approach in adolescent lung transplant candidates with acute respiratory failure using a dual cannulation strategy and hereby present first results from this procedure.

  15. The microbial fermentation characteristics depend on both carbohydrate source and heat processing: a model experiment with ileo-cannulated pigs.

    PubMed

    Nielsen, Tina Skau; Jørgensen, Henry; Knudsen, Knud Erik Bach; Lærke, Helle Nygaard

    2017-04-02

    The effects of carbohydrate (CHO) source and processing (extrusion cooking) on large intestinal fermentation products were studied in ileo-cannulated pigs as a model for humans. Pigs were fed diets containing barley, pea or a mixture of potato starch:wheat bran (PSWB) either raw or extrusion cooked. Extrusion cooking reduced the amount of starch fermented in the large intestine by 52-96% depending on the CHO source and the total pool of butyrate in the distal small intestine + large intestine by on average 60% across diets. Overall, extrusion cooking caused a shift in the composition of short-chain fatty acids (SCFA) produced towards more acetate and less propionate and butyrate. The CHO source and processing highly affected the fermentation characteristics and extrusion cooking generally reduced large intestinal fermentation and resulted in a less desirable composition of the fermentation products. The latter outcome is non-conducive to a healthy large intestinal environment and its resulting metabolic health.

  16. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    PubMed

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  17. The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation.

    PubMed

    Kim, Do Kyun; Choi, Sae Won; Kwak, Young Ho

    2012-06-01

    The aim the study was to determine the effect of SonoPrep® on the delivery and analgesic effects of EMLA® cream prior to intravenous (iv) cannulation in a tertiary pediatric emergency department. Children aged between 5 and 10 years were enrolled. Patients were randomized to receive either sonophoresis with SonoPrep® or sham sonophoresis followed by application of EMLA® cream for 5 min prior to iv cannulation. The primary outcome measurement was the child's rating of pain immediately after iv placement, using a 10-cm visual analog scale (VAS). Parents or guardians and blinded researchers were additionally asked to rate their perception of the child's pain using the 10-cm VAS and the Wong-Baker Face scale. A total of 42 patients completed the study (21 in the study group, 21 in the control group). The baseline characteristics between the groups were similar. The VAS pain score was significantly lower in children treated with sonophoresis compared with the sham sonophoresis (median (percentiles 25th-75th), 20.0 (10.0-22.5) vs. 60.0 (31.0-87.5); p < 0.001). The parent's perception of the child's pain was significantly lower in the study group vs. the control group by the VAS (median (percentiles 25th-75th), 10.0 (10.0-20.0) vs. 50.0 (15.0-80.0); p < 0.001) and Wong-Baker Face scale (median (percentiles 25th-75th), 2.0 (2.0-2.0) vs. 4.0 (2.5-4.5); p < 0.001). The researcher's evaluation of the child's discomfort was also significantly lower in the study group (2.0 (1.0-3.0) vs. 4.0 (2.5-4.5); p < 0.001). The application of sonophoresis using SonoPrep® followed by the 5-min application of EMLA® cream showed significant benefit in young children in terms of pain reduction and patient satisfaction.

  18. Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

    PubMed Central

    Hayashi, Shiro; Nishida, Tsutomu; Shimakoshi, Hiromi; Shimoda, Akiyoshi; Amano, Takahiro; Sugimoto, Aya; Takahashi, Kei; Mukai, Kaori; Matsubara, Tokuhiro; Yamamoto, Masashi; Nakajima, Sachiko; Fukui, Koji; Inada, Masami

    2016-01-01

    AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase levels and other factors for predicting post-ERCP pancreatitis. METHODS This was a retrospective, single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013. Serum amylase levels were measured 2 h post-procedure, and patient- and procedure-related pancreatitis (PEP) risk factors were analyzed using a logistic model. RESULTS A total of 1520 cases (average age 72 ± 12 years, 60% male) were initially enrolled in this study, and 1403 cases (725 patients) were ultimately analyzed after the exclusion of 117 cases. Fifty-five of these cases developed PEP. We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP. Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio (OR) 2.28, 95%CI: 1.132-4.651, P = 0.0210] and 2 h amylase levels greater than the cutoff level (OR = 24.1, 95%CI: 11.56-57.13, P < 0.0001) were significant predictive factors for PEP. Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level (85%), and six of the remaining eight patients who developed PEP (75%) required longer cannulation times. Only 2 of the 1403 patients (0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times. CONCLUSION These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP. PMID:28042392

  19. Utility of near-infrared light devices for pediatric peripheral intravenous cannulation: a systematic review and meta-analysis.

    PubMed

    Park, Joon Min; Kim, Min Joung; Yim, Hyeon Woo; Lee, Won-Chul; Jeong, Hyunsuk; Kim, Na Jin

    2016-12-01

    We investigated the utility of near-infrared (NIR) light devices for peripheral intravenous cannulation (PIVC) in pediatric patients. We searched three databases, MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomized controlled trials that compared PIVC using NIR light devices and the "traditional" method (with no assistive device) were included. The primary outcome was a failure rate at the first attempt, and the effect size was measured by the risk ratio for failure. Subgroup analysis was performed according to control group risk for failure at first attempt as an indicator of difficult procedure (low vs. high). Eleven studies were included in the meta-analysis. There was no significant difference in the primary outcome between the two methods (risk ratio 1.03, confidence interval 0.89-1.20, I (2) = 48 %). In a subgroup analysis, the subgroup difference between subsets of low and high control group risk was significant (I (2) = 83 %). In the subset of the high control group risk, using NIR light devices showed a lower risk for failure than the traditional method (risk ratio 0.81, confidence interval 0.64-1.01, I (2) = 0 %).

  20. Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

    PubMed

    Sotto, Juan Alejandro R; Ayuste, Eduardo C; Bowyer, Mark W; Almonte, Josefina R; Dofitas, Rodney B; Lapitan, Marie C M; Pimentel, Elisabeth A; Ritter, E Matthew; Wherry, David C

    2009-01-01

    This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense.

  1. Backscattering particle immunoassays in wire-guide droplet manipulations

    PubMed Central

    Yoon, Jeong-Yeol; You, David J

    2008-01-01

    A simpler way for manipulating droplets on a flat surface was demonstrated, eliminating the complications in the existing methods of open-surface digital microfluidics. Programmed and motorized movements of 10 μL droplets were demonstrated using stepper motors and microcontrollers, including merging, complicated movement along the programmed path, and rapid mixing. Latex immunoagglutination assays for mouse immunoglobulin G, bovine viral diarrhea virus and Escherichia coli were demonstrated by merging two droplets on a superhydrophobic surface (contact angle = 155 ± 2°) and using subsequent back light scattering detection, with detection limits of 50 pg mL-1, 2.5 TCID50 mL-1 and 85 CFU mL-1, respectively, all significantly lower than the other immunoassay demonstrations in conventional microfluidics (~1 ng mL-1 for proteins, ~100 TCID50 mL-1 for viruses and ~100 CFU mL-1 for bacteria). Advantages of this system over conventional microfluidics or microwell plate assays include: (1) minimized biofouling and repeated use (>100 times) of a platform; (2) possibility of nanoliter droplet manipulation; (3) reprogrammability with a computer or a game pad interface. PMID:19014703

  2. Counterregulatory deficits occur within 24 h of a single hypoglycemic episode in conscious, unrestrained, chronically cannulated mice

    PubMed Central

    Jacobson, Lauren; Ansari, Tasneem; McGuinness, Owen P.

    2006-01-01

    Hypoglycemia-induced Counterregulatory failure is a dangerous complication of insulin use in diabetes mellitus. Controlled hypoglycemia studies in gene knockout models, which require the use of mice, would aid in identifying causes of defective counterregulation. Because stress can influence Counterregulatory hormones and glucose homeostasis, we developed glucose clamps with remote blood sampling in conscious, unrestrained mice. Male C57BL/6 mice implanted with indwelling carotid artery and jugular vein catheters were subjected to 2 h of hyperinsulinemic glucose clamps 24 h apart, with a 6-h fast before each clamp. On day 1,, blood glucose was maintained (euglycemia, 178 ± 4 mg/dl) or decreased to 62 ± 1 mg/dl (hypoglycemia) by insulin (20 mU·kg−1·min−1) and variable glucose infusion. Donor blood was continuously infused to replace blood sample volume. Baseline plasma epinephrine (32 ± 8 pg/ml), corticosterone (16.1 ± 1.8 μg/dl), and glucagon (35 ± 3 pg/ml) were unchanged during euglycemia but increased significantly during hypoglycemia, with a glycemic threshold of ~80 mg/dl. On day 2, all mice underwent a hypoglycemic clamp (blood glucose, 64 ± 1 mg/dl). Compared with mice that were euglycemic on day 1, previously hypoglycemic mice had significantly higher glucose requirements and significantly lower plasma glucagon and corticosterone (n = 6/group) on day 2. Epinephrine tended to decrease, although not significantly, in repeatedly hypoglycemic mice. Pre- and post-clamp insulin levels were similar between groups. We conclude that counterregulatory responses to acute and repeated hypoglycemia in unrestrained, chronically cannulated mice reproduce aspects of counterregulation in humans, and that repeated hypoglycemia in mice is a useful model of counterregulatory failure. PMID:16533951

  3. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor

    PubMed Central

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the ‘MAU style’ trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust

  4. Internal bone transport using a cannulated screw as a mounting device in the treatment of a post-infective ulnar defect.

    PubMed

    Tsitskaris, Konstantinos; Havard, Heledd; Bijlsma, Paulien; Hill, Robert A

    2016-04-01

    Bone transport techniques can be used to address the segmental bone loss occurring after debridement for infection. Secure fixation of the bone transport construct to the bone transport segment can be challenging, particularly if the bone is small and osteopenic. We report a case of a segmental ulnar bone defect in a young child treated with internal bone transport using a cannulated screw as the mounting device. We found this technique particularly useful in the treatment of bone loss secondary to infection, where previous treatment and prolonged immobilisation had led to osteopenia. This technique has not been previously reported.

  5. Technical note: Can the sulfur hexafluoride tracer gas technique be used to accurately measure enteric methane production from ruminally cannulated cattle?

    PubMed

    Beauchemin, K A; Coates, T; Farr, B; McGinn, S M

    2012-08-01

    An experiment was conducted to determine whether using ruminally cannulated cattle affects the estimate of enteric methane (CH(4)) emissions when using the sulfur hexafluoride (SF(6)) tracer technique with samples taken from a head canister. Eleven beef cattle were surgically fitted with several types of ruminal cannula (2C, 3C, 3C+washer, 9C; Bar Diamond, Parma, ID). The 2C and 3C models (outer and inner flanges with opposite curvature) had medium to high leakage, whereas the 9C models (outer and inner flanges with the same curvature) provided minimum to moderate leakage of gas. A total of 48 cow-day measurements were conducted. For each animal, a permeation tube containing sulfur hexafluoride (SF(6)) was placed in the rumen, and a sample of air from around the nose and mouth was drawn through tubing into an evacuated canister (head canister). A second sample of air was collected from outside the rumen near the cannula into another canister (cannula canister). Background concentrations were also monitored. The methane (CH(4)) emission was estimated from the daily CH(4) and SF(6) concentrations in the head canister (uncorrected). The permeation SF(6) release rate was then partitioned based on the proportion of the SF(6) concentration measured in the head vs. the cannula canister. The CH(4) emissions at each site were calculated using the two release rates and the two CH(4):SF(6) concentration ratios. The head and cannula emissions were summed to obtain the total emission (corrected). The difference (corrected - uncorrected) in CH4 emission was attributed to the differences in CH(4):SF(6) ratio at the 2 exit locations. The proportions of CH(4) and SF(6) recovered at the head were greater (P < 0.001) for the 9C cannulas (64% and 66%) compared with the other cannulas, which were similar (P > 0.05; 2C, 6% and 4%; 3C, 17% and 15%; 3C+washer, 19% and 14%). Uncorrected CH(4) emissions were ± 10% of corrected emissions for 53% of the cow-day measurements. Only when more

  6. Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.

    PubMed

    Ohira, Suguru; Yaku, Hitoshi; Nakajima, Shunsuke; Takahashi, Akihiko

    2014-08-01

    We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.

  7. [An international comparison of physician control systems].

    PubMed

    Jian, Wei-yan; Xiong, Xian-jun; Li, Jing-hu; Ding, Yang; Wang, Li-li; Guo, Yan

    2011-04-18

    This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.

  8. Safe and easy method with little modification in technique is useful for successful internal jugular vein cannulation on same side even after intra-arterial puncture without using ultrasound guidance in adult cardiac patients

    PubMed Central

    Thosani, Rajesh; Patel, Jigar; Gandhi, Hemang; Doshi, Chirag; Kothari, Jignesh

    2016-01-01

    Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate. PMID:27052069

  9. Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study—80 Case Studies and 6 Years of Follow-Up

    PubMed Central

    Poggetti, Andrea; Rosati, Marco; Castellini, Iacopo; Evangelisti, Gisberto; Battistini, Pietro; Parchi, Paolo; Lisanti, Michele

    2015-01-01

    Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head–trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV. PMID:26261746

  10. Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study-80 Case Studies and 6 Years of Follow-Up.

    PubMed

    Poggetti, Andrea; Rosati, Marco; Castellini, Iacopo; Evangelisti, Gisberto; Battistini, Pietro; Parchi, Paolo; Lisanti, Michele

    2015-08-01

    Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.

  11. Digestibility energy and amino acids of canola meal from two species (Brassica juncea and Brassica napus) fed to distal ileum cannulated grower pigs.

    PubMed

    Le, M H A; Buchet, A D G; Beltranena, E; Gerrits, W J J; Zijlstra, R T

    2012-12-01

    Yellow-seeded Brassica juncea is a novel canola species targeted to grow in the southern Canadian prairies where thermotolerance, disease resistance, and adaptation to dry agronomic conditions are required. The support of its cultivation needs nutritional evaluation of its coproduct. The B. juncea canola meal (CM) contains less fiber than conventional, dark-seeded Brassica napus CM but also slightly less Lys. In a 6 × 6 Latin square, 6 distal ileum cannulated pigs (47 kg BW) were fed 6 diets to determine the apparent ileal digestibility (AID) and standardized ileal digestibility (SID) of CP and AA, AID and apparent total tract digestibility (ATTD) of energy, and VFA content in digesta and feces. Pigs were fed 6 diets: basal [46% wheat (Triticum aestivum) and corn (Zea mays) starch], 4 diets with 46% wheat and either B. juncea or B. napus CM at 25 or 50%, and a N-free diet based on corn starch. The B. juncea CM had higher (P < 0.05) ATTD of energy than B. napus CM (68.6 vs. 60.3%) likely due to its lower fiber content. Ileal total VFA was lower (P < 0.001) in pigs fed B. juncea than B. napus CM diets. In pigs fed B. juncea CM, the molar ratio in digesta was lower (P < 0.001) for acetate and butyrate whereas the propionate ratio was lower (P < 0.001) in feces than in pigs fed B. napus CM diets. The CM species did not affect the AID of energy, SID of AA, and feces VFA content. The DE value was higher (P < 0.05) and content of SID Lys was lower (P < 0.05) for B. juncea than B. napus CM. In conclusion, availability of B. juncea CM, a coproduct of a canola species grown in Canadian prairie land, will increase flexibility in swine feed formulation.

  12. The metabolism of 4-bromoaniline in the bile-cannulated rat: application of ICPMS (79/81Br), HPLC-ICPMS & HPLC-oaTOFMS

    PubMed Central

    Duckett, Catherine; McCullagh, Michael; Smith, Christopher; Wilson, Ian D

    2015-01-01

    Abstract 1. An excretion balance study was performed following i.p. administration of 4-bromoaniline (50 mg kg−1) to bile-cannulated rats, using bromine-detected (79/81Br) ICPMS for quantification. Approximately 90% of the dose was recovered in urine (68.9 ± 3.6%) and bile (21.4 ± 1.4%) by 48 h post-administration. 2. HPLC-ICPMS (79/81Br) was used to selectively detect and profile the major urinary and biliary-excreted metabolites and determined that the 0–12 h urine contained at least 21 brominated metabolites with 19 bromine-containing peaks observed in the 6–12 h bile samples. 3. The urinary and biliary metabolites were subsequently profiled using HPLC-oaTOFMS. By exploiting the distinctive bromine isotope pattern ca. 60 brominated metabolites were detected in the urine in negative electrospray ionisation (ESI) mode while bile contained ca. 21. 4. While a large number of bromine-containing metabolites were detected, the profiles were dominated by a few major components with the bulk of the 4-bromoaniline-related material in urine accounted for by 4-bromoanaline O-sulfate (∼75% of the total by ICPMS, 84% by TOFMS). In bile a hydroxylated N-acetyl compound was the major metabolite detected, forming some ∼65% of the 4-bromoaniline-related material by ICPMS (37% by TOFMS). PMID:25837688

  13. Arsenic trioxide treatment of rabbit liver VX-2 carcinoma via hepatic arterial cannulation-induced apoptosis and decreased levels of survivin in the tumor tissue

    PubMed Central

    Li, Hong; Gong, Jian; Jiang, Xuyuan; Shao, Haibo

    2013-01-01

    Aim To investigate the role of tumor apoptosis-inhibitory protein survivin in arsenic trioxide-induced apoptosis in VX-2 carcinoma in the rabbit liver by means of transcatheter arterial chemoembolization. Methods Sixteen rabbits with 32 implanted hepatic VX-2 tumors were randomly divided into two groups. The experimental group received 2 mg of arsenic trioxide and 1 mL of ultra-fluid lipiodol co-injected via hepatic arterial cannulation and the control group received only 1 mL of lipiodol. Animals were sacrificed 3 weeks after trans-catheterial arterial chemoembolization. Tumor tissue and tumor-peripheral tissue were collected for analysis. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling staining was used to assess tumor cells apoptosis. Immunohistochemistry was used to assess the presence of survivin protein. Reverse transcription polymerase chain reaction was used to determine the expression of survivin gene. Results The number of apoptotic cells significantly increased in the tumor tissue (5.20 ± 0.60%) compared to tumor-peripheral tissue (1.29 ± 0.42%) of the arsenic trioxide-treated group. Survivin expression levels in the tumor tissue were significantly reduced in arsenic trioxide-treated group (7.68 ± 0.65) compared to the control group (35.30 ± 4.63). Conclusion Transcatheter arterial chemoembolization with arsenic trioxide induced apoptosis of VX-2 carcinoma, in which tumor apoptosis-inhibitory protein survivin may have played a role. PMID:23444241

  14. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures

    PubMed Central

    Tan, Honglue; Dai, Pengyi; Yuan, Yanhao

    2016-01-01

    Abstract It was a retrospective case–control study. The aim of this study was to explore the clinical efficacy and complication of treatment using a modified Kirschner wire tension band (MKTB) or a cannulated screw tension band (CSTB) in transverse patellar fractures. In total, 55 patients with transverse patellar fractures were retrospectively reviewed and divided into 2 groups according to the surgical technique: 29 patients were in the MKTB group and 26 patients in the CSTB group. Bǒstman's clinical grading scale, including range of movement (ROM), pain, ability to work, atrophy of quadriceps femoris, assistance in walking, effusion, giving way, and stair-climbing, was used to evaluate the clinical results. Complications including painful hardware, implant loosening or breakage, and bone nonunion were also assessed. Both groups were evaluated at the final follow-up before removing implant in the MKTB group. The Bǒstman's score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group (P < 0.05). Twelve patients in the MKTB group underwent implant removal, and the score of ROM, pain, and effusion were higher than before removing implant (P < 0.05), but there was no difference compared to the CSTB group (P > 0.05). Seventeen patients achieved excellent results, 9 had good results, and 3 reported fair results in the MKTB group; the CSTB group had excellent results in 22 patients and good results in 4 patients, showing a significant difference in the excellent rate between the 2 groups (P = 0.021). Total Bǒstman scores in the MKTB and CSTB groups (26.96 ± 4.47 and 29.42 ± 1.47, respectively) were significantly different (P = 0.01). Total scores in the MKTB group after removing implant were higher than those before removing implant (P = 0.001), and similar to those in the CSTB group (P = 0.224). Eleven patients in the MKTB group reported painful hardware, including 4

  15. Nutrient digestibility of solvent-extracted Brassica napus and Brassica juncea canola meals and their air-classified fractions fed to ileal-cannulated grower pigs.

    PubMed

    Zhou, X; Zijlstra, R T; Beltranena, E

    2015-01-01

    Energy and nutrient digestibility of solvent-extracted canola meal (CM) is limited in pigs by its relatively high fiber content. The seed hull, which greatly contributes to the fiber content of CM, is denser than the oil-free cotyledon. By utilizing streams of air, air classification partially separates these seed components on the basis of their different sizes and densities to produce a low-fiber, light-particle fraction and a high-fiber, heavy-particle fraction. Compared with parent CM, ADF and NDF were reduced by 31.9% and 29.5% in the light-particle fraction and were enriched by 16.5% and 9.0% in the heavy-particle fraction (DM basis), respectively. Particle size was 638, 18.9, and 76.1 µm for the parent CM and light- and heavy-particle fractions, respectively. To determine the nutrient digestibility of CM and their air-classified fractions, Brassica napus and B. juncea CM and their 2 air-classified fractions were evaluated in a 2 × 3 factorial arrangement together with a basal diet and an N-free diet. The experiment was conducted as an 8 × 8 Latin square in which diets contained 40% B. napus or B. juncea CM or their air-classified fractions and 60% basal diet. Digesta data from pigs fed the N-free diet served to subtract basal endogenous AA losses. Eight ileal-cannulated barrows (32 kg initial BW) were fed the 8 diets at 2.7 times maintenance DE for eight 11-d periods. At the end of each period, feces were collected for 48 h, and ileal digesta were collected for two 12-h periods. The DE and calculated NE values and the apparent total tract digestibility (ATTD) of GE were 6.3%, 10.0%, and 7.8% greater (P < 0.001) for B. juncea CM than for B. napus CM; 6.1%, 10.8%, and 5.3% greater (P < 0.001) for the light-particle fraction than for parent CM; and 5.4%, 7.2%, and 3.8% lower (P < 0.001) for the heavy-particle fraction than for parent CM, respectively. The standardized ileal digestibilities (SID) of His, Ile, Val, Asp, and Tyr were greater (P < 0.05) for B

  16. Ultrasound Guidance as a Rescue Technique for Peripheral Intravenous Cannulation

    DTIC Science & Technology

    2006-09-14

    painful, time consuming, and may result in arterial puncture, nerve damage, and paresthes ias.5 Other routes such as central venous or venous cut down...peripherally inserted central lines-PICCS), femoral catheterizations during cardiopulmonary resuscitation, and peripheral IV catheters in difficult...techniques for gaining venous access. What to do when peripheral intravenous catheterization is not possible. J Crit 11/n. 1993;8:435-442. 2. Nee PA

  17. A pilot/introducer needle for central vein cannulation.

    PubMed

    Suzuki, T; Kanazawa, M; Kinefuchi, Y; Fukuyama, H; Takiguchi, M; Yamamoto, M; Abe, K; Okuda, Y

    1995-12-01

    A kit for safe and easy insertion of a central vein cannula was devised. A small gauge (22 gauge) metal pilot needle was equipped with a Y-shaped hub which had a side-port to accept a small gauge (0.46 mm) Seldinger guide wire. Once the needle reached the vein, guidewire was threaded in through the side-port. There was no need to remove the pilot needle and no need to repeat vein puncture with a larger-bore needle. Three puncture methods were used with the kit: (1) the central approach via the internal jugular vein, (2) the supraclavicular approach via the junction of the internal jugular vein and subclavian vein, and (3) the infraclavicular approach via the subclavian vein. Each method was used on 20 patients, for total of 60 patients, with a high success rate. Less than 3 minutes were required from puncture to catheter insertion. No serious complications were encountered.

  18. Research into pain perception with arteriovenous fistula (avf) cannulation.

    PubMed

    Figueiredo, Ana E; Viegas, Ariani; Monteiro, Mara; Poli-de-Figueiredo, Carlos E

    2008-12-01

    Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients(7) perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (+/-1.7), compared to 3.1 (+/-2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique.

  19. Proximal migration of a 5 French pancreatic stent during bile stone extraction: a successful retrieval using mini-snare.

    PubMed

    Liao, Yu-Sheng; Zhao, Qiu; Fan, Yan; Wu, Jie

    2014-01-01

    Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications.

  20. Cervical lymph cannulation to investigate the efflux and effects of intracerebroventricular cytokine infusions.

    PubMed

    Seabrook, T J; Dickstein, J B; Hay, J B

    2001-02-01

    It is well documented that there is communication between the cerebral spinal fluid (CSF) and cervical lymphatics. Recently, it has been demonstrated that tumor necrosis factor alpha (TNF-alpha) introduced into the CSF appears in the cervical lymph. However, the functional significance of this is less clear. Here we describe a protocol to quantitate the efflux of TNF-alpha from the CSF into cervical lymph. In addition, we describe a methodology to examine the effects of an intracerebroventricular (i.c.v.) infusion of TNF-alpha on lymph volume, cellularity and cell phenotype. While TNF-alpha was recovered in the cervical lymph following infusion of 125-I labeled TNF-alpha, the dosage of TNF-alpha used in this study had no effect on cervical lymph flow, cellularity or cell subsets. This protocol can be used to study the efflux of i.c.v. injected macromolecules and their effects on lymphocytes in cervical lymph and the regional lymph nodes.

  1. Protein digestibility evaluations of meat and fish substrates using laboratory, avian and ileally cannulated dog assays

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fish and meat protein serves as important protein sources in the human and companion animal diets: however, limited information is available on differences in protein quality. Pollock fillet, and salmon fillet, beef loin, pork loin and chicken breast, were evaluated for protein quality and amino aci...

  2. A survey of the use of ultrasound guidance in internal jugular venous cannulation.

    PubMed

    McGrattan, T; Duffty, J; Green, J S; O'Donnell, N

    2008-11-01

    It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 2002, promoting the use of ultrasound in placement of internal jugular venous cannulae, utilisation of ultrasound has increased throughout the United Kingdom. We report the findings of a postal survey of 2000 senior anaesthetists in the United Kingdom which enquired about their use of ultrasound for internal jugular vein cannulae placement. Only 27% use 2D ultrasound as their first choice technique, although 35% use it as their first choice when teaching. There was no significant difference in practice between those working within a sub specialty in anaesthesia. There continues to be discrepancies between the application of the guideline and how senior anaesthetists both site and teach the placement of internal jugular vein central venous cannulae.

  3. [Pharyngeal hemorrhaging due to iatrogenic false aneurysm. Complication after cannulation of the internal jugular vein].

    PubMed

    Kreckel, V; Langwara, H

    2009-03-01

    Catheterization of the internal jugular vein is used for temporary access to the central vein in patients with acute or chronic renal failure. The most frequent problem is the arterial puncture and accidental placement of the large catheter in an artery. This case report describes a rare secondary complication by accidental catheterization of the right common carotid artery after intended dual lumen catheter insertion into the right internal jugular vein. A false aneurysm with pharyngeal hemorrhaging developed 2 weeks after the puncture. The diagnosis was made using colour-Doppler ultrasound and the aneurysm was treated with vascular surgery.

  4. Metabolic Studies on WR-158,122 in Bile Duct Cannulated Rats and Monkeys.

    DTIC Science & Technology

    1980-02-15

    0.80 60.09 20.1 1.657 hol benzyl alcohol 12.1 high 205.5 1.04 ca 4 108.13 13.1 1.66 furfuryl alco- 12.5 high 170 1.13 M 98.1 - 1.92 hol (unstable) ethyl...sulfate, niacin supplement, calcium O. pantothenate, copper sulfate, vitamin B12 supplement, vitamin D3 supplement, manganese sulfate, riboflavin...1.02 88.10 2.209 0.45 acetone 10.0 0.14 56.2 0.79 CO 58.09 20.70 2.72 . isoaWl alcohol 10.0 high 132.0 0.80 2.67 88.15 14.7 1.82 tert. -butyl alcohol

  5. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program

    PubMed Central

    Grenda, David S.; Moll, Vanessa; Kalin, Craig M.

    2017-01-01

    Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support. PMID:28275616

  6. Metabolic Disposition of Labeled WR-158,122 in a Bile Duct Cannulated Rhesus Monkey.

    DTIC Science & Technology

    1980-02-18

    and diluted to 124.08 g. It contained 2.50 mg WR-158,122/ml and 1.86 ;Ci/ml. The suspension was stored at 4°C. Assay of the suspension gave the...of BF2* powder and nitrofurazone ointment. SMA 12/60 assays were run on plasma samples at I day after surgery, just prior to the first and second...penicillin G, 250 mg dihydrostreptomycin, 10 mg chlorpheniramine maleate, and 25 mg diphemanil- methylsulfate. Preservatives are 20 mg procaine HCl

  7. Pharmacological evidence for capacitative Ca(2+) entry in cannulated and pressurized skeletal muscle arterioles.

    PubMed

    Potocnik, S J; Hill, M A

    2001-09-01

    Arteriolar myogenic tone shows a marked dependency on extracellular Ca(2+). The contribution played by mechanisms such as intracellular Ca(2+) release and capacitative entry, however, are less certain. The present studies aimed to demonstrate functional evidence for involvement of such mechanisms in myogenic tone and reactivity. Single cremaster arterioles were denuded of endothelium, pressurized under no-flow conditions and loaded with fura 2-AM for measurement of changes in intracellular Ca(2+) [Ca(2+)](i). The cell permeable, putative, IP(3) receptor antagonist 2APB (2 aminoethoxydiphenyl borate) was used to determine the possible role of IP(3) receptor-mediated mechanisms in arteriolar myogenic tone and reactivity. Arterioles dilated in response to increasing concentrations of 2APB (1 - 300 microM) without a concomitant change in global [Ca(2+)](i). Also 2APB (50 microM) completely inhibited the myogenic constriction in response to a step change in luminal pressure (50 - 120 mmHg) with no apparent effect on pressure-mediated increases in [Ca(2+)](i). 2APB markedly attenuated the constrictor response and [Ca(2+)](i) increase stimulated by phenylephrine but not KCl. Capacitative Ca(2+) influx in arterioles was demonstrated either by re-addition of extracellular [Ca(2+)] following pre-treatment with 1 or 10 microM nifedipine in Ca(2+) free buffer or exposure of vessels to thapsigargin (1 microM) to induce store depletion. In both cases 2APB inhibited the increase in [Ca(2+)](i). Capacitative Ca(2+) entry showed an inverse relationship with intraluminal pressure over the range 10 - 120 mmHg. Consistent with an effect on a Ca(2+) entry pathway, 2APB had no effect on intracellular (caffeine releasable) Ca(2+) stores while decreasing the rate of Mn(2+) quench of fura 2 fluorescence. The results provide functional evidence for capacitative Ca(2+) entry in intact arteriolar smooth muscle. The effectiveness of 2APB in inhibiting both non-voltage gated Ca(2+) entry and responsiveness to an acute pressure step is consistent with the involvement of an axis involving IP(3)-mediated and or capacitative Ca(2+) entry mechanisms in myogenic reactivity. Given the lack of effect of 2APB on pressure-induced changes in global [Ca(2+)](i) it is suggested that such mechanisms participate on a localized level to couple the myogenic stimulus to contraction.

  8. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program.

    PubMed

    Grenda, David S; Moll, Vanessa; Kalin, Craig M; Blum, James M

    2017-02-01

    Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support.

  9. Infraclavicular axillary vein cannulation using ultrasound in a mechanically ventilated general intensive care population.

    PubMed

    Glen, H; Lang, I; Christie, L

    2015-09-01

    Central venous catheter (CVC) insertion is commonly undertaken in the ICU. The use of ultrasound (US) to facilitate CVC insertion is standard and is supported by guidelines. Because the subclavian vein cannot be insonated where it underlies the clavicle, its use as a CVC site is now less common. The axillary vein, however, can be seen on US just distal to the subclavian vein and placement of a CVC at this site gives a result which is functionally indistinguishable from a subclavian CVC. We evaluated placement of US-guided axillary CVCs in mechanically ventilated intensive care patients. Data were collected for 125 consecutive US-guided axillary CVC procedures in ventilated patients in an adult intensive care setting. All lines were inserted using real-time US guidance with an out-of-plane technique. One hundred and twenty-five procedures occurred in 119 patients. Successful line placement was achieved in 117 out of 125 (94%) procedures. Complications included four procedures that required repeating due to catheter malposition and one arterial puncture. The median number of attempts per procedure was one (IQR 1 to 2). Thirty-nine (31%) patients had a body mass index of 30 or above, 43 (34%) patients had a coagulopathy and 70 (56%) patients had significant ventilator dependence (FiO2 of 0.5 or above, or positive end expiratory pressure 10 cmH20 or above). The technique of US-guided axillary CVC access can be undertaken successfully in ventilated intensive care patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it be adopted more widely in the intensive care population.

  10. Metabolism Studies on WR-158,122 in Bile Duct Cannulated Rats and Monkeys.

    DTIC Science & Technology

    1981-02-16

    quantities of the 4 milled feces samples were placed in 15 ml grad- uated centrifuge tubes and extracted three tir.es with 5 ml THF as follows: tubes...were shaken for 15 min on an automatic shaker, centrifuged for 10 min and each solvent layer poured into a LSC vial. The TIC was evaporated wit N2 in a...were centrifuged for 30 min. The supernates were poured into LSC vials and counted in 15 ml of Biofluor. Results THF extracted almost the save dpm/mg

  11. Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: What can be done?

    PubMed Central

    Hauser, Goran; Milosevic, Marko; Stimac, Davor; Zerem, Enver; Jovanović, Predrag; Blazevic, Ivana

    2015-01-01

    Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis. PMID:25632179

  12. Rotational Stability of Scaphoid Osteosyntheses: An In Vitro Comparison of Small Fragment Cannulated Screws to Novel Bone Screw Sets

    PubMed Central

    Erhart, Jochen; Unger, Ewald; Schefzig, Philip; Varga, Peter; Trulson, Inga; Gormasz, Anna; Trulson, Alexander; Reschl, Martin; Hagmann, Michael; Vecsei, Vilmos; Mayr, Winfried

    2016-01-01

    Background The current standard of care for operative repair of scaphoid fractures involves reduction and internal fixation with a single headless compression screw. However, a compression screw in isolation does not necessarily control rotational stability at a fracture or nonunion site. The single screw provides rotational control through friction and bone interdigitation from compression at the fracture site. We hypothesize that osteosyntheses with novel bone screw sets (BSS) equipped with anti-rotational elements provide improved rotational stability. Methods Stability of osteosynthesis under increasing cyclic torsional loading was investigated on osteotomized cadaveric scaphoids. Two novel prototype BSS, oblique type (BSS-obl.) and longitudinal type (BSS-long.) were compared to three conventional screws: Acutrak2®mini, HCS®3.0 and Twinfix®. Biomechanical tests were performed on scaphoids from single donors in paired comparison and analyzed by balanced incomplete random block design. Loading was increased by 50 mNm increments with 1,000 cycles per torque level and repeated until a rotational clearance of 10°. Primary outcome measure was the number of cycles to 10° clearance, secondary outcome measure was the maximum rotational clearance for each torque level. Findings BSS-obl. performed significantly better than Acutrak2®mini and HCS® (p = 0.015, p<0.0001). BSS-long. performed significantly better than HCS® (p = 0.010). No significant difference in performance between BSS-obl. and BSS-long. (p = 0.361), between BSS obl. and Twinfix® (p = 0.50) and BSS long. and Twinfix® (p = 0.667) was detected. Within the torque range up to 200 mNm, four of 21 (19%) BSS-long. and four of 21 (19%) BSS-obl. preparations showed early failure. The same loading led to early failure in four (29%) Twinfix®, seven (50%) Acutrak2®mini and 10 (71%) HCS® of 14 screw samples, respectively. Conclusions For both BSS and to a lesser extent for Twinfix® (as dual-component screw), higher rotational stabilities were identified in comparison to single component headless compression screws. PMID:27258387

  13. A Surgical Procedure for the Chronic Cannulation of the Carotid Artery and the Jugular Vein in Dogs,

    DTIC Science & Technology

    1986-05-01

    neck incision was closed with 3/0 chromic interrupted suture for the fascia and the subcutaneous layers, and 3/0 Prolene (Ethicon Sutures Limited...Peterborough) subcuticular for the skin. The back incision was closed with 3/0 Prolene subcuticular. Cannulae were wrapped in adhesive tape in a butterfly...fashion (about 2x3 cm) and the wings were anchored to the skin with 3/0 Prolene . The jacket (described below) was put on the dog and the cannulae

  14. Removal of a femoral nail with osseous overgrowth at the end-cap: A navigated and cannulated minimally invasive technique.

    PubMed

    Marintschev, Ivan; Rausch, Sascha; Fujak, Albert; Klos, Kajetan; Hofmann, Gunther O; Gras, Florian

    2013-01-01

    Intramedullary nail removal can be demanding, especially in cases of implant breakage or bony overgrowth at the end-cap, if the exact insertion depth of the nail is neglected in the index surgery. In the presented case, two challenging nail removals were necessary. The first was performed in a re-nailing procedure due to a pseudarthrosis with implant breakage, and the second was performed during hardware removal after fracture healing in a situation where there was deep intramedullary placement of the exchange nail. For the second implant removal a minimally invasive approach based on instrument placements over a navigated guide-wire was used to reduce the iatrogenic morbidity associated with an extensive open approach to the nail and to decrease the radiation exposure for the patient and the operating team.

  15. The Electron Microscopy of the Effects of Treatment with Coumarin (Venalot) and by Thoracic Duct Cannulation on Thermal Injuries

    PubMed Central

    Casley-Smith, J. R.; Földi-Börcsök, E.; FÖldi, M.

    1973-01-01

    The effects of coumarin (Venalot) and of external lymphatic drainage were examined with the electron microscope in rat hind legs and mouse ears that were injured by heat. Coumarin, especially when lymph drainage was added, greatly reduced the amounts of protein in the tissues and the concomitant oedema fluid, lymphatic dilatation, open interendothelial junctions and lymph protein concentration. While there were crude indications that the increased blood vascular permeability was unchanged, it was considered that there was insufficient evidence to decide between the various hypotheses as to the modes of action of these treatments. ImagesFig. 1Fig. 2Fig. 7Fig. 8Fig. 5Fig. 6Fig. 3Fig. 4 PMID:4689821

  16. Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report

    PubMed Central

    Kim, Jeong-Eun; Jeon, Joon-Pyo; Kim, Yongsuk; Jeong, Su Ah

    2014-01-01

    A 23-year-old male underwent a left internal jugular vein catheterization during extended surgery for treatment of multiple fractures due to a traffic accident. Although the catheterization was performed under ultrasound (US) guidance, iatrogenic perforation of the central vein and pleura occurred. The catheter was removed, and the perforated site was addressed under thoracoscopy rather than an open thoracotomy. This case suggests that using US does not completely guarantee a complication-free outcome, and that catheter placement should be carefully confirmed. In addition, this case suggests that thoracoscopy may be an ideal method of resolving a perforation of the central vein and pleura. PMID:24851167

  17. Minimally Invasive Spinal Arthrodesis in Osteoporotic Population Using a Cannulated and Fenestrated Augmented Screw: Technical Description and Clinical Experience

    PubMed Central

    Lubansu, Alphonse; Rynkowski, Michal; Abeloos, Laurence; Appelboom, Geoffrey; Dewitte, Olivier

    2012-01-01

    We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to 13.3 months postoperatively. No radiological complications were observed. Based on this experience, PMMA augmentation technique through the novel fenestrated screws provided an effective and long lasting fixation in osteoporotic patients. Applying this procedure through percutaneous or minimally invasive approach under fluoroscopic control seems to be safe. PMID:22970360

  18. The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study.

    PubMed

    Jang, Y-E; Lee, J-H; Park, Y-H; Byon, H-J; Kim, H-S; Kim, C-S; Kim, J-T

    2013-10-01

    We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position. Lung deflation during the supraclavicular approach significantly decreased the volume of lung crossing the reference line by a median (IQR [range]) of 1.0 (0.6 to 1.3 [0.0 to 4.8]) mm, p < 0.001, irrespective of the application of PEEP or patient position. However, during the infraclavicular approach, lung deflation showed no change in the distance of the pleura from the reference line regardless of PEEP or patient position. We conclude that lung deflation moves the lung apex caudally and can reduce the potential risk of pneumothorax during a supraclavicular approach to the right subclavian vein in infants.

  19. Maturity of coastal bermudagrass and alfalfa affects ruminal in situ and total tract dry matter and phosphorus disappearance in cannulated steers.

    PubMed

    Riojas-McCollister, A V; Lambert, B D; Muir, J P

    2011-04-01

    Variability of phosphorus (P) availability among forage species and plant maturity is largely ignored when formulating ruminant diets. To determine if variability in P availability changes with forage species and/or maturity, ruminal in situ and total (ruminal+post-ruminal) dry matter (DM) and phosphorus disappearance (PD) from alfalfa (ALF; Medicago sativa) and coastal bermudagrass (CB; Cynodon dactylon) harvested at four stages of maturity was measured in cattle. Forages were hand clipped at 14, 21, 28 and 35 days after first cutting. Ruminal in situ DM disappearance (DMD) and PD were measured after 24 h ruminal incubation in Dacron bags. Total tract DMD and PD were measured using the mobile nylon bag technique. Disappearance of DM and P were greater (p≤0.05) in the rumen than post-rumen for both species regardless of maturity; however, 80 g PD/kg DM in 35-day ALF (9% of total PD) and 224 g PD/kg of 35-day CB (38% of total PD) occurred post ruminally. Alfalfa DM disappeared to a greater (p ≤ 0.05) extent than CB and showed 5% greater total tract PD at 14 days and 13% more at 35 days compared to the grass. Alfalfa total tract PD decreased (p ≤ 0.05) 5.4% from 14- to 35-day maturity while the decrease was far greater for CB, 12.4%. Results from this study indicate that ruminant nutritionists should take into account forage species and maturity when calculating PD in diets; these details can be used to aid in formulating more precise rations that reduce fecal-phosphorus excretion into the environment.

  20. In situ cannulation, microgrid follow-up and low-density plating provide first passage endothelial cell masscultures for in vitro lining.

    PubMed

    Zilla, P; Fasol, R; Dudeck, U; Siedler, S; Preiss, P; Fischlein, T; Müller-Glauser, W; Baitella, G; Sanan, D; Odell, J

    1990-08-01

    A rapid and reliable harvest and culture technique was developed to provide a sufficient number of autologous endothelial cells for the confluent in vitro lining of cardiovascular prostheses. Enzymatic endothelial cell detachment was achieved by the in situ application of collagenase to short vessel segments. This harvest technique resulted in a complete lack of contaminating smooth muscle cells in all of 124 cultures from nonhuman primates and 13 cultures from human adults. The use of a microgrid technique enabled the daily in situ quantification of available endothelial cells. To assess ideal plating densities after passage the population doubling time was continuously related to the cell density. Surprisingly, a low plating density of 1.5 X 10(3) endothelial cells/cm2 achieved 43% shorter cell cycles than the usual plating density of 1.0 X 10(4) endothelial cells/cm2. Moreover, low density plating enabled mass cultures after one single cell passage, thereby reducing the cell damaging effect of trypsin. When the growth characteristics of endothelial cells from five anatomically different vessel sites were compared, the external jugular vein--which would be easily accessible and dispensable in each patient--proved to be an excellent source for endothelial cell cultures. By applying in situ administration of collagenase, low density plating and microgrid follow-up to adult human saphenous vein endothelial cells, 14,000,000 first passage endothelial cells--sufficient for the in vitro lining of long vascular prostheses--were obtained 26.2 days after harvest. (95% confidence interval:22.3 to 32.2 days).

  1. Long-Term Bioeffects of 435MHz Radiofrequency Radiation on Selected Blood-Borne Endpoints in Cannulated Rats. Volume 2. Plasma ACTH (adrenocorticotropic Hormone) and Plasma Corticosterone

    DTIC Science & Technology

    1987-08-01

    stress hormone concentrations. In this study , an increase in plasma corticosterone was observed after barbiturate anesthesia (Fig. 5). Plasma ACTH...C.H., and Schindler, J. In vitro and vivo adrenal corticosterone secretion following stress. Am J Physiol 196:579-582 (1959). 16. Gale, G.C...related thereto. The animals involved in this study were procured, maintained, and used in accordance with the Animal Welfare Act and the "Guide for

  2. Long-term bioeffects of 435-MHz radiofrequency radiation on selected blood-borne endpoints in cannulated rats. Volume 6. Cardiovascular studies. Final report, October 1982-June 1985

    SciTech Connect

    Popovic, V.P.; Toler, J.C.; Bonasera, S.J.; Popovic, P.P.; Honeycutt, C.B.

    1988-01-01

    Two hundred adult male white rats with chronically implanted aortic cannulas were randomly divided into 2 groups. Animals in the first group were exposed to low-level pulsed-wave 435-MHz radiofrequency radiation for approximately 22 hours daily, 7 days a week, for 6 months. Animals in the second group were maintained under identical conditions but were not radiated. The cannulas were used to record heart rate and arterial blood pressure in unrestrained, unanesthetized rats. Statistical analysis of the results did not indicate any increase in heart rate or arterial blood pressure of RFR-exposed animals when compared to sham-exposed animals. Thus, chronic exposure to the low-level radiofrequency environment did not induce stress that was manifested as increases in heart rate or mean arterial blood pressure. This result correlated with the conclusion of a previous report demonstrating no RFR effects on plasma norepinephrine and epinephrine concentrations in the group of rats.

  3. Long-Term Bioeffects of 435-MHz Radiofrequency Radiation on Selected Blood-Borne Endpoints in Cannulated Rats. Volume 3. Plasma Prolactin.

    DTIC Science & Technology

    1987-06-01

    pulses are small, except curing sleeo when marxec rises in prolactin concentrations have been noted. Plasma prolactin level in indisturbed Intact...plasma prolactin can be used to measure the level of stress [123. intraventricular brain injection of 2-endorphin (aLPH51_,) in urethane- anesthetized...entire blood sampling period, there was considerable variance In the data, suggesting animal activity at the time of blood sampling. Since the sampling

  4. An unusual condition during internal jugular vein catheterisation: vertebral artery catheterisation.

    PubMed

    Korkmaz, Ozge; Göksel, Sabahattin; Söylemez, Burçak; Durmuş, Kasim; Işbir, Ahmet Cemil; Berkan, Öcal

    Vertebral artery cannulation is an unusual complication during internal jugular vein cannulation. We report a case of vertebral artery cannulation, which occurred during an attempt to cannulate the right internal jugular vein, and we discuss the management of such a rare complication.

  5. 50 CFR 218.20 - Specified activity and specified geographical area and effective dates.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (Hellfire missile); (B) Tube-launched Optically tracked Wire-guided (TOW) missile; (C) Mine Neutralization (20 lb NEW charges); and (D) 5″ Naval Gunfire. (ii) Training Exercises: (A) Mine Neutralization (20...

  6. 50 CFR 218.20 - Specified activity and specified geographical area and effective dates.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (Hellfire missile); (B) Tube-launched Optically tracked Wire-guided (TOW) missile; (C) Mine Neutralization (20 lb NEW charges); and (D) 5″ Naval Gunfire. (ii) Training Exercises: (A) Mine Neutralization (20...

  7. Dual wire welding torch and method

    DOEpatents

    Diez, Fernando Martinez; Stump, Kevin S.; Ludewig, Howard W.; Kilty, Alan L.; Robinson, Matthew M.; Egland, Keith M.

    2009-04-28

    A welding torch includes a nozzle with a first welding wire guide configured to orient a first welding wire in a first welding wire orientation, and a second welding wire guide configured to orient a second welding wire in a second welding wire orientation that is non-coplanar and divergent with respect to the first welding wire orientation. A method of welding includes moving a welding torch with respect to a workpiece joint to be welded. During moving the welding torch, a first welding wire is fed through a first welding wire guide defining a first welding wire orientation and a second welding wire is fed through a second welding wire guide defining a second welding wire orientation that is divergent and non-coplanar with respect to the first welding wire orientation.

  8. Welding skate with computerized controls

    NASA Technical Reports Server (NTRS)

    Wall, W. A., Jr.

    1968-01-01

    New welding skate concept for automatic TIG welding of contoured or double-contoured parts combines lightweight welding apparatus with electrical circuitry which computes the desired torch angle and positions a torch and cold-wire guide angle manipulator.

  9. 76 FR 60455 - 36(b)(1) Arms Sales Notification

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... Frequency (RF) Tube-Launched Optically-Tracked Wire-Guided Missiles (TOW-2A), 7 Fly-to-Buy RF TOW-2A... Optically-Tracked Wire-Guided Missiles (TOW-2A), 7 Fly-to-Buy RF TOW-2A Missiles, 40 BGM-71F-3-RF TOW-2B... tracker beacons (xenon and thermal) for the launcher to track and guide the missile in flight....

  10. A Systems Engineering Approach to Allocate Resources Between Protection and Sensors for Ground Systems for Offensive Operations in an Urban Environment

    DTIC Science & Technology

    2014-09-01

    Propelled Grenade SITREP Situation Report TOW Tube- Launched , Optically-Tracked, Wire-Guided TRL Technology Readiness Level UAV Unmanned Aerial Vehicle ...simulation is the M2 Bradley. The vehicle boasts a 25mm cannon with a complement of the Tube Launched , Optical Tracked and Wire Guided (TOW) Anti...deployed on the ground and where the pressure or vibrations from an armored vehicle triggers its detonation when the vehicle rolls over the mines

  11. Finding the sweet spot for non-apical RV pacing - "love's labor's lost or much ado about nothing:" a new angiographic technique to accomplish accurate physiological RV septal pacing in under 5 minutes from venous cannulation (or bust).

    PubMed

    Srivatsa, Sanjay S

    2014-03-01

    Right ventricular septal pacing has been long touted as a more physiologic alternative to right ventricular apical pacing. This article reviews the physiologic and clinical evidence for right ventricular septal versus apical pacing, and presents a novel angiographic technique for efficient attainment of the optimal septal pacing site. The reasons for equivocal clinical findings in septal versus apical pacing studies are discussed, and a new strategy for non-apical pacing clinical trial design utilizing comparative anatomic assessment of septal pacing site versus clinical outcome is proposed.

  12. Intake and digestibility by sheep, and in-situ disappearance in cannulated cows, and chemical composition of crabgrass hayed at two moisture concentrations and treated with a non-viable lactobacillus-lactic acid additive

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Crabgrass [Digitaria ciliaris (Retz.) Koel.] is a high-quality warm-season annual that can be used as hay, but field curing time may be lengthy compared with other forages. A 1.6-ha field of common crabgrass was divided into 12 plots that were used in a randomized complete block design with a 2 × 2 ...

  13. Long-term bioeffects of 435-MHz radiofrequency radiation on selected blood-borne endpoints in cannulated rats. Volume 2. Plasma ACTH (adrenocorticotropic hormone) and plasma corticosterone. Final report, 20 August 1984-16 February 1986

    SciTech Connect

    Popovic, V.P.; Toler, J.C.; Bonasera, S.J.; Popovic, P.P.; Honeycutt, C.B.

    1987-08-01

    Two hundred adult male white rats with chronically implanted aortic cannulas were randomly divided into two groups. Animals in the first group were exposed to low-level (1.0 mW/cm2) pulsed-wave 435-MHz radiofrequency radiation (RFR) for approximately 22 h daily, 7 days each week, for 6 months. Animals in the second group were maintained under identical conditions, but were not radiated. The cannulas were used to draw microsamples (0.3 mL) of aortic blood from the unrestrained, unanesthetized rats on a cyclic schedule. Plasma adrenocorticotropic hormone (ACTH) and plasma corticosterone concentrations were determined by radioimmunoassays hormone (ACTH) and plasma corticosterone concentrations were determined by radioimmunoassays. Statistical analysis of the results did not indicate increased plasma ACTH and plasma corticosterone concentrations in exposed animals when compared to sham-exposed animals. Exposure to this low-level radiofrequency environment did not induce stresses that were manifested as an alteration in plasma hormones.

  14. ENTRY POINT FOR THE ANTEGRADE FEMORAL INTRAMEDULLARY NAIL: A CADAVER STUDY

    PubMed Central

    Labronici, Pedro José; Galeno, Luiz; Teixeira, Thiago Martins; Franco, José Sergio; Hoffmann, Rolix; de Toledo Lourenço, Paulo Roberto Barbosa; Giordano, Vincenzo; Pallottino, Alexandre; do Amaral, Ney Pecegueiro

    2015-01-01

    Objective: To analyze the natural exit of the wire guides in major trochanter through retrograde femoral approach, in cadaver specimens. Material and Method: 100 femurs had been perforated between the femoral condyles, at 1.2 cm of the intercondylar region. A 3-mm straight wire guide was introduced, through retrograde approach, until the proximal extremity of femur was reached. Femurs were assessed for posterosuperior and anterosuperior portions of major trochanter, pear-shaped cavity, and upper median line between the head-neck and the major trochanter. Results: in 62%, the straight wire guides exited at the anterior surface of major trochanter. In the pear-shaped cavity, the median distance found was 1.0 cm and the interquartile range was 0.5 cm, initially expressing, in relation to pear-shaped cavity, better accuracy. Conclusion: the central axis of the medullar canal, at coronal plane, projected better accuracy in the region of the pear-shaped cavity. PMID:27077057

  15. The Light Armored Cavalry Regiment -- Reconnaissance Force of the Future

    DTIC Science & Technology

    1992-12-01

    appli- que armor made this possible. The Bradely Scout Vehicle, armed with a 25 mm cannon and a wire guided missile system, could now engage and destroy...University Press. 1986 Palmer, David Richard, Summons of the Trumpet. Novato. CA. Presidio Press. 1978. Palmer, Bruce Jr., The 25 Year War. America’s Military

  16. Endoscopic removal of esophageal and ruminal foreign bodies in 5 Holstein calves

    PubMed Central

    Gomez, Diego E.; Cribb, Nicola C.; Arroyo, Luis G.; Desrochers, André; Fecteau, Gilles; Nichols, Sylvain

    2014-01-01

    Endoscopic removal of esophageal and ruminal foreign bodies was successfully performed in 5 Holstein-Friesian calves under sedation or general anesthesia by using an electrocautery snare or a wire-guided Dormi basket. This report describes the endoscopic manipulations, treatment, and outcomes of esophageal foreign body removal in these calves. PMID:25320385

  17. Manual tube-to-tubesheet welding torch

    DOEpatents

    Kiefer, Joseph H.; Smith, Danny J.

    1982-01-01

    A welding torch made of a high temperature plastic which fits over a tube intermediate the ends thereof for welding the juncture between the tube and the back side of a tube plate and has a ballooned end in which an electrode, filler wire guide, fiber optic bundle, and blanketing gas duct are disposed.

  18. Rocket center Peenemuende - Personal memories

    NASA Technical Reports Server (NTRS)

    Dannenberg, Konrad; Stuhlinger, Ernst

    1993-01-01

    A brief history of Peenemuende, the rocket center where Von Braun and his team developed the A-4 (V-2) rocket under German Army auspices, and the Air Force developed the V-1 (buzz bomb), wire-guided bombs, and rocket planes, is presented. Emphasis is placed on the expansion of operations beginning in 1942.

  19. Welding torch and wire feed manipulator

    NASA Technical Reports Server (NTRS)

    Williams, R. T.

    1967-01-01

    Welding torch and wire feed manipulator increase capability for performing automatic welding operations. The manipulator rotates on its horizontal axis to avoid obstacles as they approach the torch. The initial individual attitudes of the torch and wire guide are set with respect to the general configuration of the part.

  20. Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery (HAI)_2

    ClinicalTrials.gov

    2016-10-24

    Cardiovascular Disease; Healthcare Associated Infectious Disease; Sternal Superficial Wound Infection; Deep Sternal Infection; Mediastinitis; Thoracotomy; Conduit Harvest or Cannulation Site; Sepsis; Pneumonia

  1. Radio-guided localization of clinically occult breast lesions: current modalities and future directions.

    PubMed

    Aydogan, Fatih; Velidedeoglu, Mehmet; Kilic, Fahrettin; Yilmaz, Halit

    2014-01-01

    The extensive availability of breast cancer screening programs and improvement in diagnostic imaging have led to more frequent detection of suspicious and clinically occult breast lesions. Early detection of tumor is important for breast-conserving treatment. Incomplete excision is a major risk factor for local recurrence. Following precise localization and removing the entire lesion while achieving adequate clear margins is the key factor for successful management of non-palpable breast lesions. For this purpose, several techniques such as wire-guided localization, intra-operative ultrasound guided resection, radio-guided occult lesion localization and radioactive seed localization have been described and applied. In this article, we overview the two commonly used localization techniques, radio-guided occult lesion localization and wire-guided localization, particularly describing their advantages and drawbacks.

  2. Plasma arc torch with coaxial wire feed

    DOEpatents

    Hooper, Frederick M

    2002-01-01

    A plasma arc welding apparatus having a coaxial wire feed. The apparatus includes a plasma arc welding torch, a wire guide disposed coaxially inside of the plasma arc welding torch, and a hollow non-consumable electrode. The coaxial wire guide feeds non-electrified filler wire through the tip of the hollow non-consumable electrode during plasma arc welding. Non-electrified filler wires as small as 0.010 inches can be used. This invention allows precision control of the positioning and feeding of the filler wire during plasma arc welding. Since the non-electrified filler wire is fed coaxially through the center of the plasma arc torch's electrode and nozzle, the wire is automatically aimed at the optimum point in the weld zone. Therefore, there is no need for additional equipment to position and feed the filler wire from the side before or during welding.

  3. Prolonged bile duct obstruction: a new experimental model for cirrhosis in the rat.

    PubMed Central

    Kountouras, J.; Billing, B. H.; Scheuer, P. J.

    1984-01-01

    Hepatic morphological abnormalities were examined in rats whose bile ducts had been either cannulated and then obstructed or irreversibly ligated for 5, 10, 15 and 28 days or longer. Throughout the experiment most of the morphological changes observed in the cannulated group were comparable to those in the ligated group. Portal inflammation and marginal bile duct proliferation were noted with the same frequency in both groups. Biliary obstruction for 15 days or more led to cirrhosis. After 28 days obstruction, five out of six cannulated rats and four out of six ligated animals respectively developed cirrhosis. The development of cirrhosis was progressive and associated with ascites. It is concluded that in the rat the morphological sequelae of long term cholestasis induced by either cannulation and obstruction or ligation of bile ducts are similar and are accompanied by cirrhosis. The advantages of this experimental model for the study of human cirrhosis are discussed. Images Fig. 1 Fig. 2 PMID:6743531

  4. Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

    PubMed Central

    Lee, Tae Hoon; Park, Sang-Heum

    2016-01-01

    Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access. PMID:27642848

  5. Comparison of Iontophoretic Lidocaine to EMLA Cream for Pain Reduction Prior to Intravenous Fannulation in Adults

    DTIC Science & Technology

    2000-10-01

    i COMPARISON OF IONTOPHORETIC LIDOCAINE TO EMLA CREAM FOR PAIN REDUCTIONPRIOR TO INTRAVENOUS CANNULATION IN ADULTS Kenneth Lee Spence LT, NC, USN...COMPARISON OF IONTOPHORETIC LIDOCAINE TO EMLA CREAM FOR PAIN REDUCTION PRIOR TO INTRAVENOUS CANNULATION IN ADULTS 5a. CONTRACT NUMBER 5b. GRANT...most operative anesthesia, can be a source of pain and anxiety. Lidocaine , a local anesthetic, is frequently injected intradermally to decrease pain

  6. Butorphanol premedication to facilitate invasive monitoring in cardiac surgery patients before induction of anaesthesia.

    PubMed

    Tripathi, Mukesh; Nath, Soumya Shanker; Banerjee, Sudipto; Tripathi, Mamta

    2009-01-01

    Cannulations (peripheral vein, radial artery and jugular vein) performed for invasive monitoring before induction of anaesthesia in cardiac surgery patients may be associated with stress and anxiety. The efficacy and safety of butorphanol premedication was assessed in setting up of invasive monitoring. The study was a prospective, randomized, double blind, placebo controlled one with 70 patients undergoing elective cardiac surgery. In group-1 patients (n = 35) (placebo) intramuscular saline was administered 1-2 hours before the surgery in equivalent volume to butorphanol. In group-2 (n = 35) butorphanol (1, 1.5 and 2 mg for three body weight groups < 40 kg, 41-60 kg and> 60 kg, respectively) was administered 1-2 hours before surgery. Observer blinded for medication recorded the sedation score, pupil size and pain after each cannulation using visual analogue score (VAS). Student's 't' test and Chi-square test for proportions, Mann-Whitney test for non-parametric data was carried out. The median pain score of cannulation in group-2 (butorphanol) in the hand (10 mm) and neck (20 mm) were significantly (P < 0.05) lower than group-1 (placebo) patients (hand = 30 mm and neck = 40 mm). Pain during neck cannulation was significantly (P < 0.05) reduced (VAS < 30 mm) in patients with the pupil size of < 2.5 mm. Since the pain during neck cannulation was more than pain during hand cannulations in both the groups, we conclude that the intensity of pain depends also upon the site of cannulation. Besides the analgesic effect of butorphanol, its sedative effect helped to effectively decrease the pain during neck cannulation in conscious patients.

  7. False aneurysm of aorta secondary to partial occlusion clamp injury: diagnosis by nuclear flow study

    SciTech Connect

    Becker, R.M.; Wexler, J.; Frater, R.W.

    1981-09-01

    A 72-year-old woman presented 12 months postaortic valve replacement with a false aneurysm near the aortic cannulation site. The diagnosis was suspected from clinical findings and confirmed by a nuclear flow study. The patient refused surgery and died shortly afterward. At autopsy, a smooth-walled 1 cm defect adjacent to the cannulation site (presumably related to injury from a partial occlusion clamp) was found; this would have been easily reparable with surgery.

  8. Resternotomy, a single-center experience.

    PubMed

    Salehi, Mehrdad; Bakhshandeh, Ali Reza; Saberi, Kianoush; Alemohammad, Mahmood; Sobhanian, Keivan; Karamnezhad, Maziar; Rigi, Farangis Sarouneh

    2017-01-01

    Background Reoperations are technically more difficult because of the risks associated with reentry in a heart with more advanced pathology, little reserve, and more frequent comorbidities. Routine peripheral cannulation before resternotomy is inadvisable, time-consuming, and has no noticeable role in decreasing the risks of reentry. We present our experience of resternotomy without routine peripheral cannulation. Methods This was a retrospective study on 237 consecutive patients who underwent resternotomy between June 2011 and July 2013. Their mean age was 47.7 ± 18.2 years. We chose the best approach individually, according to lateral radiograph findings, patient risk factors, and previous surgery. Our goal was to observe events intraoperatively and their outcomes postoperatively. Results Mean intensive care unit stay was 3.1 ± 0.9 days. Twenty-one (8.8%) patients died during their hospital stay. The most common cause of death was renal failure in 15 (71.4%) patients, coagulopathy in 4 (19%), and cardiac failure in 2 (9.5%). We had 3 right ventricular, one right atrial, one pulmonary artery, and 2 inferior vena caval tears during resternotomy and dissection; bleeding was controlled easily without peripheral cannulation. Femoral cannulation before resternotomy was performed in one patient who needed an emergency pulmonary embolectomy. Conclusions Based on our experience, resternotomy with central cannulation is a safe strategy, and peripheral cannulation before resternotomy should be reserved for highly selected patients.

  9. Knuckle technique guided by intravascular ultrasound for in-stent restenosis occlusion treatment

    PubMed Central

    Tasic, Mladen; Jagic, Nikola; Miloradovic, Vladimir; Nikolic, Dusan

    2015-01-01

    One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion. PMID:25848374

  10. Small Structures, Big Droplets: The Role of Nanoscience in Fog Harvesting.

    PubMed

    Pinchasik, Bat-El; Kappl, Michael; Butt, Hans-Jürgen

    2016-12-27

    Designing materials for water harvesting has gained much attention in recent years as water scarcity continues to be one of the biggest problems facing mankind. In this issue of ACS Nano, Xu et al. propose a new device for harvesting water from fog. They use conically shaped copper wires with periodic roughness to enhance condensation and transport of water drops. While the periodic roughness enhances drop coalescence and motion, the conical shape of the wires guides the drops in a specific direction. Together, a self-sustained water-harvesting system is described which does not require additional external stimulus but makes use of a smart design and economic production.

  11. Release of experimental retinal vein occlusions by direct intraluminal injection of ocriplasmin

    PubMed Central

    Stassen, Jean Marie; Meenink, Thijs C M; Janssens, Tom; Vanheukelom, Valérie; Naus, Gerrit J L; Beelen, Maarten J; Jonckx, Bart

    2016-01-01

    Purpose Retinal vein occlusions (RVO) are a major cause of vision loss in people aged 50 years and older. Current therapeutic options limit the consequences of RVO but do not eliminate the cause. Cannulation of the involved vessel and removal of the clot may provide a more permanent solution with a less demanding follow-up. However, cannulation of smaller retinal veins remains challenging. This paper explores the use of ocriplasmin (recombinant plasmin without its kringles) to clear RVO, using a robotic micromanipulator. Methods Branch RVO were induced in a porcine model with rose bengal followed by 532 nm endolaser to the superior venous branch of the optic nerve. The vein was cannulated proximal to the occlusion or beyond the first branching vessel from the obstruction. The vein was infused with a physiologic citric acid buffer solution (CAM) or CAM/ocriplasmin. The time of cannulation, number of attempts, and the ability to release the thrombus were recorded. Results Cannulation and infusion was possible in all the cases. The use of a micromanipulator allowed for a consistent cannulation of the retinal vein and positional stability allowed the vein to remain cannulated for up to 20 min. In none of the attempts (5/5) with CAM did the thrombus dissolve, despite repeat infusion/relaxation cycles. In 7/7 injections of CAM/ocriplasmin near to the point of obstruction, the clot started to dissolve within a few minutes of injection. An infusion, attempted beyond the first venous branch point proximal to the clot, was unsuccessful in 2/3 attempts. Conclusions Ocriplasmin is effective in resolving RVO if injected close to the site of occlusion with the use of a micromanipulator. PMID:27688592

  12. A rapid and non-surgical procedure for jugular catheterization of pigs.

    PubMed

    Matte, J J

    1999-07-01

    A rapid and non-surgical method for jugular catheterization in pigs was set up in 30 piglets of 6.2 kg, 23 pigs of 46 kg and 84 kg and two lactating multiparous sows. The animal was restrained on a V-shaped table (piglets) or with a rope around the mandible (slaughter pigs and sows). The vein was located with the Vacutainer system and a wire guide was inserted into the Vacutainer needle up to the vein lumen. When the needle was removed, the catheter was inserted over the wire guide and advanced until it penetrated the skin and thereafter, the vein wall. The catheter was fixed outside by a large tape and coiled inside a patch just behind the ears. The technique utilizes readily available material and is no more risky for the animal than a single blood sampling. Moreover, it can be performed within 15 to 20 min (including animal restraint) within pens. This new approach might have important implications not only for research purposes by facilitating repeated blood samplings but also for projects which require a rapid and easy method for testing of any kind of pharmaceutical or other type of products under husbandry conditions.

  13. Cast polycrystalline silicon photovoltaic module manufacturing technology improvements. Annual subcontract report, 1 January 1996--31 December 1996

    SciTech Connect

    Wohlgemuth, J.

    1997-10-01

    This report describes Solarex`s accomplishments during this phase of the Photovoltaic Manufacturing Technology (PVMaT) program. During this reporting period, Solarex researchers converted 79% of production casting stations to increase ingot size and operated them at equivalent yields and cell efficiencies; doubled the casting capacity at 20% the cost of buying new equipment to achieve the same capacity increase; operated the wire saws in a production mode with higher yields and lower costs than achieved on the ID saws; purchased additional wire saws; developed and qualified a new wire-guide coating material that doubles the wire-guide lifetime and produces significantly less scatter in wafer thickness; ran an Al paste back-surface-field process on 25% of all cells in manufacturing; completed environmental qualification of modules using cells produced by an all-print metallization process; qualified a vendor-supplied Tedlar/ethylene vinyl acetate (EVA) laminate to replace the combination of separate sheets of EVA and Tedlar backsheet; substituted RTV adhesive for the 3M Very High Bond tape after several field problems with the tape; demonstrated the operation of a prototype unit to trim/lead attach/test modules; demonstrated the use of light soldering for solar cells; demonstrated the operation of a wafer pull-down system for cassetting wet wafers; and presented three PVMaT-related papers at the 25th IEEE Photovoltaic Specialists Conference.

  14. Guided electromagnetic waves observed on a conducting ionospheric tether

    NASA Astrophysics Data System (ADS)

    James, H. G.; Balmain, K. G.

    2001-01-01

    On the up leg of its flight through the auroral nightside ionosphere to an apogee of 824 km, the tethered double payload Observations of Electric Field Distributions in the Ionospheric Plasma: A Unique Strategy (OEDIPUS) C was the site of experiments on wire-guided electromagnetic (EM) waves. Waves were transmitted from the upper subpayload to a receiver on the lower subpayload along a conducting wire aligned within a few degrees of the Earth's magnetic field. Such EM waves were observed at almost all frequencies in the range 0.1-8.0 MHz. There was a deep stop band between the cyclotron and upper hybrid resonance frequencies where the cold plasma theory predicts a propagation cutoff, and there were shallower attenuation bands at frequencies where hot-plasma electrostatic waves may affect the guided EM modes. Resonances of the wire-guided waves with the tether length were observed throughout the entire tethered portion of the flight. The resonances appear as a set of fringes when all the data are presented in a frequency-versus-time summary. The fringe shapes in this summary have been compared with the predictions of an early theory, which give generally good agreement. The exceptions are frequencies close to the stop band, where cold-plasma dispersion effects are expected to be greatest. Another theory based on a different derivation of the dispersion relation includes a vacuum sheath gap outside the conductor. The absolute fringe intensities and positions predicted agree moderately well with the observations.

  15. Effects of fatty acid supplements on milk yield and energy balance of lactating dairy cows.

    PubMed

    Harvatine, K J; Allen, M S

    2006-03-01

    Saturated and unsaturated fatty acid supplements (FS) were evaluated for effects on yield of milk and milk components, concentration of milk components including milk fatty acid profile, and energy balance. Eight ruminally and duodenally cannulated cows and 8 noncannulated cows were used in a replicated 4 x 4 Latin square design experiment with 21-d periods. Treatments were control and a linear substitution of 2.5% fatty acids from saturated FS (SAT; prilled, hydrogenated free fatty acids) for partially unsaturated FS (UNS; calcium soaps of long-chain fatty acids). The SAT treatment did not change milk fat concentration, but UNS linearly decreased milk fat in cannulated cows and tended to decrease milk fat in noncannulated cows compared with control. Milk fat depression with UNS corresponded to increased concentrations of trans-10, cis-12 conjugated linoleic acid and trans C18:1 fatty acids in milk. Milk fat profile was similar for SAT and control, but UNS decreased concentration of short- and medium-chain FA. Digestible energy intake tended to decrease linearly with increasing unsaturated FS in cannulated and noncannulated cows. Increasing unsaturated FS linearly increased empty body weight and net energy gain in cannulated cows, whereas increasing saturated FS linearly increased plasma insulin. Efficiency of conversion of digestible energy to milk tended to decrease linearly with increasing unsaturated FS for cannulated cows only. Addition of SAT provided little benefit to production and energy balance, whereas UNS decreased energy intake and milk energy yield.

  16. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  17. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  18. Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing.

    PubMed

    Gutowski, Christina; Abrams, Jeffrey S; Gutowski, W T

    2013-08-01

    Tibial shaft fractures with a wedge butterfly segment are often repaired with intramedullary fixation. At the time of presentation, the fragment may appear benign on radiographs as a portion of the cortical bone in an acceptable position. However, a segment that includes the entire circumference of the tibial cortex can be a problem during surgical stabilization. This ring effect will demand cannulation of the butterfly segment with the guide wire before rod insertion. Since computed tomography is not always necessary for minimally displaced fractures, this issue may not be discovered until surgery. Lack of cannulation may lead to painful nonunion. Preoperative recognition of this fracture pattern and intraoperative butterfly cannulation will improve the postoperative stability of this fracture.

  19. Iatrogenic Transient Complete Heart Block in a Preexisting LBBB

    PubMed Central

    Kalamkar, Prachi; Bonnet, Christopher A.; Bajwa, Omer A.

    2016-01-01

    Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure. PMID:27478653

  20. Clinical review: Vascular access for fluid infusion in children

    PubMed Central

    Haas, Nikolaus A

    2004-01-01

    The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access. PMID:15566619

  1. Comparison of Conventional versus Steerable-Catheter Guided Coronary Sinus Lead Positioning in Patients Undergoing Cardiac Resynchronization Device Implantation

    PubMed Central

    Er, Fikret; Yüksel, Dilek; Hellmich, Martin; Gassanov, Natig

    2015-01-01

    Objectives The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS) cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT). Background Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation. Methods 176 consecutive patients with ischemic and non-ischemic heart failure undergoing CRT implantation from January 2008 to December 2012 at the University Hospital of Cologne were identified. During the study period two concurrent CS cannulation techniques were used: standard CS cannulation technique (standard-group, n = 113) and CS cannulation using a steerable electrophysiology (EP) catheter (EPCath-group, n = 63). Propensity-score matched pairs of conventional and EP-catheter guided CS cannulation made up the study population (n = 59 pairs). Primary endpoints were total fluoroscopy time and contrast medium amount used during procedure. Results The total fluoroscopy time was 30.9 min (interquartile range (IQR), 19.9–44.0 min) in the standard-group and 23.4 min (IQR, 14.2-34-2 min) in the EPCath-group (p = 0.011). More contrast medium was used in the standard-group (60.0 ml, IQR, 30.0–100 ml) compared to 25.0 ml (IQR, 20.0–50.0 ml) in the EPCath-group (P<0.001). Conclusions Use of steerable EP catheter was associated with significant reduction of fluoroscopy time and contrast medium use in patients undergoing CRT implantation. PMID:26599637

  2. Virtual ventriculostomy with 'shifted ventricle': neurosurgery resident surgical skill assessment using a high-fidelity haptic/graphic virtual reality simulator.

    PubMed

    Lemole, Michael; Banerjee, P Pat; Luciano, Cristian; Charbel, Fady; Oh, Michael

    2009-05-01

    Based on a study of 48 neurological residents using a high fidelity haptic/graphic virtual reality simulator to perform ventricular cannulation, we recorded absolute Euclidean distance from the catheter tip to the foramen of Monroe within the ventricle. The data suggest that as expected, successful first attempts to cannulate the virtual 'shifted ventricle' are much less frequent than previous assessments with normal virtual ventricular anatomy. Furthermore, the significant improvement observed by the second attempt implies that the learning curve has been affected and the process 'jump started'.

  3. Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine

    PubMed Central

    Scheer, Bernd Volker; Perel, Azriel; Pfeiffer, Ulrich J

    2002-01-01

    In order to evaluate the complications and risk factors associated with peripheral arterial catheters used for haemodynamic monitoring, we reviewed the literature published from 1978 to 2001. We closely examined the three most commonly used arterial cannulation sites. The reviewed papers included a total of 19,617 radial, 3899 femoral and 1989 axillary artery catheterizations. Factors that contribute to higher complication rates were investigated. Major complications occurred in fewer than 1% of the cases, and rates were similar for the radial, femoral and axillary arteries. We conclude that arterial cannulation is a safe procedure. PMID:12133178

  4. Effects of rumen fill on short-term ingestive behavior and circulating concentrations of ghrelin, insulin, and glucose of dairy cows foraging vegetative micro-swards

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of ruminal fill (RF) on foraging behaviour, intake rate and the levels of circulating ghrelin, insulin and glucose was measured with four rumen-cannulated lactating dairy cows foraging micro-swards of vegetative orchardgrass. The treatments compared were removal of 1.00 (RF0), 0.66 (RF33)...

  5. Effect of ruminal fill on foraging behavior, intake rate, and plasma ghrelin, serum insulin and glucose levels of cattle grazing a vegetative micro-sward

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of ruminal fill (RF) on foraging behavior, intake rate and levels of circulating ghrelin, insulin and glucose was measured with four rumen-cannulated lactating dairy cows foraging micro-swards of vegetative orchardgrass. The treatments compared were removal of 1.00 (RF0), 0.66 (RF33), 0....

  6. Effect of herbage depletion on short-term foraging dynamics and diet quality of steers grazing wheat pastures

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Two complementary experiments were completed to assess short-term foraging dynamics, diet quality, and ruminal degradation kinetics of herbage consumed by steers with 3 level of herbage depletion. Experiment (Exp.) 1 was a behavioral study in which 3 ruminally cannulated steers were allocated to gra...

  7. Arginine supplementation does not alter nitrogen metabolism of beef steers during a lipopolysaccharide challenge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Demand for Arg is reported to increase during immune challenge. This study evaluated the effects of lipopolysaccharide (LPS) and abomasal Arg infusion on N metabolism and immune response of 20 ruminally cannulated steers (369 ± 46 kg BW) in a randomized block design. Each block was 20 d and consiste...

  8. Cattle Differ in Ability to Adapt to Small Intestinal Digestion of Starch

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to evaluate the impact of post-ruminal starch digestion on inflammatory response in dairy cattle. Six cull, nonpregnant, nonlactating, multiparous cannulated Holstein dairy cows (BW 804±101 kg) were fed a high forage diet ad libitum starting 15 d before the infusion p...

  9. Arginine supplementation does not alter nitrogen metabolism of beef steers during a lipopolysaccharide challenge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Demand for arginine (Arg) is reported to increase during immune challenges. This study evaluated effects of lipopolysaccharide (LPS) and abomasal Arg infusion on nitrogen (N) metabolism and immune response of 20 ruminally cannulated steers (369 ± 46 kg BW) in a randomized block design. Each block co...

  10. Effects of feeding different amounts of supplemental glycerol on ruminal environment and digestibility of lactating dairy cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A study was conducted to evaluate the effects of increasing amounts of dietary glycerol on rumen environment, blood metabolites, and nutrient digestibility. Six rumen cannulated Holstein cows averaging 56 ± 18 DIM and 38.0 ± 8.2 kg/d of milk were used in the study. Experimental design was a replicat...

  11. The effect of brown midrib corn silage and dried distillers' grains with solubles on milk production, nitrogen utilization and microbial community structure in dairy cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Thirty-six Holstein cows, four of which were ruminally cannulated, (mean ± SD, 111 ± 35 DIM; 664 ± 76.5 kg BW) were used in replicated 4×4 Latin squares to investigate the effects of brown midrib (bm3) and conventional (DP) corn silages and the inclusion of dried distillers grains with solubles (DDG...

  12. Mechanisms of Coagulation Abnormalities and Trauma

    DTIC Science & Technology

    2011-07-01

    demonstrated a 6.1% reduction in mortality and a 19.4% reduction in 28-day mortality in septic patients who received recombinant aPC in continuous infusion ...sodium chloride solution. After the laparotomy and vessel cannulations, all incisions were bathed with lidocaine 1% for analgesia, and the isoflurane was

  13. Analysis of rumen motility patterns using a wireless telemetry system to characterize bovine reticuloruminal contractions

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to characterize rumen motility patterns of cattle fed once daily. Eight ruminally-cannulated Holstein steers (BW = 321 ± 11 kg) were fed alfalfa cubes once daily at 1.5 × NEm top-dressed with a TM-salt pre-mix. Three 24-h collection periods were conducted and each com...

  14. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  15. Tracheostomy in Young Children: Implications for Assessment and Treatment of Communication and Feeding Disorders.

    ERIC Educational Resources Information Center

    Simon, Bonnie M.; McGowan, Joy Silverman

    1989-01-01

    The article reviews studies showing that speech and language intervention during the period of cannulation can benefit tracheostomized and ventilator-dependent children by improving their communicative functioning while decreasing their frustration with the tracheostomy placement. Therapeutic interventions with feeding skills are also recommended.…

  16. Communicative Intentions of Three Prelinguistic Children with a History of Long-Term Tracheostomy.

    ERIC Educational Resources Information Center

    Kertoy, Marilyn K.; Waters, Robert J.

    1995-01-01

    Early communication was examined for 3 children (ages 20 to 27 months) who had been tracheostomized during their first year and were still cannulated. Communication means and intentions and rate of communication were examined. Potential contributions of social, cognitive, and language skills to the onset of early words were assessed. (Author/SW)

  17. Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

    PubMed

    Paliwal, Bharat; Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

  18. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients.

    PubMed

    Moini, Majid; Rasouli, Mohammad R; Kenari, Mohammad Mahmoodzadeh; Mahmoodi, Hamid Reza

    2009-01-01

    To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD), we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (p< 0.05). In conclusion, our results showed that the external jugular vein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

  19. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    PubMed

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  20. Minimally Invasive Mitral Valve Surgery I

    PubMed Central

    Ailawadi, Gorav; Agnihotri, Arvind K.; Mehall, John R.; Wolfe, J. Alan; Hummel, Brian W.; Fayers, Trevor M.; Farivar, R. Saeid; Grossi, Eugene A.; Guy, T. Sloane; Hargrove, W. Clark; Khan, Junaid H.; Lehr, Eric J.; Malaisrie, S. Chris; Murphy, Douglas A.; Rodriguez, Evelio; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Shemin, Richard J.; Smith, J. Michael; Smith, Robert L.; Weldner, Paul W.; Goldman, Scott M.; Lewis, Clifton T. P.; Barnhart, Glenn R.

    2016-01-01

    Abstract Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. PMID:27654407

  1. Alteration of basal metabolic rate in Holstein steers during fescue toxicosis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The results of this study indicate that consumption of E+ tall fescue by cattle results in a reduction in basal metabolic rate. Six ruminally cannulated steers were weight-matched and pair-fed during a two period crossover experiment. Each period consisted of two temperatures (22°C and 30°C). During...

  2. [Suprapapilar puncture for biliary access to advanced cancer of the papilla and severe coagulopathy].

    PubMed

    Artifon, E; Couto, D S; Navarro, A

    2009-01-01

    Biliary cannulation to perform endoscopic retrograde cholangiopancreatography (ERCP) may be difficult in patients with advanced papillary cancer, due to anatomical and technical reasons. Sphincterotomy may be contraindicated in severe coagulopathy. We report a recently described technique of suprapapillary puncture for biliary access with use of an Artifon's catheter for biliary access in a high-risk patient with coagulopathy and periampullary neoplasm.

  3. UPTAKE AND ELIMINATION OF DICHLOROACETIC ACID BY RAINBOW TROUT

    EPA Science Inventory

    Dichloroacetic acid (DCA) is a by-product of drinking water chlorination and is a hepatocarcinogen in rodents. Preliminary results of a chronic testing effort with Japanese medaka suggest the possibility of similar effects is fish. Adult rainbow trout were cannulated from the dor...

  4. Effect of feeding cows genetically modified maize on the bacterial community in the bovine rumen.

    PubMed

    Wiedemann, S; Gürtler, P; Albrecht, C

    2007-12-01

    Rumen-cannulated cows (n = 4) were fed successively silage made from either conventional or genetically modified (GM) maize. Results revealed no effects of GM maize on the dynamics of six ruminal bacterial strains (investigated by real-time PCR) compared to the conventional maize silage.

  5. Alteration of fasting heat production during fescue toxicosis in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of fasting heat production (FHP) during fescue toxicosis. Six ruminally cannulated Holstein steers (BW=348 ±13 kg) were weight-matched into pairs and utilized in a two period crossover design experiment. Each period consisted of two temperature segments,...

  6. Alteration of fasting heat production during fescue toxicosis in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of fasting heat production (FHP) during fescue toxicosis. Six ruminally cannulated Holstein steers (BW = 348±26kg) were weight matched into pairs and utilized in a two period crossover design experiment. Each period consisted of two segments, one each at...

  7. Post-extraction algal residue in steam-flaked corn-based diets for beef cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effects of post-extraction algal residue (PEAR) as N source 23 in steam-flaked corn-based (SFC) beef cattle finishing diets on intake, duodenal flow, digestion, ruminal microbial efficiency, ruminal parameters, and blood constituents were evaluated. Ruminally and duodenally cannulated steers (BW...

  8. pH Dynamics and Bacterial Community Composition in the Rumen of Lactating Dairy Cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effect of pH dynamics on ruminal bacterial community composition (BCC) was studied in 8 ruminally cannulated Holstein cows fitted with indwelling electrodes that recorded pH at 10-min intervals over a 2.4-d period. Cows were fed a silage-based TMR supplemented with monensin. Ruminal samples wer...

  9. Orchardgrass forage effects on bacterial communities and long-chain fatty acid profiles in the rumen of Holstein heifers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The aim of this study was to determine if ruminal bacterial community composition (BCC) and long-chain fatty acid (FA) profiles differed in heifers grazing in orchardgrass pasture (OP) versus those fed hay (OH) harvested from the same field at the same stage of maturity. Five ruminally cannulated Ho...

  10. Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax

    SciTech Connect

    Gaba, Ron C. Owens, Charles A.; Bui, James T.; Carrillo, Tami C.; Knuttinen, M. Grace

    2011-02-15

    Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.

  11. A home-made low-cost hydraulic swivel and catheter assembly for blood pressure recording and drug infusion in freely moving mice.

    PubMed

    Tsai, Meng-Li; Huang, Jian-Jia; Chou, Li-Min; Chen, Chien-Chang

    2008-06-01

    We constructed a chassis that tightly fixes catheters for cannulation to the muscle. It can buffer pulling forces to avoid a mechanical tearing of the skin of mice as a result of movement. A simple hydraulic swivel was also made for blood pressure recording and drug infusion in freely moving mice.

  12. Effects of including saponins (Micro-aid®) on intake, rumen fermentation, and digestibility in steers fed low-quality prairie hay

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sixteen ruminally-cannulated crossbred steers (529 ± 45 kg initial body weight, BW) were used to evaluate in situ dry matter (DM), neutral detergent fiber (aNDF), and N degradation characteristics of low quality prairie hay, blood urea nitrogen (BUN) and rumen fermentation parameters in steers provi...

  13. In Situ Digestibility of Grass Hay after Heifer Diets were Abruptly Switched from 35 to 70% Concentrate to 100% Forage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Twelve ruminally-cannulated Hereford-cross heifers (non-pregnant, 2-yr-old, 508 ± 2 kg) were randomly assigned to 3 individually-fed, pre-experiment diets (4 heifers/diet). Diets were: 1) all forage, (CONTROL); 2) 35% concentrate, (35%), and 3) 70% concentrate (70%). Heifers were fed the diets for...

  14. In Situ Digestibility of Grass Hay after Heifer Diets were Abruptly Switched from 35 or 70% Concentrate to 100% Forage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Twelve ruminally-cannulated Hereford cross heifers (non-pregnant, 2-yr-old, 508 ± 2 kg) were randomly assigned to 3 individually-fed, pre-experiment diets (4 heifers/diet). Diets were: 1) all forage,(CONTROL); 2) 35% concentrate, (35%), and 3) 70%concentrate (70%). Heifers were fed the diets for ~10...

  15. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    PubMed

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  16. Pharmacometrics of Pterostilbene: Pre-Clinical Pharmacokinetics and Metabolism, Anti-Cancer, Anti-Inflammatory, Anti-Oxidant, and Analgesic Activity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Purpose: To evaluate the pre-clinical pharmacokinetics and pharmacodynamics of pterostilbene. Methods: Rat liver microsomes were used to evaluate in vitro phase I and II metabolism. Right jugular vein cannulated male Sprague-Dawley rats were dosed intravenously with 20 mg/kg of pterostilbene and sam...

  17. Effects of ruminal dosing of Holstein cows with Megasphaera elsdenii on milk fat production, ruminal chemistry, and bacterial strain persistence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Megasphaera elsdenii (Me) is a lactate-utilizing bacterium whose ruminal abundance has been shown to be greatly elevated during milk fat depression (MFD). To further examine this association, a total of 25 cannulated multiparous Holstein cows were examined in three studies in which strains of Me wer...

  18. Mitomycin-C: 'a ray of hope' in refractory corrosive esophageal strictures.

    PubMed

    Nagaich, N; Nijhawan, S; Katiyar, P; Sharma, R; Rathore, M

    2014-04-01

    Increasingly frequent dilation may become a self-defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin-C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin-C was applied for 2-3 minutes at the strictured esophageal segment after dilation with wire-guided Savary-Gilliard dilator. Patient was kept nil by mouth for 2-3 hours. After 4-6 sessions of mitomycin-C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin-C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.

  19. Mesoscopic mechanical resonators as quantum noninertial reference frames

    NASA Astrophysics Data System (ADS)

    Katz, B. N.; Blencowe, M. P.; Schwab, K. C.

    2015-10-01

    An atom attached to a micrometer-scale wire that is vibrating at a frequency ˜100 MHz and with displacement amplitude ˜1 nm experiences an acceleration magnitude ˜109ms -2 , approaching the surface gravity of a neutron star. As one application of such extreme noninertial forces in a mesoscopic setting, we consider a model two-path atom interferometer with one path consisting of the 100 MHz vibrating wire atom guide. The vibrating wire guide serves as a noninertial reference frame and induces an in principle measurable phase shift in the wave function of an atom traversing the wire frame. We furthermore consider the effect on the two-path atom wave interference when the vibrating wire is modeled as a quantum object, hence functioning as a quantum noninertial reference frame. We outline a possible realization of the vibrating wire, atom interferometer using a superfluid helium quantum interference setup.

  20. Clip migration after vacuum-assisted stereotactic breast biopsy: a pitfall in preoperative wire localization.

    PubMed

    Bernaerts, A; De Schepper, A; Van Dam, P; Pouillon, M

    2007-01-01

    Vacuum-assisted stereotactic breast biopsy has become an irreplaceable instrument in the management of suspicious mammographic lesions. If the initial mammographic lesion becomes obscured or absent following the biopsy, a clip is commonly placed by interventional breast radiologists at the biopsy site. This enables future wire localization if atypical or malignant histology warrants excision. Currently, clip malposition or migration has become increasingly recognized in the literature as a possible complication of stereotactic breast biopsy. As in this case, recognition of migration of the clip was crucial in the planning of the patient's subsequent wire localization procedure. This article aims to increase the awareness of radiologists and surgeons of this potential pitfall to prevent false-negative biopsies and minimize positive surgical margins after wire-guided breast conservation surgery. Routine evaluation of pre- and postbiopsy mammograms and prospective identification of inaccurate clip placement before stereotactic wire localization and excision should be performed.

  1. Extramedullary haematopoiesis in axillary lymph nodes following neoadjuvant chemotherapy for locally advanced breast cancer.

    PubMed

    Takhar, Arunjit Singh; Ney, Alex; Patel, Meera; Sharma, Anup

    2013-05-22

    We report the case of a 53-year-old lady who presented with a lump in her left breast. Her initial investigations demonstrated a grade III invasive ductal carcinoma of the breast that was tethered to the pectoralis major; imaging and cytology also revealed metastatic nodes in the left axilla. After undergoing neoadjuvant chemotherapy with evidence of clinical and radiological tumour response, a wire-guided wide local excision and axillary node clearance was performed. When a histological analysis of the specimen was performed, there was no evidence of a viable metastatic tumour in the axillary lymph nodes, but there were several areas of extramedullary haematopoiesis. There are only two other reports in the literature of this finding. This could represent a potential source of false-positive diagnosis of axillary metastasis from breast cancer. It would be prudent to consider biopsy prior to clearance if there are megakaryocytes in axillary node cytology.

  2. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.

    PubMed

    Pikwer, A; Bååth, L; Davidson, B; Perstoft, I; Akeson, J

    2008-01-01

    Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.

  3. Routine Use of Distal Arterial Perfusion in Pediatric Femoral Venoarterial Extracorporeal Membrane Oxygenation.

    PubMed

    Schad, Christine A; Fallon, Brian P; Monteagudo, Julie; Okochi, Shunpei; Cheung, Eva W; Morrissey, Nicholas J; Kadenhe-Chiweshe, Angela V; Aspelund, Gudrun; Stylianos, Steven; Middlesworth, William

    2017-01-01

    Lower-extremity ischemia is a significant complication in children on femoral venoarterial extracorporeal membrane oxygenation (VA ECMO). Our institution currently routinely uses distal perfusion catheters (DPCs) in all femoral arterial cannulations in attempts to reduce ischemia. We performed a single-center, retrospective review of pediatric patients supported with femoral VA ECMO from January 2005 to November 2015. The outcomes of patients with prophylactic DPC placement at cannulation (prophylactic DPC) were compared to a historical group with DPCs placed in response only to clinically evident ischemic changes (reactive DPC). Ischemic complication requiring invasive intervention (fasciotomy or amputation) was the primary outcome. Twenty-nine patients underwent a total of 31 femoral arterial cannulations, 17 with prophylactic DPC and 14 with reactive DPC. Ischemic complications requiring invasive intervention developed in 2 of 17 (12%) prophylactic DPC patients versus 4 of 14 (29%) reactive DPC. In the reactive DPC group, 7 of 14 (50%) had ischemic changes postcannulation, six underwent DPC placement, and three out of six of these patients still required invasive intervention. One of the seven patients had ischemic changes, did not undergo DPC, and required amputation. While a greater percentage of patients in the prophylactic group was cannulated during extracorporeal cardiopulmonary resuscitation (ECPR), statistical significance was not otherwise demonstrated. We demonstrate feasibility of superficial femoral artery (SFA) access in pediatric patients. We note fewer ischemic complications with prophylactic DPC placement, and observe that salvaging a limb with a reactive DPC was only successful 50% of the time. Although there was no statistical difference in the primary outcome between the two groups, limitations and confounding factors include small sample size and a greater percentage of patients in the prophylactic DPC group cannulated with ECPR in progress.

  4. Facile mechanical shaking method is an improved isolation approach for islet preparation and transplantation

    PubMed Central

    Yin, Nina; Chen, Tao; Yu, Yuling; Han, Yongming; Yan, Fei; Zheng, Zhou; Chen, Zebin

    2016-01-01

    Successful islet isolation is crucial for islet transplantation and cell treatment for type 1 diabetes. Current isolation methods are able to obtain 500–1,000 islets per rat, which results in a waste of ≥50% of total islets. In the present study, a facile mechanical shaking method for improving islet yield (up to 1,500 per rat) was developed and summarized, which was demonstrated to be more effective than the existing well-established stationary method. The present results showed that isolated islets have a maximum yield of 1,326±152 when shaking for 15 min for the fully-cannulated pancreas. For both fully-cannulated and half-cannulated pancreas in the presence of rat DNAse inhibitor, the optimal shaking time was amended to 20 min with a further increased yield of 1,344±134 and 1,286±124 islets, respectively. Furthermore, the majority of the isolated islets were morphologically intact with a well-defined surface and almost no central necrotic zone, which suggested that the condition of islets obtained via the mechanical shaking method was consistent with the stationary method. Islet size distribution was also calculated and it was demonstrated that islets from the stationary method exhibited the same size distribution as the non-cannulated group, which had more larger islets than the fully-cannulated and half-cannulated groups isolated via the shaking method. In addition, the results of glucose challenge showed that the refraction index of each group was >2.5, which indicated the well-preserved function of isolated islets. Furthermore, the transplanted islets exhibited a therapeutic effect after 1 day of transplantation; however, they failed to control blood glucose levels after ~7 days of transplantation. In conclusion, these results demonstrated that the facile mechanical shaking method may markedly improve the yield of rat islet isolation, and in vitro and in vivo investigation demonstrated the well-preserved function of isolated islets in the control of

  5. Development of the A-DIVA Scale:

    PubMed Central

    van Loon, Fredericus H. J.; Puijn, Lisette A. P. M.; Houterman, Saskia; Bouwman, Arthur R. A.

    2016-01-01

    Abstract Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85–8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09–6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39–6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92–8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12–5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A

  6. [Giant pseudoaneurysm of the ascending aorta following the aortic valve replacement;report of a case].

    PubMed

    Kawahara, Yu; Inage, Yuichi; Masaki, Naoki; Toyama, Shuji; Fukasawa, Manabu

    2013-08-01

    56-year-old male, who had undergone re-aortic valve replacement (AVR) 33 years ago, received preoperative study for pancreatic surgery. Computed tomography (CT) revealed a giant pseudoaneurysm (7 cm diameter) of the ascending aorta. The ascending aorta was not dilated. A midline skin incision was performed, followed by full sternotomy. A tight pericardial adhesion was carefully dissected. Cardiopulmonary bypass was established by femoral arterial and bicaval venous cannulation. The pseudoaneurysm was incised under the retrograde cardioplegic protection. A communication between ascending aorta and aneurysm was found 1 cm distal to the previous aortic suture line. This communication coincided with the cardioplegic root cannulation site. The aortic prosthetic valve was intact. The ascending aorta was replaced with 26 mm prosthetic graft. Postoperative course was uneventful. In this case, CT was useful to select the approach to the complicated postoperative surgical site.

  7. Endoscopy and papillotomy in diseases of the biliary tract and pancreas

    SciTech Connect

    Siegel, J.H.

    1980-12-01

    Endoscopic retrograde cholangiography (ERCP), the most advanced of the gastrointestinal endoscopic procedures, provides both specific diagnostic information pertaining to diseases of the biliary tract and pancreas and definitive therapy available only with this modality. ERCP is safe and accurate, establishing a primary diagnosis in 80% of cases and, in experienced hands, cannulation is successful in 98%. In addition to cholangiography, pancreatography has been a significant achievement providing accurate diagnostic yield through direct cannulation and opacification of the pancreatic duct while permitting collection of secretions for cytological evaluation and chemical analyses. The therapeutic extension of ERCP, endoscopic papillotomy (EPT), is successful in 94% of cases in the treatment of common bile duct stones and papillary stenosis, providing comparable results to surgical procedures while reducing morbidity, mortality and convalescence. Because of the accuracy and safety of these procedures, they should be considered early in suspected diseases of the biliary tract and pancreas so that the clinician can establish a specific diagnosis and provide definitive therapy.

  8. Three new techniques for creation of a steerable sheath, a 4F snare, and bidirectional sheath inversion using existing endovascular materials.

    PubMed

    Mallios, Alexandros; Yankovic, Willy; Boura, Benoit; Combes, Myriam

    2012-09-01

    We present three novel techniques for creation of (1) a steerable sheath, (2) a 4F snare device, and (3) dual anterograde and retrograde double-wire percutaneous transluminal angioplasty access technique using a single femoral puncture. These techniques were conceived and bench-tested in our institution, allowing the utilization of inexpensive equipment for complicated endovascular procedures. They offer (1) controlled navigation, no-touch vessel cannulation and cannulation of angulated vessels, contralateral limb of stent grafts, fenestrations, and branches; (2) a low-profile (4F external diameter) modifiable snare with the ability to expand to the size of an entire aneurysm and the ability to undo the snare in case of blockage with other endovascular material; and (3) in situ sheath inversion for concomitant anterograde and retrograde percutaneous angioplasty with a single femoral puncture.

  9. Eustachian Tube Dilation via a Transtympanic Approach in 6 Cadaver Heads: A Feasibility Study.

    PubMed

    Dean, Marc; Chao, Wei-Chieh; Poe, Dennis

    2016-10-01

    The goal of this study was to evaluate the feasibility of endoscopic transtympanic balloon dilation of the cartilaginous eustachian tube. To accomplish this, transtympanic balloon dilation of the cartilaginous eustachian tube was performed on 11 eustachian tubes (6 cadaver heads). The balloon catheter was introduced and passed through the protympanic orifice of the eustachian tube transtympanically under endoscopic view and cannulated without incident in all cadavers. Computed tomography was then performed postprocedure to evaluate for inadvertent dilation of the bony eustachian tube, adverse placement of the balloon, or any bony fractures. The balloon was seen to be successfully inflated in the cartilaginous portion without damage to surrounding structures in all cases. This demonstrates that under endoscopic guidance, the protympanic orifice of the eustachian tube can be feasibly cannulated and reliably traversed, allowing for targeted dilation of the cartilaginous eustachian tube from a transtympanic approach.

  10. Septicemia

    PubMed Central

    Austin, T. W.; Holliday, R. L.

    1976-01-01

    Certain factors which are major determinants in the survival of the septic patient - age, underlying disease, infecting organism - are beyond the physician's control. Others, however, we can have some impact on. These include initial vigorous supportive treatment, early and appropriate antibiotic administration and timely surgical intervention. In the following discussion current understanding of the pathophysiology of sepsis is outlined, together with a practical approach to the problem of patient management. PMID:21308028

  11. Prospective Durability Testing of a Vascular Access Phantom

    DTIC Science & Technology

    2010-09-01

    ultrasound guidance when obtaining central venous access.19,20 The increasing use of ultrasound guidance for vascular access has created an educational...with difficult intravenous access. Ann Emerg Med. 2005;46:456-61. 7. Gallieni M, Cozzolino M. Uncomplicated central vein catheterization of high risk...al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: The third sonography

  12. Endothelial Receptor a Blockade Alters the Hemodynamic Response to Nitric Oxide Inhibition in the Rat

    DTIC Science & Technology

    2007-11-02

    pressure and a fall in renal blood flow and GFR (3,9,19,22). These studies indicate that the constitutive production of NO contibutes to the modulation...of basal vascular tone in the resistance vessels of the kidney and other organs and plays an essential role in the regulation of blood pressure and...probe in the carotid artery and maintained between 36 and 38°C. Both femoral arteries were cannulated with PE-50 tubing, one for blood pressure

  13. Traumatic Brain Injury Creates Biphasic Systemic Hemodynamic and Organ Blood Flow Responses in Rats

    DTIC Science & Technology

    1990-01-01

    injury. Fluid percussion brain injury produced an immediate systemic hypertension followed by a hypotension and low cardiac output. Organ blood flows...37.5°C using a heating pad. The right femoral artery was cannulated for blood pressure monitoring using a quartz transducer (Hewlett Packard) and an...Since the hypertensive responses were usually maximal at 30 sec after injury, the mean arterial pressure and heart rate at 30 sec after sham injury

  14. 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

  15. 1994 Toxic Hazards Research Unit (THRU) Annual Report.

    DTIC Science & Technology

    1995-04-01

    pharmacologically active chemicals on the cardiovascular system in animals involve direct cannulation of major arteries and direct injection of drugs into the...Mancia. 1990. Intra - arterial pressure alterations during tail-cuff blood pressure measurements in normotensive and hypertensive rats. J...These models are used to define target organ toxicity based on the tissue-specific dose and are used in intra - and interspecies extrapolation. Data

  16. Role of No in the Regulation of Systemic and Renal Hemodynamics Following Hemorrhagic Shock in the Rate

    DTIC Science & Technology

    2007-11-02

    suprapubic incision for urine sampling. The right internal jugular vein was cannulated with two PE-50 catheters. Inulin , PAH and pentobarbital sodium...aortic arch (10). Glomerular filtration rate (GFR) and effective renal plasma flow were determined by the renal clearance of inulin -carboxyl...Carboxyl-14C] and aminohippuric acid P-[glycyl-2-3H] respectively (New England Nuclear, Boston, MA). The 14C- inulin was infused at a rate of 0.06uCi/min

  17. Dynamic Changes in Shunt and Ventilation-Perfusion Mismatch Following Experimental Pulmonary Contusion

    DTIC Science & Technology

    2010-04-01

    completed 1 Jun 2009; accepted in final form 15 Jul 2009 ABSTRACT The objective of this study was to investigate early changes in oxygenation by means of the...computed tomography (CT) scans were performed before and 10, 30, 60, and 120 min after injury. Three- dimensional CT scan reconstruction enabled...and femoral artery on the right side and both femoral veins were cannulated with arterial tubing. A Foley catheter was placed in the bladder . At

  18. Transradial approach for coronary angiography and interventions in patients with coronary bypass grafts: tips and tricks.

    PubMed

    Burzotta, Francesco; Trani, Carlo; Hamon, Martial; Amoroso, Giovanni; Kiemeneij, Ferdinand

    2008-08-01

    Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues and we present a series of tips and tricks which may facilitate angiography and interventions on both internal mammary and aorto-coronary grafts.

  19. Successful staged operation for acute type A aortic dissection with paraplegia.

    PubMed

    Ando, Takashi; Abe, Hiroyuki; Nagata, Tokuichiro; Makuuchi, Haruo

    2013-06-01

    A 75-year-old man presented with both paraplegia and acute occlusion of the abdominal aorta at onset. Extraanatomical bypass was performed following spinal drainage. After 3 days, the ascending aorta replaced under cardiopulmonary bypass using the extraanatomical bypass graft for arterial cannulation. The abdominal aorta was replaced after 6 months. A staged operation is one of the options for acute aortic dissection with paraplegia and acute occlusion of the abdominal aorta.

  20. Arthroscopic stabilization procedures for recurrent anterior shoulder instability.

    PubMed

    Yahiro, M A; Matthews, L S

    1989-11-01

    Anterior shoulder instability is a common and functionally disabling problem in young athletes. The goal in treatment of this condition is a stable, yet mobile, joint. Current methods now being utilized in the arthroscopic stabilization of the anterior shoulder include staple capsulorrhaphy, removable rivet capsulorrhaphy, cannulated screw fixation, and the transglenoid suture technique. These techniques and the clinical experience with each are reviewed, with an emphasis on providing stability, improving function, and allowing earlier rehabilitation in the unstable shoulder of the athlete.

  1. Coronary air embolism in off-pump surgery caused by blower-mister device.

    PubMed

    Korkmaz, Askin Ali; Guden, Mustafa; Korkmaz, Feride; Yuce, Murat

    2008-01-01

    Gaseous emboli caused by the blower-mister result in air locks within coronary vessels. We describe the case of a coronary air embolism caused by a blower-mister device on off-pump surgery. The tip of the device unexpectedly entered the coronary artery through arteriotomy and caused the air emboli. Air locks in the coronary circulation led to hemodynamic deterioration, and cardiopulmonary bypass was started following the emergency cannulation.

  2. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula

    PubMed Central

    Shellenberger, M. Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal. PMID:26958565

  3. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula.

    PubMed

    West, Sara; Shellenberger, M Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  4. Intrapelvic Protrusion of a Broken Guide Wire Fragment during Fixation of a Femoral Neck Fracture

    PubMed Central

    Afshar, Ahmadreza

    2017-01-01

    During fixation of a femoral neck fracture in a 23-year-old male patient with cannulated screws, a broken guide wire fragment inadvertently advanced through the hip joint and protruded into the pelvis. A second surgical approach was needed to remove the broken fragment from the pelvis. Awareness of such a potentially devastating complication will make surgeons more cautious during implementation of orthopedic instruments and increases patient’s safety during surgery.

  5. Plating of patella fractures: techniques and outcomes.

    PubMed

    Taylor, Benjamin C; Mehta, Sanjay; Castaneda, Joaquin; French, Bruce G; Blanchard, Chris

    2014-09-01

    Operative treatment of displaced patella fractures with tension band fixation remains the gold standard, but is associated with a significant rate of complications and symptomatic implants. Despite the evolution of tension band fixation to include cannulated screws, surprisingly little other development has been made to improve overall patient outcomes. In this article, we present the techniques and outcomes of patella plating for displaced patella fractures and patella nonunions.

  6. Suture-induced right coronary artery stenosis.

    PubMed

    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard

    2010-01-01

    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  7. Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae

    SciTech Connect

    Bozkurt, Alper Kırbaş, İsmail; Kasapoglu, Benan; Teber, Mehmet Akif

    2015-08-15

    PurposeTo present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).MethodsWe retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.ResultsIn total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20–79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788–1,334 days). Patient age, sex, and AVF age did not affect the survival time.ConclusionWe suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.

  8. Pullout performance comparison of novel expandable pedicle screw with expandable poly-ether-ether-ketone shells and cement-augmented pedicle screws.

    PubMed

    Aycan, Mehmet Fatih; Tolunay, Tolga; Demir, Teyfik; Yaman, Mesut Emre; Usta, Yusuf

    2017-02-01

    Aim of this study is to assess the pullout performance of various pedicle screws in different test materials. Polyurethane foams (Grade 10 and Grade 40) produced in laboratory and bovine vertebrae were instrumented with normal, cannulated (cemented), novel expandable and normal (cemented) pedicle screws. Test samples were prepared according to the ASTM F543 standard testing protocols and surgical guidelines. To examine the screw placement and cement distribution, anteriosuperior and oblique radiographs were taken from each sample after insertion process was completed. Pullout tests were performed in an Instron 3369 testing device. Load versus displacement graphs were recorded and the ultimate pullout force was defined as the maximum load (pullout strength) sustained before failure of screw. Student's t-test was performed on each group whether the differences between pullout strength of pedicle screws were significant or not. While normal pedicle screws have the lowest pullout strength in all test materials, normal pedicle screws cemented with polymethylmethacrylate exhibit significantly higher pullout performance than others. For all test materials, there is a significant improvement in pullout strength of normal screws by augmentation. While novel expandable pedicle screws with expandable poly-ether-ether-ketone shells exhibited lower pullout performance than normal screws cemented with polymethylmethacrylate, their pullout performances in all groups were higher than the ones of normal and cannulated pedicle screws. For all test materials, although cannulated pedicle screws exhibit higher pullout strength than normal pedicle screws, there are no significant differences between the two groups. The novel expandable pedicle screws with expandable poly-ether-ether-ketone shells may be used instead of normal and cannulated pedicle screws cemented with polymethylmethacrylate due to their good performances.

  9. Minimal contribution of the gastrointestinal tract to splanchnic uptake of intravenously infused ethanol

    SciTech Connect

    Huang, Mingta )

    1992-02-26

    The uptake of iv infused ethanol in the liver and the GI tract were determined by the portal-hepatic and arterial-portal gradients of ethanol in this report. Male Wistar rats were cannulated either in the portal vein (P), the hepatic vein (H) and the inferior vena cava (V) or in the common carotid artery (A), the portal vein (P) and the inferior vena cava (V). The experiments were performed in the fed state only on those animals whose daily food consumption has returned to pre-cannulation level. Ethanol was infused into V at a rate of 15.2 umol/min/rat for 90 min. Five sets of P and H blood or A and P blood were simultaneously taken from PHV and APV cannulated rats between 60 and 90 min of infusion when plasma ethanol concentrations in A,P and H were found to reach plateau. Ethanol concentration P was 3.10 {plus minus} 1.17 mM (SD), H was 2.64 {plus minus} 1.19 mM(SD). The difference between the two was highly significant. P-H gradient was 0.46 {plus minus} 0.06 mM(SD). A-P gradients of ethanol in APV cannulated were 0.03 {approximately} 0.04 mM, 12 {approximately} 15 times lower than hepatic gradient. It was concluded that the role of alcohol dehydrogenase activity recently found in the GI tract in metabolizing blood ethanol is insignificant in comparison to that of the liver.

  10. Comparison Between Human and Porcine Thromboelastograph Parameters in Response to Ex-Vivo Changes to Platelets, Plasma, and Red Blood Cells

    DTIC Science & Technology

    2013-01-01

    the effect of isolated changes in platelet count on the rotational thromboelastometry (ROTEM) parameters using platelet-rich plasma and platelet-poor...ongoing therapeutic anticoagulation therapy, use of over-the-counter drugs such as aspirin, ibuprofen , herbal products, or nonsteroidal anti-inflammatory...Inc., Bothell, Washington, USA) to guide access to the femoral vein. The vein was cannulated (SI-09700, 7 Fr. Side -port/ Percutaneous Sheath Catheter

  11. Venous Cannula Positioning in Arterial Deoxygenation During Veno‐Arterial Extracorporeal Membrane Oxygenation—A Simulation Study and Case Report

    PubMed Central

    Lindfors, Mattias; Frenckner, Björn; Sartipy, Ulrik; Bjällmark, Anna

    2016-01-01

    Abstract Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is indicated in reversible life‐threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed‐loop real‐time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA‐ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno‐arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario. PMID:27086941

  12. Anesthetic considerations in robotic mitral valve surgery

    PubMed Central

    Andre, J. Valery; Ritter, Matthew J.

    2017-01-01

    The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case. Several peripheral cannulation strategies for cardiopulmonary bypass (CPB) exist and the anesthesia team may assist with percutaneous cannulation of the superior vena cava (SVC) or positioning of an endo-pulmonary vent. Similarly the anesthesiologist may be asked to percutaneously cannulate the coronary sinus for retrograde cardioplegia delivery. The need for one-lung ventilation (OLV) and heavy reliance on transesophageal echocardiography (TEE) occupy much of the anesthesiologist’s attention during these cases. Variations in institutional practice exist. Reviews of current practice and future studies may help refine the anesthetic approach to robot-assisted cardiac surgery. PMID:28203541

  13. Photic and circadian regulation of melatonin production in the Mozambique tilapia Oreochromis mossambicus.

    PubMed

    Nikaido, Yoshiaki; Ueda, Satomi; Takemura, Akihiro

    2009-01-01

    Diverse circadian systems related to phylogeny and ecological adaptive strategies are proposed in teleosts. Recently, retinal photoreception was reported to be important for the circadian pacemaking activities of the Nile tilapia Oreochromis niloticus. We aimed to confirm the photic and circadian responsiveness of its close relative-the Mozambique tilapia O. mossambicus. Melatonin production in cannulated or ophthalmectomized fish and its secretion from cultured pineal glands were examined under several light regimes. Melatonin production in the cannulated tilapias was measured at 3-h intervals; it fluctuated daily, with a nocturnal increase and a diurnal decrease. Exposing the cannulated fish to several light intensities (1500-0.1 lx) and to natural light (0.1 and 0.3 lx) suppressed melatonin levels within 30 min. Static pineal gland culture under light-dark and reverse light-dark cycles revealed that melatonin synthesis increased during the dark periods. Rhythmic melatonin synthesis disappeared on pineal gland culture under constant dark and light conditions. After ophthalmectomy, plasma melatonin levels did not vary with light-dark cycles. These results suggest that (1) Mozambique tilapias possess strong photic responsiveness, (2) their pineal glands are sensitive to light but lack circadian pacemaker activity, and (3) they require lateral eyes for rhythmic melatonin secretion from the pineal gland.

  14. Long-Term Follow-Up Results of Delayed Fixation of Femoral Neck Fractures in Adults

    PubMed Central

    Elmi, Asghar; Tabrizi, Ali; Rouhani, Alireza; Mirzatolouei, Fardin

    2013-01-01

    Background Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible. Objectives The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws. Patients and Methods This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined. Results In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively. Conclusions Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option. PMID:24350142

  15. Consecutive pathological and immunological alterations during experimentally induced swine dysentery - a study performed by repeated endoscopy and biopsy samplings through an intestinal cannula.

    PubMed

    Jacobson, M; Lindberg, R; Jonasson, R; Fellström, C; Waern, M Jensen

    2007-06-01

    The development of intestinal lesions after inoculation with Brachyspira hyodysenteriae was followed by repeated endoscopy and biopsy sampling through a caecal cannula. Seven eight-week-old pigs were cannulated and inoculated, two were cannulated but not inoculated, and two pigs were inoculated but not cannulated. Endoscopy, biopsy, and blood sampling to determine SAA (serum amyloid A), haptoglobin, cortisol, and WBC counts were performed at scheduled time-points. At the third day of disease, endoscopy showed a hyperaemic, perturbed mucosa and excessive amount of mucus. Histologically, crypt hyperplasia, depletion of goblet cell mucus, and erosions were noted. Simultaneously, elevated acute phase proteins and circulating monocytes, and decreased number of intraepithelial CD3(+) cells were observed. After five days the pigs recovered. Intestinal lesions were demarcated and interspersed among apparently normal mucosa and blood parameters returned to initial values. Endoscopy through an intestinal cannula made it possible to follow the development of intestinal alterations in vivo and describe the sequential events during the course of swine dysentery. The number of animals used in a study could thus be minimised and the precision of the experiment increased.

  16. New technical approaches in stereotaxic catheterization of cerebral ventriculi: implications for the L-arginine/NO synthase/nitric oxide cascade.

    PubMed

    Manolidis, G; Neamţu, C; Vasincu, D; Jaba, Irina-Maria; Rădăşanu, Oana; Mungiu, O C

    2004-01-01

    In order to study the actions of certain substances at cerebral level, a stereotactic device for ensuring a precise catheterization of points in certain cerebral areas was used. For the operation technique was used a stereotaxic atlas specifically designed for rat brain (G. Paxinos, C. Watson, 1998), which offers all the necessary information for the identification of the trepanation. Stereotaxic implantation of cannules in the brain is useful for microinjecting solutions containing various substances (in amounts of microl), directly and targeted in the anatomical structures of the brain. The technique described can use either metalic or silastic cannules, that have variable lumen (usually for adapting a Hamilton syringe). The cannules can be implanted at cerebroventricular level, having the possibility to target all the cerebral ventricles. The intracerebroventricular (icv) administration of L-arginine induces a significant increase of response latency for mechano-algesic test. The most obvious changes are induced following the administration of the association of L-NAME with L-arginine, situation when is manifested an important increase of the response latency, starting with 5 minutes post-administration and continuing up to 45 minutes determination. The increase is significantly higher compared with the results obtained with L-arginine alone. A similar evolution is registered in the case of the plantar test.

  17. A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

    PubMed Central

    Baysal, Birol; Akin, Hakan; Masri, Omar; İnce, Ali Tüzün; Senturk, Hakan

    2015-01-01

    Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients. Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP. Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered. Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative. PMID:26347424

  18. Incidence of cannula associated deep vein thrombosis after veno-venous ECMO.

    PubMed

    Menaker, Jay; Tabatabai, Ali; Rector, Raymond; Dolly, Katelyn; Kufera, Joseph; Lee, Eugenia; Kon, Zachary; Sanchez, Pablo; Pham, Si; Herr, Daniel L; Mazzeffi, Michael; Rabinowitz, Ronald P; OʼConnor, James V; Stein, Deborah M; Scalea, Thomas M

    2017-02-13

    Limited literature regarding the incidence of cannula associated deep vein thrombosis (CaDVT) following veno-venous extracorporeal membrane oxygenation (VV ECMO) exists. The purpose of this study was to identify the incidence of post decannulation CaDVT and identify any associated risk factors. Forty eight patients were admitted between August 2014 and January 2016 to the Lung Rescue Unit were included in the study. Protocolized anticoagulation levels (partial thromboplastin time 45-55 second) and routine post decannulation DVT screening were in place during the study period. Forty-one (85.4%) patients had CaDVT. Of those with CaDVT, 31 (76%) patients were treated with full anti-coagulation therapy. 34 (76%) patients with right internal jugular cannulation had CaDVT at cannula site. Twenty-five (61%) patients had CaDVT in the lower extremity. (18 associated right femoral vein cannulation; 7 left femoral vein cannulation) 18 (44%) patients had both upper and lower extremity CaDVT. Overall, patients with CaDVT tended to be older, have a higher body mass index (BMI) and on ECMO longer (p=NS). Mean PTT during time on ECMO between patients that did and did not have CaDVT did not differ. No clinical evidence of pulmonary embolism was seen.

  19. Comparative toxicokinetics and metabolism of rebaudioside A, stevioside, and steviol in rats.

    PubMed

    Roberts, A; Renwick, A G

    2008-07-01

    The toxicokinetics and metabolism of rebaudioside A, stevioside, and steviol were examined in rats for comparative purposes to determine whether toxicological studies conducted previously with stevioside would be applicable to the structurally-related glycoside, rebaudioside A. Single, oral doses of the radiolabelled compounds were extensively and rapidly absorbed with plasma concentration-time profiles following similar patterns for stevioside and rebaudioside A. Elimination of radioactivity from plasma was essentially complete within 72h. All plasma samples had similar metabolite profiles; the predominant radioactive component in all samples was steviol, with lower amounts of steviol glucuronide(s) and low levels of one or two other metabolites. Rebaudioside A, stevioside, and steviol were metabolized and excreted rapidly, with the majority of the radioactivity eliminated in the feces within 48h. Urinary excretion accounted for less than 2% of the administered dose for all compounds in both intact and bile duct-cannulated rats, and the majority of the absorbed dose was excreted via the bile. After administration of the compounds to intact and bile duct-cannulated rats, radioactivity in the feces was present primarily as steviol. The predominant radioactive compound detected in the bile of all cannulated rats was steviol glucuronide(s), indicating de-conjugation in the lower intestine. Overall, the data on toxicokinetics and metabolism indicate that rebaudioside A and stevioside are handled in an almost identical manner. These studies support the use of toxicological safety studies conducted with stevioside for the safety assessment of rebaudioside A.

  20. Effect of Periradial Administration of Papaverine on Radial Artery Diameter

    PubMed Central

    Nagaraja, P. S.; Singh, Naveen G.; Manjunatha, N.; Desai, Rushikesh Chintamanrao

    2017-01-01

    Background: Radial artery cannulation is a skillful procedure. An experienced anesthesiologist might also face difficulty in cannulating a feeble radial pulse. Aim: The purpose of the study was to determine whether periradial subcutaneous administration of papaverine results in effective vasodilation and improvement in the palpability score of radial artery. Settings and Design: Prospective, double-blinded trial. Methodology: Thirty patients undergoing elective cardiac surgery were enrolled in the study. 30 mg of papaverine with 1 ml of 2% lignocaine and 3 ml of normal saline were injected subcutaneously 1–2 cm proximal to styloid process of the radius. Radial artery diameter before and after 20 min of injection papaverine was measured using ultrasonography. The palpability of the radial pulse was also determined before the injection of papaverine and 20 min later. Patients were monitored for hemodynamics and any complications were noted. Statistical Analysis Used: Student's t-test for paired data. Results: Radial artery diameter increased significantly (P < 0.0001), and the pulse palpability score also showed statistically significant improvement (P < 0.0001) after periradial subcutaneous administration of papaverine. There was no statistically significant difference in heart rate, mean arterial blood pressure before and after papaverine injection. No complications were noted in 24 h of follow-up. Conclusion: Periradial subcutaneous administration of papaverine significantly increased the radial artery diameter and pulse palpability score, which had an impact on ease of radial artery cannulation essential for hemodynamic monitoring in cardiac surgical patients. PMID:28298790

  1. Endophthalmitis: a rare complication of arteriovenous fistula infection.

    PubMed

    Desai, Madhav; Rapoor, Ram; Gudithi, Swarna Latha; Kumar, Ravi; Prasad, Neela; Dakshinamurty, Kaligotla Venkata

    2008-04-01

    Vascular access infection is a frequent problem in patients undergoing maintenance hemodialysis. Infection of arteriovenous fistula (AVF) is less common than dialysis catheter-associated infection. Previous case reports described endophthalmitis secondary to hemodialysis catheter-related infection, but not secondary to native AVF infection. We report a rare patient of endophthalmitis as a metastatic infection of AVF cannulation site abscess. A 19-year-old girl on maintenance hemodialysis for the past 2 years has presented with a history of fever, chills, and rigor of 3-days duration and painful dimness of vision in the left eye of 1-night duration. It was followed by redness of the eye, photophobia, and ocular discharge. On examination, the patient was febrile with an abscess near cannulation site of AVF. There was no perception of light in the left eye, conjunctiva was congested, cornea was clear, hypopyon present, and pupil was mid-dilated, not reacting to light. Lens was clear. Vitreitis and exudative retinal detachment was present. Methicillin sensitive Staphylococcus aureus was isolated from blood, pus from AVF abscess and vitreous fluid. Diagnosis of endophthalmitis was confirmed by B-scan ultrasound. She was treated with both intravenous and intraocular antibiotics and drainage of pus from AVF abscess and therapeutic vitrectomy. Though arteriovenous abscess responded to sensitive antibiotics and drainage, vision has not improved much. Strict aseptic precautions during regular AVF cannulation are required. Lapses may lead to loss of vision apart from described complications like access closure, endocarditis, and osteomyelitis.

  2. Venous Cannula Positioning in Arterial Deoxygenation During Veno-Arterial Extracorporeal Membrane Oxygenation-A Simulation Study and Case Report.

    PubMed

    Lindfors, Mattias; Frenckner, Björn; Sartipy, Ulrik; Bjällmark, Anna; Broomé, Michael

    2017-01-01

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA-ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno-arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario.

  3. Effect of naloxone on regional cerebral blood flow during endotoxin shock in conscious rats

    SciTech Connect

    Law, W.R.; Ferguson, J.L. )

    1987-09-01

    Maintenance of cerebral blood flow (CBF) is vital during cardiovascular shock. Since opioids have been implicated in the pathophysiology of endotoxin shock and have been shown to alter cerebral perfusion patterns, the authors determined whether opioids were responsible for any of the changes in regional CBF observed during endotoxin shock and whether the use of naloxone might impair or aid in the maintenance of CBF. When blood flow (BF) is studied with radioactively-labeled microspheres in rats, the left ventricle of the heart is often cannulated via the right carotid artery. Questions have arisen concerning the potential adverse effects of this method on CBF in the hemisphere ipsilateral to the ligated artery. They measured right and left regional CBF by use of this route of cannulation. Twenty-four hours after cannulations were performed, flow measurements were made using radiolabeled microspheres in conscious unrestrained male Sprague-Dawley rats (300-400 g) before and 10, 30, and 60 min after challenging with 10 mg/kg Escherichia coli endotoxin (etx) or saline. Naloxone (2 mg/kg) or saline was given as a treatment 25 min post-etx. They found no significant differences between right and left cortical, midbrain, or cerebellar BF at any time in any treatment group. Therefore naloxone treatment of endotoxin shock may be beneficial in preventing decreases in regional CBF.

  4. Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995-2007.

    PubMed

    Cook, T M; Bland, L; Mihai, R; Scott, S

    2009-07-01

    The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

  5. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

    PubMed Central

    Kogias, Evangelos; Sircar, Ronen; Krüger, Marie T.; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2015-01-01

    Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726. PMID:26075297

  6. Eliminating a Major Cause of Wire Drawing Breakage in A-15 High-Field Superconductors

    SciTech Connect

    Austen, Alfred R.

    2003-05-20

    Eliminating a Major Cause of Wire Drawing Breakage in A-15 High-Field Superconductors Phase 1 Summary Purpose of the research: The Phase 1 goal was to make a significant improvement in the wire drawing technology used for difficult to draw superconductor precursor composites. Many ductile Nb-Al and Nb-Sn precursor wire composites have experienced the onset of wire drawing breakage at about 1.5 mm diameter. Phase 1 focused on evaluating the role that precision rigid guidance of the wire into the drawing die and the hydrostatic stress state at the die entrance played in preventing wire breakage. Research carried out: The research performed depended upon the construction of both a mechanical wire guide and a hydrostatic pressure stiffened wire guidance system. Innovare constructed the two wire guidance systems and tested them for their ability to reduce wire drawing breakage. One set of hardware provided rigid alignment of the wires to their wire drawing die axes within 0.35 degrees using ''hydrostatic pressure stiffening'' to enable the precision guidance strategy to be implemented for these highly flexible small diameter wires. This apparatus was compared to a guide arrangement that used short span mechanical guide alignment with a misalignment limit of about 0.75 degrees. Four A-15 composite wires with breakage histories were drawn to evaluate the use of these wire guiding systems to reduce and/or eliminate wire breakage. Research findings and results: In Phase 1, a breakthrough in wire drawing technology for A-15 superconductor composites was achieved by dramatically limiting or eliminating breakage in four different A-15 composite precursor wire designs during the drawing of these very desirable composites that previously could not be drawn to near final size. Research results showed that the proposed Phase 1 mechanical wire guides were sufficiently effective and successful in eliminating breakage when used along with other advanced wire drawing technology to

  7. Reliability testing of the Hughes temperature controlled 1/4 watt split cycle cryogenic cooler (HD-1045 (V)/UA)

    NASA Astrophysics Data System (ADS)

    Shaffer, James; Dunmire, Howard; Samuels, Raemon; Trively, Martin

    1989-12-01

    The U.S. Army CECOM Center for Night Vision and Electro-Optics (C2NVEO) is responsible for developing cryogenic coolers for all infrared imaging systems for the Army. C2NVEO also maintains configuration management control of the forward-looking infrared (FLIR) Common Module coolers used in thermal imagers in fielded Army weapon systems such as: M60A3 and M1 Tanks, Bradley Fighting Vehicle (BFV) System, tube-launched, optically tracked, wire-guided (TOW) Missile System, and Army Attack Helicopters. Currently, there are over 30,000 coolers in fielded systems and several thousand more are added each year. C2NVEO conducts development programs and monitors contractor internal research and development efforts to improve cooler performance such as reliability, audio noise, power consumption, and output vibration. The HD-1045 1/4-Watt Split Stirling Cooler was originally designed and developed by the C2NVEO in the early 1970s as a replacement for the gas bottle/cryostat used on the Manportable Common Thermal Night Sights. To date, however, the HD-1045 cooler has been used in the field in the Integrated Sight Unit (ISU) of the BFV System and is currently being used in the Driver Thermal Viewer (DTV) full scale development program. This document describes and reports the results of reliability testing done on Hughes Temperature Controlled 1/4 Watt split Cycle Cryogenic Coolers (HD-1045 (V)/UA), referred to herein as the coolers.

  8. [Endoscopic sclerosis with pneumatic distension for pyriform sinus fistula treatment].

    PubMed

    Sanchís Blanco, G; Gutiérrez San Román, C; Bordallo Vázquez, M; Cortés Sáez, J; Barrios Fontoba, J E; Lluna González, J; Esteban Ricós, M J; Vila Carbó, J J

    2014-01-01

    Classic treatment for pyriform sinus fistula (PSF) has been surgical excision; however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air flow through the flexible endoscope was used to distend the pyriform sinus and facilitate recognition of the fistula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, performing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very effective; hence we consider it might become a first line therapy for PSF.

  9. Flight experiments and evolutionary development of a laser-propelled transatmospheric vehicle

    NASA Astrophysics Data System (ADS)

    Mead, Franklin B., Jr.; Myrabo, Leik N.; Messitt, Donald G.

    1998-09-01

    In a series of spectacular experiments conducted at the High Energy Laser Systems Test Facility (HELSTF), White Sands Missile Range (WSMR), NM, using 13- to 15-cm diameter, 40- to 60-g vehicles designed to fly on the 10 kW PLVTS pulsed carbon dioxide laser (1 kJ pulses for 30 microsecond duration at 10 Hz), Prof. Leik Myrabo of Rensselaer Polytechnic Institute (RPI) and Dr. Franklin Mead of the Air Force Research Laboratory's (AFRL) Propulsion Directorate, have been successfully flying laser propelled Lightcraft under a joint Air Force/NASA flight demonstration program. The axisymmetric Lightcraft vehicles are propelled by airbreathing, pulsed- detonation engines with an infinite fuel specific impulse. Impulse coupling coefficients have been measured with ballistic pendulums as well as a piezoelectric load cell and fall in the range of 100 to 200 N/MW. Horizontal wire-guided flights up to 400 ft, using a unique laser beam pointing and tracking guidance system, have demonstrated up to 2.0 G's acceleration measured by a photo-optic array. Spin-stabilized free-flights with active tracking/beam control have been accomplished to altitudes of 15.25 meters. This paper will summarize the progress made to date on the Lightcraft Technology Demonstration flight test program, since the first 12 - 14 July 1996, experiments at HELSTF.

  10. Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

    SciTech Connect

    Landman, Joanne; Kulawansa, Sagarika; McCarthy, Michael; Troedson, Russell; Phillips, Michael; Tinning, Jill; Taylor, Donna

    2015-03-15

    Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL. Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins. Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases. ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

  11. High-performance, extrusion-cast explosives with low sensitivity: Interim report No. 2

    SciTech Connect

    Scribner, K.J.; von Holtz, E.; Simpson, R.L.

    1989-01-10

    Lawrence Livermore National Laboratory (LLNL) has developed a class of explosives having both high performance for modern precision munitions and greater safety for reduced vulnerability of launch platforms (ships, planes, ammunition storage sites) to enemy fire or accidents. Known as extrusion-cast explosives (ECXs), they have demonstrated performance levels equivalent to the most powerful now available, but test results indicate they are far less sensitive than the conventional high-energy explosives. Specifically, in a sympathetic-detonation test, ECX that was immediately adjacent to a deliberately-detonated donor charge did not detonate in two of three tests, whereas Comp B did detonate sympathetically in this test. Also, this ECX provided performance equivalent to that of the high-performance explosive LX-14, when tested in the TOW (tube-launched, optically-sighted, wire-guided) missile. This report describes the performance, vulnerability, and processing (at this stage of development) of this class of explosives. 9 refs., 18 figs., 11 tabs.

  12. A clever technique for placement of a urinary catheter over a wire

    PubMed Central

    Abbott, Joel E.; Heinemann, Adam; Badalament, Robert; Davalos, Julio G.

    2015-01-01

    Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system. PMID:26229328

  13. Elucidating low-frequency vibrational dynamics in calcite and water with time-resolved third-harmonic generation spectroscopy.

    PubMed

    Wang, Liang; Liu, Weimin; Fang, Chong

    2015-07-14

    Low-frequency vibrations are foundational for material properties including thermal conductivity and chemical reactivity. To resolve the intrinsic molecular conformational dynamics in condensed phase, we implement time-resolved third-harmonic generation (TRTHG) spectroscopy to unravel collective skeletal motions in calcite, water, and aqueous salt solution in situ. The lifetime of three Raman-active modes in polycrystalline calcite at 155, 282 and 703 cm(-1) is found to be ca. 1.6 ps, 1.3 ps and 250 fs, respectively. The lifetime difference is due to crystallographic defects and anharmonic effects. By incorporating a home-built wire-guided liquid jet, we apply TRTHG to investigate pure water and ZnCl2 aqueous solution, revealing ultrafast dynamics of water intermolecular stretching and librational bands below 500 cm(-1) and a characteristic 280 cm(-1) vibrational mode in the ZnCl4(H2O)2(2-) complex. TRTHG proves to be a compact and versatile technique that directly uses the 800 nm fundamental laser pulse output to capture ultrafast low-frequency vibrational motion snapshots in condensed-phase materials including the omnipresent water, which provides the important time dimension to spectral characterization of molecular structure-function relationships.

  14. A Portable, Shock-Proof, Surface-Heated Droplet PCR System for Escherichia coli Detection

    PubMed Central

    Angus, Scott V.; Cho, Soohee; Harshman, Dustin K.; Song, Jae-Young; Yoon, Jeong-Yeol

    2015-01-01

    A novel polymerase chain reaction (PCR) device was developed that uses wire-guided droplet manipulation (WDM) to guide a droplet over three different heating chambers. After PCR amplification, end-point detection is achieved using a smartphone-based fluorescence microscope. The device was tested for identification of the 16S rRNA gene V3 hypervariable region from Escherichia coli genomic DNA. The lower limit of detection was 103 genome copies per sample. The device is portable with smartphone-based end-point detection and provides the assay results quickly (15 min for a 30-cycle amplification) and accurately. The system is also shock and vibration resistant, due to the multiple points of contact between the droplet and the thermocouple and the Teflon film on the heater surfaces. The thermocouple also provides realtime droplet temperature feedback to ensure it reaches the set temperature before moving to the next chamber/step in PCR. The device is equipped to use either silicone oil or coconut oil. Coconut oil provides additional portability and ease of transportation by eliminating spilling because its high melting temperature means it is solid at room temperature. PMID:26164008

  15. The VascuLuminator: effectiveness of a near-infrared vessel imaging system as a support in arterial puncture in children

    NASA Astrophysics Data System (ADS)

    Cuper, Natascha J.; de Graaff, Jurgen C.; Kalkman, Cor J.; Verdaasdonk, Rudolf M.

    2010-02-01

    A practical near-IR blood vessel imaging system, the 'VascuLuminator', was developed to facilitate the puncturing of blood vessels for different procedures. Technical solutions were found for certain difficulties, such as obtaining a maximum image contrast by reducing the interference of IR light present in the surroundings. In phantom studies it was shown that the device is able to visualize blood vessels of different sizes to a clinically relevant maximum depth. In a preliminary clinical study, the use of the VascuLuminator resulted in decrease of the failure rate in blood withdrawal in young children from 13% to 2% and the laboratory technicians were satisfied with the practical application of the device. After this study, the effectiveness of the VascuLuminator was investigated to facilitate arterial cannulation in a group of children undergoing cardiac surgery. In an ongoing study, 71 children up to 3 years of age were included and time of arterial cannulation, number of punctures and puncture site were recorded. In 38 patients, cannulation was performed without the VascuLuminator and in 33 patients with VascuLuminator by pediatric anesthesiologists. The initial results do not show significant differences in time and in number of punctures with and without the use of the VascuLuminator. However, the VascuLuminator was able to visualize the arteries in most cases. In 11 of the 33 cases, the artery was located by using only the near-infrared image was used, without palpating for a pulse or knowledge of anatomical landmarks. Further clinical studies are needed to identify the patients groups that will benefit the most from VascuLuminator-assisted vessel punctures.

  16. Orientation of the foramen ovale: an anatomical study with neurosurgical considerations

    PubMed Central

    Zdilla, Matthew J.; Hatfield, Scott A.; McLean, Kennedy A.; Laslo, Jillian M.; Cyrus, Leah M.; Lambert, H. Wayne

    2015-01-01

    Unsuccessful cannulation of the foramen ovale (FO) continues to occur with both fluoroscopic technique and technique utilizing CT paired with navigational technology. Despite advances in stereotactic neurosurgical imaging and technique, anatomical variation of the FO occasionally prevents successful cannulation. Morphometric study of the FO has been limited to length, width, and area parameters; therefore, this report analyzed the orientation of the FO. One hundred thirty-nine crania (235 foramina ovalae) were photographed and assessed digitally by ImageJ software (NIH). Foramina were fit with a best fit ellipse. For orientation, the midsagittal plane was located by bisecting the basilar process of the occiput, the coronal plane was identified as perpendicular to the midsagittal plane. The angles between the major axis of the best fit ellipse of the FO and the midsagittal and coronal planes were measured. The angle formed between the major axis of the best fit ellipse of the FO and the coronal plane averaged 35.43° ± 9.74° (Mean ± SD) on the left and 36.47° ± 7.60° on the right. The angle formed between the major axis of the best fit ellipse of the FO and the sagittal plane averaged 54.57° ± 9.74° on the left and 53.53° ± 7.60° on the right. No significant difference was found between FO orientation among the sexes. Understanding the orientation of the FO may aid in stereotactic neurosurgical planning and successful cannulation of the FO. PMID:26703059

  17. Latarjet Fixation

    PubMed Central

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  18. Effects of corn silage hybrid and dietary concentration of forage NDF on digestibility and performance by dairy cows.

    PubMed

    Qiu, X; Eastridge, M L; Wang, Z

    2003-11-01

    Eight intact multiparous cows and four ruminally and duodenally cannulated primiparous cows were fed four diets in a replicated 4 x 4 Latin square design: 1) 17% forage neutral detergent fiber (NDF) with brown midrib corn silage (BMRCS), 2) 21% forage NDF with BMRCS, 3) 17% forage NDF with conventional corn silage (CCS), and 4) 21% forage NDF with CCS. Diets contained 17.4% crude protein and 38.5% NDF. Each period consisted of 4 wk for intact cows and 2 wk for cannulated cows. For intact cows, DM intake was higher for BMRCS than CCS, and milk urea N was higher for 21 than 17% forage NDF. Milk protein yield tended to be higher and milk urea N lower for cows fed BMRCS than those fed CCS. Milk yield and milk protein percentage were similar among treatments. For the cannulated cows, ruminal mat consistency was similar among treatments. Based on a 72 h in situ incubation, BMRCS was lower in indigestible NDF than CCS. The BMRCS resulted in a higher proportion of ruminal propionate than CCS. Cows fed 21% forage NDF had a higher proportion of acetate and a lower proportion of propionate than cows fed 17% forage NDF. The total tract digestibility of nutrients and efficiency of bacterial N synthesis were similar among treatments, except that BMRCS resulted in lower intestinal fatty acid digestibility than CCS, and 17% forage NDF tended to result in higher total tract fatty acid digestibility than 21% forage NDF. Ruminal NDF digestibility was similar among dietary treatments. The increased milk production observed from feeding BMRCS in some studies may be explained by higher DM intake rather than increased total tract digestibility of the diets.

  19. Rodent Working Heart Model for the Study of Myocardial Performance and Oxygen Consumption

    PubMed Central

    Kheir, John N.

    2016-01-01

    Isolated working heart models have been used to understand the effects of loading conditions, heart rate and medications on myocardial performance in ways that cannot be accomplished in vivo. For example, inotropic medications commonly also affect preload and afterload, precluding load-independent assessments of their myocardial effects in vivo. Additionally, this model allows for sampling of coronary sinus effluent without contamination from systemic venous return, permitting assessment of myocardial oxygen consumption. Further, the advent of miniaturized pressure-volume catheters has allowed for the precise quantification of markers of both systolic and diastolic performance. We describe a model in which the left ventricle can be studied while performing both volume and pressure work under controlled conditions. In this technique, the heart and lungs of a Sprague-Dawley rat (weight 300-500 g) are removed en bloc under general anesthesia. The aorta is dissected free and cannulated for retrograde perfusion with oxygenated Krebs buffer. The pulmonary arteries and veins are ligated and the lungs removed from the preparation. The left atrium is then incised and cannulated using a separate venous cannula, attached to a preload block. Once this is determined to be leak-free, the left heart is loaded and retrograde perfusion stopped, creating the working heart model. The pulmonary artery is incised and cannulated for collection of coronary effluent and determination of myocardial oxygen consumption. A pressure-volume catheter is placed into the left ventricle either retrograde or through apical puncture. If desired, atrial pacing wires can be placed for more precise control of heart rate. This model allows for precise control of preload (using a left atrial pressure block), afterload (using an afterload block), heart rate (using pacing wires) and oxygen tension (using oxygen mixtures within the perfusate). PMID:27584550

  20. Premedication with midazolam in intellectually disabled dental patients: Intramuscular or oral administration? A retrospective study

    PubMed Central

    Boku, Aiji; Sugimura, Mitsutaka; Oyamaguchi, Aiko; Inoue, Mika; Niwa, Hitoshi

    2016-01-01

    Background The use of midazolam for dental care in patients with intellectual disability is poorly documented. The purpose of this study was to determine which method of premedication is more effective for these patients, 0.15 mg/kg of intramuscular midazolam or 0.3 mg/kg of oral midazolam. Material and Methods This study was designed and implemented as a non-randomized retrospective study. The study population was composed of patients with intellectual disability who required dental treatment under ambulatory general anesthesia from August 2009 through April 2013. Patients were administered 0.15 mg/kg of midazolam intramuscularly (Group IM) or 0.3 mg/kg orally (Group PO). The predictor variable was the method of midazolam administration. The outcome variables measured were Observer’s Assessment of Alertness/ Sedation (OAA/S) Scale scores, the level of cooperation when entering the operation room and for venous cannulation, post-anesthetic agitation and recovery time. Results Midazolam was administered intramuscularly in 23 patients and orally in 21 patients. More patients were successfully sedated with no resistance behavior during venous cannulation in Group PO than in Group IM (p=0.034). There were no differences in demographic data and other variables between the groups. Conclusions The results of this study suggest that oral premedication with 0.3 mg/kg of midazolam is more effective than 0.15 mg/kg of midazolam administered intramuscularly, in terms of patient resistance to venous cannulation. If both oral and intramuscular routes of midazolam are acceptable in intellectually disabled patients, the oral route is recommended. Key words:Premedication, midazolam, intellectual disability. PMID:27031068

  1. Design of a Novel MRI Compatible Manipulator for Image Guided Prostate Interventions

    PubMed Central

    Krieger, Axel; Susil, Robert C.; Ménard, Cynthia; Coleman, Jonathan A.; Fichtinger, Gabor; Atalar, Ergin

    2012-01-01

    This paper reports a novel remotely actuated manipulator for access to prostate tissue under magnetic resonance imaging guidance (APT-MRI) device, designed for use in a standard high-field MRI scanner. The device provides three-dimensional MRI guided needle placement with millimeter accuracy under physician control. Procedures enabled by this device include MRI guided needle biopsy, fiducial marker placements, and therapy delivery. Its compact size allows for use in both standard cylindrical and open configuration MRI scanners. Preliminary in vivo canine experiments and first clinical trials are reported. PMID:15709668

  2. Pharmacist-led minor ailment programs: a Canadian perspective

    PubMed Central

    Taylor, Jeff Gordon; Joubert, Ray

    2016-01-01

    Pharmacists have a long history of helping Canadians with minor ailments. This often has involved management with over-the-counter medications. If pharmacists felt that the best care required something more robust, they would refer the patient to a physician. In hopes of improving the care of such ailments, Canadian provinces have granted pharmacists the option of selecting medications traditionally under physician control. This review examines the Canadian perspective on pharmacists prescribing for minor ailments and the evidence of value for these programs. It might provide guidance for other jurisdictions contemplating such a move. PMID:27570460

  3. A clinical research analytics toolkit for cohort study.

    PubMed

    Yu, Yiqin; Zhu, Yu; Sun, Xingzhi; Tao, Ying; Zhang, Shuo; Xu, Linhao; Pan, Yue

    2012-01-01

    This paper presents a clinical informatics toolkit that can assist physicians to conduct cohort studies effectively and efficiently. The toolkit has three key features: 1) support of procedures defined in epidemiology, 2) recommendation of statistical methods in data analysis, and 3) automatic generation of research reports. On one hand, our system can help physicians control research quality by leveraging the integrated knowledge of epidemiology and medical statistics; on the other hand, it can improve productivity by reducing the complexities for physicians during their cohort studies.

  4. Infraclavicular access to the axillary vein - new possibilities for the catheterization of the central veins in the intensive care unit.

    PubMed

    Gawda, Ryszard; Czarnik, Tomasz; Łysenko, Lidia

    2016-01-01

    Central vein cannulation is one of the most commonly performed procedures in intensive care. Traditionally, the jugular and subclavian vein are recommended as the first choice option. Nevertheless, these attempts are not always obtainable for critically ill patients. For this reason, the axillary vein seems to be a rational alternative approach. In this narrative review, we evaluate the usefulness of the infraclavicular access to the axillary vein. The existing evidence suggests that infraclavicular approach to the axillary vein is a reliable method of central vein catheterization, especially when performed with ultrasound guidance.

  5. Ultrasound-Assisted Peripheral Venous Access in Young Children: A Randomized Controlled Trial and Pilot Feasibility Study

    PubMed Central

    Bair, Aaron E.; Rose, John S.; Vance, Cheryl W.; Andrada-Brown, Emily; Kuppermann, Nathan

    2008-01-01

    Objectives Intravenous (IV) access in children treated in the emergency department (ED) is frequently required and often difficult to obtain. While it has been shown that ultrasound can be useful in adults for both central and peripheral venous access, research regarding children has been limited. We sought to determine if the use of a static ultrasound technique could, a) allow clinicians to visualize peripheral veins and b) improve success rates of peripheral venous cannulation in young children in the ED. Methods We performed a randomized clinical trial of children < 7 years in an academic pediatric ED who required IV access and who had failed the first IV attempt. We randomized patients to either continued standard IV attempts or ultrasound-assisted attempts. Clinicians involved in the study received one hour of training in ultrasound localization of peripheral veins. In the ultrasound group, vein localization was performed by an ED physician who marked the skin overlying the target vessel. Intravenous cannulation attempts were then immediately performed by a pediatric ED nurse who relied on the skin mark for vessel location. We allowed for technique cross-over after two failed IV attempts. We recorded success rate and location of access attempts. We compared group success rates using differences in 95% confidence intervals (CI). Results We enrolled 44 children over a one-year period. The median age of enrollees was 9.5 months. We visualized peripheral veins in all patients in the ultrasound group (n=23) and in those who crossed over to ultrasound after failed standard technique attempts (n= 8). Venipuncture was successful on the first attempt in the ultrasound group in 13/23 (57%, CI, 35% to 77%), versus 12/21 (57%, CI, 34% to 78%) in the standard group, difference between groups 0.6% (95% CI −30% to 29%). First attempt cannulation success in the ultrasound group was 8/23 (35%, CI, 16% to 57%), versus 6/21 (29%, CI, 11% to 52%) in the standard group

  6. Expect the unexpected: malposition of a large-bore central venous catheter in the urinary bladder.

    PubMed

    Schummer, Wolfram; Schummer, Claudia; Gorse, Andrej; Becker, Udo; Marx, Christiane; Brauer, Martin

    2004-12-01

    We report the case of a femoral vein cannulation in a critically ill trauma patient with the malposition of a large-bore central venous catheter in the urinary bladder. Recognition of the malposition was hampered by bloody tamponade of the bladder in the context of blunt thoraco-abdominal trauma with kidney and liver laceration. A high index of clinical suspicion and the institution of adequate therapy were the key to achieving a successful clinical outcome. We discuss the anatomy of femoral veins, including their close relation to a distended bladder. The application of ultrasound even in emergency situations is stressed.

  7. Transcholecystic operative cholangiography: an alternative technique.

    PubMed Central

    Tinckler, L.

    1991-01-01

    The current standard methods of carrying out operative cholangiography by cannulating the cystic duct or by direct puncture of the common bile duct are not without practical difficulties and potential hazards. An alternative method of introducing contrast material into the bile ducts for intra-operative imaging is described which is easy to perform, effective and safe. The technique consists of injecting contrast material into the previously emptied gallbladder and then propelling the contrast into the bile ducts by squeezing the viscus before taking X-ray films. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:1996863

  8. Intrapulmonary receptors in the Tegu lizard: I. Sensitivity to CO2.

    PubMed

    Feede, M R; Kuhlmann, W D; Scheid, P

    1977-02-01

    Single unit vagal recordings from intrapulmonary receptors were obtained in decerebrate, paralyzed lizards both during pump ventilation and during unidirectional ventilation on the cannulated, sack-shaped lung. Two types of receptors were identified: (1) CO2-receptors, which increased their discharge frequency as intrapulmonary CO2 concentration decreased but were not sensitive to stretch of the lung. (2) Mechanoreceptors, which rapidly increased discharge frequency when the lung was stretched. These receptors' CO2 sensitivity varied. Lungs of lizards thus appeared to possess both CO2 receptors, which have functional characteristics similar to those in birds, and mechanoreceptors with properties similar to stretch receptors in mammals.

  9. Miniarthrotomy assisted percutaneous screw fixation for displaced medial malleolus fractures – A novel technique

    PubMed Central

    Saini, Pramod; Aggrawal, Abhinav; Meena, Sanjay; Trikha, Vivek; Mittal, Samarth

    2014-01-01

    Aim To describe here a technique of miniarthrotomy assisted percutaneous screw insertion for displaced Herscovici type B and C medial malleolar fractures. Method Incision was made centred over the superomedial angle of the ankle mortise, about half a cm medial to tibialis anterior. Arthrotomy was done and reduction obtained. Percuntaneously, two 4 mm cancellous cannulated screws were inserted through medial malleolus. Results and conclusion This approach allows direct visualization of reduction, removal of entrapped soft tissue and preservation of saphenous vein and nerve. PMID:25983507

  10. Percutaneous coil embolisation of a false aortic aneurysm following coronary surgery and mediastinitis.

    PubMed

    Barbetakis, Nikolaos; Xenikakis, Theocharis; Efstathiou, Andreas; Fessatidis, Ioannis

    2007-01-01

    A 71-year-old male patient was admitted with methicillin-resistant staphylococcus aureus mediastinitis two months after coronary artery bypass grafting. Treatment with immediate surgical debridement, removal of sternal wires and use of vacuum-assisted closure device was started. Spiral computerised tomography and aortography revealed a false aortic aneurysm at the cannulation site. Active mediastinitis and the patient's objection to further surgery led us to perform percutaneous coil embolisation. No postoperative complication was observed and one year later the patient is in excellent condition.

  11. Capillaroscopy and the measurement of capillary pressure

    PubMed Central

    Shore, Angela C

    2000-01-01

    Capillaries play a critical role in cardiovascular function as the point of exchange of nutrients and waste products between the tissues and circulation. Studies of capillary function in man are limited by access to the vascular bed. However, skin capillaries can readily be studied by the technique of capillaroscopy which enables the investigator to assess morphology, density and blood flow velocity. It is also possible to estimate capillary pressure by direct cannulation using glass micropipettes. This review will describe the techniques used to make these assessments and will outline some of the changes that are seen in health and disease. PMID:11136289

  12. A Novel Method of Macropathologic and Arteriographic Examination of Carotid Specimens Obtained from Autopsy

    SciTech Connect

    Schulte-Altedorneburg, Gernot; Droste, Dirk W.; Kollar, Jozsef; Hegedues, Csaba; Gomba, Szabolcs; Ringelstein, E. Bernd; Csiba, Laszlo

    2000-07-15

    Twenty carotid bifurcations were examined. During autopsy, carotid bifurcations were removed in toto. Unfixed carotids were ligated and cannulated for injection of an angiographic contrast medium followed by injection of a tissue-embedding medium at physiologic pressure and temperature. The carotid bifurcation was frozen and cut manually in 3-mm cross-sections. Photographs were then taken of every slice. Angiography, filling with tissue-embedding material, and sectioning were successful in all cases. In the macropathologic sections, the extent, configuration and location of atherosclerotic lesions could be identified.

  13. Glass-Fiber-based MR-safe Guidewire for MR Imaging-guided Endovascular Interventions: In Vitro and Preclinical in Vivo Feasibility Study.

    PubMed

    Massmann, Alexander; Buecker, Arno; Schneider, Guenther K

    2017-03-14

    Purpose To evaluate glass-fiber-based guidewires that are safe for magnetic resonance (MR) imaging-guided endovascular interventions by using a phantom and an in vivo swine model. Materials and Methods MR imaging-safe guidewires were made from micropultruded glass and/or aramid fibers and epoxy resin with diameters of 0.89 mm (0.035 inch) for standard and stiff guidewires and 0.36 mm (0.014 inch) for micro guidewires. MR imaging visibility and mechanical properties were assessed in a pulsatile flow model. After approval was obtained from the institutional animal care and use committee, MR imaging guidewires were evaluated for standard endovascular procedures in nine pigs. Real-time steady-state free-precession sequences were used for MR imaging-guided catheterization, balloon dilation, and stent implantation into aorto-iliac/visceral arteries and the vena cava (temporal resolution, five images per second; and spatial resolution, 150-mm field of view, and 128 × 128 matrix) with a 1.5-T clinical imager. Visualization with the guidewires was rated on a four-point scale, handling was rated on a three-point scale, and catheterization times for different vessel regions were determined by two interventional radiologists. Afterward, handling ratings and catheterization times were obtained for standard nitinol guidewires during x-ray-based fluoroscopy. Cannulation times, signal intensity in each vessel region, and visualization and handling ratings were measured for the MR imaging guidewires. Bland-Altman analysis was performed for inter- and intraobserver variability of cannulation time. Spearman rank correlation was used to compare handling of MR imaging guidewires and standard nitinol guidewires. Results MR imaging guidewires were characterized by good to excellent visibility, with a continuous artifact of 2 mm in diameter and 4 × 8-mm ball-shaped tip marker. Stiffness, flexibility, and guidance reflected comparable times for all in vitro and in vivo procedures with

  14. Alanine increases blood pressure during hypotension

    NASA Technical Reports Server (NTRS)

    Conlay, L. A.; Maher, T. J.; Wurtman, R. J.

    1990-01-01

    The effect of L-alanine administration on blood pressure (BP) during haemorrhagic shock was investigated using anesthetized rats whose left carotid arteries were cannulated for BP measurement, blood removal, and drug administration. It was found that L-alanine, in doses of 10, 25, 50, 100, and 200 mg/kg, increased the systolic BP of hypotensive rats by 38 to 80 percent (while 100 mg/kg pyruvate increased BP by only 9.4 mmhg, not significantly different from saline). The results suggest that L-alanine might influence cardiovascular function.

  15. Hematuria following kidney tumorectomy: can it hide an arteriovenous fistula?

    PubMed

    Pavan, Nicola; Liguori, Giovanni; Vedovo, Francesca; Bucci, Stefano; Bertolotto, Michele; Trombetta, Carlo

    2015-01-01

    We present the case and radiologic images of a 64-year-old man who presented with gross hematuria and fever 2 months after undergoing retroperitoneal partial nephrectomy for a 4.7 × 4.6 cm papillary renal cell carcinoma. Angio-TC demonstrated an aneurysmatic dilatation of the anterior inferior segmental artery of the right kidney with an arteriovenous fistula; the patient was treated with angiography and selective cannulation by deploying 4 platinum coils. At follow-up, we used contrast-enhanced ultrasound to monitor coil embolization of the renal artery pseudoaneurysm.

  16. [Excision of a left atrial myxoma through right minithoracotomy in a patient with multiple myeloma; report of a case].

    PubMed

    Koyama, Yutaka; Goto, Yoshihiro; Ogawa, Shinji; Baba, Hiroshi; Okawa, Yasuhide

    2014-12-01

    We present a case of a 63-year-old female who underwent an excision of a left atrial myxoma. Previously, she had been diagnosed with multiple myelomas and received radiation therapy and chemotherapy. A left atrial myxoma was found at an annual medical check-up. The myxoma was removed via a right minithoracotomy with peripheral cannulation to minimize bleeding complications and surgical site infection. She was transferred to the referring hospital on postoperative day 7 due to recurrence of multiple myelomas. She was doing well 14 months after the operation. Right minithoracotomy is a useful approach to minimizing the risks of bleeding and infection in patients with multiple myelomas.

  17. 3D Near Infrared and Ultrasound Imaging of Peripheral Blood Vessels for Real-Time Localization and Needle Guidance

    PubMed Central

    Chen, Alvin I.; Balter, Max L.; Maguire, Timothy J.; Yarmush, Martin L.

    2016-01-01

    This paper presents a portable imaging device designed to detect peripheral blood vessels for cannula insertion that are otherwise difficult to visualize beneath the skin. The device combines near infrared stereo vision, ultrasound, and real-time image analysis to map the 3D structure of subcutaneous vessels. We show that the device can identify adult forearm vessels and be used to guide manual insertions in tissue phantoms with increased first-stick accuracy compared to unassisted cannulation. We also demonstrate that the system may be coupled with a robotic manipulator to perform automated, image-guided venipuncture. PMID:27981261

  18. Structural Analysis and Optimization of the Support Device Used for a Proximal Fracture of the Femur

    DTIC Science & Technology

    2008-12-01

    L bend for valgus curvature. The end caps on both the short and long nail are offered in three sizes: standard, +5mm and +10mm. Both nails are...of the iliac crest [3]. Once the incision is made, a cannulated curved awl is used to open the medullary canal. When reaming the medullary canal...forces produce a bending moment on the proximal end of the femur. By simulating this load, the bone and gamma nail are tested to the limits. The

  19. Methods for study of cardiovascular adaptation of small laboratory animals during exposure to altered gravity. [hypothermia for cardiovascular control and cancer therapy

    NASA Technical Reports Server (NTRS)

    Popovic, V.

    1973-01-01

    Several new techniques are reported for studying cardiovascular circulation in small laboratory animals kept in metabolic chambers. Chronical cannulation, miniaturized membrane type heart-lung machines, a prototype walking chamber, and a fluorocarbon immersion method to simulate weightlessness are outlined. Differential hypothermia work on rat cancers provides localized embedding of radionuclides and other chemotherapeutical agents in tumors and increases at the same time blood circulation through the warmed tumor as compared to the rest of the cold body. Some successful clinical applications of combined chemotherapy and differential hypothermia in skin cancer, mammary tumors, and brain gliomas are described.

  20. Temperature control using a heat exchanger of a cardioplegic system in cardiopulmonary bypass model for rats.

    PubMed

    Kim, Won Gon; Choi, Se Hun; Kim, Jin Hyun

    2008-12-01

    Small animal cardiopulmonary bypass (CPB) model would be a valuable tool for investigating pathophysiological and therapeutic strategies on bypass. However, the rat CPB models have a number of technical limitations. Effective maintenance and control of core temperature by heat exchanger (HE) is among them. The purpose of this study was to confirm the effect of rectal temperature maintenance and hypothermic control using a HE of cardioplegia system in CPB model for rats. The miniature circuit consisted of a reservoir, HE, membrane oxygenator, and roller pump; the static priming volume was 40 cc. In the first stage of experiment, 10 male Sprague-Dawley rats were divided into two groups; HE group was subjected to CPB with HE from a cardioplegia system, and control group was subjected to CPB with warm water circulating around the reservoir. Partial CPB was conducted at a flow rate of 40 mg/kg/min for 20 min after venous cannulation (via the internal jugular vein) and arterial cannulation (via the femoral artery). Rectal temperature was measured after anesthetic induction, after cannulation, 5, 10, 15, and 20 min after CPB. Arterial blood gas with hematocrit was also analyzed, 5 and 15 min after CPB. In the second stage with the same experimental setting, rectal temperatures were lowered in 10 rats to the target temperature of 32 degrees C. After reaching the target temperature, animals were rewarmed. Rectal temperature was measured after cannulation, 5, 10, 15, 20, 25, and 30 min after CPB. Arterial blood gas with hematocrit was also analyzed, 5 and 15 min after CPB. Rectal temperature change differed between the two groups (P < 0.01). The temperatures of the HE group were well maintained during CPB, whereas the control group was under progressive hypothermia. Rectal temperature 20 min after CPB was 36.16 +/- 0.32 degrees C in the HE group and 34.22 +/- 0.36 degrees C in the control group. In the second set of experiments, the hypothermia targeted (32 degrees C) was

  1. Enormous Pedunculated Vegetation Originating in the Left Ventricular Apex in a Patient with Infective Endocarditis

    PubMed Central

    Murata, Azusa; Inoue, Kenji; Maruyama, Sonomi; Iguchi, Shigekazu; Sugita, Manabu; Hiki, Makoto; Okazaki, Shinya; Okai, Iwao; Fujiwara, Yasumasa; Sumiyoshi, Masataka; Yamamoto, Taira; Amano, Atsushi; Daimon, Masao; Daida, Hiroyuki

    2016-01-01

    A healthy teenage Japanese girl was admitted to our hospital after experiencing out-of-hospital cardiac arrest. She had attempted to commit suicide by taking 4,950 mg of disopyramide and 12 mg of flunitrazepam. Mechanical cardiopulmonary support was started with percutaneous cannulation of the femoral vessels. Several days later, a blood culture tested positive for Staphylococcus aureus. Transthoracic echocardiography showed a large mobile and solid mass attached to the apical part of the left ventricle. To the best of our knowledge, the anatomical location of a pedunculated mass originating from the apex is a rare condition. PMID:27746434

  2. Extracorporeal Membrane Oxygenation in Adults - Variants, Complications during Therapy, and the Role of Radiological Imaging.

    PubMed

    Beck, Laura; Burg, Matthias C; Heindel, Walter; Schülke, Christoph

    2017-02-01

    Background Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation - veno-venous for ECMO and veno-arterial for ECLS - distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. Methods The review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)". Results Critical illness- and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function. Key points · Cannula placement is usually documented by radiography.. · Computed tomography is appropriate in the face of inconclusive cannula placement and probable complications.. · In veno-venous ECMO, no contrast enhancement artifacts are to be expected.. · Veno-arterial ECLS leads to pseudo-filling defects, pseudomembranes and irregular contrast enhancement of heart and pulmonary vessels

  3. Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus

    PubMed Central

    Kanto, Ryo; Fukunishi, Shigeo; Morooka, Takatoshi; Seino, Daisuke; Takashima, Takayuki; Yoshiya, Shinichi; Tanaka, Juichi

    2014-01-01

    An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence. PMID:24592345

  4. Aqueous Flow Measured by Fluorophotometry in the Mouse

    PubMed Central

    Toris, Carol B.; Fan, Shan; Johnson, Thomas V.; Camras, Lucinda J.; Hays, Cassandra L.; Liu, Hong; Ishimoto, Bruce M.

    2016-01-01

    Purpose A fluorophotometer designed to measure aqueous flow in murine eyes was tested with artificial fluorescein chambers and in live mice with different anesthesia regimens, aqueous flow suppressants, and an anterior chamber cannulation method. Methods Two hours following topical fluorescein application, one group of CD-1 mice was anesthetized with ketamine/xylazine, 2,2,2-tribromoethanol, or ketamine alone. Cornea and anterior chamber fluorescein concentrations were measured periodically for 60 to 90 minutes by fluorophotometric scans to calculate aqueous flow. Later, a subgroup of mice underwent aqueous flow measurement by anterior chamber cannulation. A third group was treated with timolol, dorzolamide, and vehicle in a crossover manner 1 hour prior to fluorophotometric scans. Results Aqueous flow with ketamine/xylazine anesthesia (0.09 ± 0.05 μL/min, mean ± SD, n = 24) was slower than with tribromoethanol or ketamine alone (P < 0.001). Timolol reduced aqueous flow from 0.20 ± 0.07 μL/min to 0.07 ± 0.03 μL/min (P = 0.001) under tribromoethanol anesthesia and from 0.14 ± 0.03 μL/min to 0.10 ± 0.02 μL/min (P = 0.004) under ketamine anesthesia but not under ketamine/xylazine anesthesia. Dorzolamide reduced aqueous flow from 0.09 ± 0.03 to 0.06 ± 0.03 μL/min (P = 0.04) under ketamine/xylazine anesthesia. Aqueous flow by anterior chamber cannulation (0.20 ± 0.13 μL/min) was greater (P = 0.05) than by fluorophotometry (0.09 ± 0.07 μL/min). Conclusions A new noninvasive fluorophotometric method detected effects of general anesthesia and known aqueous suppressants on aqueous flow in mice. Aqueous flow measured by fluorophotometry was slower than by cannulation, and was technically easier with less variability. The mouse fluorophotometer is useful for repeated measurements of aqueous flow in the murine eye making crossover and longitudinal studies possible. PMID:27447085

  5. Modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair.

    PubMed

    Kondoh, Haruhiko; Funatsu, Toshihiro; Taniguchi, Kazuhiro

    2013-01-01

    We present a modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair. After the proximal and distal anastomosis of a main tubular graft with four pre-sewn side branches, each visceral artery is cannulated and perfused with 25 °C blood (sum total, 800 mL/min). Then, each side branch is placed around the main graft, forming a gently curved loop around it. Finally, the orifice of each visceral artery is sutured to a side branch. This technique prevents kinking of the side branches and enables hemostasis to be secured with a clear view of all the suture lines.

  6. Berlin Heart ventricular assist device in a child with hypoplastic left heart syndrome.

    PubMed

    Chu, Michael W A; Sharma, Kapil; Tchervenkov, Christo I; Jutras, Luc F; Lavoie, Josée; Shemie, Sam D; Laliberte, Eric; Calaritis, Christos; Cecere, Renzo

    2007-03-01

    We report the implantation of a Berlin Heart ventricular assist device (VAD) in a 4-year-old boy with hypoplastic left heart syndrome previously palliated with Norwood and Glenn operations, who presented with progressive ventricular failure and hypoxemia. Insertion of a 30-mL pneumatic pediatric pump with cannulation of the systemic right ventricle and aorta had a salutary effect on cardiac output, improving oxygen saturations. While awaiting heart transplantation, multiple thromboembolic complications developed and he died, despite therapeutic heparinization and aspirin therapy. Important lessons learned about VAD support in Glenn physiology, anticoagulation, and complications of the Berlin Heart are discussed.

  7. Chemical Composition, In vitro Gas Production, Ruminal Fermentation and Degradation Patterns of Diets by Grazing Steers in Native Range of North Mexico

    PubMed Central

    Murillo, M.; Herrera, E.; Carrete, F. O.; Ruiz, O.; Serrato, J. S.

    2012-01-01

    The objective of the study was to quantify annual and seasonal differences in the chemical composition, in vitro gas production, in situ degradability and ruminal fermentation of grazing steers’ diets. Diet samples were collected with four esophageal cannulated steers (350±3 kg BW); and four ruminally cannulated heifers (342±1.5 kg BW) were used to study the dry matter degradation and fermentation in rumen. Data were analyzed with repeated measurements split plot design. The crude protein, in vitro dry matter digestibility and metabolizable energy were higher during the first year of trial and in the summer (p<0.01). The values of calcium, phosphorus, magnesium, zinc and copper were higher in summer (p<0.05). The gas produced by the soluble and insoluble fractions, as well as the constant rate of gas production were greater in summer and fall (p<0.01). The ammonia nitrogen (NH3N) and total volatile fatty acids concentrations in rumen, the soluble and degradable fractions, the constant rate of degradation and the effective degradability of DM and NDF were affected by year (p<0.05) and season (p<0.01). Our study provides new and useful knowledge for the formulation of protein, energetic and mineral supplements that grazing cattle need to improve their productive and reproductive performance. PMID:25049495

  8. Validation of the Use of Nonnaive Surgically Catheterized Rats for Pharmacokinetics Studies

    PubMed Central

    Deshmukh, Sujal V; Durston, Jessica; Shomer, Nirah H

    2008-01-01

    Although large animals, such as dogs and nonhuman primates, often are used for more than 1 pharmacokinetics study, common practice is to use only naive rodents for pharmacokinetics studies. We undertook a series of studies to validate whether surgically cannulated nonnaive rats could be used again after a 7-d washout. When vascular catheters are cared for appropriately, we find that they remain patent for more than 2 wk, with negligible drug carryover. Hematocrit decreased approximately 11% after pharmacokinetics studies but rebounded to prestudy levels after a 7-d washout. We empirically tested whether drugs known to alter drug disposition (1-aminobenzotriazole and quinidine) had residual effects on drug disposition after a 7-d washout and found that they did not. This finding suggests that after a 7-d washout, nonnaive rats likely would produce pharmacokinetics data similar to those of naive rats. We also tested reference compounds in naive and nonnaive rats and found no difference in pharmacokinetics parameters. Using surgically cannulated rats for a second study was feasible because of the relatively noninvasive nature of pharmacokinetics sampling (unrestrained rats attached to automated blood samplers). In addition, reusing surgically altered animals yields considerable cost savings. Our studies indicate that pharmacokinetics parameters did not differ significantly between naive and nonnaive rats. Cost–benefit analysis, monetary considerations, and validation studies support using rats for a second study after a 7-d washout period. PMID:19049252

  9. [Placement of central venous catheters and patient safety].

    PubMed

    de Jonge, E

    2007-01-27

    Placement of a central venous catheter is one of the most common invasive procedures and is associated with septic and mechanical complications, such as bleeding and pneumothorax. Up to 30% of attempts to cannulate the central vein fail. Correct positioning of the patient can help to maximise the success rate. For placement of catheters in the subclavian vein, patients should be in the Trendelenburg position without the use of a shoulder roll to retract the shoulders. Traditionally, central venous catheters are placed using a 'blind' technique that relies on external anatomical reference marks to localise the vein. However, unnoticed anatomical variations or central venous thrombosis may contribute to cannulation failure with this technique. The use of ultrasound has been shown to increase the success rate and avoid mechanical complications when placing a catheter in the internal jugular vein. It may also increase the success rate in subclavian vein catheterisation. To increase patient safety, the use of ultrasound when placing a central venous catheter should be embraced and become the standard of care.

  10. A new device to noninvasively estimate the intraocular pressure produced during ocular compression

    PubMed Central

    Korenfeld, Michael S; Dueker, David K

    2016-01-01

    Purpose To describe a noninvasive instrument that estimates intraocular pressure during episodes of external globe compression and to demonstrate the accuracy and reliability of this device by comparing it to the intraocular pressures simultaneously and manometrically measured in cannulated eyes. Methods A thin fluid-filled bladder was constructed from flexible and inelastic plastic sheeting and was connected to a pressure transducer with high pressure tubing. The output of the pressure transducer was sent to an amplifier and recorded. This device was validated by measuring induced pressure in the fluid-filled bladder while digital pressure was applied to one surface, and the other surface was placed directly against a human cadaver eye or in vivo pig eye. The human cadaver and in vivo pig eyes were each cannulated to provide a manometric intraocular pressure control. Results The measurements obtained with the newly described device were within ~5% of simultaneously measured manometric intraocular pressures in both a human cadaver and in vivo pig eye model for a pressure range of ~15–100 mmHg. Conclusion This novel noninvasive device is useful for estimating the intraocular pressure transients induced during any form of external globe compression; this is a clinical setting where no other devices can be used to estimate intraocular pressure. PMID:26955260

  11. Endothelial, renal and hepatic variables in Wistar rats treated with Vancomycin.

    PubMed

    Bruniera, Felipe R; Ferreira, Felipe M; Savioli, Luiz R M; Bacci, Marcelo R; Feder, David; Pereira, Edimar C; Pedreira, Mavilde L G; Peterlini, Maria A S; Perazzo, Fábio F; Azzalis, Ligia A; Rosa, Paulo C P; Junqueira, Virginia B C; Sato, Monica A; Fonseca, Fernando L A

    2014-12-01

    Vancomycin (VCM) is indicated in combat against Gram-positive infections, but it is not considered a first-choice drug because of its adverse effects. It is believed that oxidative stress is the primary mechanism of endothelial injury and the consequent VCM toxicity, which varies from phlebitis to nephrotoxicity. Moreover, dose recommendations, dilution, rates and types of infusion are still controversial. The aim of this study was to determine the effect of different VCM dilutions in endothelial, liver and kidney injuries by biochemical parameters and histopathological analysis. Wistar rats were randomly divided into six groups and subjected to femoral vein cannulation for drug administration. Control groups received 0.9 ml of saline and the others received VCM (10mg/Kg/day) at dilutions of 5.0 and 10.0 mg/mL for 3 and 7 days. Homocysteine, hs-CRP, AST, ALT, GGT, urea, creatinine, lycopene, alpha-tocopherol, beta-carotene and retinol were analyzed. Kidney, liver and cannulated femoral vein fragments were collected.This study showed alterations in ALT which featured hepatotoxicity. However, drug dilutions were not able to show changes in other biochemical parameters. In contrast, kidney and endothelium pathological changes were observed. More studies are needed to characterize VCM induced kidney and endothelium toxicity and biochemical markers able to show such morphological modifications.

  12. Removal of a broken guide wire entrapped in a fractured femoral neck.

    PubMed

    Zhu, Qing-hua; Ye, Tian-wen; Guo, Yong-fei; Wang, Chong-li; Chen, Ai-min

    2013-01-01

    Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.

  13. Acute intake of plant stanol esters induces changes in lipid and lipoprotein metabolism-related gene expression in the liver and intestines of mice.

    PubMed

    De Smet, Els; Mensink, Ronald P; Konings, Maurice; Brufau, Gemma; Groen, Albert K; Havinga, Rick; Schonewille, Marleen; Kerksiek, Anja; Lütjohann, Dieter; Plat, Jogchum

    2015-06-01

    The kinetics of plant stanol uptake and routing in 8-week-old C57BL/6J mice were determined after a plant stanol ester gavage. In addition, acute changes in intestinal and hepatic gene expression were investigated. Mice were fed a plant sterol/stanol poor diet from weaning. At the age of 8 weeks, they received an oral gavage consisting of 0.25 mg cholesterol + 50 mg plant stanol esters dissolved in olive oil. Animals were euthanized at different time points. In a second comparable set-up, mesenteric lymph-cannulated versus sham-operated mice received the same oral gavage, which was now deuterium labeled. Intestinal and hepatic sitostanol concentrations increased within 15 min post-gavage. This rapid hepatic appearance was absent in lymph-cannulated mice, suggesting a very fast lymph-mediated uptake. Hepatic mRNA expression of SREBP2 and its target genes rapidly decreased, whereas expression of LXR target genes increased. The intestinal SREBP2 pathway was increased, whereas the expression of LXR target genes hardly changed. The fivefold and sixfold increased expression of intestinal LDLr and PCSK9 is suggestive of TICE activation. We conclude that in C57BL/6J mice plant stanol kinetics are fast, and affect intestinal and hepatic gene expression within 15 min postprandial after lymph-mediated uptake.

  14. Surgical access via right thoracotomy facilitates tricuspid valve surgery in sheep

    PubMed Central

    Bothe, Wolfgang; Diab, Mahmoud; Ostermann, Romanus; Schwarzer, Michael; Woelfel, Luisa; Bischoff, Sabine; Schubert, Harald

    2017-01-01

    In quadrupeds, the three-dimensional orientation of the heart with respect to the thorax is fundamentally different from that in humans. In this study, we assessed the best surgical approach to the tricuspid valve in sheep. Firstly, different surgical access sites to the tricuspid valve were tested in sheep cadavers, the anatomy was analyzed, and the optimal surgical approach to the tricuspid valve was determined. Secondly - along with cardiopulmonary bypass and cardioplegic arrest -the chosen approach was tested in six adult sheep in vivo. Anatomical analyses revealed that a left thoracotomy provided optimal access to the aorta and left heart. However, visualization of the right heart was significantly impaired. In contrast, a right thoracotomy provided good access to the right heart, but the ascending aorta was difficult to approach. Therefore, in the in vivo studies, arterial cannulation was performed through a carotid (n = 4) or femoral (n = 2) artery. In conclusion, a right-sided thoracotomy allows good visualization of all components of the tricuspid valve complex in sheep, but not of the ascending aorta. Consequently, peripheral vessels are preferred for arterial cannulation. This work may stimulate the investigation of pathomechanisms and/or novel treatment options for tricuspid valve pathologies. PMID:27456775

  15. Changes in adipose tissue stromal-vascular cells in primary culture due to porcine sera

    SciTech Connect

    Jewell, D.E.; Hausman, G.J.

    1986-03-01

    This study was conducted to determine the response of rat stromal-vascular cells to pig sea. Sera were collected from unselected contemporary (lean) and high backfat thickness selected (obese) pigs. Sera from obese pigs were collected either by exsanguination or cannulation. sera from lean pigs during the growing phase (45 kg) and the fattening phase (100-110 kg) were collected. Stromal-vascular cells derived rom rat inguinal tissue were cultured on either 25 cm/sup 2/ flasks, collagen-coated coverslips or petri dishes. Cell proliferation was measured by (/sup 3/H)-thymidine incorporation during the fourth day of culture. Coverslip cultures were used for histochemical analysis. Petri dish cultures were used for analysis of Sn-glycerol-3-phosphate dehydrogenase (GPDH) activity. All cells were plated for 24 hours in media containing 10 fetal bovine sera. Test media contained 2.5, 5.0, 10.0% sera. Sera from obese pigs increased GPDH activity and fat cell production when compared to the lean controls. The increased concentration of sera increased esterase activity and lipid as measured with oil red O. The sera from obese pigs collected at slaughter stimulated more fat cell production than obese sera collected by cannulation. These studies show there are adipogenic factors in obese pigs sera which promote fat cell development in primary cell culture.

  16. Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate.

    PubMed

    Thelen, Simon; Betsch, Marcel; Schneppendahl, Johannes; Grassmann, Jan; Hakimi, Mohssen; Eichler, Christian; Windolf, Joachim; Wild, Michael

    2013-11-01

    This biomechanical study is the first to compare 3 fixation methods-bilateral fixed-angle plate, modified anterior tension wiring, and cannulated lag screws with anterior tension wiring-in multifragmentary distal patella fractures. A T-shaped 3-part fracture simulating a multifragmentary articular distal patella fracture (AO/OTA 34-C2.2) was created in 18 human cadaver knee specimens. Three groups were created using homogenous ages and bone mineral densities based on the fixation method received. Repetitive testing over 100 cycles was performed by moving the knee against gravity from 90° flexion to full extension. Failure was defined as fracture displacement greater than 2 mm. In all patellae using fixed-angle plates, an anatomical fracture reduction could be maintained throughout cyclic testing, whereas anterior tension wiring and lag screws with tension wiring showed significant fracture displacement after 100 cycles, with mean fracture gaps of 2.0±1.3 and 1.9±1.6 mm, respectively. The differences in fracture gaps between the fixed-angle plate group and the other 2 groups were statistically significant. In both groups using tension wiring, half of the constructs (3 of 6 in each group) failed due to a fracture displacement greater than 2 mm. The bilateral fixed-angle plate was the only fixation method that sustainably stabilized a multifragmentary articular distal patella fracture during cyclic loading when compared with modified anterior tension wiring and cannulated lag screws with anterior tension wiring.

  17. Ultrasound-guided catheterisation of the subclavian vein: freehand vs needle-guided technique.

    PubMed

    Maecken, T; Heite, L; Wolf, B; Zahn, P K; Litz, R J

    2015-11-01

    The objective of this prospective, randomised study was to examine the impact of a multi-angle needle guide for ultrasound-guided, in-plane, central venous catheter placement in the subclavian vein. One hundred and sixty patients were randomly allocated to two groups, freehand or needle-guided, and then 159 catheterisations were analysed. Cannulation of the first examined access site was successful in 96.9% of cases with no significant difference between groups. There were three arterial punctures and no other severe injuries. Catheter misplacements did not differ between the groups. Higher success rates within the first and second attempts in the needle-guided group were observed (p = 0.041 and p = 0.019, respectively). Use of the needle guide reduced the access time from a median (IQR [range]) of 30 (18-76 [6-1409]) s to 16 (10-30 [4-295]) s; p = 0.0001, and increased needle visibility from 31.8% (9.7%-52.2% [0-96.67]) to 86.2% (62.5%-100% [0-100]); p < 0.0001. A multi-angle needle guide significantly improved aligning the needle and ultrasound plane compared with the freehand technique when cannulating the subclavian vein. Use of the guide resulted in faster access times and increased success at the first and second attempts.

  18. Dynamic multiplanar real time ultrasound guided infraclavicular subclavian vein catheterization.

    PubMed

    Zhong, Xin; Hamill, Mark; Collier, Bryan; Bradburn, Eric; Ferrara, John

    2015-06-01

    Ultrasound guided vascular access has been well-characterized as a safe and effective technique for internal jugular and femoral vein catheterization. However, there is limited experience with the use of ultrasound to access the infraclavicular subclavian vein. Multiple ultrasound techniques do exist to identify the subclavian vein, but real time access is limited by vessel identification in a single planar view. To overcome this limitation, a novel technique of ultrasound guided infraclavicular subclavian vein catheterization using a real time multiplanar approach has been developed. The initial experience with this approach is described. A single surgeon used combined oblique, transverse, and longitudinal views along with Doppler color flow images to both define the infraclavicular anatomy and to obtain subclavian vein access in 42 adult patients (20 M/22 F and 22 L/20 R) with a mean body mass index of 29.2 (range = 18.9-55.4). Chest x-ray was obtained to confirm position and to rule out pneumothorax. Subclavian vein cannulation was achieved in 100 per cent of patients; subsequent catheterization was successful in 92.9 per cent. The number of attempts required for cannulation averaged 1.3 (range = 1-5), and decreased after a five patient learning curve. No patient developed a pneumothorax, hematoma, or cannula malposition. Ultrasound guided multiplanar infraclavicular subclavian vein access appears to be a safe and effective adjunct for central line placement.

  19. Topical Proparacaine and Episcleral Venous Pressure in the Rabbit

    PubMed Central

    Zamora, David O.; Kiel, Jeffrey W.

    2015-01-01

    Purpose To determine the effect of proparacaine-induced topical anesthesia on episcleral venous pressure (EVP). Methods In anesthetized rabbits (n = 11), EVP was measured with a servonull micropressure system, with glass pipettes with 2- to 3-μm tips used to cannulate episcleral veins. Additional measurements included arterial, intraocular, and orbital venous pressures obtained by direct cannulation, to assess the ocular pressure gradients, and carotid blood flow and heart rate, to verify preparation stability. The protocol entailed 5 to 10 minutes of stable baseline recording followed by topical application of proparacaine (0.5%, 10 μL) with continued measurements for another 5 to 15 minutes. Results Baseline EVP without topical anesthesia was 12.3 ± 1.1 mm Hg. EVP decreased significantly to 8.7 ± 0.9 mm Hg within minutes after application of proparacaine. A small decrease also occurred in intraocular pressure. All other measured variables were unchanged. Conclusions These results suggest that the episcleral circulation is under tonic neural control and that either an upstream resistance site is under tonic vasodilatory control or a downstream site is under vasoconstrictor control. PMID:19151377

  20. Bicondylar tibial plateau fractures treated with fine-wire circular external fixation.

    PubMed

    Ferreira, N; Marais, L C

    2014-04-01

    Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.

  1. Oleyl alcohol inhibits intestinal long-chain fatty acid absorption in rats.

    PubMed

    Murota, K; Kawada, T; Matsui, N; Sakakibara, M; Takahashi, N; Fushiki, T

    2000-12-01

    Long-chain fatty acids are important nutrients, but obesity is the most common nutritional disorder in humans. In this study we investigated the effect of oleyl alcohol on the intestinal long-chain fatty acid absorption in rats. We administered [14C]oleic acid and oleyl alcohol as lipid emulsion intraduodenally in unanesthetized lymph-cannulated rats and measured the lymphatic output of oleic acid. Second, we orally administered lipid emulsion with a stomach tube and measured the luminal and mucosal oleic acid residues. Furthermore, rats were fed oleyl alcohol as a dietary component for 20 days, and fecal lipid and the weight of adipose tissues were measured. In lymph-cannulated rats, triglyceride and [14C]oleic acid output in the lymph were significantly lower in the presence of oleyl alcohol when compared with the absence of oleyl alcohol in a dose-dependent manner. The radioactivity remaining in the intestinal lumen was more strongly detected in rats that had been orally administered oleyl alcohol than in the controls. The feces of rats fed an oleyl-alcohol-added diet contained much higher amounts of lipids, and the weights of their adipose tissues were significantly lower than in the control group. These results suggest that oleyl alcohol inhibits the rat gastrointestinal absorption of long-chain fatty acids in vivo.

  2. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

    PubMed Central

    El Nakeeb, Ayman; El Hanafy, Ehab; Salah, Tarek; Atef, Ehab; Hamed, Hosam; Sultan, Ahmad M; Hamdy, Emad; Said, Mohamed; El Geidie, Ahmed A; Kandil, Tharwat; El Shobari, Mohamed; El Ebidy, Gamal

    2016-01-01

    AIM To detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity. METHODS This is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected. RESULTS The study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP. CONCLUSION PEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP. PMID:27909551

  3. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

    SciTech Connect

    Solar, Miroslav; Ceral, Jiri; Krajina, Antonin; Ballon, Marek; Malirova, Eva; Brodak, Milos; Cap, Jan

    2010-08-15

    Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.

  4. Hemodynamics on abrupt stoppage of centrifugal pumps during left ventricular assist.

    PubMed

    Kono, S; Nishimura, K; Nishina, T; Akamatsu, T; Komeda, M

    2000-01-01

    A magnetically suspended centrifugal pump (MSCP), developed for long-term ventricular assist, is reliable and durable because it has no shaft or seal. However, with nonvalve pumps such as a MSCP, regurgitation occurs when they accidentally stop without cannula clamping. We investigated the hemodynamics during temporary stoppage of a MSCP being used as a left ventricular assist system (LVAS), comparing two inflow cannulation sites. In four sheep (weight, 35-45 kg), microspheres were injected into the left main coronary artery to induce heart failure. An outflow cannula was sutured onto the descending aorta, and two inflow cannulae were inserted into the left atrium and the left ventricle. The MSCP was stopped with both the left ventricular cannula and left atrial cannula clamped, and the hemodynamics and P-V loops were recorded. Each cannula was then unclamped in order, and similar parameters were recorded. LVEDP increased at unclamping of the left ventricular cannula (ULVC), and rose further at unclamping of the left atrial cannula (ULAC). Aortic pressure did not change at ULVC, but decreased at ULAC. The effective systemic flow that subtracted the regurgitant flow through the MSCP from left ventricular output was half at ULVC and almost 0 at ULAC. When stopping centrifugal pumps without circuit clamping, hemodynamic deterioration is less at ULVC than at ULAC. This finding suggests that left ventricular inflow cannulation is recommended to allow more time in emergency situations.

  5. Which is the easiest and safest technique for central venous access? A retrospective survey of more than 5,400 cases.

    PubMed

    Pittiruti, M; Malerba, M; Carriero, C; Tazza, L; Gui, D

    2000-01-01

    There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the 'low lateral' approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arte-rial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the 'low lateral' approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation.

  6. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.

    PubMed

    Panteli, Michalis; Rodham, Paul; Giannoudis, Peter V

    2015-03-01

    Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. The cornerstone of their management is anatomic reduction and stable internal fixation of the femoral neck in an attempt to salvage the femoral head. Complications including avascular necrosis of the femoral head, non-union and post-traumatic osteoarthritis are not uncommon. The clinical outcomes of these patients can be improved with good pre-operative planning, optimization of surgical procedures and introduction of new improved implants and techniques. In the herein study, we attempt to describe the biomechanical properties of the hip and compare the performance of the most commonly used devices. Experimental evidence suggests that in Pauwels type III fracture patterns a cephalomedullary nail was significantly stronger in axial loading. Moreover, in unstable basicervical patterns cannulated screws (triangular configuration) demonstrated a lower ultimate load to failure, whereas in subcapital or transervical patterns both the cannulated screws (triangular configuration) and the sliding hip screw demonstrated no compromise in fixation strength. The fracture pattern appears to be the major determinant of the ideal type of implant to be selected. For a successful outcome each patient needs to be considered on an individual basis taking into account all patient and implant related factors.

  7. Lateral Decubitus All-Arthroscopic Latarjet Procedure for Treatment of Shoulder Instability

    PubMed Central

    Lewington, Matthew R.; Urquhart, Nathan; Wong, Ivan H.

    2015-01-01

    Shoulder instability can be a challenging condition to treat when it becomes refractory to soft-tissue procedures or when bone loss exceeds 25% to 27% of the glenoid. The Bristow-Latarjet procedure has been developed and popularized to deal with these concerns. Traditionally, the procedure has been performed as an open approach; however, this has been recently supplanted by novel arthroscopic techniques. We present a technique for the procedure performed with the patient in a semi-lateral decubitus position that assists with optimal graft placement on the native glenoid. We use the cannulated Bristow-Latarjet Instability Shoulder System (DePuy Mitek, Raynham, MA). After a diagnostic arthroscopic evaluation, we use multiple arthroscopic anterior portals to debride the rim of the glenoid. The coracoid is prepared and taken down arthroscopically, and the cannulated guide is attached and advanced through an arthroscopically created subscapularis split. With the shoulder held in a reduced position, we are then able to drill and anchor the graft to the native glenoid. The patient is able to begin gentle range-of-motion exercises immediately postoperatively. PMID:26258032

  8. Choleretic activity of Gentiana lutea ssp. symphyandra in rats.

    PubMed

    Oztürk, N; Herekman-Demir, T; Oztürk, Y; Bozan, B; Başer, K H

    1998-08-01

    Effects of an ethanolic extract prepared from G. lutea ssp. symphyandra roots on the bile production and liver in rats were investigated. Bile flows of rats which were treated by a single i.p. dose of CCl(4) 24 h prior to experiments were measured after the cannulation of bile duct under urethane anaesthesia. After an equilibration period of 1 h, the lyophilized extract were administered intraduodenally (500 mg/kg i.p.), while control animals received physiological saline only. To monitor the effect of multiple dose therapy, rats received the same dose of G. lutea ssp. symphyandra extract for 3 days (2 days prior to CCl(4) administration) and their bile flows were measured after the cannulation. In all groups, bile samples were collected for 3 h with 15 min intervals. After the completion of bile flow experiment, rat livers were removed and put in neutral formaldehyde solution (10%) for the histological examination. According to results obtained, multiple dose treatment of rats with the plant extract normalized the decreased bile flow due CCl(4), whereas single dose therapy was ineffective on the impaired bile flow. These data indicate that the extract prepared from Gentiana lutea ssp. symphyandra roots has a hepatoprotective activity.

  9. Augmented secretion of lysosomal enzyme into pancreatic juice after short term obstruction of the pancreatic duct in rats.

    PubMed

    Hirano, T; Manabe, T; Kyogoku, T; Ando, K; Yotsumoto, F; Imanishi, K; Ohshio, G

    1992-05-01

    To find out if and when lysosomal enzymes are excreted into pancreatic juice in physiological and pathological conditions, the changes in the secretion of cathepsin B into pancreatic juice were investigated in 66 Wistar rats with cannulation of common pancreatic-biliary duct and common bile duct, and infusions of caerulein and secretin. In a separate experiment ducts were cannulated and secretin infused as before, but in one group the ducts were "obstructed" and in another they were allowed to remain patent. Obstruction of the pancreatic duct for three hours caused a moderate significant rise in serum amylase activity. Cathepsin B activity in the pancreatic subcellular fractions was redistributed, and the amount of cathepsin B increased. In rats with obstructed ducts the secretion of cathepsin B and other lysosomal enzymes that were stimulated by caerulein was significantly greater than in the animals in which the ducts remained patent. Lysosomal enzymes associated with zymogen granules are secreted into pancreatic juice together with digestive enzymes after stimulation by gut hormones, and they may have pathophysiological roles in pancreatic juice.

  10. The System Design and Evaluation of a 7-DOF Image-Guided Venipuncture Robot.

    PubMed

    Balter, Max L; Chen, Alvin I; Maguire, Timothy J; Yarmush, Martin L

    2015-08-01

    Accessing the venous bloodstream to deliver fluids or obtain a blood sample is the most common clinical routine practiced in the U.S. Practitioners continue to rely on manual venipuncture techniques, but success rates are heavily dependent on clinician skill and patient physiology. In the U.S., failure rates can be as high as 50% in difficult patients, making venipuncture the leading cause of medical injury. To improve the rate of first-stick success, we have developed a portable autonomous venipuncture device that robotically servos a needle into a suitable vein under image guidance. The device operates in real time, combining near-infrared and ultra-sound imaging, image analysis, and a 7-degree-of-freedom (DOF) robotic system to perform the venipuncture. The robot consists of a 3-DOF gantry to image the patient's peripheral forearm veins and a miniaturized 4-DOF serial arm to guide the cannula into the selected vein under closed-loop control. In this paper, we present the system architecture of the robot and evaluate the accuracy and precision through tracking, free-space positioning, and in vitro phantom cannulation experiments. The results demonstrate sub-millimeter accuracy throughout the operating workspace of the manipulator and a high rate of success when cannulating phantom veins in a skin-mimicking tissue model.

  11. Advanced in vitro approach to study neurovascular coupling mechanisms in the brain microcirculation

    PubMed Central

    Kim, Ki Jung; Filosa, Jessica A

    2012-01-01

    An understanding of the signalling events underlying neurovascular coupling mechanisms in the brain is a crucial step in the development of novel therapeutic approaches for the treatment of cerebrovascular-associated disorders. In this study we present an enhanced in vitro brain slice preparation from male Wistar rat cortical slices that incorporates haemodynamic variables (flow and pressure) into parenchymal arterioles resulting in the development of myogenic tone (28% from maximum dilatation). Moreover, we characterized flow-induced vascular responses, resulting in various degrees of vasoconstrictions and the response to 10 mm K+ or astrocytic activation with the mGluR agonist, t-ACPD (100 μm), resulting in vasodilatations of 33.6 ± 4.7% and 38.6 ± 4.6%, respectively. Using fluorescence recovery, we determined perfusate velocity to calculate diameter changes under different experimental pH conditions. Using this approach, we demonstrate no significant differences between diameter changes measured using video microscopy or predicted from the velocity values obtained using fluorescence recovery after photobleaching. The model is further validated by demonstrating our ability to cannulate arterioles in two brain regions (cortex and supraoptic nucleus of the hypothalamus). Altogether, we believe this is the first study demonstrating successful cannulation and perfusion of parenchymal arterioles while monitoring/estimating luminal diameter and pressure under conditions where flow rates are controlled. PMID:22310311

  12. In vitro flow investigations in the aortic arch during cardiopulmonary bypass with stereo-PIV.

    PubMed

    Büsen, Martin; Kaufmann, Tim A S; Neidlin, Michael; Steinseifer, Ulrich; Sonntag, Simon J

    2015-07-16

    The cardiopulmonary bypass is related to complications like stroke or hypoxia. The cannula jet is suspected to be one reason for these complications, due to the sandblast effect on the vessel wall. Several in silico and in vitro studies investigated the underlying mechanisms, but the applied experimental flow measurement techniques were not able to address the highly three-dimensional flow character with a satisfying resolution. In this work in vitro flow measurements in a cannulated and a non-cannulated aortic silicone model are presented. Stereo particle image velocimetry measurements in multiple planes were carried out. By assembling the data of the different measurement planes, quasi 3D velocity fields with a resolution of~1.5×1.5×2.5 mm(3) were obtained. The resulting velocity fields have been compared regarding magnitude, streamlines and vorticity. The presented method shows to be a suitable in vitro technique to measure and address the three-dimensional aortic CPB cannula flow with a high temporal and spatial resolution.

  13. Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments

    PubMed Central

    Ekbom, K; Jakobsson, J; Marcus, C

    2005-01-01

    Aims: To evaluate the efficacy and safety of nitrous oxide treatment given to children presenting procedural problems in a paediatric outpatient department. Methods: The study comprised 70 children 6–18 years old. Two different groups were studied. (1) Children presenting with problems in establishing venous cannulation (VC) (n = 50). The patients were randomised to conventional treatment (CO); cutaneous application of EMLA or nitrous oxide treatment (NO); N2O and EMLA. (2) Anxious children/children undergoing painful procedures who repeatedly come to the clinic (n = 20). These children underwent two procedures with CO/NO, the order of priority being randomised. Altogether the study included 90 procedures. Main outcome measures were procedure time, number of attempts required to establish VC, pain, and evaluation. Results: All procedures were performed with NO while four VC (8%) were not possible to perform with CO. The number of attempts required to establish VC was lower when using NO (median 2, range 2–9), compared with CO (median 4, range 2–9). The estimated pain was lower with NO. The total mean time required was similar for NO and CO when the time required for the NO procedure was included. One complication, tinnitus, was observed; it disappeared within 3 minutes. Conclusion: The pretreatment with nitrous oxide is a time effective and safe method for use at paediatric outpatient departments to reduce pain, facilitate venous cannulation, and thereby reduce the number of costly cancellations of planned procedures. PMID:16177164

  14. Recent approaches of lipid-based delivery system for lymphatic targeting via oral route.

    PubMed

    Chaudhary, Shilpa; Garg, Tarun; Murthy, R S R; Rath, Goutam; Goyal, Amit K

    2014-12-01

    Lymphatic system is a key target in research field due to its distinctive makeup and huge contributing functions within the body. Intestinal lymphatic drug transport (chylomicron pathway) is intensely described in research field till date because it is considered to be the best for improving oral drug delivery by avoiding first pass metabolism. The lymphatic imaging techniques and potential therapeutic candidates are engaged for evaluating disease states and overcoming these conditions. The novel drug delivery systems such as self-microemulsifying drug delivery system, nanoparticles, liposomes, nano-lipid carriers, solid lipid carriers are employed for delivering drugs through lymphatic system via various routes such as subcutaneous route, intraperitoneal route, pulmonary route, gastric sub-mucosal injection, intrapleural and intradermal. Among these colloidal particles, lipid-based delivery system is considered to be the best for lymphatic delivery. From the last few decades, mesenteric lymph duct cannulation and thoracic lymph duct cannulation are followed to assess lymphatic uptake of drugs. Due to their limitations, chylomicrons inhibitors and in-vitro models are employed, i.e. lipolysis model and permeability model. Currently, research on this topic still continues and drainage system used to deliver the drugs against lymphatic disease as well as targeting other organs by modulating the chylomicron pathway.

  15. Adaptive Kinematic Control of a Robotic Venipuncture Device Based on Stereo Vision, Ultrasound, and Force Guidance.

    PubMed

    Balter, Max L; Chen, Alvin I; Maguire, Timothy J; Yarmush, Martin L

    2017-02-01

    Robotic systems have slowly entered the realm of modern medicine; however, outside the operating room, medical robotics has yet to be translated to more routine interventions such as blood sampling or intravenous fluid delivery. In this paper, we present a medical robot that safely and rapidly cannulates peripheral blood vessels-a procedure commonly known as venipuncture. The device uses near-infrared and ultrasound imaging to scan and select suitable injection sites, and a 9-DOF robot to insert the needle into the center of the vessel based on image and force guidance. We first present the system design and visual servoing scheme of the latest generation robot, and then evaluate the performance of the device through workspace simulations and free-space positioning tests. Finally, we perform a series of motion tracking experiments using stereo vision, ultrasound, and force sensing to guide the position and orientation of the needle tip. Positioning experiments indicate sub-millimeter accuracy and repeatability over the operating workspace of the system, while tracking studies demonstrate real-time needle servoing in response to moving targets. Lastly, robotic phantom cannulations demonstrate the use of multiple system states to confirm that the needle has reached the center of the vessel.

  16. One unit's experiences when establishing buttonhole technique, analysis of reasons for failure of procedure: a report.

    PubMed

    Galante, Nelson Zocoler; Rabelo, Lúcia Lima; Yamamoto, Atsuko; Bonato, Rozana Aparecida; Azevedo, Luiz Sergio

    2010-06-01

    The buttonhole technique of access of needle insertion into a single selected site in the arteriovenous fistula has proved to be a reliable alternative to older methods due to its overall low complication rates. Although the use of blunt needles improves the technique, the success rate of cannulation with these needles is difficult to predict. We analysed the short-term outcome of 16 patients receiving in-centre haemodialysis and compared clinical relevant parameters between patients with and without buttonhole technique failure. Our dialysis unit treats about 180 patients and is located in a tertiary hospital in Sao Paulo, Brazil. The variables as discussed in the paper were the same for both groups. The incidence of technique failure was 43.7%. Patients enrolled later in the study had a better buttonhole failure-free survival rates than patients enrolled at the beginning (p < 0.05). Patients' clinical characteristics did not predict the success rate of buttonhole tunnel tracks cannulation with blunt needles. This paper also reports on our successes and failures in buttonhole technique and gives some reasons and reflections for both.

  17. Endoscopic Retrograde Cholangiopancreatography in Bilioenteric Anastomosis

    PubMed Central

    Park, Eun Taek

    2016-01-01

    For diagnosis and treatment of pancreatobiliary diseases, endoscopic retrograde cholangiopancreatography (ERCP) is useful method nowadays and its technically success rate is usually in about 90%-95% of patients with normal gastric and pancreaticobiliary anatomy. Recently ERCP is significantly challenging after intestinal reconstruction, particularly in patients who have undergone pancreaticoduodenectomy (PD, classic Whipple’s operation) or pylorus-preserving pancreatoduodenectomy (PPPD) with reconstruction. PD and PPPD relate to numerous techniques have been presented for reconstruction of the digestive tract and pancreaticobiliary tree during the resection bilioenteric stricture commonly occurs later in the postoperative course and developed in 5-year cumulative probability of biliary stricture rate of 8.2% and pancreaticoenteric stricture of 4.6%. This complication was no difference in incidence between patients with benign or malignant disease. In PD or PPPD with reconstruction, short pancreatobiliary limb with biliojejunal anastomosis site is made usually, modestly success rate of intubation to blind loop and cannulation with conventional endoscope. However, in combined Reux-en-Y anastomosis, longer pancreatobiliary limb and additional Reux limb are obstacle to success intubation and cannulation by using conventional endoscope. In this situation, new designed enetroscope with dedicated accessories is efficient. PMID:27838918

  18. Luminescence targeting and imaging using a nanoscale generation 3 dendrimer in an in vivo colorectal metastatic rat model

    PubMed Central

    Alcala, Marco A.; Kwan, Shu Ying; Shade, Chad M.; Lang, Megan; Uh, Hyounsoo; Wang, Manyan; Weber, Stephen G.; Bartlett, David L.; Petoud, Stéphane; Lee, Yong J.

    2010-01-01

    Surgery is currently the best approach for treating either primary or metastatic hepatic malignancies. Since only 20% of patients with hepatic cancer are operable, regional therapies (RT) are emerging as alternate treatment modalities. However, RT's can have their own limitations at controlling tumor growth or lack the ability to detect such metastases. More can be done to enhance their efficacy. An animal model of hepatic metastases coupled with a gastroduodenal artery (GDA) cannulation technique may provide a site to apply such therapies. In our study, splenic injections were performed with CC531 adenocarcinoma cells, which generated metastatic hepatic tumors in WAG/RijHsd rats. Cannulation of GDA was achieved via a polyethylene catheter. Infusion of generation 3 polyamidoamine 4-amino-1,8-naphthalimide containing 8 europium ions (Eu-G3P4A18N) dendrimer via the GDA resulted in luminescence of the hepatic metastatic nodules. Imaging of the metastatic hepatic nodules was obtained with the help of a digital charge coupled device camera. PMID:20946969

  19. Onset of pulsatile pressure causes transiently increased filtration through artery wall.

    PubMed

    Alberding, Jonathan P; Baldwin, Ann L; Barton, Jennifer K; Wiley, Elizabeth

    2004-05-01

    Convective fluid motion through artery walls aids in the transvascular transport of macromolecules. Although many measurements of convective filtration have been reported, they were all obtained under constant transmural pressure. However, arterial pressure in vivo is pulsatile. Therefore, experiments were designed to compare filtration under steady and pulsatile pressure conditions. Rabbit carotid arteries were cannulated and excised from male New Zealand White rabbits anesthetized with pentobarbitol sodium (30 mg/kg i.v. administered). Hydraulic conductance was measured in cannulated excised rabbit carotid arteries at steady pressure. Next, pulsatile pressure trains were applied within the same vessels, and, simultaneously, arterial distension was monitored using Optical coherence tomography (OCT). For each pulse train, the volume of fluid lost through filtration was measured (subtracting volume change due to residual distension) and compared with that predicted from steady pressure measurements. At 60- and 80-mmHg baseline pressures, the experimental filtration volumes were significantly increased compared with those predicted for steady pressure (P < 0.05). OCT demonstrated that the excess fluid volume loss was significantly greater than the volume that would be lost through residual distension (P < 0.05). After 30 s, the magnitude of the excess of fluid loss was reduced. These results suggest that sudden onset of pulsatile pressure may cause changes in arterial interstitial hydration.

  20. Lymphatic transport of fat in rats with normal- and malabsorption following intake of fats made from fish oil and decanoic acid. Effects of triacylglycerol structure.

    PubMed

    Straarup, E M.; Høy, C -E.

    2001-07-01

    Fish oils contain essential polyunsaturated fatty acids of the n-3 family. In fat malabsorption the n-3 fatty acids are poorly absorbed. Absorption may be improved by modifying the fatty acid profile of fish oil through interesterification with medium chain fatty acids. We examined the absorption of fish oil interesterified with decanoic acid in rats with normal- and malabsorption compared to a physical mixture and the fish oil itself. The interesterified fats were: 1) a regiospecific fat with decanoic acid located mainly in the sn1/3-positions and a long chain fatty acid from fish oil in the sn2-position, 2) a fat with a random distribution of fatty acids in all positions of the triacylglycerol. The main mesenteric lymph duct was cannulated for collection of lymph. In the malabsorbing rats the common bile duct was cannulated as well to divert both pancreatic juice and bile. The fatty acid composition in lymph samples collected for 24 hours was determined. Accumulated transport of n-3 fatty acids from fish oil was improved in malabsorbing rats and recoveries of fatty acids after 24 hours were improved in both rats with normal- and malabsorption administered the randomized fat compared to fish oil.

  1. The System Design and Evaluation of a 7-DOF Image-Guided Venipuncture Robot

    PubMed Central

    Balter, Max L.; Chen, Alvin I.; Maguire, Timothy J.; Yarmush, Martin L.

    2015-01-01

    Accessing the venous bloodstream to deliver fluids or obtain a blood sample is the most common clinical routine practiced in the U.S. Practitioners continue to rely on manual venipuncture techniques, but success rates are heavily dependent on clinician skill and patient physiology. In the U.S., failure rates can be as high as 50% in difficult patients, making venipuncture the leading cause of medical injury. To improve the rate of first-stick success, we have developed a portable autonomous venipuncture device that robotically servos a needle into a suitable vein under image guidance. The device operates in real time, combining near-infrared and ultra-sound imaging, image analysis, and a 7-degree-of-freedom (DOF) robotic system to perform the venipuncture. The robot consists of a 3-DOF gantry to image the patient's peripheral forearm veins and a miniaturized 4-DOF serial arm to guide the cannula into the selected vein under closed-loop control. In this paper, we present the system architecture of the robot and evaluate the accuracy and precision through tracking, free-space positioning, and in vitro phantom cannulation experiments. The results demonstrate sub-millimeter accuracy throughout the operating workspace of the manipulator and a high rate of success when cannulating phantom veins in a skin-mimicking tissue model. PMID:26257588

  2. Clamping of fine Kirschner wires in external fixators.

    PubMed

    Zamani, Ahmad R; Oyadiji, S Olutunde

    2016-11-01

    In Ilizarov circular (ring) external fixators, fine Kirschner wires are used to fix the bone to the fixator. Clamping of the wires to the rings with different bolt torques has been studied. However, the relation between the bolt torque and the fixation load applied to the wire was not investigated. In this work, finite element method is used to address this problem. Here, a fully three-dimensional model of the wire fixation assembly was built, with geometric details like threads on the bolt to produce a realistic simulation of the clamping of the wire. Both cannulated and slotted bolt types were studied and values of 0.2, 0.25, 0.3 and 0.45 were used for coefficient of friction. A torque was applied to the nut while the ring section and bolt kept in place. The results for bolt load, nut rotation as well as axial and radial wire deformations were obtained. The results demonstrated a linear relation between the bolt load and the bolt torque. The coefficient of this relationship was shown to be inversely proportional to the coefficient of friction. For all results, the bolt load (N) was approximately 124 times the bolt torque (N m) divided by the friction coefficient. The results highlighted the difference between the cannulated and the slotted bolts in terms of their grip on the wire.

  3. A case of pancreaticobiliary maljunction with a connecting duct without a long common channel.

    PubMed

    Kikuyama, Masataka; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Koizumi, Satomi; Tabata, Taku; Honda, Goro

    2017-04-01

    Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall, usually forming an abnormally long common channel. In PBM, since the long common channel defeats the effect of the sphincter of Oddi, pancreatobiliary reflux frequently occurs, resulting in high rates of biliary tract cancers. We present the case of a 68-year-old female with advanced gallbladder cancer concomitant with bile duct cancer associated with PBM without biliary dilatation that had an extremely rare configuration showing a connecting duct without a long common channel. Pancreatography in the selectively cannulated main pancreatic duct showed the terminal portion of the common bile duct via an abnormal connecting duct. Cholangiography in the selectively cannulated lower bile duct showed the main and accessory pancreatic ducts via the connecting duct. The bile amylase level was markedly elevated. This case of a rare configuration of PBM with a connecting duct without a long common channel is the first such reported case in the English literature.

  4. FRET detection of Octamer-4 on a protein nanoarray made by size-dependent self-assembly

    PubMed Central

    Tran, Phat L.; Gamboa, Jessica R.; You, David J.

    2010-01-01

    An alternative approach for fabricating a protein array at nanoscale is suggested with a capability of characterization and/or localization of multiple components on a nanoarray. Fluorescent micro- and nanobeads each conjugated with different antibodies are assembled by size-dependent self-assembly (SDSA) onto nanometer wells that were created on a polymethyl methacrylate (PMMA) substrate by electron beam lithography (EBL). Antibody-conjugated beads of different diameters are added serially and electrostatically attached to corresponding wells through electrostatic attraction between the charged beads (confirmed by zeta potential analysis) and exposed p-doped silicon substrate underneath the PMMA layer. This SDSA method is enhanced by vibrated-wire-guide manipulation of droplets on the PMMA surface containing nanometer wells. Saturation rates of antibody-conjugated beads to the nanometer patterns are up to 97% under one component and 58–70% under two components nanoarrays. High-density arrays (up to 40,000 wells) could be fabricated, which can also be multi-component. Target detection utilizes fluorescence resonance energy transfer (FRET) from fluorescent beads to fluorescent-tagged secondary antibodies to Octamer-4 (Oct4), which eliminates the need for multiple steps of rinsing. The 100 nm green beads are covalently conjugated with anti-Oct4 to capture Oct4 peptides (39 kDa); where the secondary anti-Oct4 and F(ab)2 fragment of anti-gIgG tagged with phycoerythrin are then added to function as an indicator of Oct4 detection. FRET signals are detected through confocal microscopes, and further confirmed by Fluorolog3 spectrofluorometer. The success rates of detecting Oct4 are 32% and 14% of the beads in right place under one and two component nanoarrays, respectively. Ratiometric FRET is used to quantify the amount of Oct4 peptides per each bead, which is estimated about 2 molecules per bead. PMID:20652550

  5. Holmium:YAG laser and guidewires; is there a durability difference among guidewires against laser energy? An in-vitro experimental study.

    PubMed

    Bagbanci, Sahin

    2017-03-07

    Purpose To evaluate the durability differences between five different type of guidewire against laser energy in an in-vitro experimental ureteral model. Methods The study was performed at the Department of Urology, Medicine Faculty of Ahi Evran University. An in-vitro experimental ureteral model was created for the work; a silicon ureteral model in a saline filled container. Experiments were performed on five different type of guidewire; ZIPwire, Sensor PTFE Nitinol guidewire, Roadrunner® PC wire guide, Amplatz Super Stiff and Zebra Urologic Guidewire. These guidewires were grouped from one to five, respectively. Laser fibers were contacted to the guidewire, and laser energy was fired to the pre-marked tip and body parts in different adjustments. Results The breakage of the guidewires was detected only on the flexible tip parts in group1.a, group1.b, group2.a, group 2.b, group4.a, and group4.b. The body parts of the guidewires were resistant against laser energy in all groups and did not break. The breakage of the guidewires occurred after 3-joule x 10 hertz (30 Watt) experiment. Group-1a and 1b were different from group-2a,2b,4a, and 4b according to Kruskal-Wallis H test. Conclusions The body parts of the guidewires in all study groups were resistant against laser energy. The tip parts of ZipwireTM, SensorTM PTFE Nitinol, and Amplatz Super StiffTM guidewire should be kept away from the surgical field when the high power settings of the laser are being used. The body parts of the guidewires can be utilized in the surgical field safely.

  6. System safety management lessons learned from the US Army acquisition process

    SciTech Connect

    Piatt, J.A.

    1989-05-01

    The Assistant Secretary of the Army for Research, Development and Acquisition directed the Army Safety Center to provide an audit of the causes of accidents and safety of use restrictions on recently fielded systems by tracking residual hazards back through the acquisition process. The objective was to develop lessons learned'' that could be applied to the acquisition process to minimize mishaps in fielded systems. System safety management lessons learned are defined as Army practices or policies, derived from past successes and failures, that are expected to be effective in eliminating or reducing specific systemic causes of residual hazards. They are broadly applicable and supportive of the Army structure and acquisition objectives. Pacific Northwest Laboratory (PNL) was given the task of conducting an independent, objective appraisal of the Army's system safety program in the context of the Army materiel acquisition process by focusing on four fielded systems which are products of that process. These systems included the Apache helicopter, the Bradley Fighting Vehicle (BFV), the Tube Launched, Optically Tracked, Wire Guided (TOW) Missile and the High Mobility Multipurpose Wheeled Vehicle (HMMWV). The objective of this study was to develop system safety management lessons learned associated with the acquisition process. The first step was to identify residual hazards associated with the selected systems. Since it was impossible to track all residual hazards through the acquisition process, certain well-known, high visibility hazards were selected for detailed tracking. These residual hazards illustrate a variety of systemic problems. Systemic or process causes were identified for each residual hazard and analyzed to determine why they exist. System safety management lessons learned were developed to address related systemic causal factors. 29 refs., 5 figs.

  7. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    PubMed

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  8. Rocket center Peenemünde — Personal memories

    NASA Astrophysics Data System (ADS)

    Dannenberg, Konrad; Stuhlinger, Ernst

    Von Braun built his first rockets as a young teenager. At 14, he started making plans for rockets for human travel to the Moon and Mars. The German Army began a rocket program in 1929. Two years later, Colonel (later General) Becker contacted von Braun who experimented with rockets in Berlin, gave him a contract in 1932, and, jointly with the Air Force, in 1936 built the rocket center Peenemünde where von Braun and his team developed the A-4 (V-2) rocket under Army auspices, while the Air Force developed the V-1 (buzz bomb), wire-guided bombs, and rocket planes. Albert Speer, impressed by the work of the rocketeers, allowed a modest growth of the Peenemünde project; this brought Dannenberg to the von Braun team in 1940. Hitler did not believe in rockets; he ignored the A-4 project until 1942 when he began to support it, expecting that it could turn the fortunes of war for him. He drastically increased the Peenemünde work force and allowed the transfer of soldiers from the front to Peenemünde; that was when Stuhlinger, in 1943, came to Peenemünde as a Pfc.-Ph.D. Later that year, Himmler wrenched the authority over A-4 production out of the Army's hands, put it under his command, and forced production of the immature rocket at Mittelwerk, and its military deployment against targets in France, Belgium, and England. Throughout the development of the A-4 rocket, von Braun was the undisputed leader of the project. Although still immature by the end of the war, the A-4 had proceeded to a status which made it the first successful long-range precision rocket, the prototype for a large number of military rockets built by numerous nations after the war, and for space rockets that launched satellites and traveled to the Moon and the planets.

  9. Current status of ultrasound-guided surgery in the treatment of breast cancer

    PubMed Central

    Volders, José H; Haloua, Max H; Krekel, Nicole MA; Meijer, Sybren; van den Tol, Petrousjka M

    2016-01-01

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant

  10. Comparison of bloat potential between a variety of soft-red versus a variety of hard-red winter wheat forage.

    PubMed

    Akins, M S; Kegley, E B; Coffey, K P; Caldwell, J D; Lusby, K S; Moore, J C; Coblentz, W K

    2009-10-01

    Some aspects of wheat pasture bloat have been researched extensively, but few studies have evaluated the effect of wheat type or variety on bloat. Eight Gelbvieh x Angus ruminally cannulated heifers (515 +/- 49 kg of BW) and 48 Angus heifers (238 +/- 12 kg of BW) grazed 1-ha pastures of hard-red or soft-red winter wheat (Triticum aestivum L.) to evaluate the effect of wheat variety on bloat potential. In Exp. 1, cattle grazed from November 11 to 22 and from November 26 to December 7, 2006, in a crossover design. In Exp. 2, cattle were shrunk for 20 h and then grazed from December 19 to 20, 2006, and from January 19 to 20, 2007. In both experiments, bloat was scored at 1000 and 1600 h daily. Rumen samples were collected at 0600, 1200, and 1800 h during each of the last 2 d of each period in Exp. 1 and during both days of each period of Exp. 2. Rumen samples were evaluated for pH, foam production and strength, and viscosity. In Exp. 1, cannulated heifers grazing soft-red had a greater (P < 0.01) percentage of observed bloat (21.9 vs. 5.6%) than those grazing hard-red winter wheat, but bloat incidence was low (2.1%) for the stocker cattle, with no difference between hard-red and soft-red winter wheat (P = 0.52). Viscosity of the rumen fluid was affected (P = 0.03) by the wheat variety x time interaction, with soft-red at 1200 and 1800 h being more viscous than soft-red at 0600 h and hard-red at all times. Foam strength, as determined by bubbling CO(2) gas through rumen fluid, had a wheat variety x time interaction (P = 0.02) with both wheat varieties similar at 0600 h but soft-red having greater foam strength at 1200 and 1800 h. In Exp. 2, no bloat was observed, and no differences between wheat varieties were observed for any of the rumen foam measures. Therefore, for these 2 varieties, the soft-red winter wheat had a greater bloat potential than the hard-red winter wheat based on results from the cannulated heifers, but no differences were observed in the frequency

  11. Acute Radiation Hypotension in the Rabbit: a Model for the Human Radiation Shock Syndrome.

    NASA Astrophysics Data System (ADS)

    Makale, Milan Theodore

    This study has shown that total body irradiation (TBI) of immature (40 to 100 day old) rabbits leads to an acute fall in mean arterial pressure (MAP) 30 to 90 minutes after exposure, which takes no more than about three minutes, and often results in pressures which are less than 50% of the lowest pre-exposure MAP. This is termed acute cardiovascular collapse (ACC). ACC is often accompanied by ECG T-wave elevation, a sharp rise in ear temperature, labored breathing, pupillary constriction, bladder emptying, and loss of abdominal muscle tone. About 73% of 40 to 100 day rabbits exhibit ACC; the others and most older rabbits display gradual pressure reductions (deliberate hypotension) which may be profound, and which may be accompanied by the same changes associated with ACC. ACC and deliberate hypotension occurred in rabbits cannulated in the dorsal aorta, and in non-operated animals. The decline in MAP for all 40 to 100 day cannulated rabbits (deliberate and ACC responders) is 55.4%. The experiments described below only involved 40 to 100 day cannulated TBI rabbits. Heart region irradiation resulted in an average MAP decline of 29.1%, with 1/15 rabbits showing ACC. Heart shielding during TBI reduced the decline in MAP to 19%, with 1/10 rabbits experiencing ACC. These results imply that the heart region, which includes the heart, part of the lungs, neural receptors, roots of the systemic vessels, and the blood, is a sensitive target. Bilateral vagotomy reduced the decline in MAP to 24.9%, and abolished ACC. Atropine (6 mg/kg) reduced the frequency of ACC to 26%, and the decline in MAP to 41.4%. In 11/13 rabbits the voltage generated by left vagal transmission rose after TBI. The vagi appear to participate in radiation hypotension. Heart shielding together with bilateral vagotomy reduced the decline in MAP to only 9.9%, with no ACC responders. The mean right ventricular pressure (MRVP) rose after TBI in 8/10 rabbits. In animals which displayed either ACC or steep

  12. The impact of work time control on physicians' sleep and well-being.

    PubMed

    Tucker, P; Bejerot, E; Kecklund, G; Aronsson, G; Åkerstedt, T

    2015-03-01

    Physicians' work schedules are an important determinant of their own wellbeing and that of their patients. This study considers whether allowing physicians control over their work hours ameliorates the effects of demanding work schedules. A questionnaire was completed by hospital physicians regarding their work hours (exposure to long shifts, short inter-shift intervals, weekend duties, night duties, unpaid overtime; and work time control), sleep (quantity and disturbance) and wellbeing (burnout, stress and fatigue). Work time control moderated the negative impact that frequent night working had upon sleep quantity and sleep disturbance. For participants who never worked long shifts, work time control was associated with fewer short sleeps, but this was not the case for those who did work long shifts. Optimizing the balance between schedule flexibility and patient needs could enhance physicians' sleep when working the night shift, thereby reducing their levels of fatigue and enhancing patient care.

  13. HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria.

    PubMed

    Von der Heidt, Andreas; Ammenwerth, Elske; Bauer, Karl; Fetz, Bettina; Fluckinger, Thomas; Gassner, Andrea; Grander, Willhelm; Gritsch, Walter; Haffner, Immaculata; Henle-Talirz, Gudrun; Hoschek, Stefan; Huter, Stephan; Kastner, Peter; Krestan, Susanne; Kufner, Peter; Modre-Osprian, Robert; Noebl, Josef; Radi, Momen; Raffeiner, Clemens; Welte, Stefan; Wiseman, Andreas; Poelzl, Gerhard

    2014-11-01

    Heart failure (HF) is approaching epidemic proportions worldwide and is the leading cause of hospitalization in the elderly population. High rates of readmission contribute substantially to excessive health care costs and highlight the fragmented nature of care available to HF patients. Disease management programs (DMPs) have been implemented to improve health outcomes, patient satisfaction, and quality of life, and to reduce health care costs. Telemonitoring systems appear to be effective in the vulnerable phase after discharge from hospital to prevent early readmissions. DMPs that emphasize comprehensive patient education and guideline-adjusted therapy have shown great promise to result in beneficial long-term effects. It can be speculated that combining core elements of the aforementioned programs may substantially improve long-term cost-effectiveness of patient management.We introduce a collaborative post-discharge HF disease management program (HerzMobil Tirol network) that incorporates physician-controlled telemonitoring and nurse-led care in a multidisciplinary network approach.

  14. The future of general medicine.

    PubMed

    Firth, John

    2014-08-01

    It is a truth universally acknowledged that there is a problem with general medicine. Physicians have become increasingly specialised over the past 30 years or so, and specialist care has produced increasingly better outcomes for some patients. The patients left behind are looked after by general medicine, where demand is increasing, operational priority within hospitals is low, there is little professional kudos and recruitment is suffering. Three recent reports - Hospitals on the Edge?, the Future Hospital Commission report, and the Shape of Training report - have described the problems, but not articulated compelling solutions. Here, I discuss what is good about general medicine, what is bad and make suggestions for improvement. These involve getting specialities to take responsibility for care of appropriate admissions automatically and without delay, giving general physicians control over the service that they provide, and using well-chosen financial drivers to support movement in the right direction.

  15. Fetal and neonatal imaging and strategy of primary neonatal heart transplantation in hypoplastic left heart with Ebstein's anomaly.

    PubMed

    Hammel, James M; Danford, David A; Spicer, Robert L; Kutty, Shelby

    2015-03-01

    We present the anatomic constellation of mitral stenosis/aortic atresia variant of hypoplastic left heart syndrome, Ebstein's anomaly, and partial anomalous pulmonary venous return, an exceeding rare congenital heart defect. Prenatal echocardiography led to concern about the capacity of the right ventricle to increase cardiac output with lung expansion and pulmonary arterial runoff at birth, prompting the precaution of extracorporeal membrane oxygenator standby at delivery. Stage I palliation was not attempted, and control of pulmonary arterial blood flow was achieved with pulmonary artery banding, allowing sufficient ongoing hemodynamic stability. Orthotopic cardiac transplantation, repair of hypoplastic aortic arch, and primary sutureless repair of left pulmonary veins was performed, using dual-site arterial cannulation and continuous mild hypothermic cardiopulmonary bypass. We discuss how this unique echocardiographic anatomy influenced the surgical decision and point out how it guided therapy toward a strategy of primary transplantation rather than standard staged surgical palliation.

  16. Bilateral Femoral Neck Fatigue Fracture due to Osteomalacia Secondary to Celiac Disease: Report of Three Cases.

    PubMed

    Selek, Ozgur; Memisoglu, Kaya; Selek, Alev

    2015-08-01

    Bilateral non traumatic femoral neck fatigue fracture is a rare condition usually occurring secondary to medical conditions such as pregnancy, pelvic irradiation, corticosteroid exposure, chronic renal failure and osteomalacia. In this report, we present three young female patients with bilateral femoral neck fracture secondary to osteomalacia. The underlying cause of osteomalacia was Celiac disease in all patients. The patients were treated with closed reduction and internal fixation with cannulated lag screws. They were free of pain and full weight bearing was achieved at three months. There were no complications, avascular necrosis and nonunion during the follow up period. In patients with bone pain, non traumatic fractures and muscle weakness, osteomalacia should be kept in mind and proper diagnostic work-up should be performed to identify the underlying cause of osteomalacia such as celiac disease.

  17. Patellar fractures--a review of classification, genesis and evaluation of treatment.

    PubMed

    Neumann, M V; Niemeyer, P; Südkamp, N P; Strohm, P C

    2014-01-01

    The patellar bone is involved in repetitive, load bearing motion sequences every day and functions as a vectorial force translator. A fracture rate of 1% of all skeletal fractures is reported and surgical treatment often required. beside a direct trauma mechanism, indirect mechanism but as well as fatigue fractures after reconstructive knee surgery are published. The fracture management is dependent on the soft tissue condition and a variety of surgical options are known. new generation of low profile plates show promising results but the conventional cerclage wiring technique with K-wires is widely preferred. best functional results with sustainable stability are biomechanically seen after a combined fixation technique using anterior cerclage wiring with cannulated screw fixation. A definite algorithm of treatment of patellar bone fractures is yet not defied but a review of classification and surgical techniques should give assistance in decision making.

  18. Effect of abomasal infusion of aspartate on nitrogen balance and plasma amino acids in Holstein steers.

    PubMed

    Wessels, R H; Titgemeyer, E C

    1998-01-01

    We investigated the effect of abomasally infused aspartate (Asp) on N balance and plasma amino acids in steers. Four ruminally cannulated Holstein steers (180 kg) housed in metabolism crates were used in an experiment designed as a 4 x 3 Youden square. Steers received continuous abomasal infusions of water or water containing 40 or 80 g Asp/d. Steers were fed twice daily a diet containing 473 g/kg corn, 463 g/kg alfalfa hay and 52 g/kg soybean meal at levels near ad libitum intake. Abomasally infused Asp had no effect on N balance. Infusion of 80 g Asp/d increased (P < 0.05) plasma concentrations of Asp, glutamate and alanine. Metabolism of Asp by gut tissues probably prevented the large change in plasma concentration of Asp that seems necessary to trigger hormonal responses. We conclude that abomasal supplementation of steers with up to 80 g/d of Asp does not enhance performance.

  19. Morphology of the pancreatic ductal epithelium after traumatization of the papilla of Vater or endoscopic retrograde pancreatography with various contrast media in cats.

    PubMed

    Bub, H; Bürner, W; Riemann, J F; Stolte, M

    1983-07-01

    The epithelium of the pancreatic duct in cats was examined histologically, in the scanning electron and in the transmission electron microscope, after traumatization of the papilla of Vater or after pancreatography (ERP) with various contrast media. Ten minutes after traumatizing the papilla by repeated cannulation, we found lesions of the surface membrane of the epithelial cells. After ERP with the contrast media metrizamide and sodium meglumine ioxaglate, in the acute experiments, the least damage was observed when the low-osmolar, non-ionic metrizamide was used. In our chronic experiments the epithelial changes did not correlate with the contrast medium used. The degree of papillary stenoses and, probably, the initial injection pressure are more important. A mixture of the antiseptic polyvinyl pyrrolidone iodine to the contrast medium, which would prevent a bacterial contamination of the pancreatic duct after ERP, is morphologically justifiable but entails a risk of latent hyperthyroidism. Parenchymography with this mixture damaged the epithelium more than pancreatography.

  20. En bloc transplantation of horseshoe kidney in Korea

    PubMed Central

    Bang, Jun Bae; Lee, Jae Myeong; Oh, Chang-Kwon; Lee, Kyo Won; Park, Jae Berm; Kim, Sung Joo

    2017-01-01

    Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney. PMID:28289672

  1. Subclavian artery pseudoaneurysm complicating central venous catheterization: endovascular treatment with Amplatzer Vascular Plug 4 and covered stent.

    PubMed

    Rossi, Umberto G; Petrocelli, Francesco; Ferro, Carlo

    2013-12-01

    Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. The patient underwent urgent endovascular treatment with deployment of covered stent into the left subclavian artery (SCA) after embolization of the origin of the left internal mammary artery with Amplatzer Vascular Plug 4. The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.

  2. [Persistent left superior vena cava. Implications in central venous catheterisation].

    PubMed

    Lacuey Lecumberri, G; Ureña, M; Martínez Basterra, J; Basterra, N

    2009-01-01

    The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC). The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient.

  3. pH-adjustment and discomfort caused by the intradermal injection of lignocaine.

    PubMed

    Martin, A J

    1990-11-01

    One hundred adult day-case patients who required intravenous access had cannulae inserted using local anaesthesia with 1% lignocaine, 1% lignocaine with adrenaline or the corresponding pH-adjusted solutions. The local anaesthetic solutions were modified by the addition of 1 ml 8.4% sodium bicarbonate to 10 ml lignocaine. Pain scores at different stages of cannulation were noted and showed a significant reduction after use of pH-adjusted solutions (p less than 0.02 for the plain lignocaine, and less than 0.001 for the lignocaine with adrenaline). Modification of the pH of lignocaine solutions by the addition of sodium bicarbonate is a simple method significantly to reduce the discomfort caused by the infiltration of the local anaesthetic.

  4. An extraordinary mechanism causing intraoperative migration of the Kirschner-wire.

    PubMed

    Eroğlu, Mehmet; Özcan, Özal; Şentürk, İhsan; Yücehan, Mehmet

    2016-01-01

    Migration of Kirschner wires (K-wires) postoperatively and with use of cannulated implants intraoperatively is a well-known complication. In this article, we present an extraordinary mechanism causing intraoperative migration of a K-wire. A K-wire which was used for temporary fixation of fracture fragments migrated forwardly due to its contact with the drill bit while drilling a hole for a screw. The interaction between the K-wire and the drill bit simulated a gear wheel effect and thus the rotating K-wire advanced. Although no complications occurred in this case, we believe that the mentioned mechanism may be of importance particularly in osteoporotic patients and may cause damage to vital structures.

  5. Minimally invasive valve surgery.

    PubMed

    Woo, Y Joseph; Seeburger, Joerg; Mohr, Friedrich W

    2007-01-01

    As alternatives to standard sternotomy, surgeons have developed innovative, minimally invasive approaches to conducting valve surgery. Through very small skin incisions and partial upper sternal division for aortic valve surgery and right minithoracotomy for mitral surgery, surgeons have become adept at performing complex valve procedures. Beyond cosmetic appeal, apparent benefits range from decreased pain and bleeding to improved respiratory function and recovery time. The large retrospective studies and few small prospective randomized studies are herein briefly summarized. The focus is then directed toward describing specific intraoperative technical details in current clinical use, covering anesthetic preparation, incision, mediastinal access, cardiovascular cannulation, valve exposure, and valve reconstruction. Finally, unique situations such as pulmonic valve surgery, reoperations, beating heart surgery, and robotics are discussed.

  6. An implantable blood pressure and flow transmitter.

    NASA Technical Reports Server (NTRS)

    Rader, R. D.; Meehan, J. P.; Henriksen, J. K. C.

    1973-01-01

    A miniature totally implantable FM/FM telemetry system has been developed to simultaneously measure blood pressure and blood flow, thus providing an appreciation of the hemodynamics of the circulation to the entire body or to a particular organ. Developed for work with animal subjects, the telemetry system's transmission time is controlled by an RF signal that permits an operating life of several months. Pressure is detected by a miniature intravascular transducer and flow is detected by an extravascular interferometric ultrasonic technique. Both pressure and flow are calibrated prior to implanting. The pressure calibration can be checked after the implanting by cannulation; flow calibration can be verified only at the end of the experiment by determining the voltage output from the implanted sensing system as a function of several measured flow rates. The utility of this device has been established by its use in investigating canine renal circulation during exercise, emotional encounters, administration of drugs, and application of accelerative forces.

  7. Presentation of hemiplegic migraine--hemiplegia and hemi-sensory loss following general anaesthesia.

    PubMed

    Lin, L; Adey, C

    2007-06-01

    We report a case of a 15-year-old male who developed severe left-sided hemiplegia and hemi-sensory loss 20 minutes after arrival in post anaesthetic care unit following an uneventful general anaesthesia for removal of a cannulated screw of left hip. Initial CT and MRI/MRA with diffusion-weighted imaging were unremarkable. The patient was transferred to The Royal Children's Hospital Melbourne and was commenced on heparin infusion pending investigation results. Complete recovery occurred within 36 hours. Eventually, hemiplegic migraine was diagnosed on the basis of negative investigations and a retrospective history of the patient's migraine. This case demonstrates that the management of peri-operative neurological deficits must be approached in a systematic fashion. Hemiplegic migraine is a well-defined clinical syndrome. It is not merely a diagnosis of exclusion.

  8. A review of the iStent® trabecular micro-bypass stent: safety and efficacy

    PubMed Central

    Wellik, Sarah R; Dale, Elizabeth A

    2015-01-01

    There is a significant demand for procedures that can effectively treat glaucoma with low risk and good visual outcomes. To fill this void, procedures termed “minimally invasive glaucoma surgery”, are gaining in popularity. This review will focus on the safety and efficacy of one such minimally invasive glaucoma surgery procedure, the trabecular micro-bypass stent. This stent is intended to lower intraocular pressure by directly cannulating Schlemm’s canal and thereby enhancing aqueous outflow. Recent randomized controlled trials and case series have demonstrated the micro-bypass stent to be a relatively safe procedure, with limited complications and no serious adverse sequelae. The most common complication across all studies was stent obstruction or malposition, which generally did not result in any adverse outcome in vision or pressure control. In addition, increased rates of hypotony, choroidal hemorrhage, or infection were not seen with the micro-bypass stent in comparison to cataract surgery alone. PMID:25931808

  9. The Biology of Hemodialysis Vascular Access Failure

    PubMed Central

    Brahmbhatt, Akshaar; Misra, Sanjay

    2016-01-01

    Arteriovenous fistulas (AVFs) are essential for patients and clinicians faced with end-stage renal disease (ESRD). While this method of vascular access for hemodialysis is preferred to others due to its reduced rate of infection and complications, they are plagued by intimal hyperplasia. The pathogenesis of intimal hyperplasia and subsequent thrombosis is brought on by uremia, hypoxia, and shear stress. These forces upregulate inflammatory and proliferative cytokines acting on leukocytes, fibroblasts, smooth muscle cells, and platelets. This activation begins initially with the progression of uremia, which induces platelet dysfunction and primes the body for an inflammatory response. The vasculature subsequently undergoes changes in oxygenation and shear stress during AVF creation. This propagates a strong inflammatory response in the vessel leading to cellular proliferation. This combined response is then further subjected to the stressors of cannulation and dialysis, eventually leading to stenosis and thrombosis. This review aims to help interventional radiologists understand the biological changes and pathogenesis of access failure. PMID:27011423

  10. Proof of concept: Developing a peer reviewed, evidence-based, interactive e-learning programme.

    PubMed

    Sinclair, Peter; Schoch, Monica; Black, Kirsten; Woods, Matthew

    2011-06-01

    Knowledge and skill acquisition related to vascular access are traditionally individual institutional educational initiatives. Australia currently has no national evidence based education programme for renal nurses. A survey of Australian and New Zealand Nephrology Educators' conducted in 2009, identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web-based approaches supporting the tenets of e-learning methodologies. This paper discusses the development, implementation and proposed evaluation of a peer reviewed Australasian e-learning programme on buttonhole cannulation. It will further highlight the benefits of inter-organisational partnerships and how these partnerships can facilitate positive change in teaching and learning practices. This project has unique characteristics that collectively provide value, distinction and innovation to nurses, patients and renal departments. As the e-learning programme was founded on a platform of evidence-based practice it is therefore easily transferable to an international context.

  11. Isolated fracture-dislocation of the scaphoid's proximal pole treated by scaphoid internal fixation and scapho-lunate ligament reconstruction.

    PubMed

    Rosati, Marco; Parchi, Paolo; Lisanti, Michele

    2009-05-01

    We present a case of irreducible palmar dislocation of the proximal fragment of a scaphoid fracture without carpal dislocation. We observed this lesion 2 days after the injury and we immediately operated the patient with a combined volar and dorsal access: using the Henry access we reduced the fracture and we inserted a cannulated screw to synthesize the scaphoid, using the dorsal access we repaired the complete rupture of the scapho-lunate ligament using a mini anchor. Stabilization among scaphoid, lunate and capitate was performed using Kirschner wires. X-ray showed fracture healing after 90 days. No clinical or radiographic evidence of carpal instability was revealed, on standard X-rays or on dynamic evaluations. No sign of avascular necrosis or degenerative arthritis was observed after 9 months.

  12. PubMed Central

    Montevecchi, F.; Meccariello, G.; Hoff, P.T.; Corso, R.M.; Galletti, C.; Al-Rawashdeh, M.F.H.; Vicini, C.

    2017-01-01

    SUMMARY Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis. PMID:28374870

  13. [Triple fracture of the shoulder suspensory complex].

    PubMed

    Tamimi Mariño, I; Martin Rodríguez, I; Mora Villadeamigo, J

    2013-01-01

    The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly.

  14. Disposable non-sterile gloves: a policy for appropriate usage.

    PubMed

    Raybould, L M

    Since the implementation of universal precautions, the use of disposable gloves has become part of everyday clinical practice. Guidance has been published to advise healthcare workers of the risks of latex allergies associated with the wearing of powdered latex gloves. The literature supports the use of gloves when contact with blood or body fluids is likely. However, an audit of glove usage indicated that practitioners were wearing gloves inappropriately, i.e. to wash patients (20%). The results of this study also demonstrated that a small percentage of staff (20%) were wearing vinyl gloves to deal with blood spillages and for venepuncture (13%) and cannulation (10%). A glove policy and a flow chart to assist staff in the selection of gloves were introduced. An educational programme for all hospital staff was commenced. These measures can assist healthcare workers in making an informed choice regarding glove usage.

  15. Bilateral stress fracture of femoral neck in non-athlete - case report.

    PubMed

    Oliveira, Ubiratan Stefani de; Labronici, Pedro José; João Neto, André; Nishimi, Alexandre Yukio; Pires, Robinson Esteves Santos; Silva, Luiz Henrique Penteado

    2016-01-01

    Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

  16. Sonographically guided placement of intravenous catheters in minipigs.

    PubMed

    Pinkernelle, Jens; Raschzok, Nathanael; Teichgräber, Ulf K M

    2009-07-01

    Many procedures in minipigs require establishment of reliable deep venous access with a large-bore catheter. In animal experiments, such catheters are typically implanted surgically. In clinical settings, however, ultrasound imaging is routinely used to facilitate safe, minimally invasive puncture of deep vessels. The authors describe a technique for using ultrasound guidance to puncture and cannulate the minipig femoral vein. They carried out the procedure in six minipigs for the purpose of injecting contrast agents for subsequent imaging scans. The procedure was ultimately successful in all pigs, took 10 min on average and resulted in no physiological complications. In one minipig, however, a 10-cm-long catheter became dislodged from the femoral vein; use of a longer (25-cm-long) catheter was optimal for establishing reliable intravenous access.

  17. Video-atlas on minimally invasive mitral valve surgery-The David Adams technique.

    PubMed

    Castillo, Javier G; Milla, Federico; Anyanwu, Anelechi C; Adams, David H

    2013-11-01

    Median sternotomy has unquestionably evolved over recent decades. Modern sternotomy involves a 7-8 cm lower midline skin incision, tunneling of the subcutaneous tissues with subsequent creation of myocutaneous flaps, full sternotomy, and standard cardiopulmonary bypass techniques with central cannulation. In experienced centers, modern sternotomy may achieve all the goals of minimally invasive surgery, including excellent cosmesis, excellent postoperative pain control, low rates of bleeding and transfusion (our re-exploration rate for bleeding is <1%), and the ability to perform any reconstructive technique that would be used in a standard sternotomy, with very high repair rates (our most recent series documented a repair rate exceeding 99% in an all-comers population of degenerative disease regardless of complexity).

  18. An unusual case of simultaneous bilateral neck of femur fracture following electrocution injury-A case report and review of literature

    PubMed Central

    Nekkanti, Supreeth; Vijay, C; Theja, JS Sujana; RaviShankar, R; Raj, Sumit

    2016-01-01

    Introduction: Simultaneous bilateral fractures of the neck of femur is rare. Hypocalcemia, epilepsy, osteoporosis and electrical injuries are known to cause similar injuries. Case Report: We report a case of a 43-year-old male who sustained an electrical shock injury following which he fell from a height of around 4 feet. Radiological studies confirmed bilateral transcervical neck of femur fracture. Laboratory investigations revealed the patient had extremely low levels of vitamin D (11.1ng/ml). Patient was treated with three 6.5 mm cannulated cancellous screws on each side. Patient had good functional outcome at the end of one year. Conclusion: We report this case as a rare etiological combination of hypovitaminosis D and electrical injury causing bilateral neck of femur fracture. Such injuries should be diagnosed at the earliest and goal of treatment should be to preserve both the hip joints. Early management would avoid potential complications like non-union and avascular necrosis. PMID:28116275

  19. A rare case of percutaneous coronary intervention in achondroplasia.

    PubMed

    Srinivas, Sunil Kumar; Ramalingam, Rangaraj; Manjunath, Cholenahally Nanjappa

    2013-06-01

    Achondroplastic individuals are associated with increased cardiac risk when compared to the general population. Coronary interventions in patients with achondroplasia have not been studied previously. We report the case of a 32-year-old male smoker with achondroplasia who presented with acute chest pain of 3 hours duration. He was diagnosed with acute inferior and right ventricular myocardial infarction and thrombolyzed with streptokinase. Since the patient continued to have pain and hypotension, he was taken for rescue percutaneous coronary intervention (PCI). Because of short stature and kyphoscoliosis, difficulties were faced in cannulating the coronaries and performing intervention. He had total occlusion of proximal right coronary artery, for which angioplasty with stenting was done. To our knowledge, this is the first case of PCI conducted in an achondroplastic patient.

  20. Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature

    PubMed Central

    Kida, Akihiko; Shirota, Yukihiro; Houdo, Yuji; Wakabayashi, Tokio

    2016-01-01

    The incidence of pancreatitis induced by anastomotic stricture following pancreaticodigestive tract anastomosis as a late-onset adverse event has been reported to be 3% or lower, but some cases repeatedly relapse and are difficult to treat. Endoscopic identification and treatment of the anastomotic site are considered to be difficult, and only a small number of cases have been reported. We present three cases with recurrent pancreatitis induced by anastomotic stricture following pancreaticojejunostomy applied after pancreaticoduodenectomy. We successfully identified the anastomotic site and performed endoscopic dilatation of the anastomotic stricture, and pancreatitis has not recurred. We characterized endoscopic features of the anastomotic site, understanding of which is essential to identify the site, and investigated useful techniques to identify the site and perform cannulation for pancreatography. Furthermore, we showed the safety and usefulness of endoscopic dilatation for anastomotic stricture following pancreaticojejunostomy according to our three cases and a review of the literature. PMID:27803744

  1. Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report

    PubMed Central

    Mazzini, Juan Pretell

    2009-01-01

    Introduction Elbow dislocations in children are uncommon injuries. Dislocations with associated fractures or so-called complex dislocations of the elbow can be challenging to diagnose and treat. Case presentation A 14-year-old male had a posterolateral elbow dislocation after a fall. Closed reduction with traction was performed. Radiographs after initial reduction showed a fragment entrapped into the humero-cubital joint. Computerized tomography scan showed the fragment belonging to the medial epicondyle. Open reduction and internal fixation with a 3.0 millimeter cannulated screw was performed, with restoring of the normal function of the elbow at final follow up. Conclusion Elbow dislocations in children can be associated with bone lesions. These injuries must be suspected to avoid misleading diagnosis and achieve good results. PMID:19829829

  2. Cross-limb vascular shunting for major limb replantation.

    PubMed

    Lee, Yao-Chou; Lee, Jing-Wei

    2009-02-01

    In the management of traumatic major limb amputation, rapid re-establishment of circulation to the amputated part is imperative so as to prevent complications related to reperfusion injury, especially for those already suffering from prolonged ischemia. A temporary, extra-anatomic cross limb shunting with infusion lines can be used to perfuse the amputated part almost instantaneously. This allows the surgeon to carry out skeletal fixation and other reparative works in an unhurried manner. The cannulation site is targeted at intact vessels far away from the injury zone, obviating the need to explore and handle traumatized vessels at the mangled stump ends, thus greatly simplifying and expediting the revascularization process. Such a method had been successfully applied in 2 young people suffering traumatic arm amputation and thigh amputation, respectively. We suggested that such a procedure could be a useful adjunct in the field of major limb replantation.

  3. [Experimental peritonitis: sequential bacteriologic study of the lymph and blood].

    PubMed

    Gramática, L; Dutari, C; Lada, P; Papa, E; Jaime, P; Gramática, L

    1989-12-01

    In 7 dogs with fecal peritonitis, induced by incision of the cecum, and in the same number of control animals the thoracic duct was cannulized at the neck level together with a femoral vein for the purpose of sequential study of the routes of bacterial dissemination. The findings show: a) rapid appearance of germs in lymph and then in blood in animals with peritonitis, b) a progressive increase in the number of species isolated in each sample, and c) that the lymphatic flow and drainage of bacterias lasted throughout the 12 hours that the experiment lasted. The microbes isolated in lymph and blood were related to the flora of the intestinal segment where the infection originated, with development of a large number of anaerobic species.

  4. Comparison of extracellular dopamine concentration in awake unstressed and postsurgical nitrous oxide sedated rats.

    PubMed

    Kofke, W A; Stiller, R L; Rose, M E

    1995-10-01

    Nitrous oxide (N2O), 70%, in O2 is often used as a control condition after surgical preparation in rodents undergoing neuroscience investigations. Concern has been expressed that this constitutes a stressful condition. Microdialysis was used in 15 rats to assess extracellular striatal dopamine concentrations during overnight soundproof isolation and on the following day after vascular cannulation and halothane excretion under N2O sedation with concomitant neuromuscular blockade. The overnight dialysate dopamine concentration was 22.8 +/- 8.7 pg/40 microliters. Thirty minutes after stopping halothane, the dialysate concentration was 362.6 +/- 91.6 pg/40 microliters during postsurgical N2O sedation. These data indicate that (a) compared to an unstressed baseline, significant brain dopamine effects occur with N2O sedation after surgery with halothane N2O anesthesia, and (b) baseline conditions can have a major effect on microdialysis data expressed as percentage of baseline.

  5. Pathologic Femoral Neck Fracture Due to Fanconi Syndrome Induced by Adefovir Dipivoxil Therapy for Hepatitis B

    PubMed Central

    Lee, Yoon-Suk; Kim, Byung-Kook; Lee, Ho-Jae

    2016-01-01

    In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved. PMID:27247753

  6. Current Opinions on Surgical Treatment of Fractures of the Condylar Head

    PubMed Central

    Boffano, Paolo; Benech, Rodolfo; Gallesio, Cesare; Arcuri, Francesco; Benech, Arnaldo

    2014-01-01

    Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the temporomandibular joint induced by the trauma. Several techniques have been proposed to reduce and fix fractures of the condylar head, such as standard bone screws, resorbable screws, resorbable pins, and cannulated lag screws. Therefore, the aim of this article is to review the literature about the surgical treatment of fractures of the condylar head to resume the current knowledge about open treatment of such fractures. PMID:25050145

  7. Cafeteria diet induce changes in blood flow that are more related with heat dissipation than energy accretion

    PubMed Central

    Sabater, David; Agnelli, Silvia; Arriarán, Sofía; Romero, María del Mar; Fernández-López, José Antonio; Alemany, Marià

    2016-01-01

    Background. A “cafeteria” diet is a self-selected high-fat diet, providing an excess of energy, which can induce obesity. Excess of lipids in the diet hampers glucose utilization eliciting insulin resistance, which, further limits amino acid oxidation for energy. Methods. Male Wistar rats were exposed for a month to “cafeteria” diet. Rats were cannulated and fluorescent microspheres were used to determine blood flow. Results. Exposure to the cafeteria diet did not change cardiac output, but there was a marked shift in organ irrigation. Skin blood flow decreased to compensate increases in lungs and heart. Blood flow through adipose tissue tended to increase in relation to controls, but was considerably increased in brown adipose tissue (on a weight basis). Discussion. The results suggest that the cafeteria diet-induced changes were related to heat transfer and disposal. PMID:27547590

  8. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

    SciTech Connect

    Amoretti, Nicolas Gallo, Giacomo Bertrand, Anne-Sophie; Bard, Robert L.; Kelekis, Alexis

    2016-01-15

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  9. Suppression of postprandial hypertriglyceridemia in rats and mice by oolong tea polymerized polyphenols.

    PubMed

    Toyoda-Ono, Yoshiko; Yoshimura, Makiko; Nakai, Masaaki; Fukui, Yuko; Asami, Sumio; Shibata, Hiroshi; Kiso, Yoshinobu; Ikeda, Ikuo

    2007-04-01

    Oolong tea-polymerized polyphenols (OTPP) are characterized polyphenols produced from semi-fermented tea (oolong tea). In the present study, we evaluated the suppressive effects of oolong tea extract and OTPP on postprandial hypertriglyceridemia in rats and mice. Lymphatic recovery of triglycerides in rats cannulated in the thoracic duct was delayed by the administration of oolong tea extract at 100 and 200 mg per head, and more effectively than with green tea extract. OTPP delayed lymphatic triglyceride absorption at 20 mg/head, though (-)-epigallocatechin gallate (EGCG) did not do so at the same dose. OTPP also suppressed postprandial hypertriglyceridemia after administration of olive oil in mice. The area under the curve (AUC) of plasma triglycerides was significantly decreased, by 53% and 76%, in the 500 and 1,000 mg/kg OTPP groups respectively, as compared with the control group. These results suggest that OTPP is responsible for the suppression of hypertriglyceridemia by ingestion of oolong tea.

  10. Central venous catheter placement: where is the tip?

    PubMed

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  11. Posterior rat eye during acute intraocular pressure elevation studied using polarization sensitive optical coherence tomography

    PubMed Central

    Fialová, Stanislava; Augustin, Marco; Fischak, Corinna; Schmetterer, Leopold; Handschuh, Stephan; Glösmann, Martin; Pircher, Michael; Hitzenberger, Christoph K.; Baumann, Bernhard

    2016-01-01

    Polarization sensitive optical coherence tomography (PS-OCT) operating at 840 nm with axial resolution of 3.8 µm in tissue was used for investigating the posterior rat eye during an acute intraocular pressure (IOP) increase experiment. IOP was elevated in the eyes of anesthetized Sprague Dawley rats by cannulation of the anterior chamber. Three dimensional PS-OCT data sets were acquired at IOP levels between 14 mmHg and 105 mmHg. Maps of scleral birefringence, retinal nerve fiber layer (RNFL) retardation and relative RNFL/retina reflectivity were generated in the peripapillary area and quantitatively analyzed. All investigated parameters showed a substantial correlation with IOP. In the low IOP range of 14-45 mmHg only scleral birefringence showed statistically significant correlation. The polarization changes observed in the PS-OCT imaging study presented in this work suggest that birefringence of the sclera may be a promising IOP-related parameter to investigate. PMID:28101419

  12. Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation.

    PubMed

    Montevecchi, F; Cammaroto, G; Meccariello, G; Hoff, P T; Corso, R M; Galletti, C; Al-Rawashdeh, M F H; Vicini, C

    2017-02-01

    Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.

  13. Effects of neomycin on the biliary excretion and enterohepatic circulation of mestranol and 17beta-oestradiol.

    PubMed

    Brewster, D; Jones, R S; Symons, A M

    1977-05-15

    The continued circulation of free steroids depends on their resorption from the gut following the hydrolysis of biliary conjugates. In this study, the bile duct of female Wistar albino rats was cannulated. Animals receiving labeled steroids or labeled bile intraductally also had the duodenum fitted with a cannula connected with a dosing syringe. In neomycin-treated rats, recirculation was impaired up to 50%. The deconjugation of mestranol and estradiol biliary conjugates was shown in vitro uponiincubation with rat caecal microorganisms, and the inhibition of such hydrolysis by neomycin was observed in vitro. Neomycin pretreatment reduced the biliary excretion of mestranol and estradiol after intraductal administration. It was thought that suppression of the gut microflora by neomycin was a major factor in the impairment of the intrahepatic circulation of mestranol and estradiol metabolites. This effect may be important regarding the half-life of estrogenic compounds of the contraceptive pill.

  14. Off-pump insertion of an extracorporeal LVAD through a left upper-quadrant incision.

    PubMed

    Cohn, William E; Frazier, O H

    2006-01-01

    Insertion of an extracorporeal left ventricular assist device for temporary ventricular support via median sternotomy can be challenging in patients with a history of cardiac surgery, because these patients often poorly tolerate the lengthy dissection and cardiac manipulation necessary for exposure of the left ventricular apex and ascending aorta. Our approach, transdiaphragmatic left ventricular inflow cannulation with return through a graft sewn to the supraceliac aorta, can be accomplished through a left upper-quadrant abdominal incision without entering the peritoneal cavity, mediastinum, or left hemithorax. Repeated sternotomy and mediastinal dissection are thus avoided. To our knowledge, this report documents the 1st use of this technique for insertion of an extracorporeal pulsatile ventricular assist device for temporary ventricular support.

  15. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    PubMed

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  16. Pinolenic Acid in Structured Triacylglycerols Exhibits Superior Intestinal Lymphatic Absorption As Compared to Pinolenic Acid in Natural Pine Nut Oil.

    PubMed

    Chung, Min-Yu; Woo, Hyunjoon; Kim, Juyeon; Kong, Daecheol; Choi, Hee-Don; Choi, In-Wook; Kim, In-Hwan; Noh, Sang K; Kim, Byung Hee

    2017-03-01

    The positional distribution pattern of fatty acids (FAs) in the triacylglycerols (TAGs) affects intestinal absorption of these FAs. The aim of this study was to compare lymphatic absorption of pinolenic acid (PLA) present in structured pinolenic TAG (SPT) where PLA was evenly distributed on the glycerol backbone, with absorption of pine nut oil (PNO) where PLA was predominantly positioned at the sn-3 position. SPT was prepared via the nonspecific lipase-catalyzed esterification of glycerol with free FA obtained from PNO. Lymphatic absorption of PLA from PNO and from SPT was compared in a rat model of lymphatic cannulation. Significantly (P < 0.05) greater amounts of PLA were detected in lymph collected for 8 h from an emulsion containing SPT (28.5 ± 0.7% dose) than from an emulsion containing PNO (26.2 ± 0.6% dose), thereby indicating that PLA present in SPT has a greater capacity for lymphatic absorption than PLA from PNO.

  17. Selective serotonin reuptake inhibitor exposure constricts the mouse ductus arteriosus in utero.

    PubMed

    Hooper, Christopher W; Delaney, Cassidy; Streeter, Taylor; Yarboro, Michael T; Poole, Stanley; Brown, Naoko; Slaughter, James C; Cotton, Robert B; Reese, Jeff; Shelton, Elaine L

    2016-09-01

    Use of selective serotonin reuptake inhibitors (SSRIs) is common during pregnancy. Fetal exposure to SSRIs is associated with persistent pulmonary hypertension of the newborn (PPHN); however, a direct link between the two has yet to be established. Conversely, it is well known that PPHN can be caused by premature constriction of the ductus arteriosus (DA), a fetal vessel connecting the pulmonary and systemic circulations. We hypothesized that SSRIs could induce in utero DA constriction. Using isolated vessels and whole-animal models, we sought to determine the effects of two commonly prescribed SSRIs, fluoxetine and sertraline, on the fetal mouse DA. Cannulated vessel myography studies demonstrated that SSRIs caused concentration-dependent DA constriction and made vessels less sensitive to prostaglandin-induced dilation. Moreover, in vivo studies showed that SSRI-exposed mice had inappropriate DA constriction in utero. Taken together, these findings establish that SSRIs promote fetal DA constriction and provide a potential mechanism by which SSRIs could contribute to PPHN.

  18. AngioJet rheolytic thrombectomy for thrombotic myocardial injury in a 15-year-old cystic fibrosis patient during lung transplantation.

    PubMed

    Hayes, Don; Schell, Randall M; Plunkett, Mark D; Gurley, John C; Hoopes, Charles W

    2012-08-01

    We report on an acute myocardial injury caused by thrombotic emboli during off-pump bilateral sequential lung transplantation in a 15-year-old female patient with end-stage cystic fibrosis. A few minutes after reperfusion of the right (second sequential) allograft, the patient developed hemodynamic collapse, including hypotension, acute akinesis of the anterior and lateral myocardial walls, and severe mitral regurgitation. Thrombus was noted within the left atrium and ventricle on intraoperative transesophageal echocardiogram. After emergent cannulation for cardiopulmonary bypass, the patient underwent left cardiac catheterization with AngioJet rheolytic thrombectomy and removal of the clot from the distal left anterior descending coronary artery. Reperfusion was established without the need for stent placement or further intervention. The patient required short-term life support with venoarterial extracorporeal membrane oxygenation.

  19. Comparison of the inhibition of biliary excretion produced by certain inducing agents including 2,3,7,8-tetrachlorodibenzo-p-dioxin

    SciTech Connect

    Berman, E.F.; Schaus, P.; Fujimoto, J.M.

    1986-01-01

    Rats were treated with chlordecone, mirex, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and respective solvent vehicle. Under urethane or pentobarbital anesthesia, the bile duct was cannulated and radioactive morphine, imipramine, or ouabain was given by segmented retrograde intrabiliary injection. The spectrum of inhibition of biliary excretion by chlordecone and mirex were similar in that morphine glucuronide and in part polar imipramine metabolite recoveries in bile were decreased; ouabain recovery was unaffected. TCDD was different in that it markedly decreased the recovery of ouabain. Thus, it appears that chlordecone, mirex, and TCDD inhibit the canalicular transport of the glucuronide metabolites of morphine and imipramine into bile, and TCDD affects in addition the canalicular transport of ouabain into bile.

  20. Benzo(a)pyrene uptake by lymph: a possible transport mode for immunosuppressive chemicals

    SciTech Connect

    Busbee, D.L.; Joe, C.O.; Rankin, P.W.; Ziprin, R.L.; Wilson, R.D.

    1984-01-01

    Benzo(a)pyrene, a lipophilic promutagen, reached maximal concentrations in the thoracic duct lymphatic circulation within 2 h after gastric instillation. Benzo(a)pyrene in lymph obtained by thoracic duct cannulation decreased to approximately control levels within 4 h after treatment. When lymph was not allowed to enter the blood vascular circulation, serum levels of benzo(a)pyrene increased very slowly, suggesting minimal mesenteric blood vascular absorption of the lipophilic hydrocarbon. Benzo(a)pyrene partitions into lymph lipoproteins as a function of the lipoprotein concentration. Data suggest that low-density lipoproteins may take up benzo(a)pyrene more efficiently than do very low-density or high-density lipoproteins, and that lymph components other than lipoproteins do not take up and transport benzo(a)pyrene. We propose that lipophilic xenobiotic compounds interact with cells of the immune system via lymphatic lipoprotein transport of potentially mutagenic, carcinogenic, or immuno-suppressive agents.

  1. Delayed Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt: A Case Report and Literature Review.

    PubMed

    Ma, Li; Chen, Yi-Li; Yang, Shu-Xu; Wang, Yi-Rong

    2015-11-01

    The ventriculoperitoneal (VP) shunt is a routine procedure for cerebrospinal fluid (CSF) diversion, and is associated with many complications. A delayed hemorrhage after the VP shunt surgery, however, is quite rare. In this study, we report a case involving late-onset hemorrhage. The 67-year-old male patient with a history of head trauma and brain surgery underwent a VP shunt placement for hydrocephalus. The surgery course was uneventful and no bleeding was revealed in the first computed tomographic (CT) scan after the procedure. However, a massive intraparenchymal and intraventricular hemorrhage occurred 8 h following adjustment of the valve system on the 8th day after surgery.Erosion of the vasculature by catheter cannulation and a sudden reduction of CSF pressure after downregulation of the valve could be one of the possible causes of the intracerebral hemorrhage (ICH).

  2. Portable robot for autonomous venipuncture using 3D near infrared image guidance.

    PubMed

    Chen, Alvin; Nikitczuk, Kevin; Nikitczuk, Jason; Maguire, Tim; Yarmush, Martin

    2013-09-01

    Venipuncture is pivotal to a wide range of clinical interventions and is consequently the leading cause of medical injury in the U.S. Complications associated with venipuncture are exacerbated in difficult settings, where the rate of success depends heavily on the patient's physiology and the practitioner's experience. In this paper, we describe a device that improves the accuracy and safety of the procedure by autonomously establishing a peripheral line for blood draws and IV's. The device combines a near-infrared imaging system, computer vision software, and a robotically driven needle within a portable shell. The device operates by imaging and mapping in real-time the 3D spatial coordinates of subcutaneous veins in order to direct the needle into a designated vein. We demonstrate proof of concept by assessing imaging performance in humans and cannulation accuracy on an advanced phlebotomy training model.

  3. Portable robot for autonomous venipuncture using 3D near infrared image guidance

    PubMed Central

    Chen, Alvin; Nikitczuk, Kevin; Nikitczuk, Jason; Maguire, Tim; Yarmush, Martin

    2015-01-01

    Venipuncture is pivotal to a wide range of clinical interventions and is consequently the leading cause of medical injury in the U.S. Complications associated with venipuncture are exacerbated in difficult settings, where the rate of success depends heavily on the patient's physiology and the practitioner's experience. In this paper, we describe a device that improves the accuracy and safety of the procedure by autonomously establishing a peripheral line for blood draws and IV's. The device combines a near-infrared imaging system, computer vision software, and a robotically driven needle within a portable shell. The device operates by imaging and mapping in real-time the 3D spatial coordinates of subcutaneous veins in order to direct the needle into a designated vein. We demonstrate proof of concept by assessing imaging performance in humans and cannulation accuracy on an advanced phlebotomy training model. PMID:26120592

  4. Real-Time Retinal Vessel Mapping and Localization for Intraocular Surgery.

    PubMed

    Becker, Brian C; Riviere, Cameron N

    2013-01-01

    Computer-aided intraocular surgery requires precise, real-time knowledge of the vasculature during retinal procedures such as laser photocoagulation or vessel cannulation. Because vitreoretinal surgeons manipulate retinal structures on the back of the eye through ports in the sclera, voluntary and involuntary tool motion rotates the eye in the socket and causes movement to the microscope view of the retina. The dynamic nature of the surgical workspace during intraocular surgery makes mapping, tracking, and localizing vasculature in real time a challenge. We present an approach that both maps and localizes retinal vessels by temporally fusing and registering individual-frame vessel detections. On video of porcine and human retina, we demonstrate real-time performance, rapid convergence, and robustness to variable illumination and tool occlusion.

  5. Cooperative robot assistant for retinal microsurgery.

    PubMed

    Fleming, Ioana; Balicki, Marcin; Koo, John; Iordachita, Iulian; Mitchell, Ben; Handa, James; Hager, Gregory; Taylor, Russell

    2008-01-01

    This paper describes the development and results of initial testing of a cooperative robot assistant for retinal microsurgery. In the cooperative control paradigm, the surgeon and the robot share control of a tool attached to the robot through a force sensor. The system senses forces exerted by the operator on the tool and uses this information in various control modes to provide smooth, tremor-free, precise positional control and force scaling. The robot manipulator is specifically designed with retinal microsurgery in mind, having high efficacy, flexibility and ergonomics while meeting the accuracy and safety requirements of microsurgery. We have tested this robot on a biological model and we report the results for reliably cannulating approximately 80 microm diameter veins (equivalent in size to human retinal veins). We also describe improvements to the robot and the experimental setup facilitating more advanced set of experiments.

  6. En bloc transplantation of horseshoe kidney in Korea.

    PubMed

    Bang, Jun Bae; Lee, Jae Myeong; Oh, Chang-Kwon; Lee, Kyo Won; Park, Jae Berm; Kim, Sung Joo; Lee, Su Hyung

    2017-03-01

    Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.

  7. Application of ultra performance liquid chromatography-mass spectrometry to profiling rat and dog bile.

    PubMed

    Plumb, Robert S; Rainville, Paul D; Potts, Warren B; Johnson, Kelly A; Gika, Eleni; Wilson, Ian D

    2009-05-01

    Reversed-phase gradient UPLC-ESI-MS, in both positive and negative ionization modes, has been applied to the analysis of untreated bile obtained from bile-cannulated rats and dogs. The use of UPLC provided a high-resolution system that enabled global metabolite profiles of bile from the two species to be obtained that were suitable for metabolomic and metabonomic applications. When these metabolite profiles were analyzed using unsupervised multivariate statistical methods, based on principle components analysis (PCA), they were correctly classified by species of origin. Conventional approaches to characterizing sample components via, for example, mass and retention time compared to authentic standards resulted in the identification of a range of bile acids. In addition, the value of using an "MSE" approach to simplify the problem of classifying and identifying the metabolites present in the sample (as e.g., sulfates or taurine conjugates) was demonstrated.

  8. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

    PubMed

    Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

    2016-04-01

    The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases.

  9. Successful management of severe unilateral re-expansion pulmonary edema after mitral valve repair with mini-thoracotomy using extracorporeal membrane oxygenation.

    PubMed

    Kitahara, Hiroto; Okamoto, Kazuma; Kudo, Mikihiko; Yoshitake, Akihiro; Hayashi, Kanako; Inaba, Yu; Ai, Kimiaki; Suzuki, Takeshi; Morisaki, Hiroshi; Shimizu, Hideyuki

    2017-03-01

    A 60-year-old man received mitral valve repair via right mini-thoracotomy, which was followed by unilateral re-expansion pulmonary edema on the right side and severe hemoptysis just after the surgery. Despite differential lung ventilation with unilateral high positive end expiratory pressure was initiated for the affected right lung, respiratory function did not improved and hemodynamics was collapsed in the next day. Veno-venous extracorporeal membrane oxygenation was initiated by cannulation of the right jugular and the left femoral vein. After pulmonary function recovered gradually, veno-venous extracorporeal membrane oxygenation was terminated on the fifth postoperative day. He was discharged in ambulatory condition on postoperative day 52.

  10. [Slipped capital femoral epiphysis].

    PubMed

    Klein, C; Haraux, E; Leroux, J; Gouron, R

    2017-03-01

    Slipped capital femoral epiphysis (SFCE) is a disorder of the hip, characterized by a displacement of the capital femoral epiphysis from the metaphysic through the femoral growth plate. The epiphysis slips posteriorly and inferiorly. SCFE occurs during puberty and metabolic and epidemiologic risk factors, such as obesity are frequently found. Most chronic slips are diagnosed late. Sagittal hip X-rays show epiphysis slip. In case of untreated SCFE, a slip progression arises with an acute slip risk. Treatment is indicated to prevent slip worsening. The clinical and radiological classification is useful to guide treatment and it is predictive of the prognosis. In situ fixation of stable and moderately displaced SCFE with cannulated screws gives excellent results. Major complications are chondrolysis and osteonecrosis and the major sequelae are femoroacetabular impingement and early arthritis.

  11. Current opinions on surgical treatment of fractures of the condylar head.

    PubMed

    Boffano, Paolo; Benech, Rodolfo; Gallesio, Cesare; Arcuri, Francesco; Benech, Arnaldo

    2014-06-01

    Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the temporomandibular joint induced by the trauma. Several techniques have been proposed to reduce and fix fractures of the condylar head, such as standard bone screws, resorbable screws, resorbable pins, and cannulated lag screws. Therefore, the aim of this article is to review the literature about the surgical treatment of fractures of the condylar head to resume the current knowledge about open treatment of such fractures.

  12. Antibiotic Spacer Arthroplasty for Revision MTP Arthrodesis: A Novel Means to Build the Implant: A Case Report

    PubMed Central

    Bitterman, Adam; Patel, Milap; Gurtowski, James P

    2016-01-01

    Metatarsophalangeal (MTP) joint osteoarthritis (OA), also known as hallux rigidus (HR), is the most common degenerative arthropathy of the foot and is often the result of trauma. There are multiple methods of addressing the patient’s pain and limited function. Arthrodesis is the gold standard to manage severe MTP arthritis with a highly significant union rate. With various techniques of arthrodesis available, ranging from cannulated screw fixation, Kirschner wires, as well as plate and screw fixation, the orthopedic surgeon has multiple modalities to address this ailment; however, when these fail due to infection, the armament is limited. Through the idea of articulating antibiotic spacers in other regions of the body such as the knee and hip, we present a novel technique to the creation of an antibiotic spacer in the setting of a failed infected MTP arthrodesis.  PMID:27114892

  13. Antibiotic Spacer Arthroplasty for Revision MTP Arthrodesis: A Novel Means to Build the Implant: A Case Report.

    PubMed

    Bitterman, Adam; Mathew, Cristin; Patel, Milap; Gurtowski, James P

    2016-03-21

    Metatarsophalangeal (MTP) joint osteoarthritis (OA), also known as hallux rigidus (HR), is the most common degenerative arthropathy of the foot and is often the result of trauma. There are multiple methods of addressing the patient's pain and limited function. Arthrodesis is the gold standard to manage severe MTP arthritis with a highly significant union rate. With various techniques of arthrodesis available, ranging from cannulated screw fixation, Kirschner wires, as well as plate and screw fixation, the orthopedic surgeon has multiple modalities to address this ailment; however, when these fail due to infection, the armament is limited. Through the idea of articulating antibiotic spacers in other regions of the body such as the knee and hip, we present a novel technique to the creation of an antibiotic spacer in the setting of a failed infected MTP arthrodesis.

  14. Parotid salivary duct sialocele associated with glandular duct stenosis in a cat.

    PubMed

    Vallefuoco, Rosario; Jardel, Nicolas; El Mrini, Meryem; Stambouli, Fouzia; Cordonnier, Nathalie

    2011-10-01

    Feline parotid salivary duct sialocele is an uncommon disorder that has been previously reported in association with traumatic rupture of the duct in only two cats. Both cases were successfully treated by proximal duct ligation. We describe the successful surgical treatment of a parotid duct sialocele, secondary to spontaneous salivary duct stenosis, in an adult domestic shorthair cat. The cat was referred for assessment of a recurrent fluid-filled swelling on the left side of the face. Cytology of the aspirated fluid was consistent with serous saliva. The anatomical localisation of the lesion and the nature of the fluid were indicative of parotid gland/duct involvement. Retrograde sialography by parotid duct cannulation was unsuccessful because the left parotid duct opening was stenosed and obstructed by scar tissue. Surgical exploration revealed a parotid salivary duct sialocele, which was completely removed along with the parotid gland without complications.

  15. Successful extracorporeal membrane oxygenation (ECMO) support in two pediatric heart transplant patients with extreme donor/recipient size mismatch.

    PubMed

    Li, Ping; Dong, Nianguo; Zhao, Yang; Gao, Sihai

    2016-06-01

    Here we report two cases of extracorporeal membrane oxygenation (ECMO) support in pediatric patients following orthotopic heart transplantation due to low cardiac output and inability to separate from cardiopulmonary bypass (CPB). Both patients had significant donor/recipient size mismatch: ratios were 0.71 and 1.73. Cannulation was via the right atrium to ascending aorta using Maquet ECMO kits to achieve veno-arterial ECMO (VA-ECMO) configuration. Activated clotting time (ACT) was maintained at 150-170 seconds. Systemic blood pressure goals were a mean arterial pressure of 60-80 mmHg. Both patients successfully recovered the cardiac function and were discharged home without severe complications. ECMO can effectively support pediatric patients after orthotopic heart transplantation to successful recovery despite the use of extreme donor/recipient size mismatch.

  16. Ductal approaches to assessment and management of women at high risk for developing breast cancer

    PubMed Central

    Locke, Imogen; Mitchell, Gillian; Eeles, Rosalind

    2004-01-01

    The ductal approach to breast cancer, encompassing nipple aspiration, ductal lavage and duct endoscopy, allows assessment of breast ductal epithelial cells and their local microenvironment in a graded process of increasing invasiveness. Samples of ductal epithelial cells sufficient for cytological diagnosis may be safely collected, titres of individual proteins showing variation with breast cancer status may be measured, and abnormal pathology within the breast ducts may be directly visualized. Identification of surrogate molecular markers may facilitate early breast cancer detection, in conjunction with cytological assessment, and be useful for individual prediction of breast cancer risk and assessment of treatment response. However, the sensitivity and specificity of the ductal approach require further evaluation. The small quantities of nipple aspiration fluid available for analysis, and difficulties identifying and cannulating ducts remain important limitations of these techniques. PMID:14979910

  17. Current concepts for the treatment of acute scaphoid fractures.

    PubMed

    Arsalan-Werner, A; Sauerbier, M; Mehling, I M

    2016-02-01

    Fractures of the scaphoid are common injuries, accounting for approximately 80 % of carpal fractures. Differentiation between stable and unstable fractures (Herbert classification) cannot be made with conventional X-rays, so evaluation by computed tomography should additionally be performed. Under most circumstances, minimally invasive surgery with cannulated screws is the treatment of choice. A longer cast immobilization after minimal-invasive surgery is not necessary. Conservative treatment still has a place if the fracture is not dislocated nor unstable, but operative treatment can be offered to reduce the period of cast immobilization. Displaced fractures have a greater risk for nonunion and therefore should be treated operatively. Proximal pole fractures are definitely unstable, requiring treatment with screw fixation. The surgical approach depends on the location of the fracture and the preference of the surgeon.

  18. Circulatory assist with centrifugal pump as a bridge to recovery: mathematical analysis.

    PubMed

    Arpesella, G; Mikus, E; Arabia, M; Loforte, A; Mikus, P M

    2007-07-01

    Mechanical circulatory support is an essential issue in the management of patients with end-stage cardiac failure. The aim of this study is to evaluate the efficacy of temporary support with a centrifugal blood pump as bridge to heart function recovery or bridge to transplantation. Heart recovery is achieved by improving ventricular mechanical working conditions with proper modifications of preload and afterload. This article assesses the advantages of a novel 'cardiac chambers' cannulation setting versus the traditional one, in the case of biventricular or isolated right ventricular failure. The study was conducted using a numerical computer model based on the work by Guyton, Sagawa, Westerhof, and Noordergraaf. Simulation of the planned trials was achieved by changing the model parameters, the pump angular velocity, and the inflow and outflow settings.

  19. Extracorporeal Lung Support as a Bridge to Diagnosis of Pulmonary Tumor Embolism

    PubMed Central

    Halloran, Kieran

    2016-01-01

    Bridging to diagnosis is an emerging technique used in end-stage cardiorespiratory failure that prolongs a patient's life using various modalities of extracorporeal lung support (ECLS) to achieve antemortem diagnosis. Pulmonary tumor embolism occurs when cell clusters travel from primary malignancies through venous circulation to the lungs, causing respiratory failure through inflammatory and venoocclusive pathways. Due to its nonspecific symptomatology, pulmonary tumor embolism remains an elusive diagnosis antemortem. Herein, we bridge a patient who presented in acute respiratory failure to the diagnosis of pulmonary tumor embolism from a gastric signet-ring cell carcinoma using ECLS modalities including venoarterial extracorporeal membrane oxygenation and centrally cannulated Novalung pumpless extracorporeal lung assist. We demonstrate the utility of this approach in diagnostically uncertain cases in unstable patients who are potentially acceptable ECLS and transplant candidates. PMID:28070437

  20. Ileal Amino Acid Digestibility of Broken Rice Fed to Postweaned Piglets with or without Multicarbohydrase and Phytase Supplementation

    PubMed Central

    Dadalt, J. C.; Gallardo, C.; Polycarpo, G. V.; Budiño, F. E. L.; Rogiewicz, A.; Berto, D. A.; Trindade Neto, M. A.

    2016-01-01

    Most of amino acid (AA) digestibility values for feed ingredients are obtained using pigs cannulated in the distal ileum. The ileal-cannulated pig model uses pigs older than six weeks due to difficulties related to implanting the T-cannula in distal ileum of younger pigs and complications during the post-surgical recovery. However, to properly formulate the diet of weaned pigs, the nutritive value of feed ingredients should be determined with younger pigs. Thus, 25 weaned pigs were used to determine the apparent total tract digestibility (ATTD) of nutrients, energy, and apparent ileal digestibility (AID) and standardized ileal digestibility (SID) ileal AA digestibility of broken rice (BR), with or without multicarbohydrase (MC) and phytase (Phy) supplementation. Piglets were weaned at 23 d of age and individually housed in digestibility cages until 45 d of age. The trial consisted of 7 d of adaptation to the experimental diets and 3 d of excreta (feces and urine) collection. Ileal digesta was collected at slaughter (about 6 weeks of age). A completely randomized experimental design was used to determine the effects of MC and Phy. Reference diets (RD, 5% casein) was replaced by 30% of BR with or without MC, Phy, or MC+Phy. The RD was used to quantify endogenous AA losses. BR with Phy supplied had increased the ATTD of dry matter (p<0.05) and SID of histidine (p = 0.05), arginine, leucine, lysine, valine, alanine, and proline (p<0.05). BR with MC had been increased digestible energy and protein and SID for histidine (p<0.05). There was no interaction between Phy and MC on the BR nutrient digestibilities. Standardized amino acid digestibilities of BR, without enzymes, were lower than those values reported in the literature. The MC and Phy improved the digestibility of some nutrients and energy of BR in post-weaned piglet diets. PMID:27004821

  1. Intensive Hemodialysis and Potential Risks With Increasing Treatment.

    PubMed

    Kraus, Michael A; Kansal, Sheru; Copland, Michael; Komenda, Paul; Weinhandl, Eric D; Bakris, George L; Chan, Christopher T; Fluck, Richard J; Burkart, John M

    2016-11-01

    Although intensive hemodialysis (HD) can address important clinical problems, increasing treatment also introduces risks. In this review, we assess risks pertaining to 6 domains: vascular access complications, infection, mortality, loss of residual kidney function, solute balance, and patient and care partner burden. In the Frequent Hemodialysis Network (FHN) trials, short daily and nocturnal schedules increased the incidence of access complications, although the incidence of access loss was not statistically higher. Observational studies indicate that infection-related hospitalization is an ongoing challenge with short daily HD. Excess risk may be catalyzed by poor infection control practices in the home setting in which intensive HD is typically delivered, but with fixed probability of bacterial contamination per cannulation, greater treatment frequency necessarily increases the risk for infectious complications. Buttonhole cannulation may increase the risk for metastatic infections. However, intensive HD in the home setting is associated with lower risk for infection than peritoneal dialysis. Data regarding mortality are equivocal. With extended follow-up of individuals in the FHN trials, short daily HD was associated with lower risk relative to the usual schedule, whereas nocturnal HD was associated with higher risk. In many, but not all, observational studies, short daily HD has been associated with lower risk than both in-center HD and peritoneal dialysis; however, observational studies are subject to unmeasured confounding. Intensive HD can accelerate the loss of residual kidney function in new dialysis patients with substantial urine output and can deplete solutes (eg, phosphorus) to the extent that supplementation is necessary. Finally, intensive HD may increase burden on patients and caregivers, possibly leading to technique failure. Some of these problems might be addressed with careful monitoring, so that relevant interventions (eg, antibiotics

  2. Differential diagnosis of gallstones by using hypericin as a fluorescent optical imaging agent

    PubMed Central

    Miranda Cona, Marlein; Liu, Ye-Wei; Hubert, Antoine; Yin, Ting; Feng, Yuan-Bo; de Witte, Peter; Waelkens, Etienne; Jiang, Yan-Sheng; Zhang, Jian; Mulier, Stefaan; Xia, Qian; Huang, Gang; Oyen, Raymond; Ni, Yi-Cheng

    2016-01-01

    AIM: To explore the feasibility of using hypericin as an optical imaging probe with affinity for cholesterol for differential fluorescent detection of human gallstones. METHODS: Cholesterol, mixed and pigment stones from cholecystectomy patients were incubated with hypericin or solvent. After 72 h, the stones were analysed for fluorescence (365 nm) and treated with 2-propanol/dimethyl sulfoxide for high performance liquid chromatography (HPLC) analysis. Rats with virtual gallbladder containing human cholesterol, mixed or pigment gallstones (VGHG) received 5 mg/kg hypericin or solvent and VGHG rats with cholesterol stones were given different hypericin doses (5-15 mg/kg). Twelve hours later, the stones were analysed at 365 nm. Biliary excretion and metabolites of hypericin were assessed in common bile duct (CBD) cannulated rats for 9 h using fluorospectrometry, HPLC and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). RESULTS: Homogeneous high fluorescence was seen on cholesterol stones either pre-incubated with hypericin or extracted from VGHG rats receiving hypericin. Mixed stones showed a dotted fluorescent pattern, whereas pigment and solvent-treated ones lacked fluorescence. HPLC showed 7.68, 6.65 and 0.08 × 10-3 M of cholesterol in extracts from cholesterol, mixed, and pigment gallstones, respectively. Hypericin accounted for 2.0, 0.5 and 0.2 × 10-6 M in that order. On cholesterol stones from VGHG rats receiving different hypericin doses, a positive correlation was observed between dose and fluorescence. In the bile from CBD-cannulated rats, fluorescence represented 20% of the injected dose with two peaks in 9 h. HPLC analysis revealed that hypericin conjugates reached 60% of the peak area. By MALDI-TOF MS, hypericin-glucuronide was detected. CONCLUSION: This study proves the potential use of hypericin for differential fluorescent detection of human gallstones regarding their chemical composition. PMID:27547012

  3. Measurement of myocardial blood flow with oxygen-15 labelled water: comparison of different administration protocols.

    PubMed

    Hermansen, F; Rosen, S D; Fath-Ordoubadi, F; Kooner, J S; Clark, J C; Camici, P G; Lammertsma, A A

    1998-07-01

    Positron emission tomography (PET) in conjunction with C15O2 or H215O can be used to measure myocardial blood flow (MBF) and tissue fraction (TF), i.e. the fraction of the tissue mass in the volume of the region of interest. However, with C15O2 inhalation, the tissue fraction in the septum is overestimated. Bolus injection of H215O together with arterial cannulation gives very precise results but is invasive. The purpose of this study was to develop a method which circumvents these problems. A four-parameter model with parameters for MBF, TF and spill-over fractions from both left and right ventricular cavities was developed. This method was compared with a three-parameter model (no right ventricular cavity spill-over) in both septal and non-septal regions of interest for three different administration protocols: bolus injection of H215O, infusion of H215O and inhalation of C15O2. It was found that MBF can be measured with intravenous administration of H215O without the requirement for arterial cannulation. The four-parameter protocol with bolus injection was stable in clinical studies. The four-parameter model proved essential for the septum, where it gave highly significantly better fits than did the three-parameter model (P<0.00003 in each of 15 subjects). Administration of H215O together with this four-parameter model also circumvented the problem of overestimation of TF in the septum seen with C15O2 inhalation. In addition, the radiation dose of H215O protocols is lower than that of C15O2 inhalation. Using a left atrial input curve instead of a left ventricular cavity input curve gave the same mean MBF and TF.

  4. Mycotic Infection post ACL Reconstruction

    PubMed Central

    Costa-Paz, Matias; Ayerza, Miguel; Carbo, Lisandro; Sanchez, Marisa; Yacuzzi, Carlos; Muscolo, Luis

    2017-01-01

    Objectives: There are several studies in literature of septic arthritis after the ACL arthroscopic reconstruction related to bacterial germs. However, fungi infection is likely infrequent generating a massive bone loss with a catastrophic result. The purpose of this study was to describe preventive measures to decrease the mycotic infection after ACL reconstruction. Methods: Since 2005, we have diagnosed and treated 22 immunocompetent patients who underwent a surgery of an ACL lesion in other institutions in the country. Form these cases, we analyzed 19 which developed mycotic infection and an oncologic debridement was performed to control the pathology. In this series, we considered the initial surgery, the number of toilettes performed until their referral, magnitude of bone loss and final outcome. There were 5 other patients who consulted for mucormycosis, who finally were treated in other hospitals. Results: Epidemiology of mucormycosis is not clear. The exact cause is unknown due to heterogeneous data, different places and surgeons, facilities and type of surgical instruments in this series. In spite of not knowing the cause of the infection, several alternatives were evaluated in a non systematic way. Most of them related to the surgery room, sterilization place of the surgical tools, use of sterilizing liquids, cleanliness of lumen and cannulated bits. Instruments used during surgery were also evaluated: fields, shaver blades, drill types, ACL reconstruction fixation method. It is doubtful if the type of graft to reconstruct the ACL had any relation with infections. Among ideal preventive measures, the following are described: Surgery room with temperature and humidity control. Not using sterilizing liquids. Optimal preparation of surgical tools with adequate cleanliness of lumen and cannulated bits performed by adequate personnel. Sterilize in the same place where the surgery will be performed. Use of adequate instruments. The use of the central third of

  5. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush

    PubMed Central

    Groth, Sylvia L; Greider, Kelsi L

    2015-01-01

    ABSTRACT Objective: To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs. Design: Case series. Subjects and participants: Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb. Main outcome measures: Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months. Results: Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20). Conclusion: Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period. How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76. PMID:26997840

  6. Copper toxicity in the spiny dogfish (Squalus acanthias): urea loss contributes to the osmoregulatory disturbance.

    PubMed

    De Boeck, G; Hattink, J; Franklin, N M; Bucking, C P; Wood, S; Walsh, P J; Wood, C M

    2007-08-30

    Previous research showed that the spiny dogfish, Squalus acanthias, is much more sensitive to silver exposure than typical marine teleosts. The aim of the present study was to investigate if spiny dogfish were equally sensitive to copper exposure and whether the toxic mechanisms were the same. We exposed cannulated and non-cannulated spiny dogfish to measured concentrations of Cu (nominally 0, 500, 1000 and 1500 microg L(-1) Cu) for 72-96 h. All Cu exposures induced acidosis and lactate accumulation of either a temporary (500 microg L(-1)) or more persistent nature (1000 and 1500 microg L(-1)). At the two highest Cu concentrations, gill Na(+)/K(+)-ATPase activities were reduced by 45% (1000 microg L(-1)) and 62% (1500 microg L(-1)), and plasma Na(+) and Cl(-) concentrations increased by approximately 50 mM each. At the same time urea excretion doubled and plasma urea dropped by approximately 100 mM. Together with plasma urea, plasma TMAO levels dropped proportionally, indicating that the general impermeability of the gills was compromised. Overall plasma osmolarity did not change. Cu accumulation was limited with significant increases in plasma Cu and elevated gill and kidney Cu burdens at 1000 and 1500 microg L(-1). We conclude that Cu, like Ag, exerts toxic effect on Na(+)/K(+)-ATPase activities in the shark similar to those of teleosts, but there is an additional toxic action on elasmobranch urea retention capacities. With a 96 h LC(50) in the 800-1000 microg L(-1) range, overall sensitivity of spiny dogfish for Cu is, in contrast with its sensitivity to Ag, only slightly lower than in typical marine teleosts.

  7. Teaching and learning in undergraduate anaesthesia: a quantitative and qualitative analysis of practice at the University of Auckland.

    PubMed

    Sidhu, N S; Weller, J M; Mitchell, S J

    2015-11-01

    Anaesthesia encompasses a broad range of knowledge and skills of relevance to graduating doctors. For the majority of new doctors, an undergraduate clinical rotation is their only exposure to anaesthesia practice. However, the content and approach to undergraduate anaesthesia education varies between institutions. We explored our students' views and experiences, and teaching approaches and expectations of consultant anaesthetists during a clinical attachment in anaesthesia. Our mixed-method design included student and staff surveys, logbook analysis and student focus groups. Logbook analysis of all 202 students showed mean numbers of attempts for bag-mask ventilation, laryngeal mask insertion, tracheal intubation and IV cannulation were 6.8, 3.9, 3.3 and 4.5, respectively. Focus group responses (11 students, three groups) suggested a mismatch between students' expectations of performing clinical skills and the available opportunities, particularly for IV cannulation. Students often felt reluctant to ask anaesthetists to teach them, and appreciated clinician-led engagement in all aspects of learning patient management. Among the 78 anaesthetists (29.3%) responding to the survey, the five tasks most frequently identified as suitable for teaching to students all related to airway management. Our study found much unanticipated variability in student exposure, teaching practice and attitudes to teaching various skills or procedures between anaesthetists, and student opinion of their clinical attachment. The findings resulted in a review of many aspects of the attachment. It is likely that other institutions will have similar variability and we recommend they undertake similar exercises to optimise teaching and learning opportunities for undergraduate anaesthesia.

  8. Intraruminal supplementation with increasing levels of exogenous polysaccharide-degrading enzymes: effects on nutrient digestion in cattle fed a barley grain diet.

    PubMed

    Hristov, A N; McAllister, T A; Cheng, K J

    2000-02-01

    The effects of supplying increasing ruminal doses of exogenous polysaccharide-degrading enzymes (EPDE) on rumen fermentation and nutrient digestion were studied using eight ruminally cannulated heifers, four of which were also duodenally cannulated, in a replicated Latin square. The heifers were fed a diet of 85.5% rolled barley grain and 14% barley silage (DM basis), and once daily they were given intraruminal doses of 0 (Control), 100, 200, or 400 g of a preparation containing polysaccharide-degrading enzymes. Enzyme treatment decreased ruminal pH (linear, P<.001) and increased ammonia N (quadratic, P<.001) concentration. The ruminally soluble fraction and effective degradability of feed DM in situ were increased (quadratic response, P<.001) by enzyme treatment. Ruminal administration of EPDE increased ruminal fluid carboxymethylcellulase and xylanase activities linearly (P<.001) and beta-glucanase activity quadratically (P<.01), decreased (quadratic response, P<.05) ruminal fluid viscosity, and did not affect (P>.05) ruminal fluid amylase activity. Elevated levels of fibrolytic activities in the rumen resulted in increased (quadratic, P<.001) carboxymethylcellulase, xylanase, and beta-glucanase (P<.01) activities in duodenal digesta. Duodenal amylase activity and reducing sugar concentration were also increased (quadratic responses, P<.001 and P<.05, respectively) by EPDE. Xylanase activity of fecal DM was increased linearly (P<.05) with increasing ruminal EPDE levels. Apparent digestibilities of DM, crude protein, and NDF were not affected by EPDE supplementation. Enzyme treatment did not affect (P>.05) urinary excretion of allantoin and uric acid, or concentrations of glucose and urea in blood.

  9. The vascular renin-angiotensin system contributes to blunted vasodilation induced by transient high pressure in human adipose microvessels.

    PubMed

    Durand, Matthew J; Phillips, Shane A; Widlansky, Michael E; Otterson, Mary F; Gutterman, David D

    2014-07-01

    Increased intraluminal pressure can reduce endothelial function in resistance arterioles; however, the mechanism of this impairment is unknown. The purpose of this study was to determine the effect of local renin-angiotensin system inhibition on the pressure-induced blunting of endothelium-dependent vasodilation in human adipose arterioles. Arterioles (100-200 μm) were dissected from fresh adipose surgical specimens, cannulated onto glass micropipettes, pressurized to an intraluminal pressure of 60 mmHg, and constricted with endothelin-1. Vasodilation to ACh was assessed at 60 mmHg and again after a 30-min exposure to an intraluminal pressure of 150 mmHg. The vasodilator response to ACh was significantly reduced in vessels exposed to 150 mmHg. Exposure of the vessels to the superoxide scavenger polyethylene glycol-SOD (100 U/ml), the ANG II type 1 receptor antagonist losartan (10(-6) mol/l), or the angiotensin-converting enzyme inhibitor captopril (10(-5) mol/l) prevented the pressure-induced reduction in ACh-dependent vasodilation observed in untreated vessels. High intraluminal pressure had no effect on papaverine-induced vasodilation or ANG II sensitivity. Increased intraluminal pressure increased dihydroethidium fluorescence in cannulated vessels, which could be prevented by polyethylene glycol-SOD or losartan treatment and endothelial denudation. These data indicate that high intraluminal pressure can increase vascular superoxide and reduce nitric oxide-mediated vasodilation via activation of the vascular renin-angiotensin system. This study provides evidence showing that the local renin-angiotensin system in the human microvasculature may be pressure sensitive and contribute to endothelial dysfunction after acute bouts of hypertension.

  10. Effect of ruminal infusion of glucose, volatile fatty acids and hydrochloric acid on mineral metabolism in sheep.

    PubMed

    Giduck, S A; Fontenot, J P; Rahnema, S

    1988-02-01

    Two experiments were conducted to study the effects of alterations in ruminal pH and volatile fatty acid (VFA) concentrations on utilization of Mg and other minerals. In Exp. 1, two metabolism trials were conducted with 12 ruminally cannulated crossbred wethers fed 800 g/d of orchard-grass (Dactylis glomerata, L.) hay. After each feeding, wethers were ruminally infused with 500 ml (4.2 ml/min) or either 1) deionized water, 2) 40% (w/v) glucose solution, 3) .26 M propionic and .17 M butyric acid solution or 4) .35 M HCl. The pH of the VFA solution was adjusted to 6.8 with 10N NaOH. In Exp. 2, a metabolism trial was conducted with 12 ruminally cannulated crossbred wethers fed 600 g of orchard-grass hay and infused with a buffered VFA solution prepared as in Exp. 1 or with an unbuffered solution. In both experiments each trial consisted of a 5-d adaption period followed by four 5-d collections of feed, feces and urine. Compared with the glucose treatment, infusion of the buffered VFA solution produced similar acetic and propionic and higher (P less than .05) butyric acid concentrations (Exp. 1). The HCl solution produced changes in ruminal and pH values similar to those of the glucose infusion. In Exp. 1, apparent absorption of Mg was increased over twofold by the glucose infusion (P less than .05), but the other infusions had no effect. Apparent absorption of P was decreased (P less than .05) by HCl infusion, and K absorption was decreased by HCl and glucose infusions. In Exp. 2, infusion of the unbuffered VFA solution decreased apparent Mg absorption by 15.7%, compared with infusion of the buffered solution. These experiments suggest that the increased Mg absorption observed with carbohydrate supplementation is not due to alterations in ruminal pH or VFA levels.

  11. Biomechanical evaluation of the fixation methods for transcondylar fracture of the humerus:ONI plate versus conventional plates and screws.

    PubMed

    Shimamura, Yasunori; Nishida, Keiichiro; Imatani, Junya; Noda, Tomoyuki; Hashizume, Hiroyuki; Ohtsuka, Aiji; Ozaki, Toshifumi

    2010-04-01

    We biomechanically evaluated the bone fixation rigidity of an ONI plate (Group I) during fixation of experimentally created transcondylar humerus fractures in cadaveric elbows, which are the most frequently observed humeral fractures in the elderly, and compared it with the rigidity achieved by 3 conventional fixation methods:an LCP reconstruction plate 3.5 using a locking mechanism (Group II), a conventional reconstruction plate 3.5 (CRP) with a cannulated cancellous screw (Group III), and a CRP with 2 cannulated cancellous screws (CS) in a crisscross orientation (Group IV). In the axial loading test, the mean failure loads were:Group I, 98.9+/-32.6;Group II, 108.5+/-27.2;Group III, 50.0+/-7.5;and Group IV, 34.5+/-12.2 (N). Group I fixations failed at a significantly higher load than those of Groups III and IV (p<0.05). In the extension loading test, the mean failure loads were:Group I, 34.0+/-12.4;Group II, 51.0+/-14.8;Group III, 19.3+/-6.0;and Group IV, 14.7+/-3.1 (N). Group IV fixations showed a significantly lower failure load than those of Group I (p<0.05). The fixation rigidities against mechanical loading by the ONI plate and LCP plate were comparable. These results suggested that an ONI system might be superior to the CRP and CS method, and comparable to the LCP method in terms of fixation rigidity for distal humerus fractures.

  12. Blood flow index using near-infrared spectroscopy and indocyanine green as a minimally invasive tool to assess respiratory muscle blood flow in humans.

    PubMed

    Guenette, Jordan A; Henderson, William R; Dominelli, Paolo B; Querido, Jordan S; Brasher, Penelope M; Griesdale, Donald E G; Boushel, Robert; Sheel, A William

    2011-04-01

    Near-infrared spectroscopy (NIRS) in combination with indocyanine green (ICG) dye has recently been used to measure respiratory muscle blood flow (RMBF) in humans. This method is based on the Fick principle and is determined by measuring ICG in the respiratory muscles using transcutaneous NIRS in relation to the [ICG] in arterial blood as measured using photodensitometry. This method is invasive since it requires arterial cannulation, repeated blood withdrawals, and reinfusions. A less invasive alternative is to calculate a relative measure of blood flow known as the blood flow index (BFI), which is based solely on the NIRS ICG curve, thus negating the need for arterial cannulation. Accordingly, the purpose of this study was to determine whether BFI can be used to measure RMBF at rest and during voluntary isocapnic hyperpnea at 25, 40, 55, and 70% of maximal voluntary ventilation in seven healthy humans. BFI was calculated as the change in maximal [ICG] divided by the rise time of the NIRS-derived ICG curve. Intercostal and sternocleidomastoid muscle BFI were correlated with simultaneously measured work of breathing and electromyography (EMG) data from the same muscles. BFI showed strong relationships with the work of breathing and EMG for both respiratory muscles. The coefficients of determination (R(2)) comparing BFI vs. the work of breathing for the intercostal and sternocleidomastoid muscles were 0.887 (P < 0.001) and 0.863 (P < 0.001), respectively, whereas the R(2) for BFI vs. EMG for the intercostal and sternocleidomastoid muscles were 0.879 (P < 0.001) and 0.930 (P < 0.001), respectively. These data suggest that the BFI closely reflects RMBF in conscious humans across a wide range of ventilations and provides a less invasive and less technically demanding alternative to measuring RMBF.

  13. Endovascular Treatment of Autogenous Radiocephalic Fistulas with the 'Eighth Note' Deformity for Hemodialysis

    SciTech Connect

    Weng Meijui; Chen, Matt Chiung-Yu; Chi Wenche; Liu Yichun; Chien Kofen; Liang Hueilung; Pan, Huay-Ben

    2010-02-15

    The purpose of this paper is to describe a unique 'eighth note' deformity of the autogenous radiocephalic fistula for hemodialysis and to retrospectively evaluate the efficacy and safety of its endovascular treatment. Over 3 years, a total of 808 patients and 558 autogenous radiocephalic fistulas were treated for vascular access dysfunction or thrombosis. These included 14 fistulas in 14 patients (9 men, 5 women; mean age, 58.2 {+-} 2.8 years; range 27-79 years) whose fistulograms before treatment resembled a musical note, the eighth note. Endovascular treatment sought to remodel the deformed vascular access to a classic radiocephalic fistula and increase the number of cannulation sites available for hemodialysis. The technical and clinical success rates were each 92.8% (13/14). Fistula remodeling was successful in 13 patients. The postintervention primary patency was 100% at 90 days, 91.7 {+-} 0.8% at 120 days, 78.6 {+-} 13.9% at 180 days, 62.9 {+-} 17.9% at 360 days, 31.4 {+-} 24.0% at 540 days, and 0% at 720 days. The postintervention secondary patency was 100% at 90 days, 100% at 120 days, 100% at 180 days, 85.7 {+-} 13.2% at 360 days, and 85.7 {+-} 13.2% at 720 days. No major complications were noted. Minor complications were found in 71.4% of patients, all of which resolved spontaneously. In conclusion, endovascular treatment of fistulas with the eighth note deformity can effectively increase the number of available cannulation sites, facilitate fistula maturation, and facilitate thromboaspiration after fistula thrombosis.

  14. Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement

    PubMed Central

    Maier, Sven; Kari, Fabian; Rylski, Bartosz; Siepe, Matthias; Benk, Christoph; Beyersdorf, Friedhelm

    2016-01-01

    Abstract: Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart–lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion. Initial arterial cannulation is achieved via femoral artery or right axillary artery. After lower body circulatory arrest and selective antegrade cerebral perfusion for the distal arch anastomosis, we started selective lower body perfusion simultaneously to the selective antegrade cerebral perfusion and heart perfusion. Eighteen patients were successfully treated with this perfusion strategy from October 2012 to November 2015. No complications related to the heart–lung machine and the cannulation occurred during the procedures. Mean cardiopulmonary bypass time was 239 ± 33 minutes, the simultaneous selective perfusion of brain, heart, and remaining body lasted 55 ± 23 minutes. One patient suffered temporary neurological deficit that resolved completely during intensive care unit stay. No patient experienced a permanent neurological deficit or end-organ dysfunction. These high-risk procedures require a concept with a special setup of the heart–lung machine. Our perfusion strategy for aortic arch replacement ensures a selective perfusion of heart, brain, and lower body during this complex procedure and we observed excellent outcomes in this small series. This perfusion strategy is also applicable for redo procedures. PMID:27729705

  15. Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

    PubMed Central

    Kim, Hee Yeong; Choi, Jae Moon; Lee, Yong-Hun; Lee, Sukyung; Yoo, Hwanhee; Gwak, Mijeung

    2016-01-01

    Abstract Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery. In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured. All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment. The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects. PMID:27149455

  16. Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects.

    PubMed

    Kim, Hee Yeong; Choi, Jae Moon; Lee, Yong-Hun; Lee, Sukyung; Yoo, Hwanhee; Gwak, Mijeung

    2016-05-01

    Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.

  17. Toxicokinetics and metabolism of 1,2-diethylbenzene in male Sprague Dawley rats--part 2: evidence for in vitro and in vivo stereoselectivity of 1,2-diethylbenzene metabolism.

    PubMed

    Payan, J P; Cossec, B; Beydon, D; Fabry, J P; Ferrari, E

    2001-06-01

    In a previous study, it was shown that the neurotoxic compound 1,2-diethylbenzene (1,2-DEB) is mainly hydroxylated in the alkyl chain to give 1-(2'-ethylphenyl)ethanol (1,2-EPE) and excreted in urine of rats as two glucuronide compounds (GA1 and GA2). Some findings have suggested that the two enantiomers of 1,2-EPE are formed in vivo. In the present study, a chiral high-performance liquid chromatography method was developed to separate the two enantiomers of 1,2-EPE from a synthesized racemic mixture. Absolute configuration of both enantiomers was determined after esterification with (R)-(+)-alpha-methoxy-alpha-(trifluoromethyl)phenylacetic acid and analysis of their (1)H NMR spectra in CCl(4) added with Eu (fod)(3). The two main urinary metabolites, GA1 and GA2, from [(14)C]1,2-DEB-treated Sprague-Dawley rats (80 mg/kg, i.p.) were identified, after hydrolysis with beta-glucuronidase from Escherichia coli, as (R) and (S) glucuronide conjugates of 1,2-EPE, respectively. In vitro hydroxylation of 1,2-DEB and glucuroconjugation of 1,2-EPE were under stereoselective control in S9 fraction or microsomes from male Sprague-Dawley rat liver. The V(max) and K(m) constants for (R)1,2-EPE enantiomer formation determined in S9 fraction were greater than those for the (S) enantiomer. In the plasma of bile duct-cannulated rats, the ratio was 1.2 +/- 0.02 over the 1- to 4-h period after oral administration of [(14)C]1,2-DEB (100 mg/kg). In contrast, the glucuroconjugation rate of (S)1,2-DEB enantiomer was 4 times that of (R)1,2-EPE glucuroconjugation. A similar ratio of (R) to (S)1,2-EPE glucuronide conjugates was obtained in the plasma of bile duct-cannulated rats.

  18. A head-to-head hands-on comparison of ERCP mechanical simulator (EMS) and Ex-vivo Porcine Stomach Model (PSM).

    PubMed

    Leung, Joseph W; Wang, Dong; Hu, Bing; Lim, Brian; Leung, Felix W

    2011-07-01

    BACKGROUND: ERCP mechanical simulator (EMS) and ex-vivo porcine stomach model (PSM) have been described. No direct comparison was reported on endoscopists' perception regarding their efficacy for ERCP training OBJECTIVE: Comparative assessment of EMS and PSM. DESIGN: Questionnaire survey before and after practice. SETTING: Hands-on practice workshops. SUBJECTS: 22 endoscopists with prior experience in 111±225 (mean±SD) ERCP. INTERVENTIONS: Participants performed scope insertion, selective bile duct cannulation with guide wire and insertion of a single biliary stent. Simulated fluoroscopy with external pin-hole camera (EMS), or with additional transillumination (PSM) was used to monitor exchange of accessories. MAIN OUTCOME MEASURE: Participants rated their understanding and confidence before and after hands-on practice, and credibility of each simulator for ERCP training. Comparative efficacy of EMS and PSM for ERCP education was scored (1=not, 10=very) based on pre and post practice surveys: realism (tissue pliability, papilla anatomy, visual/cannulation realism, wire manipulation, simulated fluoroscopy, overall experience); usefulness (assessment of results, supplementing clinical experience, easy for trainees to learn new skills) and application (overall ease of use, prepare trainees to use real instrument and ease of incorporation into training). RESULTS: Before hands-on practice, both EMS and PSM received high scores. After practice, there was a significantly greater increase in confidence score for EMS than PSM (p<0.003). Participants found EMS more useful for training (p=0.017). LIMITATIONS: Subjective scores. CONCLUSIONS: Based on head-to-head hands-on comparison, endoscopists considered both EMS and PSM credible options for improving understanding and supplementing clinical ERCP training. EMS is more useful for basic learning.

  19. Toxicity of taurolithocholate as a model for cholestasis in the rat liver

    SciTech Connect

    Spitzer, V.M.; Loo, C.Y.

    1985-05-01

    A model was investigated to facilitate the detection of mild diffuse liver disease. The introduction of sodium taurolithocholate(TLC) into the bloodstream of rats has been shown to produce cholestasis. This study was undertaken to assess the available control over the cholestatic effect with regulated TLC. The rat model then utilized to evaluate the ability of Tc-99m Hepatolite (IDA) to predict the extent of cholestasis in mildly diseased liver. 27 Charles River rats (300-350 grams) were studied. Pentabarbital was used for anesthesia and body temperature was maintained between 37.5 and 38.5/sup 0/C. A standard tracheostomy and jugular vein and carotid artery cannulation was performed for the administration of the TLC and IDA and for blood sampling. The common bile duct was cannulated for bile collection. Bile was collected for 10 minutes post surgery and then the TLC, or just vehicle for controls, was administered. 5 minute bile collections continued for 60 minutes and blood samples were collected 9 times during the same hour period. The cumulative percent dose of IDA in the bile was found to be controllable while the blood clearance was not appreciably different for the doses investigated. Doses of 5.0, 3.75, 2.75 and 0 micromoles of TLC per 100 grams of rat weight were found to yield a 85%, 68% 45% and 15% cholestatic effect. The 45% cholestasis is reproducible and most clinically interesting the authors' studies. The 15% cholestasis for the control rats demonstrates a baseline cholestasis from the surgical intervention.

  20. A Period of Controlled Elevation of IOP (CEI) Produces the Specific Gene Expression Responses and Focal Injury Pattern of Experimental Rat Glaucoma

    PubMed Central

    Morrison, John C.; Cepurna, William O.; Tehrani, Shandiz; Choe, Tiffany E.; Jayaram, Hari; Lozano, Diana C.; Fortune, Brad; Johnson, Elaine C.

    2016-01-01

    Purpose We determine if several hours of controlled elevation of IOP (CEI) will produce the optic nerve head (ONH) gene expression changes and optic nerve (ON) damage pattern associated with early experimental glaucoma in rats. Methods The anterior chambers of anesthetized rats were cannulated and connected to a reservoir to elevate IOP. Physiologic parameters were monitored. Following CEI at various recovery times, ON cross-sections were graded for axonal injury. Anterior ONHs were collected at 0 hours to 10 days following CEI and RNA extracted for quantitative PCR measurement of selected messages. The functional impact of CEI was assessed by electroretinography (ERG). Results During CEI, mean arterial pressure (99 ± 6 mm Hg) and other physiologic parameters remained stable. An 8-hour CEI at 60 mm Hg produced significant focal axonal degeneration 10 days after exposure, with superior lesions in 83% of ON. Message analysis in CEI ONH demonstrated expression responses previously identified in minimally injured ONH following chronic IOP elevation, as well as their sequential patterns. Anesthesia with cannulation at 20 mm Hg did not alter these message levels. Electroretinographic A- and B-waves, following a significant reduction at 2 days after CEI, were fully recovered at 2 weeks, while peak scotopic threshold response (pSTR) remained mildly but significantly depressed. Conclusions A single CEI reproduces ONH message changes and patterns of ON injury previously observed with chronic IOP elevation. Controlled elevation of IOP can allow detailed determination of ONH cellular and functional responses to an injurious IOP insult and provide a platform for developing future therapeutic interventions. PMID:27942722

  1. Continuous intrathecal fluid infusions elevate nerve growth factor levels and prevent functional deficits after spinal cord ischemia.

    PubMed

    Bowes, M; Tuszynski, M H; Conner, J; Zivin, J A

    2000-11-17

    Continuous intracerebroventricular or intrathecal infusions of neurotrophic factors have been reported to prevent neuronal degeneration, stimulate axonal sprouting and ameliorate behavioral deficits in various models of CNS injury and aging. In the present study, the ability of intrathecal infusions of recombinant human nerve growth factor (NGF) to reduce functional deficits following spinal cord ischemia was investigated. Adult rabbits underwent intrathecal cannulation and continuous infusions of either 300 microg/ml recombinant human NGF or artificial CSF (vehicle) at a rate of 143 microl/day for 7 days prior to induction of spinal cord ischemia. Continuous infusions were maintained after induction of ischemia. Four days later, both NGF-treated and vehicle-infused subjects showed a significant amelioration of functional motor deficits compared to lesioned, non-infused subjects (P<0.05). The average duration of tolerated ischemia increased from 23.4+/-1.8 min in lesioned, non-infused subjects to 35.5+/-3.1 min in lesioned, artificial CSF-infused subjects and 35.6+/-4.7 min in NGF-infused subjects (mean+/-S.E.M.). Significantly elevated NGF protein levels were attained within the spinal cords of both NGF-treated subjects and artificial CSF-infused subjects, although levels were substantially higher in NGF-treated subjects (9.8+/-3.8 ng/g in NGF-infused vs. 2.0+/-0.4 ng/g in vehicle-infused and only 0.4+/-0.2 ng/g in lesioned, non-infused animals). These findings indicate that the process of intrathecal cannulation and fluid infusion elicits alterations in the spinal cord environment that are neuroprotective, including spontaneous elevations in NGF levels.

  2. A prospective, randomized, double blinded comparison of intranasal dexmedetomodine vs intranasal ketamine in combination with intravenous midazolam for procedural sedation in school aged children undergoing MRI

    PubMed Central

    Ibrahim, Mohamed

    2014-01-01

    Background: For optimum magnetic resonance imaging (MRI) image quality and to ensure precise diagnosis, patients have to remain motionless. We studied the effects of intranasal dexmedetomidine and ketamine with intravenous midazolam for pre-procedural and procedural sedation in school aged children. Patients and Methods: Children were randomly allocated to one of two groups: (Group D) received intranasal dexmedetomidine 3 μg kg–1 and (Group K) received intranasal ketamine 7 mg kg–1. Sedation levels 10, 20 and 30 min after drug instillation were evaluated using a Modified Ramsay sedation scale. A 4-point score was used to evaluate patients when they were separated from their parents and their response to intravenous cannulation. Results: The two groups were comparable in terms of the child's anxiety at presentation (P = 0.245). We observed that Group K achieved faster sedation at 10 min point with P < 0.05. A comparable sedation score at 20 and 30 min were noted. The two groups were comparable regarding to the child's acceptance of nasal administration (P = 0.65). The sedation failure rate was insignificantly differ between groups (13.7% vs. 20.6% for Group D and K respectively). Heart rate and systolic blood pressure showed a significant difference between the two groups starting from the point of 20 min. Conclusion: Intranasal dexmedetomidine 3 μg kg–1 or ketamine 7 mg kg–1 can be used safely and effectively to induce a state of moderate conscious sedation and to facilitate parents’ separation and IV cannulation. Addition of midazolam in a dose not sufficient alone to produce the target sedation achieved our goal of deep level of sedation suitable for MRI procedure. PMID:25886223

  3. Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair.

    PubMed

    Gharde, Parag; Chauhan, Sandeep; Kiran, Usha

    2006-01-01

    We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sedation scores in group A and C were excellent (3.75 +/- 0.44 and 3.80 +/- 0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A- 3.90 +/- 0.28 and group C- 3.83 +/- 0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.

  4. Plasma Pharmacokinetics and Routes of Excretion of [14C]-Labeled Arruva, a High-Potency Sweetener, Following Oral Administration to Beagle Dogs.

    PubMed

    Casterton, Phillip L; Crincoli, Christine M; Brathwaite, Witty A; Rihner, Marisa O; Nikiforov, Andrey I; Thomas, Jennifer A

    2014-05-01

    [(14)C]-Labeled arruva [sodium/potassium (2R,4R)-2-amino-4-carboxy-4-hydroxy-5-(3-indolyl) pentanoate] was administered as a single gavage dose (10 mg/kg bw) to male and female Beagle dogs and 1 bile duct-cannulated male. The mean peak arruva plasma concentration equivalent of 1.2 µg/g occurred at first sampling time point of 1 hour postdosing. The mean area under the concentration versus time curve from 0 hour postdosing to the last time point was approximately 20 µg·h/g and the mean terminal plasma elimination half-life ranged from 15 hours in females to 21 hours in males. Over 168 hours postdosing, 35% to 50% of the administered arruva was eliminated in the urine with 44% to 53% eliminated in feces; 1.3% of the administered dose was recovered in bile. Arruva and its derivatives were identified using tandem mass spectrometry, and the relative percentage of each substance was quantified via radio high-performance liquid chromatography. Over a 168-hour collection period, combined urine and feces extract data from the 6 noncannulated dogs showed that approximately 91% of the dose was excreted as unchanged parent arruva (41% in urine and 50% in feces). In the cannulated male, 95.3% was excreted as unchanged parent arruva; 50.2% in urine, 43.9% in feces, and 1.3% in bile. Lactone and lactam derivatives of arruva and 1 unidentified substance were detected in urine only during the first 24 hours postdosing with the greatest amounts detected during the first 6 hours of collection; up to 1% of lactone or lactam derivatives were detected in bile samples. Plasma pharmacokinetics data indicated rapid absorption of arruva with the majority of radioactivity located in the feces collected in the first 48 hours.

  5. Characteristics of Pseudoaneurysms in Northern India; Risk Analysis, Clinical Profile, Surgical Management and Outcome

    PubMed Central

    Lone, Hafeezulla; Ganaie, Farooq Ahmad; Lone, Ghulam Nabi; Dar, Abdul Majeed; Bhat, Mohammad Akbar; Singh, Shyam; Parra, Khursheed Ahmad

    2015-01-01

    Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury. Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling (less than 5-cm) and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded. Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1±0.6 years. Among them there were 11 (55%) men and 9 (45%) women. Nine (45%) patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 (85%) patients and 3 (15%) were managed conservatively. Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who sustain inadvertent

  6. Long-term effect of prazosin administration on blood pressure, heart and structure of coronary artery of young spontaneously hypertensive rats.

    PubMed

    Kristek, F; Koprdova, R

    2011-06-01

    The sympathetic nervous system belongs to the essential systems participating in blood pressure (BP) regulation. Inhibitory intervention into the key point of its operation (alfa 1 adrenoceptors) in the prehypertensive period of spontaneously hypertensive rats (SHR) might affect the development of the hypertension in later ontogenic periods. We studied the long-term effect of prazosin administration on the cardiovascular system of young Wistar rats and SHR. Four-week-old animals were used: Wistar rats, SHR, and Wistar rats and SHR receiving prazosin (10 mg/kg/day in tap water) by gavage. Blood pressure (BP) was measured weekly by the plethysmographic method. After six weeks under anaesthesia, the carotid artery was cannulated for BP registration, and the jugular vein was cannulated for administration of drugs. Afterwards, the animals were perfused with a glutaraldehyde fixative at a pressure of 120 mmHg. The septal branch of the left descending coronary artery was processed using electron microscopy. The prazosin administration evoked the following results in both groups: a decrease of BP and heart/body weight ratio, enhancement of hypotensive responses to acetylcholine (0.1 μg, 1 μg, and 10 μg), and an increase in the inner diameter of the coronary artery without changes in wall thickness, cross sectional area (CSA) (tunica intima+media), CSA of smooth muscle cells, and extracellular matrix. In the SHR group, a reduction was observed in BP increase after noradrenaline (1 μg) application. CSA of endothelial cells which was decreased in the SHR (compared to the control Wistar rats) was increased after prazosin treatment (up to control value). Long-term prazosin administration from early ontogeny partially prevented some pathological alterations in the cardiovascular system of SHR.

  7. Abnormal origin of right coronary artery and use of Tiger catheter through femoral route

    PubMed Central

    Datta, Goutam; Rai, Durga Prasad

    2016-01-01

    Background Abnormal origin of right coronary artery (RCA) is not uncommon. The incidence is .25–.92%. Right Judkin catheter is used universally for engaging right coronary ostium from femoral route. We have tried Tiger catheter from femoral route in abnormal origin of RCA patients. We were successful in cannulating RCA ostium in most of the cases. Materials and methods We have studied about 5120 patients over 4 years. We have selected patients from November 2010 to November 2014. Our patients are from two institutions—I.P.G.M.E.R., Kolkata and Burdwan Medical College, West Bengal. Right Judkin 3.5 and 4 were used universally. We have used AL-1,2,3, AR1,2, multipurpose, different guide catheters for cannulating RCA ostium in those cases where we failed to engage by right Judkin catheter. We have used Tiger catheter as a last resort when all endeavor failed. Results and analysis Among 40 cases of left sinus origin Type A—9, Type B—14, Type C—6, Type D—3, and Type E—8 patients were observed. But 668 cases abnormal origin of RCA were from right coronary sinus only. High take-off origin were 422 cases (8%), low take-off were 132 cases (2.5%), and posterior origin were 114 cases (2%). We could engage right coronary ostium by Tiger catheter in 690 cases (97%). We failed in 23 cases (3%). Conclusion Tiger catheter can be used successfully in abnormal RCA origin cases. It is more effective but less risky in comparison to other catheters. PMID:26896276

  8. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

    PubMed Central

    Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Jun-ichi; Sasaki, Reina; Kusakabe, Yuko; Nakamura, Masato; Yasui, Shin; Mikata, Rintaro; Miyazaki, Masaru; Yokosuka, Osamu

    2016-01-01

    AIM To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a loop-tipped guidewire. METHODS Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire (Group A, 20 patients), and a conventional straight-type guidewire (Group B, 20 patients). RESULTS The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23 (0-1) times in Group A and 2.3 ± 1.84 (0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4 (88-628) IU/L in Group A, and 552.05 ± 534.57 (101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients (10%) in Group A, and nine (45%) in Group B, showing a significantly lower value in Group A. CONCLUSION The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia. PMID:27574608

  9. The Homburg lung - efficacy and safety of a minimal-invasive pump-driven device for veno-venous extracorporeal carbon dioxide removal.

    PubMed

    Seiler, Frederik; Trudzinski, Franziska; Hennemann, Kai; Niermeyer, Tom; Schmoll, Christian; Kamp, Annegret; Bals, Robert; Muellenbach, Ralf; Haake, Hendrik; Lepper, Philipp M

    2017-01-19

    Extracorporeal carbon dioxide removal (ECCO2R) is increasingly considered a viable therapeutic approach in the management of hypercapnic lung failure in order to avoid intubation or to allow lung-protective ventilator settings. This study aimed to analyze efficacy and safety of a minimal-invasive ECCO2R device, the Homburg lung. The Homburg lung is a pump-driven system for veno-venous ECCO2R with ¼" tubing and a 0.8 m surface oxygenator. Vascular access is usually established via a 19F/21cm bilumen cannula in the right internal jugular vein. For this work we screened patient registries from two German centers for patients who underwent ECCO2R with the Homburg lung due to hypercapnic lung failure since 2013. Patients who underwent ECMO prior to ECCO2R were excluded. Patients who underwent ECCO2R more than one time were only included once. In total, 24 patients (age 53.86 ± 12.49 years. 62.5% male) were included in the retrospective data analysis. Ventilatory failure occurred due to COPD (50%), cystic fibrosis (16.7%), ARDS (12.5%), and other origins (20.8%). The system generated a blood flow of 1.18 ± 0.23 lpm. Sweep gas flow was 3.87 ± 2.97 lpm. Within four hours, PaCO2 could be reduced significantly from 82.05 ± 15.57 mmHg to 59.68 ± 12.27 mmHg, pH thereby increasing from 7.23 ± 0.10 to 7.36 ± 0.09. Cannulation-associated complications were transient arrhythmia (1/24 patients) and air embolism (1/24). Fatal complications did not occur. In conclusion, the Homburg Lung provides effective carbon dioxide removal in hypercapnic lung failure. The cannulation is a safe procedure with complication rates comparable to those in central venous catheter implantation.

  10. In vitro fermentation of various fiber and starch sources by pig fecal inocula.

    PubMed

    Wang, J F; Zhu, Y H; Li, D F; Wang, Z; Jensen, B B

    2004-09-01

    Freeze-dried ileal effluent (1% wt/vol) from cannulated pigs fed rice-based diets with the inclusion of either animal protein (CON), animal protein plus potato starch (PS), animal protein plus sugar beet pulp (SBP), or animal protein plus wheat bran (WB) was incubated anaerobically at pH 6.0 in fermenters containing 5% (wt/vol) fecal slurry comprising mineral salts medium and 50 g/L of fresh feces from pigs fed the same diets as the cannulated pigs. Samples were collected from the fermenters at 0, 2, 4, 12, 24, and 48 h during in vitro fermentation for measuring nonstarch polysaccharides (NSP), starch, and short-chain fatty acids (SCFA). Results showed that the major SCFA produced were acetate, propionate, and butyrate. The inclusion of soluble dietary fiber (diet SBP) caused the highest concentrations of acetate, propionate, butyrate, and total SCFA, whereas the increase in the production of propionate resulting from the addition of insoluble dietary fiber (diet WB) only occurred at the initial stages during 48 h in vitro fermentation. At all sampling occasions (except for 4 h), the levels of butyrate were increased (P < 0.01) by resistant starch compared with fiber sources, showing that a higher level of butyrate can be achieved through microbial fermentation by potato starch. Lowered (P < 0.05) butyrate concentrations were observed with diet WB during in vitro fermentation. With the inclusion of fiber sources, the energy originating from SCFA was similar to that from NSP disappearance, whereas the values were lower (P < 0.05) from NSP disappearance than for SCFA generated without fiber sources supplemented. We conclude that more substrate is available in ileal effluent with the addition of soluble dietary fiber, and an increased level of butyrate could be achieved through microbial fermentation by resistant starch.

  11. Slow maturation of arterio-venous fistula in seven uremic patients: use of Ash Split Cath(R) as temporary, prolonged vascular access.

    PubMed

    Conz, P A; La Greca, G

    2000-01-01

    The temporary vascular access is the essential condition required to perfrom hemodialysis in uremic patients in the absence of a permanent and utilizable vascular access. The cannulation of a central vein with a dual lumen catheter may be useful when a few weeks are required for the maturation of AVF. Longer times for AVF maturation (such as in diabetic patients and in aged patients) impose the use of a tunnelled catheter such as Tesio Catheter or Hickman Catheter which lead to minor complications and more efficient dialysis treatment. The Ash Split Cath(R), a recently introduced chronic hemodialysis catheter, provides dialysis via a transcutaneous portion containing a 14 French cylindrical shaped catheter with D-shaped lumens and a dacron cuff. Due to the slow maturing of AVF, in our Department the Ash Split Cath has been used in 7 uremic patients (3 males and 4 females) who required hemodialysis. The cannulation of the internal jugular vein was performed by an ultrasound assisted technique and the correct catheter position was verified by standard chest X-rays. The average blood flowrates were 250 ml/min, and the mean KT/V calculated in all patients one month after the beginning of the dialytic therapy was 1.09 +/- 0.02. In six patients the catheter was utilized for at least 4 months, in one patient for 8 months. The devices were easily removed when the patient's AVF was functional and usable. We found that the use of the Ash Split Cath as a temporary, prolonged vascular access in uremic patients was op-timal allowing for flexibility in organizing the dialysis treatment schedule and in yielding a good performance in the initial dialysis therapy. Moreover, this device allows, in these patients, a satisfactory dialysis efficiency.

  12. A comparison of two different doses of rectal ketamine added to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine in infants and young children.

    PubMed

    Wang, X; Zhou, Z J; Zhang, X F; Zheng, S

    2010-09-01

    In some circumstances, a high degree of sedation that results in a child being unconscious at the time of parental separation is desirable. We set out to investigate the efficacy and safety of a rectal premedication regimen designed to produce this increased level of sedation. Sixty-seven children aged two to 24 months were randomised into two groups. Group MK received 4 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine and group MKK received 8 mg x kg(-1) ketamine, 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine per rectum. The sedation score at the time of parental separation 30 minutes after drug administration and the response to intravenous cannulation were evaluated on a four-point scale. Respiratory rate, heart rate and arterial oxygen saturation were recorded immediately before parental separation. More patients in group MKK were asleep during separation (62 vs 35%, P < 0.05). Fewer patients in group MKK cried during intravenous cannulation (37 vs 68%, P < 0.05). Sedation scores were significantly increased at both time points. There was no difference between groups in vital signs at the time of parental separation and no adverse respiratory events occurred during the study period. In cases where a high degree of sedation following premedication in infants and toddlers is desired, the addition of 8 mg x kg(-1) ketamine to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine administered rectally is more efficacious than 4 mg x kg(-1) ketamine.

  13. TRALI Syndrome Complicated by Retroperitoneal Bleeding.

    PubMed

    Singh, Vijay A; Zeltsman, David

    2011-09-01

    Transfusion-related acute lung injury (TRALI) is an underdiagnosed and underreported syndrome which by itself is the third leading cause of transfusion-related mortality. The incidence of TRALI is reported to be 1 in 2000 to 5000 transfusions. When combined with uncontrollable bleeding, survival is unachievable. We report the case of a 25-year-old man, who underwent open heart surgery as an infant to correct his congenital heart disease in association with right pulmonary artery atresia. He presented with hemoptysis secondary to aspergilloma and required a pneumonectomy of the nonfunctional right lung. During pneumolysis, significant bleeding occurred from the superior vena cava. The patient required a blood transfusion and was placed on cardiopulmonary bypass to control the bleeding. Simultaneous occurrence of severe pulmonary edema and retroperitoneal bleeding were noted. Approximately 8 L of frothy edema fluid were drained from the only functional left lung starting ~15 minutes after the transfusion and lasting for several hours until the end of the case. It most likely represented TRALI syndrome. Increasing abdominal girth and poor volume return to the pump were consistent with and pathognomonic for retroperitoneal bleeding. Though primary surgical bleeding in the chest was controlled successfully and a pneumonectomy performed without further difficulty, we were unable to separate the patient from cardiopulmonary bypass due to the inability to oxygenate. As a result, we could not reverse the anti-coagulation which potentially exacerbated the retroperitoneal bleeding. After multiple unsuccessful attempts the patient succumbed. This ill-fated case demonstrates the quandary of obtaining vascular access for emergency cardiopulmonary bypass while in the right thoracotomy position. It may be beneficial to have both the femoral artery and vein cannulated before positioning a patient in a lateral decubitus position. In addition, early direct access to the right atrium

  14. Mammary ductoscopy in the evaluation and treatment of pathologic nipple discharge: a Canadian experience

    PubMed Central

    Simpson, Jory S.; Connolly, Elizabeth M.; Leong, Wey L.; Escallon, Jamie; McCready, David; Reedijk, Michael; Easson, Alexandra M.

    2009-01-01

    Background Mammary ductoscopy allows direct visualization of ductal epithelium using a fibreoptic microendoscope. As the first centre in Canada to apply ductoscopy to surgical practice, we report our experience with this technology. Methods Between 2004 and 2008, 65 women with pathologic nipple discharge underwent ductoscopy before surgical duct excision under general anesthetic. Prospective data collection included cannulation and complication rates, procedure length and lesion visualization rate compared with preoperative ductography, if performed. In addition, we classified the endoscopic appearance according to Makita and colleagues and correlated it with surgical pathology. Results It took longer than 6 months to overcome technical problems before the routine use of ductoscopy in the operating room. The ductoscope was easy to use: we achieved cannulation in 63 of 66 breast ducts (95%) and we visualized a lesion in 52 of 63 breast ducts (83%). The mean procedure length was 5.1 minutes, with no complications. Lesions seen on ductography were seen endoscopically 30 of 33 (91%) times. All 3 malignancies were seen: invasive carcinoma in 1 of 62 (1.6%) and in situ disease in 2 of 62 (3.2%) patients. Surgeons found ductoscopy helpful in defining the extent of duct excision. Except for the “polypoid solitary” class, which accurately predicted a papilloma (23/23), we found poor correlation between Makita and colleague’s endoscopic classification and final pathology. Conclusion Ductoscopy is feasible, safe and practical. Our surgeons routinely use it to identify the location and extent of duct excision without ordering preoperative ductography. Identifying pathology based on the endoscopic appearance is unreliable unless the lesion is solitary and polypoid. PMID:20011159

  15. Cardiovascular and inflammatory response to cholecystokinin during endotoxemic shock.

    PubMed

    Saia, Rafael Simone; Bertozi, Giuliana; Mestriner, Fabíola Leslie; Antunes-Rodrigues, José; Queiróz Cunha, Fernando; Cárnio, Evelin Capellari

    2013-01-01

    Cholecystokinin (CCK) was first described as a gastrointestinal hormone, but its receptors have been located in cardiac and vascular tissues, as well as in immune cells. Our aims were to investigate the role of CCK on lipopolysaccharide (LPS)-induced hypotension and its ability to modulate previously reported inflammatory mediators, therefore affecting cardiovascular function. To conduct these experiments, rats had their jugular vein cannulated for drug administration, and also, the femoral artery cannulated for mean arterial pressure (MAP) and heart rate records. Endotoxemia induced by LPS from Escherichia coli (1.5 mg/kg; i.v.) stimulated the release of CCK, a progressive drop in MAP, and increase in heart rate. Plasma tumor necrosis factor α (TNF-α), interleukin 10 (IL-10), nitrate, vasopressin, and lactate levels were elevated in the endotoxemic rats. The pretreatment with proglumide (nonselective CCK antagonist; 30 mg/kg; i.p.) aggravated the hypotension and also increased plasma TNF-α and lactate levels. On the other hand, CCK (0.4 μg/kg; i.v.) administered before LPS significantly restored MAP, reduced aortic and hepatic inducible nitric oxide synthase (iNOS) production, and elevated plasma vasopressin and IL-10 concentrations; it did not affect TNF-α. Physiological CCK concentration reduced nitrite and iNOS synthesis by peritoneal macrophages, possibly through a self-regulatory IL-10-dependent mechanism. Together, these data suggest a new role for the peptide CCK in modulating MAP, possibly controlling the inflammatory response, stimulating the anti-inflammatory cytokine, IL-10, and reducing vascular and macrophage iNOS-derived nitric oxide production. Based on these findings, CCK could be used as an adjuvant therapeutic agent to improve cardiovascular function.

  16. Cardiovascular responses to catecholamines at 12 degrees C in the American bullfrog (Rana catesbeiana).

    PubMed

    Herman, C A; Robleto, D O; Mata, P L; Heller, R S

    1986-10-01

    The effects of epinephrine, norepinephrine, phenylephrine, and isoproterenol on blood pressure and heart rate were studied in cannulated American bullfrogs, Rana catesbeiana. The bullfrogs were chronically cannulated with a T cannula in the right sciatic artery. In warm-acclimated (22 degrees C) bullfrogs, preinjection mean systemic arterial pressure (SAP) prior to experimental treatment was 13.1 +/- 0.7 mm Hg. Preinjection heart rate was 34.8 +/- 1.8 beats per minute. These parameters were lower in cold-acclimated (12 degrees C) bullfrogs. Cold-acclimated animals had mean SAP values of 8.2 +/- 0.3 mm Hg, and heart rate was 11.1 +/- 1.1 beats per minute. Epinephrine, norepinephrine, and phenylephrine increased blood pressure to an equivalent degree in warm- and cold-acclimated animals. Dose-related decreases in heart rate in response to these catecholamines were observed in warm- but not in cold-acclimated bullfrogs. Warm-acclimated animals were more responsive to isoproterenol from 0.03 micrograms/kg body weight (bw) to 10 micrograms/kg bw than were cold-acclimated animals. The response to isoproterenol was effectively blocked by propranolol (5 mg/kg bw) in both warm- and cold-acclimated animals. Propranolol alone decreased mean SAP in both warm- and cold-acclimated animals, suggesting blockade of endogenous sympathetic activity. Beta receptor response thus appears diminished, but not absent at 12 degrees C. However, the alpha receptors responsible for elevation of blood pressure equally responsive at 12 degrees and 22 degrees C.

  17. Effect of xylanases on ileal viscosity, intestinal fiber modification, and apparent ileal fiber and nutrient digestibility of rye and wheat in growing pigs.

    PubMed

    Lærke, H N; Arent, S; Dalsgaard, S; Bach Knudsen, K E

    2015-09-01

    Two experiments were performed to study the effect of xylanase on ileal extract viscosity, in vivo fiber solubilization and degradation, and apparent ileal digestibility (AID) of fiber constituents, OM, CP, starch, and crude fat in rye and wheat in ileal-cannulated pigs. In Exp. 1, coarse rye without (NX) or with addition of xylanase from Aspergillus niger (AN), (BS), or (TR) was fed to 8 ileal-cannulated barrows (initial BW 30.9 ± 0.3 kg) for 1 wk each according to a double 4 × 4 Latin square design. In Exp. 2, fine rye, fine wheat, and coarse wheat with or without a combination of xylanase from and were fed to 6 ileal-cannulated barrows (initial BW 33.6 ± 0.5 kg) for 1 wk according to a 6 × 6 Latin square design with a 2 × 3 factorial arrangement of enzyme and cereal matrix. Chromic oxide (0.2%) was used as an inert marker. Ileal effluent was collected for 8 h on d 5 and 7 and pooled for analysis. In Exp. 1, TR reduced intestinal viscosity of pigs fed rye from 9.3 mPa·s in the control diet (NX) to 6.0 mPa·s ( < 0.001), whereas AN and BS had no effect. None of the enzymes changed the concentration of total arabinoxylan, high-molecular-weight arabinoxylan (HMW-AX), or arabinoxylan oligosaccharides (AXOS) in the liquid phase of digesta. In Exp. 2, the enzyme combination reduced intestinal viscosity for all 3 cereal matrices ( < 0.05), but the viscosity was much higher with fine rye (7.6 mPa·s) than with fine and coarse wheat (<1.7 mPa·s). Simultaneously, the total concentration of arabinoxylan in the liquid phase of digesta increased by 82.4% in fine wheat ( < 0.002) and by 45.9% in coarse wheat ( < 0.006), and AXOS increased 16-fold with enzyme addition. Similar effects of enzyme were not seen with rye. The concentration of xylooligosaccharides in the liquid phase of digesta increased with enzyme addition, but for xylose, it was only significant for wheat, for which it increased 3.9-fold ( < 0.001). None of the xylanases affected AID of arabinoxylan of rye

  18. Effect of Supplemental Corn Dried Distillers Grains with Solubles Fed to Beef Steers Grazing Native Rangeland during the Forage Dormant Season.

    PubMed

    Murillo, M; Herrera, E; Ruiz, O; Reyes, O; Carrete, F O; Gutierrez, H

    2016-05-01

    Two experiments were conducted to evaluate the effects of the level of corn dry distillers grains with solubles (CDDGS) supplementation on growing performance, blood metabolites, digestion characteristics and ruminal fermentation patterns in steers grazing dormant forage. In Exp. 1, of growth performance, 120 steers (204±5 kg initial body weight [BW]) were distributed randomly into 3 groups (each of 40 steers), which were provided with the following levels of CDDGS supplement: 0%, 0.25%, or 0.50% BW. All groups of steers were grazed for 30 days in each of 3 grazing periods (March, April, and May). Approximately 1,000 ha of the land was divided with electric fencing into 3 equally sized pastures (333 ha in size). Blood samples were collected monthly from 20 steers in each grazing group for analysis of glucose (G), urea-nitrogen (UN) and non-esterified fatty acids. Final BW, average daily gain (ADG) and supplement conversion (CDDGS-C) increased with increasing levels of CDDGS supplementation (p<0.05).The CDDGS supplementation also increased the plasma G and UN concentrations (p<0.05). In Exp. 2, of digestive metabolism, 9 ruminally cannulated steers (BW = 350±3 kg) were distributed, following a completely randomized design, into groups of three in each pasture. The ruminally cannulated steers were provided the same levels of CDDGS supplementation as in the growing performance study (0%, 0.25%, and 0.50% BW), and they grazed along with the other 40 steers throughout the grazing periods. The dry matter intake, crude protein intake, neutral detergent fiber intake (NDFI), apparent digestibility of dry matter (ADDM), crude protein (ADCP) and neutral detergent fiber (ADNDF) increased with increasing levels of CDDGS supplementation (p<0.05). The ruminal degradation rates of CP (kdCP), NDF (kdNDF) and passage rate (kp) also increased with increasing levels of CDDGS supplementation (p<0.05). Ruminal ammonia nitrogen (NH3-N) and propionate concentrations also increased with

  19. Selection of barley grain affects ruminal fermentation, starch digestibility, and productivity of lactating dairy cows.

    PubMed

    Silveira, C; Oba, M; Yang, W Z; Beauchemin, K A

    2007-06-01

    The objective of this study was to evaluate the effects of 2 lots of barley grain cultivars differing in expected ruminal starch degradation on dry matter (DM) intake, ruminal fermentation, ruminal and total tract digestibility, and milk production of dairy cows when provided at 2 concentrations in the diet. Four primiparous ruminally cannulated (123 +/- 69 d in milk; mean +/- SD) and 4 multiparous ruminally and duodenally cannulated (46 +/- 14 d in milk) cows were used in a 4 x 4 Latin Square design with a 2 x 2 factorial arrangement of treatments with 16-d periods. Primiparous and multiparous cows were assigned to different squares. Treatments were 2 dietary starch concentrations (30 vs. 23% of dietary DM) and 2 lots of barley grain cultivars (Xena vs. Dillon) differing in expected ruminal starch degradation. Xena had higher starch concentration (58.7 vs. 50.0%) and greater in vitro 6-h starch digestibility (78.0 vs. 73.5%) compared with Dillon. All experimental diets were formulated to supply 18.3% crude protein and 20.0% forage neutral detergent fiber. Dry matter intake and milk yield were not affected by treatment. Milk fat concentration (3.55 vs. 3.29%) was greater for cows fed Dillon compared with Xena, but was not affected by dietary starch concentration. Ruminal starch digestion was greater for cows fed high-starch diets compared with those fed low-starch diets (4.55 vs. 2.49 kg/d), and tended to be greater for cows fed Xena compared with those fed Dillon (3.85 vs. 3.19 kg/d). Ruminal acetate concentration was lower, and propionate concentration was greater, for cows fed Xena or high-starch diets compared with cows fed Dillon or low-starch diets, respectively. Furthermore, cows fed Xena or high-starch diets had longer duration that ruminal pH was below 5.8 (6.6 vs. 4.0 and 6.4 vs. 4.2 h/d) and greater total tract starch digestibility (94.3 vs. 93.0 and 94.3 vs. 93.0%) compared with cows fed Dillon or low-starch diets, respectively. These results

  20. Ruminal phosphorus disappearance from corn and soybean feedstuffs.

    PubMed

    Mjoun, K; Kalscheur, K F; Hippen, A R; Schingoethe, D J

    2008-10-01

    Byproducts of corn and soybeans have high phosphorus (P) content, but little is known about their P disappearance in the rumen of lactating dairy cows. In situ disappearance of P from corn and soybean feed-stuffs was determined in 2 experiments. In the first experiment, 3 ruminally cannulated lactating dairy cows were used to estimate in situ P disappearance of 9 feed ingredients that included 3 sources of dried distillers grains with solubles (DDG; DGa, DGb, DGc), corn, corn germ, solvent-extracted soybean meal, (44% CP; SBM), expeller soybean meal (SoyPlus; SP), extruded soybeans (ES), and soyhulls (SH). Nylon bags were incubated in the rumen of each cow for 2, 6, 12, 18, 24, 36, and 48 h. The water-soluble fraction of P (A(P)) was greatest in DDG (mean 82.1%) followed by corn germ (77%), with SH having the least A(P) among all feedstuffs (45%). The remaining feedstuffs (SBM, SP, ES, and corn) were similar in A(P) (64.2%). The slowly available fraction of P (B(P)) was greatest in SH (45.6%), lowest in DDG (13.5%), and intermediate, averaging 31.4%, in SBM, ES, SP, and corn. The effective disappearance of P (ED(P)) was greatest for DDG (93.5%), whereas corn germ, ES, SBM, and SP followed with an ED(P) of 93.3, 88.0, 87.5, and 87.0%, respectively. The ED(P) was less for corn and SH than for the other feedstuffs at 83.3 and 69.1%, respectively. Rate of P disappearance was similar for all feedstuffs (16.2%/h). In the second experiment, 3 new sources of DDG (DG1, DG2, and DG3), and one wet distillers grains with solubles (WDG) source were incubated for 3, 6, 12, 24, and 36 h on replicate days in the rumen of 2 cannulated lactating dairy cows. Fraction A(P) varied from 82.7 to 90.3%, with that in WDG being the least soluble. The WDG source had a greater B(P) fraction (15.8%) compared with the DDG sources (9.5%). The WDG had the lowest ED(P) (88.1%), whereas the DDG varied from 89.7 to 92.7%. Corn and soybean byproducts tested, with the exception of SH, have high

  1. Association of bleeding and thrombosis with outcome in Extracorporeal Life Support

    PubMed Central

    Dalton, Heidi J.; Garcia-Filion, Pamela; Holubkov, Richard; Moler, Frank W.; Shanley, Thomas; Heidemann, Sabrina; Meert, Kathy; Berg, Robert A.; Berger, John; Carcillo, Joseph; Newth, Christopher; Harrison, Richard; Doctor, Allan; Rycus, Peter; Dean, J Michael; Jenkins, Tammara; Nicholson, Carol

    2015-01-01

    Objective Changes in technology and increased reports of successful extracorporeal life support (ECLS) use in patient populations such as influenza, cardiac arrest and adults are leading to expansion of ECLS. Major limitations to ECLS expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, ECLS patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Study design Retrospective analysis of patients (<19 years) reported to the ELSO (Extracorporeal Life Support Organization registry from eight CPCCRN centers between 2005 and 2011. Subjects The study cohort consisted of 2036 patients [13% with congenital diaphragmatic hernia (CDH)]. Interventions none Main results In the cohort of non-CDH patients (n=1773), bleeding occurred in 38% of patients while thrombosis was noted in 31%. Bleeding and thrombosis were associated with a decreased survival by 40% (RR: 0.59; 95%CI: 0.53, 0.66) and 33% (OR 0.67; 95%CI: 0.60, 0.74). Longer duration of ECLS and use of venoarterial cannulation were also associated with increased risk of bleeding and/or thrombotic complications and lower survival. The most common bleeding events included surgical site bleeding (17%; n=306), cannulation site bleeding (14%; n=256), and intracranial hemorrhage (11%; n=192). Common thrombotic events were clots in the circuit (15%; n=274) and the oxygenator (12%; n=212), and hemolysis (plasma free hemoglobin>50 mg/dL) (10%; n=177). Among patients with CDH, bleeding and thrombosis occurred in, respectively, 45% (n=118) and 60% (n=159), Bleeding events were associated with reduced survival (RR 0.62; 95%CI: 0.46, 0.86) although thrombotic events were not (RR 0.92; 95%CI: 0.67, 1.26). Conclusions

  2. A New Orally Active, Aminothiol Radioprotector-Free of Nausea and Hypotension Side Effects at Its Highest Radioprotective Doses

    SciTech Connect

    Soref, Cheryl M.; Hacker, Timothy A.; Fahl, William E.

    2012-04-01

    Purpose: A new aminothiol, PrC-210, was tested for orally conferred radioprotection (rats, mice; 9.0 Gy whole-body, which was otherwise lethal to 100% of the animals) and presence of the debilitating side effects (nausea/vomiting, hypotension/fainting) that restrict use of the current aminothiol, amifostine (Ethyol, WR-2721). Methods and Materials: PrC-210 in water was administered to rats and mice at times before irradiation, and percent-survival was recorded for 60 days. Subcutaneous (SC) amifostine (positive control) or SC PrC-210 was administered to ferrets (Mustela putorius furo) and retching/emesis responses were recorded. Intraperitoneal amifostine (positive control) or PrC-210 was administered to arterial cannulated rats to score drug-induced hypotension. Results: Oral PrC-210 conferred 100% survival in rat and mouse models against an otherwise 100% lethal whole-body radiation dose (9.0 Gy). Oral PrC-210, administered by gavage 30-90 min before irradiation, conferred a broad window of radioprotection. The comparison of PrC-210 and amifostine side effects was striking because there was no retching or emesis in 10 ferrets treated with PrC-210 and no induced hypotension in arterial cannulated rats treated with PrC-210. The tested PrC-210 doses were the ferret and rat equivalent doses of the 0.5 maximum tolerated dose (MTD) PrC-210 dose in mice. The human equivalent of this mouse 0.5 MTD PrC-210 dose would likely be the highest PrC-210 dose used in humans. By comparison, the mouse 0.5 MTD amifostine dose, 400 {mu}g/g body weight (equivalent to the human amifostine dose of 910 mg/m{sup 2}), when tested at equivalent ferret and rat doses in the above models produced 100% retching/vomiting in ferrets and 100% incidence of significant, progressive hypotension in rats. Conclusions: The PrC-210 aminothiol, with no detectable nausea/vomiting or hypotension side effects in these preclinical models, is a logical candidate for human drug development to use in healthy

  3. Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults

    PubMed Central

    Boerner, Katelynn E.; Birnie, Kathryn A.; Taddio, Anna; McMurtry, C. Meghan; Noel, Melanie; Shah, Vibhuti; Pillai Riddell, Rebecca

    2015-01-01

    Background: This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). Design/Methods: Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). Results: No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, “ready?”) as compared with signaling of impending pain (eg, “sharp scratch”) demonstrated lower pain when signaled about the procedure (n=199): SMD=−0.97 (95% CI, −1.26, −0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, −0.48, 0.27), or fear: SMD=−0.25 (95% CI, −0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=−0.57 (95% CI, −1.82, 0.68), or fear (n=81): SMD=−0.05 (95% CI, −0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=−0.82 (95% CI, −1.21, −0.43). The quality of evidence across all trials was very low. Conclusions: There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction. PMID:26352921

  4. Effects of herbage ingestion upon ileal digestibility of amino acids in heavy Iberian pigs fed on an acorn-based diet.

    PubMed

    García-Valverde, R; Nieto, R; Aguilera, J F

    2010-10-01

    We conducted two experiments with heavy Iberian pigs to determine the ileal digestibility of amino acids (AA) in acorns and freshly cut herbage, and the effects of adding fresh herbage upon the supply of ileal digestible AA when pigs were fed on holm-oak acorns. In Experiment 1, carried out in cannulated pigs of 107 kg bodyweight (BW), daily intake of acorns reached 44.9 g DM/kg(0.75) BW. Arg, His and Thr showed the lowest apparent ileal digestibility (AID) values, whereas Met, the branched-chain AA and Phe had the highest coefficients. The AID of total EAA was 0.716 but only 0.222 for NEAA. Most of the digestive and absorptive processes of acorn protein occurred before the hindgut. Acorn provides (per kg DM) 2.27 g apparent ileal digestible Lys and 22.7 g apparent total digestible AA. Standardized ileal digestibility (SID) values for EAA, NEAA and total AA were 0.924 ± 0.020, 0.784 ± 0.041 and 0.860 ± 0.029. In Experiment 2 fresh herbage was given to six cannulated Iberian pigs of 140 kg either as a single feed (13.7 g DM/kg(0.75) BW) or as a supplement to acorns (28.4 g DM/kg(0.75) BW). When only freshly cut forage was offered the AID of the EAA, NEAA and total AA was close to 0.65 and supplied (per kg DM ingested) 5.61 g AID Lys and 91.7 g digestible AA. Standardized ileal values were 0.744 ± 0.023, 0.912 ± 0.038 and 0.831 ± 0.030 respectively. The addition of fresh forage to the acorns led to a significant decrease in AID of AA in acorn due to digesta transfer to the hindgut: His (p < 0.01), Met (p < 0.001), Phe (p = 0.092), Thr (p < 0.05) and Val (p < 0.05), but Arg, Lys and the branched-chain AA remained unaffected. The main contribution of herbage to AA nutrition of the grazing Iberian pig relies mainly on increasing the supply of digestible AA for pig tissues.

  5. Effects of dietary protein concentration and coconut oil supplementation on nitrogen utilization and production in dairy cows.

    PubMed

    Lee, C; Hristov, A N; Heyler, K S; Cassidy, T W; Long, M; Corl, B A; Karnati, S K R

    2011-11-01

    The objective of this study was to investigate the effect of metabolizable protein (MP) deficiency and coconut oil supplementation on N utilization and production in lactating dairy cows. The hypothesis of the study was that a decrease in ruminal protozoal counts with coconut oil would increase microbial protein synthesis in the rumen, thus compensating for potential MP deficiency. The experiment was conducted for 10 wk with 36 cows (13 primiparous and 23 multiparous), including 6 ruminally cannulated cows. The experimental period, 6 wk, was preceded by 2-wk adaptation and 2-wk covariate periods. Cows were blocked by parity, days in milk, milk yield, and rumen cannulation and randomly assigned to one of the following diets: a diet with a positive MP balance (+44 g/d) and 16.7% dietary crude protein (CP) concentration (AMP); a diet deficient in MP (-156 g/d) and 14.8% CP concentration (DMP); or DMP supplemented with approximately 500 g of coconut oil/head per day (DMPCO). Ruminal ammonia tended to be greater and plasma urea N (20.1, 12.8, and 13.1 mg/dL, for AMP, DMP, and DMPCO diets, respectively) and milk urea N (12.5, 8.3, and 9.5mg/dL, respectively) were greater for AMP compared with DMP and DMPCO. The DMPCO diet decreased total protozoa counts (by 60%) compared with DMP, but had no effect on the methanogens profile in the rumen. Total tract apparent digestibility of dry matter and CP was decreased by DMP compared with AMP. Fiber digestibility was lower for both DMP and DMPCO compared with AMP. Urinary N excretion was decreased (by 37%) by both DMP and DMPCO compared with AMP. The DMP and DMPCO diets resulted in greater milk N efficiency compared with AMP (32.0 and 35.1 vs. 27.6%, respectively). Milk yield was decreased by both DMP and DMPCO compared with AMP (36.2, 34.4, and 39.3 kg/d, respectively) and coconut oil supplementation suppressed feed intake and caused milk fat depression. Coconut oil supplementation decreased short-chain fatty acid (C4:0, C6:0, and

  6. Spreading dilatation to luminal perfusion of ATP and UTP in rat isolated small mesenteric arteries

    PubMed Central

    Winter, Polly; Dora, Kim A

    2007-01-01

    Levels of ATP achieved within the lumen of vessels suggest a key autacoid role. P2Y receptors on the endothelium may represent the target for ATP, leading to hyperpolarization and associated relaxation of vascular smooth muscle through the endothelium-dependent hyperpolarizing factor (EDHF) pathway. EDHF signals radially from the endothelium to cause dilatation, and appears mechanistically distinct from the axial spread of dilatation, which we showed occurs independently of a change in endothelial cell Ca2+ in rat mesenteric arteries. Here we have investigated the potential of P2Y receptor stimulation to evoke spreading dilatation in rat resistance small arteries under physiological pressure and flow. Triple cannulation of isolated arteries enables focal application of purine and pyrimidine nucleotides to the endothelium, avoiding potential complicating actions of these agents on the smooth muscle. Nucleotides were locally infused through one branch of a bifurcation, causing near maximal local dilatation attributable to EDHF. Dilatation then spread rapidly into the adjacent feed artery and upstream against the direction of luminal flow, sufficient to increase flow into the feed artery. The rate of decay of this spreading dilatation was identical between nucleotides, and matched that to ACh, which acts only on the endothelium. In contrast, focal abluminal application of either ATP or UTP at the downstream end of cannulated arteries evoked constriction, which only in the case of ATP was also associated with modest spread of dilatation. The non-hydrolysable ADP analogue, ADPβS, acting at P2Y1 receptors, caused robust local and spreading dilatation responses whether applied to the luminal or abluminal surface of pressurized arteries. Dilatation to nucleotides was sensitive to inhibition with apamin and TRAM-34, selective blockers of small- and intermediate-conductance Ca2+-activated K+ channels, respectively. These data demonstrate that direct luminal stimulation of P

  7. Effect of Supplemental Corn Dried Distillers Grains with Solubles Fed to Beef Steers Grazing Native Rangeland during the Forage Dormant Season

    PubMed Central

    Murillo, M.; Herrera, E.; Ruiz, O.; Reyes, O.; Carrete, F. O.; Gutierrez, H.

    2016-01-01

    Two experiments were conducted to evaluate the effects of the level of corn dry distillers grains with solubles (CDDGS) supplementation on growing performance, blood metabolites, digestion characteristics and ruminal fermentation patterns in steers grazing dormant forage. In Exp. 1, of growth performance, 120 steers (204±5 kg initial body weight [BW]) were distributed randomly into 3 groups (each of 40 steers), which were provided with the following levels of CDDGS supplement: 0%, 0.25%, or 0.50% BW. All groups of steers were grazed for 30 days in each of 3 grazing periods (March, April, and May). Approximately 1,000 ha of the land was divided with electric fencing into 3 equally sized pastures (333 ha in size). Blood samples were collected monthly from 20 steers in each grazing group for analysis of glucose (G), urea-nitrogen (UN) and non-esterified fatty acids. Final BW, average daily gain (ADG) and supplement conversion (CDDGS-C) increased with increasing levels of CDDGS supplementation (p<0.05).The CDDGS supplementation also increased the plasma G and UN concentrations (p<0.05). In Exp. 2, of digestive metabolism, 9 ruminally cannulated steers (BW = 350±3 kg) were distributed, following a completely randomized design, into groups of three in each pasture. The ruminally cannulated steers were provided the same levels of CDDGS supplementation as in the growing performance study (0%, 0.25%, and 0.50% BW), and they grazed along with the other 40 steers throughout the grazing periods. The dry matter intake, crude protein intake, neutral detergent fiber intake (NDFI), apparent digestibility of dry matter (ADDM), crude protein (ADCP) and neutral detergent fiber (ADNDF) increased with increasing levels of CDDGS supplementation (p<0.05). The ruminal degradation rates of CP (kdCP), NDF (kdNDF) and passage rate (kp) also increased with increasing levels of CDDGS supplementation (p<0.05). Ruminal ammonia nitrogen (NH3-N) and propionate concentrations also increased with

  8. Optic Nerve Sheath Mechanics and Permeability in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Raykin, Julia; Best, Lauren; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.; Ethier, C. R.

    2014-01-01

    Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

  9. Biomechanics of the Optic Nerve Sheath in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Ethier, C. Ross; Raykin, Julia; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.

    2014-01-01

    Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

  10. The anatomy of fluid-yielding ducts in breast cancer.

    PubMed

    Twelves, Dominique; Nerurkar, Ashutosh; Osin, Peter; Ward, Ann; Isacke, Clare M; Gui, Gerald P H

    2012-04-01

    The concept of an intraductal approach to evaluate the breast microenvironment assumes direct access to the cancer-containing duct. Central duct access to the cancer-affected lobe is essential if cytology or cell markers are to be useful indicators of pre-malignant change. Access to the cancer-bearing lobe would be less important if field change effects of malignant change were predominantly supra-lobar. The aim of this study was to determine how often duct lavage fluid drains the breast cancer-affected segment. 58 patients undergoing mastectomy for breast cancer were recruited among which 47 had at least one fluid-yielding duct. Following duct lavage, fluid-yielding ducts were perfused ex vivo with Polyurethane Elastomer (PU4ii) resin. Specimens were sliced sagittally, and the extent of resin perfusion and anatomical relationship to the cancer-affected segment was recorded. Computed tomography (CT) scanning was performed on selected mastectomies before cut-up for a feasibility study of 3D duct reconstruction. The median number of fluid-yielding ducts cannulated per cancer-affected breast was 2 (range 1-4). 35/47 (74%) mastectomy specimens were successfully cannulated for resin perfusion. 29/35 (83%) showed tracing of the cancer-affected duct system, 6/35 resin perfusions traced duct systems unaffected by cancer and 12/35 perfusions extravasated. The proportion of sagittal breast slices perfused by resin was 13-68% (median 43%). Volume rendering CT showed it is feasible to produce a simulated image of the perfused ducts. Duct access to the cancer-containing segment is feasible in the majority of patients. Fluid-yielding ducts proportionately drain a significant volume of the breast. Large symptomatic cancers may cause obstruction with distal collapse. Further quantitative study of breast perfusion CT scans may be helpful for estimating the volume fraction of breast tissue perfused by fluid-yielding ducts. The intraductal approach is a valid concept for biomarker

  11. Novel analysis for improved validity in semi-quantitative 2-deoxyglucose autoradiographic imaging.

    PubMed

    Dawson, Neil; Ferrington, Linda; Olverman, Henry J; Kelly, Paul A T

    2008-10-30

    The original [(14)C]-2-deoxyglucose autoradiographic imaging technique allows for the quantitative determination of local cerebral glucose utilisation (LCMRglu) [Sokoloff L, Reivich, M, Kennedy C, Desrosiers M, Patlak C, Pettigrew K, et al. The 2-deoxyglucose-C-14 method for measurement of local cerebral glucose utilisation-theory, procedure and normal values in conscious and anestherized albino rats. J Neurochem 1977;28:897-916]. The range of applications to which the quantitative method can be readily applied is limited, however, by the requirement for the intermittent measurement of arterial radiotracer and glucose concentrations throughout the experiment, via intravascular cannulation. Some studies have applied a modified, semi-quantitative approach to estimate LCMRglu while circumventing the requirement for intravascular cannulation [Kelly S, Bieneman A, Uney J, McCulloch J. Cerebral glucose utilization in transgenic mice over-expressing heat shock protein 70 is altered by dizocilpine. Eur J Neurosci 2002;15(6):945-52; Jordan GR, McCulloch J, Shahid M, Hill DR, Henry B, Horsburgh K. Regionally selective and dose-dependent effects of the ampakines Org 26576 and Org 24448 on local cerebral glucose utilisation in the mouse as assessed by C-14-2-deoxyglucose autoradiography. Neuropharmacology 2005;49(2):254-64]. In this method only a terminal blood sample is collected for the determination of plasma [(14)C] and [glucose] and the rate of LCMRglu in each brain region of interest (RoI) is estimated by comparing the [(14)C] concentration in each region relative to a selected control region, which is proposed to demonstrate metabolic stability between the experimental groups. Here we show that the semi-quantitative method has reduced validity in the measurement of LCMRglu as compared to the quantitative method and that the validity of this technique is further compromised by the inability of the methods applied within the analysis to appropriately determine metabolic

  12. Tonic adrenergic and serotonergic inhibition of a withdrawal reflex in rabbits subjected to different levels of surgical preparation.

    PubMed

    Ogilvie, J; Simpson, D A; Clarke, R W

    1999-01-01

    The excitability of the heel-gastrocnemius withdrawal reflex pathway has been monitored in rabbits undergoing surgical preparation for electrophysiological experimentation under Saffan anaesthesia. Reflexes were evoked by percutaneous electrodes inserted at the heel and recorded as electromyograph signals from the ipsilateral medial gastrocnemius muscle. Two levels of surgery were carried out. The "full surgical" preparation was performed under deep Saffan anaesthesia. The trachea, carotid artery, jugular vein and intrathecal space (via a small laminectomy at L1) were cannulated, the animals were decerebrated by suction, and the left hindlimb was immobilized by screw clamps applied to the tibia and the femur. The sciatic nerve and its branches were exposed by bisection of the posterior biceps muscle and the anaesthetic was withdrawn. In the "reduced surgery" preparation, procedures were carried out with a lighter level of Saffan anaesthesia and operated tissues were infiltrated with local anaesthetic. Only the cannulations were performed in these animals. The excitability of the heel-gastrocnemius reflex declined throughout the full surgical preparation, with the median threshold increasing from 0.8 to 4.2 mA (n=19) and responses to suprathreshold stimuli reducing in size. Most of this effect was reversed after surgery was complete and anaesthesia withdrawn subsequent to decerebration. There were no significant changes in reflex excitability during the reduced surgery preparation (n = 15). Animals prepared by each of these protocols were given increasing intrathecal doses of either the selective alpha2-adrenoceptor antagonist RX 821002 (0.3 to 300 microg) or the serotonin/5-hydroxytryptamine (5-HT)1A-receptor antagonist WAY-100635 (0.01 to 30 microg). Both drugs caused significant, dose-dependent increases in reflex responses, to four to six times pre-drug control in both groups of animals. There were no differences in the effects on reflexes of either drug between

  13. A South Indian Cadaveric Study About the Relationship of Hepatic Segment of Inferior Vena Cava with the Liver

    PubMed Central

    Surendran, Sudarshan; Nelluri, Venu Madhav; Kumar, Naveen; Aithal, Ashwini P

    2016-01-01

    Introduction Inferior Vena Cava (IVC) is the largest vein of the body. It runs vertically upwards in the abdomen, behind the liver. Its course is very constant in relation to liver. However, the amount of liver parenchyma related to it can vary from person to person. The data regarding its course and relations may be very useful to radiologists and surgeons during surgical treatment procedures for Budd-Chiari syndrome, liver carcinoma, liver transplant, venous cannulations and many other clinical procedures. Aim Aim of this study was to document the incidence of straight and curved course of IVC in relation to liver and also to note the pattern in which the liver tissue was related to the IVC. Materials and Methods In the current study, 95 adult cadaveric livers were observed; specifically to study the course/direction of the hepatic segment of IVC in relation to the liver. The extent of liver tissue related to various aspects of IVC was also studied. The course of the IVC was classified as straight and curved; and the relationship of liver parenchyma to the IVC was classified into 6 categories. The data was expressed as percentage incidence. Results In 78.94% cases, the IVC had a straight course in relation to the liver; whereas in 21.06% cases, it had a left sided curve (concavity of the curve towards the caudate lobe) in its course. In 6.31% cases, IVC travelled in a tunnel, being encircled by the liver parenchyma all around; in 36.84% cases, it was covered by liver parenchyma on front and sides so that only posterior surface of IVC was visible; in 3.15% cases it was covered by liver tissue on front, sides and also partly on posterior aspect; in 50.52% of cases, its anterior surface, sides and left edge of the posterior surface was covered by liver tissue; and in 3.15% cases it was covered only from the front by the liver tissue. Conclusion The data being reported here might be useful for surgeons while planning and executing various hepatic surgeries and also

  14. The Economics of Medicare Accountable Care Organizations

    PubMed Central

    Blackstone, Erwin A.; Fuhr, Joseph P.

    2016-01-01

    Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

  15. The incidence of thyroid cancer is affected by the characteristics of a healthcare system.

    PubMed

    Lee, Tae-Jin; Kim, Sun; Cho, Hong-Jun; Lee, Jae-Ho

    2012-12-01

    The aim of this study was to investigate the associations between the incidence of thyroid cancer and the characteristics of healthcare systems in OECD countries and to demonstrate that the increasing incidence of thyroid cancer is mainly due to overdiagnosis. We used a random effects panel model to regress the incidence of thyroid cancer on the characteristics of healthcare systems (i.e., share of public expenditure on health, mode of health financing, existence of referral system to secondary care, mode of payment to primary care physicians), controlling for macro context variables (i.e., GDP per capita, educational level) on a country level. Data were derived from 34 OECD countries for 2002 and 2008. The share of public expenditure on health was negatively associated with the incidence of thyroid cancer. However, it had no statistically significant effect on the mortality of thyroid cancer and on the incidence of stomach and lung cancer. In the case of colorectal cancer, it had a positive effect on the incidence rate. The upward trend of the incidence of thyroid cancer is closely related to the healthcare system that permits overdiagnosis. Increases in the proportion of public financing may help reduce the overdiagnosis of thyroid cancer.

  16. Beyond informed consent: did cancer patients challenge their physicians in the post-World War II era?

    PubMed

    Lerner, Barron H

    2004-10-01

    Historians have debated the degree to which past patients have provided meaningful consent prior to medical interventions. This article, a chart review of 170 patients treated for cancer between 1945 and 1970, adds to this literature by exploring the years when informed consent was being introduced in medical practice. As would be expected in a largely paternalistic era, physicians controlled most of the clinical encounters, even concealing cancer diagnoses. Yet thirty-one (18 percent) of the patients showed some involvement in decision making, either writing restrictions on their consent forms, asking probing questions, or otherwise challenging physicians' orders. Although the overall number of patients studied was small, minority and other ward patients were as likely as white, private patients to speak up. This study concludes that most patients passively assented to treatment, signing consent forms without making any inquiries. But a small group of patients challenged their physicians, leading them to learn more about proposed treatment options and perhaps make more informed decisions. Although motivated in part by the increasing attention to better consent practices, these patients spoke up for other reasons as well, possibly including their basic personalities, prior negative experiences in hospitals, or apprehensiveness regarding specific types of interventions. Further research should explore the factors--beyond the introduction of informed consent--that have historically promoted better dialogue between physicians and patients.

  17. Colonoscope navigation system using colonoscope tracking method based on line registration

    NASA Astrophysics Data System (ADS)

    Oda, Masahiro; Kondo, Hiroaki; Kitasaka, Takayuki; Furukawa, Kazuhiro; Miyahara, Ryoji; Hirooka, Yoshiki; Goto, Hidemi; Navab, Nassir; Mori, Kensaku

    2014-03-01

    This paper presents a new colonoscope navigation system. CT colonography is utilized for colon diagnosis based on CT images. If polyps are found while CT colonography, colonoscopic polypectomy can be performed to remove them. While performing a colonoscopic examination, a physician controls colonoscope based on his/her experience. Inexperienced physicians may occur complications such as colon perforation while colonoscopic examinations. To reduce complications, a navigation system of colonoscope while performing the colonoscopic examinations is necessary. We propose a colonoscope navigation system. This system has a new colonoscope tracking method. This method obtains a colon centerline from a CT volume of a patient. A curved line (colonoscope line) representing the shape of colonoscope inserted to the colon is obtained by using electromagnetic sensors. A coordinate system registration process that employs the ICP algorithm is performed to register the CT and sensor coordinate systems. The colon centerline and colonoscope line are registered by using a line registration method. The position of the colonoscope tip in the colon is obtained from the line registration result. Our colonoscope navigation system displays virtual colonoscopic views generated from the CT volumes. A viewpoint of the virtual colonoscopic view is a point on the centerline that corresponds to the colonoscope tip. Experimental results using a colon phantom showed that the proposed colonoscope tracking method can track the colonoscope tip with small tracking errors.

  18. Herbage intake and ruminal digestion of dairy cows grazed on perennial ryegrass pasture either in the morning or evening.

    PubMed

    Ueda, Koichiro; Mitani, Tomohiro; Kondo, Seiji

    2016-08-01

    This study aimed to clarify diurnal fluctuations of herbage intake, ruminal fermentation of herbage carbohydrates and proteins, and digesta particulate weight in the rumen of grazing dairy cows. Six ruminally cannulated, non-lactating dairy cows were grazed on perennial ryegrass/white clover pasture either in the morning (04.00 to 08.00 hours) or the evening (16.00 to 20.00 hours). Cows grazed in the evening spent more time (P < 0.01) and consumed more herbage (P < 0.01) compared with cows grazed in the morning. Higher (P < 0.05) daily mean concentrations of total volatile fatty acid, propionate and n-butyrate in rumen fluid were observed for cows grazed in the evening compared with cows grazed in the morning. Although cows grazed in the evening ingested more crude protein compared with cows grazed in the morning, no significant difference in NH3 -N concentration in rumen fluid was observed between them. The ratio of purine-derivative concentration to creatinine concentrations was higher (P < 0.01) in the urine of cows grazed in the evening than in cows grazed in the morning. These results clearly indicated that evening grazing was advantageous for dairy cows compared with morning grazing, in terms of ruminal fermentable energy intake and nitrogen utilization efficiency.

  19. Kisspeptin in the medial amygdala and sexual behavior in male rats.

    PubMed

    Gresham, Rebecca; Li, Shengyun; Adekunbi, Daniel A; Hu, Minghan; Li, Xiao Feng; O'Byrne, Kevin T

    2016-08-03

    The medial amygdala (MeA) is crucial for sexual behavior; kisspeptin (Kiss1) also plays a role in sexual function. Kisspeptin receptor (Kiss1r) knockout mice display no sexual behavior. Recently Kiss1 and Kiss1r have been discovered in the posterodorsal subnucleus of the medial amygdala (MePD). We hypothesised that Kiss1 in the MePD may have an influence on male sexual behavior. To test this we bilaterally cannulated the MePD and infused kisspeptin-10 in male rats. This caused the rats to have multiple erections, an effect specific to Kiss1 receptor activation, because Kiss1r antagonism blocked the erectile response. When Kiss1 was infused into the lateral cerebroventricle, there were no observed erections. We also measured the plasma levels of LH when Kiss1 is infused into the MePD or lateral cerebroventricle; Kiss1 increased plasma LH to comparable levels when infused into both sites. We conclude that Kiss1 has a role in male sexual behavior, which is specific to the MePD.

  20. Motion-adapted catheter navigation with real-time instantiation and improved visualisation.

    PubMed

    Lee, Su-Lin; Kwok, Ka-Wai; Wang, Lichao; Riga, Celia; Bicknell, Colin; Cheshire, Nicholas; Yang, Guang-Zhong

    2013-09-01

    The improvements to catheter manipulation by the use of robot-assisted catheter navigation for endovascular procedures include increased precision, stability of motion and operator comfort. However, navigation through the vasculature under fluoroscopic guidance is still challenging, mostly due to physiological motion and when tortuous vessels are involved. In this paper, we propose a motion-adaptive catheter navigation scheme based on shape modelling to compensate for these dynamic effects, permitting predictive and dynamic navigations. This allows for timed manipulations synchronised with the vascular motion. The technical contribution of the paper includes the following two aspects. Firstly, a dynamic shape modelling and real-time instantiation scheme based on sparse data obtained intra-operatively is proposed for improved visualisation of the 3D vasculature during endovascular intervention. Secondly, a reconstructed frontal view from the catheter tip using the derived dynamic model is used as an interventional aid to user guidance. To demonstrate the practical value of the proposed framework, a simulated aortic branch cannulation procedure is used with detailed user validation to demonstrate the improvement in navigation quality and efficiency.

  1. Effect of a non-forage fiber of red bean hulls on ruminal mat characteristics, chewing activity and milk production in dairy cows.

    PubMed

    Izumi, Kenichi; Miwa, Junpei; Ishizuka, Kenta

    2014-03-01

    The evaluation of red bean hulls (RBH) as a non-forage fiber source on ruminal mat formation, chewing activity and milk production was determined using two experiments. In experiment 1, four non-lactating, rumen-cannulated Holstein cows were offered a control diet of 60.1% forage, and an RBH diet of 51.6% forage and 9.4% RBH. Although the neutral detergent fiber (NDF) intake was higher with the RBH diet than the control diet, the physically effective NDF (peNDF) intake was lower. The rumination period tended to be longer with the RBH diet than with the control diet and the ruminal mat was formed even when the RBH diet was consumed. Ruminal fermentation parameters were not affected by treatment. In experiment 2, 40 lactating cows were fed a control diet of 53.4% forage or an RBH diet of 50.3% forage and 8.1% RBH. Dry matter intake, chewing activity and milk production were not affected by diet. Cows sorted against NDF in the control diet, but not in the RBH diet. It is concluded that normal ruminal function can be maintained because the ruminal mat was stratified and rumination activity was not reduced even when a low peNDF diet that contained RBH was given to dairy cows.

  2. Air filtering capacity of an integrated cardiopulmonary bypass unit.

    PubMed

    Mueller, Xavier M; Tevaearai, Hendrik T; Jegger, David; von Segesser, Ludwig K

    2003-01-01

    To limit the morbidity of cardiopulmonary bypass (CPB), a new concept of integrating pumping, oxygenation, and air removal into a single unit has been developed (CardioVention Inc., Santa Clara, CA). The air filtration capacity of this system was tested. Three calves (73.2 +/- 2 kg) were connected to the integrated system by jugular and carotid cannulation. The integrated unit was challenged with injections of boluses of air of 5, 10, and 20 ml, three times each, and for a blood flow of 3 L/min and 5 L/min, respectively. The bubble count and size were recorded downstream of the unit with a Doppler ultrasound. At 3 L/min, bubbles were detected after injections of 20 ml only (n = 7 for the nine boluses). At 5 L/min, 1 bubble was detected with the nine injections of 5 ml, 14 bubbles were detected with nine injections of 10 ml, and 25 bubbles were detected with nine injections of 20 ml. No bubble exceeded 40 microm in diameter as determined by the Doppler ultrasound. The air filtering capacity of the CardioVention system is excellent both in terms of bubble count and of size after injection of large boluses of air. Its integrated concept offers a simplification of the circuit with fewer devices and connections, which further reduces the risk of accidental air introduction.

  3. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

    PubMed Central

    Baniya, Ramkaji; Upadhaya, Sunil; Madala, Seetharamprasad; Subedi, Subash Chandra; Shaik Mohammed, Tabrez; Bachuwa, Ghassan

    2017-01-01

    The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10–1.14; p=0.05) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10–1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08–0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20–0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.

  4. Diversity and fluctuation in ciliate protozoan population in the rumen of cattle.

    PubMed

    Abrar, Arfan; Watanabe, Haruki; Kitamura, Tasuku; Kondo, Makoto; Ban-Tokuda, Tomomi; Matsui, Hiroki

    2016-09-01

    The purpose of this study was to investigate the diversity and fluctuation in the ciliate protozoan population in the rumen of cattle. DNA was extracted from the rumen of three ruminally cannulated, crossbred cattle and a polymerase chain reaction (PCR)-derived clone library was constructed, using a specific primer set targeting 18S ribosomal RNA genes of ciliate protozoa. DNA fragments of seven selected clones were validated for standard DNA of the protozoa-specific real-time PCR assay. Furthermore, population fluctuation of ciliate protozoa and methanogens in the cattle rumen was determined by real-time PCR. A total of 60 clones were sequenced, phylogenetically analyzed, and classified into 24 operational taxonomic units (OTUs) based on a 99% similarity criterion. More than 80% sequences were phylogenetically placed in the genus Entodinium. The rest of the sequences were placed in the genus Diploplastron (5%), Dasytricha (8.3%) and Isotricha (3.3%). The results suggest that Entodinium was the dominant group in the rumen of cattle used in this study. The ciliate protozoan population showed no significant change in numbers during the monitoring period and reached a peak at 3 h after feeding. Changes in the protozoa population were lower than those of the methanogens.

  5. Morphine blocks the Mesobuthus tamulus venom-induced augmentation of phenyldiguanide reflex and pulmonary edema in anesthetized rats

    PubMed Central

    Akella, Aparna; Tiwari, Anil K.; Rai, Om P.; Deshpande, Shripad B.

    2016-01-01

    Objective: Pulmonary edema, a manifestation of scorpion envenomation syndrome, is attributed to cardiogenic or noncardiogenic factors. Morphine is a drug used for cardiogenic pulmonary edema and its effect on Mesobuthus tamulus (MBT) venom-induced changes is not known. Therefore, we hypothesized that morphine blocks the MBT venom-induced augmentation of phenyldiguanide (PDG) reflex and pulmonary edema. Materials and Methods: Experiments were performed on anesthetized adult female rats. Trachea and jugular vein were cannulated, and the electrocardiographic potentials were recorded by connecting needle electrodes in limb lead II configuration. PDG (10 ΅g/kg, IV, bolus injection) responses were elicited by bolus injection initially, after saline/morphine (1 mg/kg) and after injecting MBT venom (100 μg/kg). The time-response area of the PDG-induced bradycardiac response after treatment was calculated as % of the initial PDG response area. At the end of experiments, lungs were excised for determination of pulmonary water content. Results: PDG produced bradycardiac response that lasted for >60 s. MBT venom augmented the PDG reflex response by 2.5 times. In morphine pretreated group, augmentation of bradycardiac response induced by MBT venom was absent. MBT venom increased the pulmonary water content, and the increase was absent in morphine pretreated animals. Conclusion: The results reveal that morphine prevents the MBT venom-induced augmentation of PDG reflex response and pulmonary edema. Thus, morphine can be useful in scorpion envenomation syndrome associated with pulmonary edema. PMID:26997727

  6. Jacaric acid is rapidly metabolized to conjugated linoleic acid in rats.

    PubMed

    Kijima, Ryo; Honma, Taro; Ito, Junya; Yamasaki, Masao; Ikezaki, Aya; Motonaga, Chihiro; Nishiyama, Kazuo; Tsuduki, Tsuyoshi

    2013-01-01

    We have shown previously that jacaric acid (JA; 8c,10t,12c-18:3), which has a conjugated triene system, has a strong anti-tumor effect. However, the characteristics of absorption and metabolism of JA have yet to be determined in vivo, and the details of absorption and metabolism of JA in the small intestine are particularly unclear. This information is required for effective use of JA in humans. Therefore, in this study we examined absorption and metabolism of JA using cannulation of the thoracic duct in rats. Emulsions of two test oils, jacaranda seed oil and tung oil, which contain JA and α-eleostearic acid (α-ESA; 9c,11t,13t-18:3), respectively, were administered to rats and lymph from the thoracic duct was collected over 24 h. We examined the rate of absorption of JA and possible conversion to a conjugated linoleic acid (CLA)containing a conjugated diene system. The positional isomerism of the CLA produced by JA metabolism was determined using gas chromatography-electron impact/mass spectrometry. The rate of absorption and percentage conversion of JA were compared with those of α-ESA. We found that JA is rapidly absorbed and converted to a CLA in rats and that the percentage conversion of JA was lower than that of α-ESA. This is the first report on the absorption and metabolism of JA and this information may be important for application of JA as a functional food.

  7. Implantable centrifugal blood pump with dual impeller and double pivot bearing system: electromechanical actuator, prototyping, and anatomical studies.

    PubMed

    Bock, Eduardo; Antunes, Pedro; Leao, Tarcisio; Uebelhart, Beatriz; Fonseca, Jeison; Leme, Juliana; Utiyama, Bruno; da Silva, Cibele; Cavalheiro, Andre; Filho, Diolino Santos; Dinkhuysen, Jarbas; Biscegli, Jose; Andrade, Aron; Arruda, Celso

    2011-05-01

    An implantable centrifugal blood pump has been developed with original features for a left ventricular assist device. This pump is part of a multicenter and international study with the objective to offer simple, affordable, and reliable devices to developing countries. Previous computational fluid dynamics investigations and wear evaluation in bearing system were performed followed by prototyping and in vitro tests. In addition, previous blood tests for assessment of normalized index of hemolysis show results of 0.0054±2.46 × 10⁻³ mg/100 L. An electromechanical actuator was tested in order to define the best motor topology and controller configuration. Three different topologies of brushless direct current motor (BLDCM) were analyzed. An electronic driver was tested in different situations, and the BLDCM had its mechanical properties tested in a dynamometer. Prior to evaluation of performance during in vivo animal studies, anatomical studies were necessary to achieve the best configuration and cannulation for left ventricular assistance. The results were considered satisfactory, and the next step is to test the performance of the device in vivo.

  8. Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.

    PubMed

    Wolff, Klaus-Dietrich; Fichter, Andreas; Braun, Christian; Bauer, Florian; Humbs, Martin

    2014-10-01

    Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons.

  9. Ultrasonographic investigation of the effect of positive end-expiratory pressure on the cross-sectional area of the femoral vein.

    PubMed

    Ryu, J H; Han, S S; Choi, W J; Kim, H; Lee, S C; Do, S H; Son, Y K

    2013-02-01

    Femoral veins are commonly used as a relatively safe alternative route for central venous cannulation. Several maneuvers are used to increase the cross-sectional area of the vein. In this study, we assessed the effect of positive end-expiratory pressure (PEEP) on the cross-sectional area (CSA) of femoral veins, using ultrasound in adult patients under positive pressure ventilation. All patients received a standardized induction of general anesthesia and intravenous fluid administration. Using ultrasound, the cross-sectional areas of both femoral veins were measured in 57 adult patients in the supine position without PEEP (control) and in the supine position with PEEP of 10 cm H(2)O. Mean arterial pressure and heart rate were recorded before and after the application of PEEP at 10 cm H(2)O. The application of 10 cm H(2)O PEEP significantly increased the CSA of the right femoral vein by 47.6 % and the left femoral vein by 48.4 % (each P < 0.001). Mean arterial pressure decreased by 2.6 mmHg (95 % CI 1.3-3.9; P < 0.001), whereas no significant change in heart rate was observed (P = 0.861). The CSA of the femoral vein is augmented with the application of 10 cm H(2)O PEEP in adult patients undergoing positive pressure ventilation.

  10. Thoracic epidural anesthesia decreases endotoxin-induced endothelial injury

    PubMed Central

    2014-01-01

    Background The sympathetic nervous system is considered to modulate the endotoxin-induced activation of immune cells. Here we investigate whether thoracic epidural anesthesia with its regional symapathetic blocking effect alters endotoxin-induced leukocyte-endothelium activation and interaction with subsequent endothelial injury. Methods Sprague Dawley rats were anesthetized, cannulated and hemodynamically monitored. E. coli lipopolysaccharide (Serotype 0127:B8, 1.5 mg x kg-1 x h-1) or isotonic saline (controls) was infused for 300 minutes. An epidural catheter was inserted for continuous application of lidocaine or normal saline in endotoxemic animals and saline in controls. After 300 minutes we measured catecholamine and cytokine plasma concentrations, adhesion molecule expression, leukocyte adhesion, and intestinal tissue edema. Results In endotoxemic animals with epidural saline, LPS significantly increased the interleukin-1β plasma concentration (48%), the expression of endothelial adhesion molecules E-selectin (34%) and ICAM-1 (42%), and the number of adherent leukocytes (40%) with an increase in intestinal myeloperoxidase activity (26%) and tissue edema (75%) when compared to healthy controls. In endotoxemic animals with epidural infusion of lidocaine the values were similar to those in control animals, while epinephrine plasma concentration was 32% lower compared to endotoxemic animals with epidural saline. Conclusions Thoracic epidural anesthesia attenuated the endotoxin-induced increase of IL-1β concentration, adhesion molecule expression and leukocyte-adhesion with subsequent endothelial injury. A potential mechanism is the reduction in the plasma concentration of epinephrine. PMID:24708631

  11. Effects of NO/sub 2/ on immune responses in pulmonary lymph of sheep

    SciTech Connect

    Joel, D.D.; Chandra, P.; Chanana, A.D.

    1982-08-01

    Sheep in which the efferent duct of the caudal mediastinal lymph node was cannulated were exposed to 5 ppm NO/sub 2/, 1.5 h/d for 10 or 11 d. Immune responses were assessed by measuring the daily output of hemolytic plaque-forming cells (PFC) in pulmonary lymph, following intrabronchial immunization with horse red blood cells (HRBC) and phytohemagglutinin- (PHA) induced transformation of blood and pulmonary lymph lymphocytes. Sheep immunized 2 d after termination of NO/sub 2/ exposure had reduced outputs of PFC as compared to those seen in sheep challenged 4 d after NO/sub 2/ exposure. Animals immunized 4 d after NO/sub 2/ exposure had outputs similar to those of air control sheep.A reduction of 38-87% in the transformation index of both blood and pulmonary lymph lymphocytes was observed in sheep exposed to NO/sub 2/. These results suggest that intermittent, short-term exposure to 5 ppm NO/sub 2/ may temporarily alter pulmonary immune responsiveness.

  12. Intra-Pituitary Administration Revisited: Development of a Novel in Vivo Approach to Investigate the Ovine Hypophysis

    PubMed Central

    Taylor, W. Andrew; Evans, Neil P.; Hertz, Carole; Skinner, Donal C.

    2011-01-01

    The anterior pituitary gland regulates physiological processes via the secretion of hormones, which are under the control of factors produced either in the hypothalamus or the pituitary gland itself. Studies investigating how the pituitary gland functions have employed both in vitro and in vivo approaches. Although in vitro analysis has the advantage that it is pituitary specific, the results may be incomplete because the tissue is isolated from other physiological inputs that could affect function under natural conditions. Without vascular input, such studies are inherently of short duration. Conversely, in vivo experiments that rely upon systemic hormone injections require high doses, are non-target specific and the precise hormone concentrations reaching the pituitary gland are difficult to control. Intracerebroventricular hormone infusions are reliant on assumptions that factors are transported to the pituitary gland from the cerebrospinal fluid and are without cerebral effects. Here we describe an innovative method to investigate anterior pituitary function in conscious sheep by direct infusion of peptides into the pituitary tissue surrounding the hypophyseal portal blood vessels. This approach is an adaptation of the hypophyseal portal cannulation technique whereby an indwelling cannula provides direct access to the rostral aspect of the adenohypophysis. Peptide infusions were achieved by insertion of a needle through the implanted cannula such that it penetrated the pituitary. Using this technique, infusion of TRH (17ng/1μl/min for up to 6h) induced a sustained rise in systemic prolactin levels that lasted for the duration of the infusion. PMID:21376082

  13. Intramuscular administration of morphine reduces mustard-oil-induced craniofacial-muscle pain behavior in lightly anesthetized rats.

    PubMed

    Han, Seung R; Lee, Min K; Lim, Koang H; Yang, Gwi Y; Jeon, Hye J; Ju, Jin S; Yoon, Young W; Kim, Sung K; Ahn, Dong K

    2008-04-01

    The present study investigated the role of peripheral opioid receptors in mustard oil-induced nociceptive behavior and inflammation in the masseter muscles of lightly anesthetized rats. Experiments were carried out on male Sprague-Dawley rats weighing between 300 and 400 g. After initial anesthesia with sodium pentobarbital (40 mg/kg, i.p.), one femoral vein was cannulated and connected to an infusion pump for the intravenous infusion of sodium pentobarbital. The rate of infusion was adjusted to provide a constant level of anesthesia. Mustard oil (MO, 30 microl) was injected into the mid-region of the left masseter muscle via a 30-gauge needle. Intramuscularly-administered morphine significantly reduced shaking behavior but not MO-induced inflammation. Intramuscular pretreatment with naloxone, an opioid receptor antagonist, reversed antinociception produced by intramuscularly-administered morphine, while intracisternal administration of naloxone did not affect the antinociception of peripheral morphine. Pretreatment with d-Pen-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP), a mu opioid receptor antagonist, but not naltrindole, a delta opioid receptor antagonist, nor norbinaltorphimine (nor-BNI), a kappa opioid receptor antagonist, reversed intramuscularly-administered morphine-induced antinociception. These results indicate that intramuscularly-administered morphine produces antinociception in craniofacial muscle nociception and that this intramuscularly-administered morphine-induced antinociception is mediated by a peripheral mu opioid receptor. Our observations further support the clinical approach of administering opioids in the periphery for the treatment of craniofacial muscle nociception.

  14. Effect of feeding palm oil by-products based diets on total bacteria, cellulolytic bacteria and methanogenic archaea in the rumen of goats.

    PubMed

    Abubakr, Abdelrahim; Alimon, Abdul Razak; Yaakub, Halimatun; Abdullah, Norhani; Ivan, Michael

    2014-01-01

    Rumen microorganisms are responsible for digestion and utilization of dietary feeds by host ruminants. Unconventional feed resources could be used as alternatives in tropical areas where feed resources are insufficient in terms of quality and quantity. The objective of the present experiment was to evaluate the effect of diets based on palm oil (PO), decanter cake (DC) or palm kernel cake (PKC) on rumen total bacteria, selected cellulolytic bacteria, and methanogenic archaea. Four diets: control diet (CD), decanter cake diet (DCD), palm kernel cake diet (PKCD) and CD plus 5% PO diet (CPOD) were fed to rumen cannulated goats and rumen samples were collected at the start of the experimental diets (day 0) and on days 4, 6, 8, 12, 18, 24 and 30 post dietary treatments. Feeding DCD and PKCD resulted in significantly higher (P<0.05) DNA copy number of total bacteria, Fibrobacter succinogenes, Ruminococcus flavefeciens, and Ruminococcus albus. Rumen methanogenic archaea was significantly lower (P<0.05) in goats fed PKCD and CPOD and the trend showed a severe reduction on days 4 and 6 post experimental diets. In conclusion, results indicated that feeding DCD and PKC increased the populations of cellulolytic bacteria and decreased the density of methanogenic archaea in the rumen of goats.

  15. Methamphetamine induces the release of endothelin.

    PubMed

    Seo, Jeong-Woo; Jones, Susan M; Hostetter, Trisha A; Iliff, Jeffrey J; West, G Alexander

    2016-02-01

    Methamphetamine is a potent psychostimulant drug of abuse that increases release and blocks reuptake of dopamine, producing intense euphoria, factors that may contribute to its widespread abuse. It also produces severe neurotoxicity resulting from oxidative stress, DNA damage, blood-brain barrier disruption, microgliosis, and mitochondrial dysfunction. Intracerebral hemorrhagic and ischemic stroke have been reported after intravenous and oral abuse of methamphetamine. Several studies have shown that methamphetamine causes vasoconstriction of vessels. This study investigates the effect of methamphetamine on endothelin-1 (ET-1) release in mouse brain endothelial cells by ELISA. ET-1 transcription as well as endothelial nitric oxide synthase (eNOS) activation and transcription were measured following methamphetamine treatment. We also examine the effect of methamphetamine on isolated cerebral arteriolar vessels from C57BL/6 mice. Penetrating middle cerebral arterioles were cannulated at both ends with a micropipette system. Methamphetamine was applied extraluminally, and the vascular response was investigated. Methamphetamine treatment of mouse brain endothelial cells resulted in ET-1 release and a transient increase in ET-1 message. The activity and transcription of eNOS were only slightly enhanced after 24 hr of treatment with methamphetamine. In addition, methamphetamine caused significant vasoconstriction of isolated mouse intracerebral arterioles. The vasoconstrictive effect of methamphetamine was attenuated by coapplication of the endothelin receptor antagonist PD145065. These findings suggest that vasoconstriction induced by methamphetamine is mediated through the endothelin receptor and may involve an endothelin-dependent pathway.

  16. Intra-osseous access (EZ-IO) for resuscitation: UK military combat experience.

    PubMed

    Cooper, B R; Mahoney, P F; Hodgetts, T J; Mellor, A

    2007-12-01

    Military trauma produces predominantly blast and fragmentation injury, commonly resulting in haemorrhagic shock. Injury patterns to limbs are such that the conventional sites for venous cannulation may be unsuitable. The EZ-IO (Vidacare, San Antonio) system is one of a number of novel products designed for intraosseous (IO) access in adults or children. In three months of combat casualty care in Helmand Province, Afghanistan, the UK Defence Medical Services used EZ-IO for emergency vascular access on 26 patients (16 adults; 10 children). 23/26 patients had IO access obtained in the emergency department; 3/26 had pre-hospital IO access within a tactically flying helicopter. A total of 32 needles were inserted, with 97% effective function. IO needles were used to administer fluid (crystalloid, packed red cells and fresh frozen plasma) and drugs (analgesics, cardiac arrest drugs, antibiotics, drugs for both rapid sequence induction and maintenance of anaesthesia). No complication of infection was noted, but pain was observed in responsive patients with the pain of infusion exceeding that of the underlying injuries in 3 cases.

  17. Leukocyte filtration in lung transplantation.

    PubMed

    Kurusz, Mark; Roach, John D; Vertrees, Roger A; Girouard, Mark K; Lick, Scott D

    2002-05-01

    Controlled reperfusion of the transplanted lung has been used in nine consecutive patients to decrease manifestations of lung reperfusion injury. An extracorporeal circuit containing a roller pump, heat exchanger and leukodepleting filter is primed with substrate-enhanced reperfusion solution mixed with approximately 2000 ml of the patient's blood. This solution is slowly recirculated to remove leukocytes prior to reperfusion. When the pulmonary anastomoses are completed, the pulmonary artery is cannulated through the untied anastomosis using a catheter containing a pressure lumen for measurement of infusion pressure. An atrial clamp is left in place on the patient's native atrial cuff to decrease the risk of systemic air embolism during the brief period of reperfusion from the extracorporeal reservoir. During reperfusion, the water bath to the heat exchanger is kept at 35 degrees C and the flow rate for reperfusion solution is between 150 and 200 m/min, keeping the pulmonary artery pressure <14 mmHg. Eight of nine patients were ventilated on 40% inspired oxygen within a few hours of operation and 7/9 were extubated on or before postoperative day 1. Six of nine patients are long-term survivors.

  18. Viscosity of human bile sampled from the common bile duct.

    PubMed

    Reinhart, Walter H; Näf, Gabriela; Werth, Baseli

    2010-01-01

    Cholestasis is a frequent gastroenterological problem, which is tackled by endoscopic procedures. Little is known about bile viscosity, a major determinant of its flow. We measured the viscosity of bile from the common bile duct during endoscopic retrograde cholangiography. Bile was aspirated immediately after cannulation of the papilla and deep-frozen. Viscosity was measured with a rotational viscometer at 37 degrees C and a broad range of shear rates (0.08-69.5 s(-1)). The majority of the 138 patients (64.5%) had bile viscosities between water (0.7 mPa.s) and the lower limit of plasma (1.1 mPa.s). In 20 patients (14.5%) it was above that of plasma (>1.4 mPa.s), and showed a non-Newtonian behaviour, i.e. the viscosity increased exponentially with decreasing shear rate. Cholecystectomized patients had a lower bile viscosity. Bile viscosities did not differ between patient groups with either choledocholithiasis, sludge, cholangitis, biliary pancreatitis, pancreatic carcinoma, or cholangiocarcinoma. We conclude that bile viscosity in the common bile duct is usually lower than that of plasma, in 15% it is higher and increases exponentially with decreasing flow rate, which may lead to a vicious cycle.

  19. Vascular Responsiveness in Adrenalectomized Rats with Corticosterone Replacement

    NASA Technical Reports Server (NTRS)

    Darlington, Daniel N.; Kaship, Kapil; Keil, Lanny C.; Dallman, Mary F.

    1989-01-01

    To determine under resting, unstressed conditions the circulating glucocorticoid concentrations that best maintain sensitivity of the vascular smooth muscle and baroreceptor responses to vasoactive agents, rats with vascular cannulas were sham-adrenalectomized (sham) or adrenalectomized (ADRX) and provided with four levels of corticosterone replacement (-100 mg fused pellets of corticosterone: cholesterol 0, 20, 40, and 80% implanted subcutaneously at the time of adrenal surgery). Changes in vascular and baroreflex responses were determined after intravenous injection of varying doses of phenylephrine and nitroglycerin with measurement of arterial blood pressure and heart rate in the conscious, chronically cannulated rats. Vascular sensitivity was decreased, and resting arterial blood pressure tended to be decreased in the adrenalectomized rats; both were restored to normal with levels of corticosterone (40%), which also maintained body weight gain, thymus weight, and plasma corticosteroid binding globulin concentrations at normal values. The baroreflex curve generated from the sham group was different from the curves generated from the ADRX+O, 20, and 40% groups, but not different from that of the ADRX+80% group, suggesting that the baroreflex is maintained by higher levels of corticosterone than are necessary for the maintenance of the other variables. These data demonstrate that physiological levels of corticosterone (40% pellet) restore vascular responsiveness, body weight, thymus weight, and transcortin levels to normal in ADRX rats, whereas higher levels (80% pellet) are necessary for restoration of the baroreflex.

  20. Arterial vascularization patterns of the splenium: An anatomical study.

    PubMed

    Kahilogullari, G; Comert, A; Ozdemir, M; Brohi, R A; Ozgural, O; Esmer, A F; Egemen, N; Karahan, S T

    2013-09-01

    The aim of this study was to provide detailed information about the arterial vascularization of the splenium of the corpus callosum (CC). The splenium is unique in that it is part of the largest commissural tract in the brain and a region in which pathologies are seen frequently. An exact description of the arterial vascularization of this part of the CC remains under debate. Thirty adult human brains (60 hemispheres) were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. Then, the brains were fixed in formaldehyde, and dissections were performed using a surgical microscope. The diameter of the arterial branches supplying the splenium of the CC at their origin was investigated, and the vascularization patterns of these branches were observed. Vascular supply to the splenium was provided by the anterior pericallosal artery (40%) from the anterior circulation and by the posterior pericallosal artery (88%) and posterior accessory pericallosal artery (50%) from the posterior circulation. The vascularization pattern of the splenium differs in each hemisphere and is usually supplied by multiple branches. The arterial vascularization of the splenium of the CC was studied comprehensively considering the ongoing debate and the inadequacy of the studies on this issue currently available in the literature. This anatomical knowledge is essential during the treatment of pathologies in this region and especially for splenial arteriovenous malformations.