Geophysical data collected from the St. Clair River between Michigan and Ontario, Canada (2008-016-FA)

USGS Publications Warehouse

Denny, Jane F.; Foster, D.S.; Worley, C.R.; Irwin, Barry J.

2011-01-01

In 2008, the U.S. Geological Survey (USGS), Woods Hole Coastal and Marine Science Center (WHCMSC), in cooperation with the U.S. Army Corps of Engineers conducted a geophysical and sampling survey of the riverbed of the Upper St. Clair River between Port Huron, Mich., and Sarnia, Ontario, Canada. The objectives were to define the Quaternary geologic framework of the riverbed of the St. Clair River to evaluate the relationship between morphologic change of the riverbed and underlying stratigraphy. This report presents the geophysical and sample data collected from the St. Clair River, May 29-June 6, 2008, as part of the International Upper Great Lakes Study, a 5-year project funded by the International Joint Commission of the United States and Canada to examine whether physical changes in the St. Clair River are affecting water levels within upper Great Lakes, to assess regulation plans for outflows from Lake Superior, and to examine the potential effect of climate change on the Great Lakes water levels (http://www.iugls.org). This document makes available the data that were used in a separate report, U.S. Geological Survey Open-File Report 2009-1137, which detailed the interpretations of the Quaternary geologic framework of the region. This report includes a description of the high-resolution acoustic and sediment-sampling systems that were used to map the morphology, surficial sediment distribution, and underlying geology of the Upper St. Clair River during USGS field activity 2008-016-FA (http://quashnet.er.usgs.gov/cgi-bin/datasource/public_ds_info.pl?fa=2008-016-FA). Video and photographs of the riverbed were also collected and are included in this data release. Future analyses will be focused on substrate erosion and its effects on river-channel morphology and geometry. Ultimately, the International Upper Great Lakes Study will attempt to determine where physical changes in the St. Clair River affect water flow and, subsequently, water levels in the Upper Great Lakes.

Bacteria and emerging chemical contaminants in the St. Clair River/Lake St. Clair Basin, Michigan

USGS Publications Warehouse

Fogarty, Lisa R.

2007-01-01

Introduction Since the enactment of the Clean Water Act in 1972, awareness of the quality of the Nation's water has continued to improve. Despite improvements to wastewater-treatment systems and increased regulation on waste discharge, bacterial and chemical contamination is still a problem for many rivers and lakes throughout the United States. Pathogenic microorganism and newly recognized chemical contaminants have been found in waters that are used for drinking water and recreation (Rose and Grimes, 2001; Kolpin and others, 2002). This summary of bacteria and emerging-chemical-contaminant monitoring in the St. Clair River/Lake St. Clair Basin (fig. 1) was initiated by the Lake St. Clair Regional Monitoring Project (LSCRMP) in 2003, in cooperation with the Michigan Department of Environmental Quality (MDEQ), the Counties of Macomb, Oakland, St. Clair, and Wayne, and the U.S. Geological Survey (USGS).

Heavy metal contamination of sediments in the upper connecting channels of the Great Lakes

USGS Publications Warehouse

Nichols, S. Jerrine; Manny, Bruce A.; Schloesser, Donald W.; Edsall, Thomas A.

1991-01-01

In 1985, sampling at 250 stations throughout the St. Marys, St. Clair, and Detroit rivers and Lake St. Clair — the connecting channels of the upper Great Lakes — revealed widespread metal contamination of the sediments. Concentrations of cadmium, chromium, copper, lead, mercury, nickel, and zinc each exceeded U.S. Environmental Protection Agency sediment pollution guidelines at one or more stations throughout the study area. Sediments were polluted more frequently by copper, nickel, zinc, and lead than by cadmium, chromium, or mercury. Sediments with the highest concentrations of metals were found (in descending order) in the Detroit River, the St. Marys River, the St. Clair River, and Lake St. Clair. Although metal contamination of sediments was most common and sediment concentrations of metals were generally highest near industrial areas, substantial contamination of sediments by metals was present in sediment deposition areas up to 60 km from any known source of pollution.

Water quality of the St. Clair River, Lake St. Clair, and their U.S. tributaries, 1946-2005

USGS Publications Warehouse

Healy, Denis F.; Chambers, Douglas B.; Rachol, Cynthia M.; Jodoin, Richard S.

2007-01-01

The St. Clair River/Lake St. Clair waterway forms an international boundary between the United States and Canada. The waters of the area are an important part of the cultural heritage of the area and serves as an important water-supply and power-generating resource; the waterway also supports an economy based largely on recreation, agriculture, and manufacturing. This report was undertaken as part of the Lake St. Clair Regional Monitoring Project for the purpose of providing a comprehensive assessment of the hydrological, chemical, and physical state of the surface water of Lake St. Clair and its tributaries. The data varied in focus and density over the period of compilation which in many cases this variation prevented the completion of statistical analyses because data did not meet minimum comparability or quality requirements for those tests. Comparison of water quality of the Belle, Black, Clinton, and Pine River Basins, as well as basins of minor rivers in the study area, showed that water quality in many of the tributaries, particularly the Clinton River and some of the minor rivers, was degraded compared to the water quality of the St. Clair River/Lake St. Clair waterway. Data analyses included comparison of nutrients, chloride, specific conductance, turbidity, biochemical oxygen demand (BOD), and pesticides among the basins and the St. Clair River. Median concentrations of total nitrate were well below the recommended USEPA total nitrogen ambient water-quality criterion of 0.54 mg/L as N for nutrient ecoregion VII for all study-area streams except the Clinton River. More than 93 percent of the phosphorus concentrations for the Belle, Black, Pine and minor river basins and 84 percent of the phosphorus concentrations for the Clinton River Basin are greater than the USEPA recommended ambient total phosphorus criterion of 0.033 mg/L for rivers and streams. Nine chloride concentrations exceeded the USEPA criterion maximum concentration (CMC) for chloride set at 860 mg/L for all study-area streams, with the six largest being in the Belle River Basin. Higher chloride concentrations were increasingly common from 2002 to 2005. The urban minor river basins had the highest median specific conductance, whereas the agricultural Pine River Basin had the lowest median specific conductance. The median values of BOD for the five basins in the study area ranged from 2.4 mg/L for the Pine River Basin to 3.2 mg/L for the Black and Clinton River Basins, whereas the median for the St. Clair River was 0.5 mg/L. In 1985, the highest concentrations of pesticides were found in samples from the mouth of the Clinton River; however, in 1996–98, the majority of high pesticide concentrations were found in samples from the Black River. Changing land-use patterns, specifically conversion of agricultural lands to urban/residential lands in the Clinton River Basin, may explain this difference. Trend analysis was done for four stream sites where adequate data were available. These analyses identified no significant water-quality changes at a stream site on the Black River, where land-use patterns have changed little in the past few decades. This stands in marked contrast to trend analysis for three stream sites in the Clinton River Basin, which has undergone significant land-use change. The changes at the Clinton River stream sites, ranging from 5 to 13 significant trends, were generally decreases in nutrients and increases in total dissolved solids (TDS) and chloride. The greater flow volume of the St. Clair River/Lake St. Clair waterway is able to assimilate incoming dissolved and suspended constituents from tributaries with little effect upon its overall water quality, although incomplete mixing may result in localized water-quality impairment downstream from tributary confluences. Mixing effects on Lake St. Clair water quality was also demonstrated in analysis of Escherichia coli (E. coli) data collected at paired nearshore/offshore sites, which reflected similarity in water quality among many paired sites.

Detection of conveyance changes in St. Clair River using historical water-level and flow data with inverse one-dimensional hydrodynamic modeling

USGS Publications Warehouse

Holtschlag, David J.; Hoard, C.J.

2009-01-01

St. Clair River is a connecting channel that transports water from Lake Huron to the St. Clair River Delta and Lake St. Clair. A negative trend has been detected in differences between water levels on Lake Huron and Lake St. Clair. This trend may indicate a combination of flow and conveyance changes within St. Clair River. To identify where conveyance change may be taking place, eight water-level gaging stations along St. Clair River were selected to delimit seven reaches. Positive trends in water-level fall were detected in two reaches, and negative trends were detected in two other reaches. The presence of both positive and negative trends in water-level fall indicates that changes in conveyance are likely occurring among some reaches because all reaches transmit essentially the same flow. Annual water-level fall in reaches and reach lengths was used to compute conveyance ratios for all pairs of reaches by use of water-level data from 1962 to 2007. Positive and negative trends in conveyance ratios indicate that relative conveyance is changing among some reaches. Inverse one-dimensional (1-D) hydrodynamic modeling was used to estimate a partial annual series of effective channel-roughness parameters in reaches forming the St. Clair River for 21 years when flow measurements were sufficient to support parameter estimation. Monotonic, persistent but non-monotonic, and irregular changes in estimated effective channel roughness with time were interpreted as systematic changes in conveyances in five reaches. Time-varying parameter estimates were used to simulate flow throughout the St. Clair River and compute changes in conveyance with time. Based on the partial annual series of parameters, conveyance in the St. Clair River increased about 10 percent from 1962 to 2002. Conveyance decreased, however, about 4.1 percent from 2003 to 2007, so that conveyance was about 5.9 percent higher in 2007 than in 1962.

Claire Zhu, PhD | Division of Cancer Prevention

Cancer.gov

Dr. Claire Zhu is a program director in the Early Detection Research Group of the Division of Cancer Prevention at the NCI, where she coordinates the Etiologic and Early Marker Studies Program (EEMS) in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), as well as manages a grant portfolio in early detection research. |

Environmental Assessment: Reevaluation of the Le Claire Base Construction Storage Yard, Le Claire, Iowa

DTIC Science & Technology

1988-06-01

RUYWAT~POF TU LZ CM AU1 CCRSTCTION STOIAGE YARD TS OF CONENT 3. Pupobe wA X 4 for Action EA- I 11. Project DescriptioO EA- 2 III. Alternatives EA- 4 IV...r W - - 3ENVIRONMENTAL ASSESSMENT REEVALUATION OF THE LE CLAIRE BASE CONSTRUCTION STORAGE YARD LE CLAIRE, IOWA I . PURPOSE AND NEED FOR...IDNR) boat ramp and the Corps storage yard will be relocated to the downstream (western) end of the new storage yard (see plate I ). The new road

16. Photocopy of Engineering Drawing (original in Engineering News, 4 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. Photocopy of Engineering Drawing (original in Engineering News, 4 October 1890. p. 292), delineator unknown. Scales indicate height in feet above sea level. The gradient in the middle section of the tunnel is incorrectly labeled 1 in 100, whereas the correct gradient is 1 in 1,000. VIEW NORTH, PROFILE OF PART OF ST. CLAIR TUNNEL UNDER RIVER SHOWING SECTION OF RIVER BED AS DETERMINED BY BORINGS, 1890. - St. Clair Tunnel, Under St. Clair River between Port Huron, MI, & Sarnia, ON, Canada, Port Huron, St. Clair County, MI

Evidence of the St. Clair-Detroit River system as a dispersal corridor and nursery habitat for transient larval burbot

USGS Publications Warehouse

McCullough, Darrin E.; Roseman, Edward F.; Keeler, Kevin M.; DeBruyne, Robin L.; Pritt, Jeremy J.; Thompson, Patricia A.; Ireland, Stacey A.; Ross, Jason E.; Bowser, Dustin; Hunter, Robert D.; Castle, Dana Kristina; Fischer, Jason; Provo, Stacy A.

2015-01-01

Burbot Lota lota are distributed across the Laurentian Great Lakes where they occupy a top piscivore role. The St. Clair-Detroit River System is known to provide a migration corridor as well as spawning and nursery habitat for many indigenous fishes of economic and ecological significance. However, knowledge is scant of the early life history of burbot and the importance of this system in their dispersal, survival, and recruitment. In order to assess the role of the St. Clair-Detroit River System to burbot ecology, we collected larval burbot during ichthyoplankton surveys in this system from 2010 to 2013 as part of a habitat restoration monitoring program. More and larger burbot larvae were found in the St. Clair River than in the lower Detroit River, although this may be due to differences in sampling methods between the two rivers. Consistent with existing studies, larval burbot exhibited ontogenesis with a distinct transition from a pelagic zooplankton-based diet to a benthic macroinvertebrate-based diet. Our results demonstrate that the St. Clair-Detroit Rivers provide food resources, required habitat, and a migration conduit between the upper and lower Great Lakes, but the contribution of these fish to the lower lakes requires further examination.

Egg deposition by lithophilic-spawning fishes in the Detroit and Saint Clair Rivers, 2005–14

USGS Publications Warehouse

Prichard, Carson G.; Craig, Jaquelyn M.; Roseman, Edward F.; Fischer, Jason L.; Manny, Bruce A.; Kennedy, Gregory W.

2017-03-14

A long-term, multiseason, fish egg sampling program conducted annually on the Detroit (2005–14) and Saint Clair (2010–14) Rivers was summarized to identify where productive fish spawning habitat currently exists. Egg mats were placed on the river bottom during the spring and fall at historic spawning areas and candidate fish spawning habitat restoration sites throughout both rivers. Widespread evidence was found of lithophilic spawning by numerous native fish species, including walleye (Sander vitreus), lake whitefish (Coregonus clupeaformis), lake sturgeon (Acipenser fulvescens), suckers (Catostomidae spp.), and trout-perch (Percopsis omiscomaycus). Walleye, lake whitefish, and suckers spp. spawned in nearly every region of each river in all years on both reef and nonreef substrates. Lake sturgeon eggs were collected almost exclusively over constructed reefs. Catch-per-unit effort of walleye, lake whitefish, and sucker eggs was much greater in the Detroit River than in the Saint Clair River, while Saint Clair River sites supported the greatest collections of lake sturgeon eggs. Collections during this study of lake sturgeon eggs on man-made spawning reefs suggest that artificial reefs may be an effective tool for restoring fish populations in the Detroit and Saint Clair Rivers; however, the quick response of lake sturgeon to spawn on newly constructed reefs and the fact that walleye, lake whitefish, and sucker eggs were often collected over substrate with little interstitial space to protect eggs from siltation and predators suggests that lack of suitable spawning habitat may continue to limit reproduction of lithophilic-spawning fish species in the Saint Clair-Detroit River System.

Bed morphology, flow structure, and sediment transport at the outlet of Lake Huron and in the upper St. Clair River

USGS Publications Warehouse

Czuba, J.A.; Best, J.L.; Oberg, K.A.; Parsons, D.R.; Jackson, P.R.; Garcia, M.H.; Ashmore, P.

2011-01-01

An integrated multibeam echo sounder and acoustic Doppler current profiler field survey was conducted in July 2008 to investigate the morphodynamics of the St. Clair River at the outlet of Lake Huron. The principal morphological features of the upper St. Clair River included flow-transverse bedforms that appear weakly mobile, erosive bedforms in cohesive muds, thin non-cohesive veneers of weakly mobile sediment that cover an underlying cohesive (till or glacio-lacustrine) surface, and vegetation that covers the bed. The flow was characterized by acceleration as the banks constrict from Lake Huron into the St. Clair River, an approximately 1500-m long region of flow separation downstream from the Blue Water Bridge, and secondary flow connected to: i) channel curvature; ii) forcing of the flow by local bed topography, and iii) flow wakes in the lee side of ship wrecks. Nearshore, sand-sized, sediment from Lake Huron was capable of being transported into, and principally along, the banks of the upper St. Clair River by the measured flow. A comparison of bathymetric surveys conducted in 2007 and 2008 identifies that the gravel bed does undergo slow downstream movement, but that this movement does not appear to be generated by the mean flow, and could possibly be caused by ship-propeller-induced turbulence. The study results suggest that the measured mean flow and dredging within the channel have not produced major scour of the upper St. Clair River and that the recent fall in the level of Lake Huron is unlikely to have been caused by these mechanisms. ?? 2011.

77 FR 29901 - Safety Zone; Marysville Days Fireworks, St. Clair River, Marysville, MI

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-21

...-AA00 Safety Zone; Marysville Days Fireworks, St. Clair River, Marysville, MI AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a temporary safety zone on the St. Clair River, Marysville, Michigan. This zone is intended to restrict vessels from a portion of the St...

75 FR 39445 - Special Local Regulation; Harrison Township Grand Prix, Lake St. Clair, Harrison Township, MI

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

...-AA08 Special Local Regulation; Harrison Township Grand Prix, Lake St. Clair, Harrison Township, MI... temporary special local regulation in the Captain of the Port Detroit Zone on Lake St. Clair, Harrison Township, Michigan. This special local regulation is intended to restrict vessels from portions of Lake St...

77 FR 40515 - Safety Zone; Detroit Symphony Orchestra at Ford House Fireworks, Lake St. Clair, Grosse Pointe...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

...-AA00 Safety Zone; Detroit Symphony Orchestra at Ford House Fireworks, Lake St. Clair, Grosse Pointe... Detroit Symphony Orchestra at the Ford House Fireworks. This zone will be effective and enforced from 10.... 165.T09-0600 Safety Zone; Detroit Symphony Orchestra at Ford House Fireworks, Lake St. Clair, Grosse...

Telemetry narrows the search for sea lamprey spawning locations in the St. Clair-Detroit River System

USGS Publications Warehouse

Holbrook, Christopher; Jubar, Aaron K.; Barber, Jessica M.; Tallon, Kevin; Hondorp, Darryl W.

2016-01-01

Adult sea lamprey (Petromyzon marinus) abundance in Lake Erie has remained above targets set by fishery managers since 2005, possibly due to increased recruitment in the St. Clair-Detroit River System (SCDRS). Sea lamprey recruitment in the SCDRS poses an enormous challenge to sea lamprey control and assessment in Lake Erie because the SCDRS contains no dams to facilitate capture and discharge is at least an order of magnitude larger in the SCDRS than most other sea lamprey-producing tributaries in the Great Lakes. As a first step toward understanding population size, spatial distribution, and spawning habitat of adult sea lampreys in the SCDRS, we used acoustic telemetry to determine where sea lampreys ceased migration (due to spawning, death, or both) among major regions of the SCDRS. All tagged sea lampreys released in the lower Detroit River (N = 27) moved upstream through the Detroit River and entered Lake St. Clair. After entering Lake St. Clair, sea lampreys entered the St. Clair River (N = 22), Thames River (N = 1), or were not detected again (N = 4). Many sea lampreys (10 of 27) were last observed moving downstream (“fallback”) but we were unable to determine if those movements occurred before or after spawning, or while sea lampreys were dead or alive. Regardless of whether estimates of locations where sea lampreys ceased migration were based on the most upstream region occupied or final region occupied, most sea lampreys ceased migration in the St. Clair River or Lake St. Clair. Results suggest that spawning and rearing in the St. Clair River could be an important determinant of sea lamprey recruitment in the SCDRS and may direct future assessment and control activities in that system.

Reconnaissance Study for the Western Lake Huron Basin, Watershed Study, Michigan, Section 905(b)

DTIC Science & Technology

2012-05-01

Isle, Alpena , Alcona, Iosco, Arenac, Bay, Tuscola, Huron, Sanilac, St. Clair, Midland, and Saginaw. With the exception of Midland and Saginaw Counties...Cheboygan, Presque Isle, Alpena , Alcona, Iosco, Arenac, Bay, Midland, Saginaw, Tuscola, Huron, Sanilac, and St. Clair. The study area includes the... Alpena Harbor. Alpena Harbor is at the mouth of the Thunder Bay River, which empties into Thunder Bay, Lake Huron. The harbor is 100 miles southeast of

33 CFR 162.132 - Connecting waters from Lake Huron to Lake Erie; communications rules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitor: (1) Channel 11 (156.55 mhz) between Lake Huron Cut Lighted Buoy 11 and Lake St. Clair Light; and (2) Channel 12 (156.60 mhz) between Lake St. Clair Light and Detroit River Light. (b) Radiotelephone... Cut Light “7” Lake Huron Cut Lighted Buoy “1” Report. Report St. Clair/Black River Junction Light...

Movement and Harvest of Fish in Lake Saint Clair, Saint Clair River, and Detroit River

DTIC Science & Technology

1985-01-01

a creel survey of the angling fishery , a trap net survey, and a tagging study of the adult fish community . The study area encompassed all of...River does not support a winter walleye fishery (C. Baker, ODNR, personal communication ). Yellow perch,-Yellow perch, like walleyes, are considered best...two basic forms: affecting the adult fish community directly, or interfering with the winter angling fishery . The fish community might be affected

The effectiveness of therapeutic assessment with an adult client: a single-case study using a time-series design.

PubMed

Aschieri, Filippo; Smith, Justin D

2012-01-01

This article presents the therapeutic assessment (TA; Finn, 2007) of a traumatized young woman named Claire. Claire reported feeling debilitated by academic demands and the expectations of her parents, and was finding it nearly impossible to progress in her studies. She was also finding it difficult to develop and sustain intimate relationships. The emotional aspects of close relationships were extremely difficult for her and she routinely blamed herself for her struggles in this arena. The assessor utilized the TA model for adults, with the exception of not including an optional intervention session. The steps of TA, particularly the extended inquiry and the discussion of test findings along the way, cultivated a supportive and empathic atmosphere with Claire. By employing the single-case time-series experimental design used in previous TA studies (e.g., Smith, Handler, & Nash, 2010; Smith, Wolf, Handler, & Nash, 2009), the authors demonstrated that Claire experienced statistically significant improvement correlated with the onset of TA. Results indicated that participation in TA coincided with a positive shift in the trajectory of her reported symptoms and with recognizing the affection she held for others in her life. This case illustrates the successful application of case-based time-series methodology in the evaluation of an adult TA. The potential implications for future study are discussed.

Hydrodynamic simulation and particle-tracking techniques for identification of source areas to public-water intakes on the St. Clair-Detroit river waterway in the Great Lakes Basin

USGS Publications Warehouse

Holtschlag, David J.; Koschik, John A.

2004-01-01

Source areas to public water intakes on the St. Clair-Detroit River Waterway were identified by use of hydrodynamic simulation and particle-tracking analyses to help protect public supplies from contaminant spills and discharges. This report describes techniques used to identify these areas and illustrates typical results using selected points on St. Clair River and Lake St. Clair. Parameterization of an existing two-dimensional hydrodynamic model (RMA2) of the St. Clair-Detroit River Waterway was enhanced to improve estimation of local flow velocities. Improvements in simulation accuracy were achieved by computing channel roughness coefficients as a function of flow depth, and determining eddy viscosity coefficients on the basis of velocity data. The enhanced parameterization was combined with refinements in the model mesh near 13 public water intakes on the St. Clair-Detroit River Waterway to improve the resolution of flow velocities while maintaining consistency with flow and water-level data. Scenarios representing a range of likely flow and wind conditions were developed for hydrodynamic simulation. Particle-tracking analyses combined advective movements described by hydrodynamic scenarios with random components associated with sub-grid-scale movement and turbulent mixing to identify source areas to public water intakes.

The effect of channel shape, bed morphology, and shipwrecks on flow velocities in the Upper St. Clair River

USGS Publications Warehouse

Czuba, Jonathan A.; Oberg, Kevin; Best, Jim; Parsons, Daniel R.

2009-01-01

In the Great Lakes of North America, the St. Clair River is the major outlet of Lake Huron and conveys water to Lake St. Clair which then flows to Lake Erie. One major topic of interest is morphological change in the St. Clair River and its impact on water levels in the Upper Great Lakes and connecting channel flows. A combined multibeam echosounder (MBES) bathymetric survey and acoustic Doppler current profiler (ADCP) flow survey of the outlet of Lake Huron and the Upper St. Clair River was conducted July 21 – 25, 2008. This paper presents how channel morphology and shipwrecks affect the flow in the Upper St. Clair River. The river is most constricted at the Blue Water Bridge near Port Huron, Michigan, with water velocities over 2 ms-1 for a flow of 5,200 m3s-1. Downstream of this constriction, the river flows around a bend and expands creating a large recirculation zone along the left bank due to flow separation. This recirculation zone reduces the effective channel width, and thus increases flow velocities to over 2 ms-1 in this region. The surveys reveal several shipwrecks on the bed of the St. Clair River, which possess distinct wakes in their flow velocity downstream of the wrecks. The constriction and expansion of the channel, combined with forcing of the flow by bed topography, initiates channel-scale secondary flow, creating streamwise vortices that maintain coherence downstream over a distance of several channel widths.

Marine Search, Rescue and Emergency Preparedness Study.

DTIC Science & Technology

1975-09-01

Stampede, Boca, and Prosser Creek Reservoirs:) U. S. Forest Svc - Troy Kurth, Recreation Officer ,, erville District, Clair Engle and Lewiston Reservoirs: U...COE - Olin M. Taylor, Jr., Resource Mgr. IDAHO Central Snake Projects Office: B/R - Robert J. Brown, Superintendent INDIAN Carlyle Lake: COE - Wayne L...department U/W: U. S. Coast Guard HOSPITAL Tahoe Forest Hosp., Truckee 587-3541 (18 mi.) WEAVERVILLE DISTRICT, CLAIR ENGLE AND LEWISTON RESERVOIRS U.S

Phylogenies of Microcystin-Producing Cyanobacteria in the Lower Laurentian Great Lakes Suggest Extensive Genetic Connectivity

PubMed Central

Davis, Timothy W.; Watson, Susan B.; Rozmarynowycz, Mark J.; Ciborowski, Jan J. H.; McKay, Robert Michael; Bullerjahn, George S.

2014-01-01

Lake St. Clair is the smallest lake in the Laurentian Great Lakes system. MODIS satellite imagery suggests that high algal biomass events have occurred annually along the southern shore during late summer. In this study, we evaluated these events and tested the hypothesis that summer bloom material derived from Lake St. Clair may enter Lake Erie via the Detroit River and represent an overlooked source of potentially toxic Microcystis biomass to the western basin of Lake Erie. We conducted a seasonally and spatially resolved study carried out in the summer of 2013. Our goals were to: 1) track the development of the 2013 summer south-east shore bloom 2) conduct a spatial survey to characterize the extent of toxicity, taxonomic diversity of the total phytoplankton population and the phylogenetic diversity of potential MC-producing cyanobacteria (Microcystis, Planktothrix and Anabaena) during a high biomass event, and 3) compare the strains of potential MC-producers in Lake St. Clair with strains from Lake Erie and Lake Ontario. Our results demonstrated a clear predominance of cyanobacteria during a late August bloom event, primarily dominated by Microcystis, which we traced along the Lake St. Clair coastline downstream to the Detroit River's outflow at Lake Erie. Microcystin levels exceeded the Province of Ontario Drinking Water Quality Standard (1.5 µg L−1) for safe drinking water at most sites, reaching up to five times this level in some areas. Microcystis was the predominant microcystin producer, and all toxic Microcystis strains found in Lake St. Clair were genetically similar to toxic Microcystis strains found in lakes Erie and Ontario. These findings suggest extensive genetic connectivity among the three systems. PMID:25207941

An improved procedure for determining grain boundary diffusion coefficients from averaged concentration profiles

NASA Astrophysics Data System (ADS)

Gryaznov, D.; Fleig, J.; Maier, J.

2008-03-01

Whipple's solution of the problem of grain boundary diffusion and Le Claire's relation, which is often used to determine grain boundary diffusion coefficients, are examined for a broad range of ratios of grain boundary to bulk diffusivities Δ and diffusion times t. Different reasons leading to errors in determining the grain boundary diffusivity (DGB) when using Le Claire's relation are discussed. It is shown that nonlinearities of the diffusion profiles in lnCav-y6/5 plots and deviations from "Le Claire's constant" (-0.78) are the major error sources (Cav=averaged concentration, y =coordinate in diffusion direction). An improved relation (replacing Le Claire's constant) is suggested for analyzing diffusion profiles particularly suited for small diffusion lengths (short times) as often required in diffusion experiments on nanocrystalline materials.

The CLAIR model: Extension of Brodmann areas based on brain oscillations and connectivity.

PubMed

Başar, Erol; Düzgün, Aysel

2016-05-01

Since the beginning of the last century, the localization of brain function has been represented by Brodmann areas, maps of the anatomic organization of the brain. They are used to broadly represent cortical structures with their given sensory-cognitive functions. In recent decades, the analysis of brain oscillations has become important in the correlation of brain functions. Moreover, spectral connectivity can provide further information on the dynamic connectivity between various structures. In addition, brain responses are dynamic in nature and structural localization is almost impossible, according to Luria (1966). Therefore, brain functions are very difficult to localize; hence, a combined analysis of oscillation and event-related coherences is required. In this study, a model termed as "CLAIR" is described to enrich and possibly replace the concept of the Brodmann areas. A CLAIR model with optimum function may take several years to develop, but this study sets out to lay its foundation. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Great Lakes/St. Lawrence Seaway Regional Transportation Study for U.S. Army Corps of Engineers.

DTIC Science & Technology

1982-04-01

LAKE HURON Two Harbors, MN Saginaw, MI Duluth-Superior, MN-WI St. Clair River, MI, St. Clair Presque Isle , MI Port of Detroit, MI Marquette, MI Detroit...Port Dolomite, MI Green Bay, WI LAKE ERIE Milwaukee, WI Chicago, IL Toledo, OH Calumet Harbor, IN-IL Sandusky, OH Lake Calumet Huron, OH Indiana Harbor...IN Lorain, OH Burns Waterway, IN Cleveland, OH Muskegon, MI Ashtabula, OH Gary, IN Conneaut, OH Escanaba, MI Erie , PA Grand Haven, MI Port of Buffalo

DETAIL OF PIER C (CANADIAN SIDE), SHOWING LOWER CHORDS, VERTICALS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL OF PIER C (CANADIAN SIDE), SHOWING LOWER CHORDS, VERTICALS AND DIAGONALS. VIEW TO NORTH. - Blue Water Bridge, Spanning St. Clair River at I-69, I-94, & Canadian Route 402, Port Huron, St. Clair County, MI

Steady-state flow distribution and monthly flow duration in selected branches of St. Clair and Detroit rivers within the Great Lakes waterway

USGS Publications Warehouse

Holtschlag, D.J.; Koschik, J.A.

2001-01-01

St. Clair and Detroit Rivers are connecting channels between Lake Huron and Lake Erie in the Great Lakes waterway, and form part of the boundary between the United States and Canada. St. Clair River, the upper connecting channel, drains 222,400 square miles and has an average flow of about 182,000 cubic feet per second. Water from St. Clair River combines with local inflows and discharges into Lake St. Clair before flowing into Detroit River. In some reaches of St. Clair and Detroit Rivers, islands and dikes split the flow into two to four branches. Even when the flow in a reach is known, proportions of flows within individual branches of a reach are uncertain. Simple linear regression equations, subject to a flow continuity constraint, are developed to provide estimators of these proportions and flows. The equations are based on 533 paired measurements of flow in 13 reaches forming 31 branches. The equations provide a means for computing the expected values and uncertainties of steady-state flows on the basis of flow conditions specified at the upstream boundaries of the waterway. In 7 upstream reaches, flow is considered fixed because it can be determined on the basis of flows specified at waterway boundaries and flow continuity. In these reaches, the uncertainties of flow proportions indicated by the regression equations can be used directly to determine the uncertainties of the corresponding flows. In the remaining 6 downstream reaches, flow is considered uncertain because these reaches do not receive flow from all the branches of an upstream reach, or they receive flow from some branches of more than one upstream reach. Monte Carlo simulation analysis is used to quantify this increase in uncertainty associated with the propagation of uncertainties from upstream reaches to downstream reaches. To eliminate the need for Monte Carlo simulations for routine calculations, polynomial regression equations are developed to approximate the variation in uncertainties as a function of flow at the headwaters of St. Clair River. Finally, monthly flow-duration data on the main channels of St. Clair and Detroit Rivers are used with the equations developed in this report to estimate the steady-state flow-duration characteristics of selected branches.

DETAIL OF EAST (CANADIAN) CANTILEVER AND ANCHOR ARMS OF MAIN ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL OF EAST (CANADIAN) CANTILEVER AND ANCHOR ARMS OF MAIN SPAN, SHOWING PIER C. VIEW TO NORTH. - Blue Water Bridge, Spanning St. Clair River at I-69, I-94, & Canadian Route 402, Port Huron, St. Clair County, MI

EAST (CANADIAN) PORTAL OF MAIN SECTION OF BRIDGE, SHOWING PANEL ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

EAST (CANADIAN) PORTAL OF MAIN SECTION OF BRIDGE, SHOWING PANEL OVER PIER C IN CENTER. VIEW TO WEST. - Blue Water Bridge, Spanning St. Clair River at I-69, I-94, & Canadian Route 402, Port Huron, St. Clair County, MI

DETAIL OF VERTICAL AT PANEL OVER PIER C, SHOWING DECK, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL OF VERTICAL AT PANEL OVER PIER C, SHOWING DECK, GUARDRAIL, VERTICAL AND UPPER CHORD, VIEW TO NORTHEAST. - Blue Water Bridge, Spanning St. Clair River at I-69, I-94, & Canadian Route 402, Port Huron, St. Clair County, MI

Environmental Study of Fish Spawning and Nursery Areas in the Saint Clair-Detroit River System

DTIC Science & Technology

1986-06-01

II , EE ;I I1\\ vl I Y", I~S CLAIR0 /3 ISO A-2.8 STATh’T MILES .’f t 52: + 3 I + + 5 -,5, + + 2 I + 455o.~L + I 6 W,11 Pt Lt+ F G 31- S 4 1 5 4 , 0 {i...11904 574590 442470 1983 August 2 77 22 20 4 10878 11352 574590 442469 1984 May 1 55 19 18 4 . 574640 442519 1984 May 2 55 19 18 4 11626 12365 574591

76 FR 35831 - Television Broadcasting Services; Eau Claire, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 73 [MB Docket No. 11-100, RM-11632; DA 11-1034] Television Broadcasting Services; Eau Claire, WI AGENCY: Federal Communications Commission. ACTION: Proposed.... ADDRESSES: Federal Communications Commission, Office of the Secretary, 445 12th Street, SW., Washington, DC...

Habitat used by juvenile lake sturgeon (Acipenser fulvescens) in the North Channel of the St. Clair River (Michigan, USA)

USGS Publications Warehouse

Boase, James C.; Manny, Bruce A.; Donald, Katherine A.L.; Kennedy, Gregory W.; Diana, James S.; Thomas, Michael V.; Chiotti, Justin A.

2014-01-01

Lake sturgeon (Acipenser fulvescens) occupy the St. Clair River, part of a channel connecting lakes Huron and Erie in the Laurentian Great Lakes. In the North Channel of the St. Clair River, juvenile lake sturgeon (3–7 years old and 582–793 mm in length) were studied to determine movement patterns and habitat usage. Fourteen juveniles were implanted with ultrasonic transmitters and tracked June–August of 2004, 2005 and 2006. Telemetry data, Geographic Information System software, side-scan sonar, video images of the river bottom, scuba diving, and benthic substrate samples were used to determine the extent and composition of habitats they occupied. Juvenile lake sturgeon habitat selection was strongly related to water depth. No fish were found in 700 mm in length selected sand and gravel areas mixed with zebra mussels and areas dominated by zebra mussels, while fish < 700 mm used these habitat types in proportion to their availability.

Im Gesprach: An Interview with Claire Kramsch on the "Multilingual Subject"

ERIC Educational Resources Information Center

Kramsch, Claire; Gerhards, Sascha

2012-01-01

In her recently published book "The Multilingual Subject: What foreign language learners say about their experience and why it matters", UC Berkeley applied-linguist Claire Kramsch approaches language learning from a new, visionary perspective. Foregrounding the interplay of cultural aspects in language learning, Kramsch understands…

SURVEY OF FLUE GAS DESULFURIZATION SYSTEMS: ST. CLAIR STATION, DETROIT EDISON CO

EPA Science Inventory

The report gives results of a survey of the flue gas desulfurization (FGD) system retrofitted on Unit 6 of Detroit Edison Co.'s St. Clair Station. The experimental FGD system, which operated through a 2-month (October 1976-January 1977) demonstration program, utilized a limestone...

76 FR 8906 - Final Flood Elevation Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-16

... from the requirements of 44 CFR part 10, Environmental Consideration. An environmental impact... downstream of Lock and of Buffalo, City of Dam No. 15. Davenport, City of Le Claire, City of Princeton, City... West 4th Street, Davenport, IA 52801. City of Le Claire Maps are available for inspection at 325...

STEM Leader from the Roeper School: An Interview with Nuclear Engineer Clair J. Sullivan

ERIC Educational Resources Information Center

Ambrose, Don

2016-01-01

Clair J. Sullivan is an assistant professor in the Department of Nuclear, Plasma and Radiological Engineering at the University of Illinois at Urbana-Champaign (UIUC). Her research interests include radiation detection and measurements; gamma-ray spectroscopy; automated isotope identification algorithms; nuclear forensics; nuclear security;…

Ground-water flow and quality near the Upper Great Lakes connecting channels, Michigan

USGS Publications Warehouse

Gillespie, J.L.; Dumouchelle, D.H.

1989-01-01

The Upper Great Lakes connecting channels are the St. Marys, St. Clair and Detroit Rivers, and Lake St. Clair. The effect of ground water on the connecting channels is largely unknown, and the controls on its movement and quality are undefined. Geologic, hydrologic, and environmental conditions near the channels have been examined.for this investigation. Included in the study area is a 50-mile reach of channel beginning at Whitefish Bay and extending to Neebish Island, and a 90-mile reach of channel between Port Huron and Pointe Mouillee in Lake Erie. Glacial deposits, which transmit most ground water to the channels, range from less than 100 feet in thickness in the southern part of the St. Clair-Detroit River area to more than 250 feet in thickness in the northern part. Marine seismic surveys were used at some locations to determine the thickness of deposits. Glacial deposits in the St. Marys River area range from less than 10 feet to more than 300 feet in thickness. Permeable bedrock in the southern reach of the Detroit River area and throughout most of the St. Marys River area may contribute substantial amounts of water to the channels. Total ground-water discharge to the channels, by area, is estimated as follows! St. Marys area, 76 cubic feet per second; St. Clair area, 11 cubic feet per second; Lake St. Clair area, 46 cubic feet per second; and Detroit area, 54 cubic feet per second. Analyses of water from 31 wells, 25 of which were installed by the U.S. Geological Survey, were made for organic compounds, trace metals, and other substances. Volatile hydrocarbons, and base neutral, acid extractable, and chlorinated neutral compounds were not detectable in water at most locations. Concentrations of trace metals, however, were higher than common in natural waters at some locations.

An acoustic doppler current profiler survey of flow velocities in St. Clair River, a connecting channel of the Great Lakes

USGS Publications Warehouse

Holtschlag, David J.; Koschik, John A.

2003-01-01

Acoustic Doppler current profilers (ADCP) were used to measure flow velocities in St. Clair River during a survey in May and June of 2002, as part of a study to assess the susceptibility of public water intakes to contaminants on the St. Clair-Detroit River Waterway. The survey provides 2.7 million point velocity measurements at 104 cross sections. Sections are spaced about 1,630 ft apart along the river from Port Huron to Algonac, Michigan, a distance of 28.6 miles. Two transects were obtained at each cross section, one in each direction across the river. Along each transect, velocity profiles were obtained 2-4 ft apart. At each velocity profile, average water velocity data were obtained at 1.64 ft intervals of depth. The raw position and velocity data from the ADCP field survey were adjusted for local magnetic anomalies using global positioning system (GPS) measurements at the end points of the transects. The adjusted velocity and ancillary data can be retrieved through the internet and extracted to column-oriented data files.

Reconnecting to Mission: Connecticut College's Outreach to New London during the Claire Gaudiani Era

ERIC Educational Resources Information Center

Marthers, Paul

2009-01-01

During her presidency (1988-2001), Claire Gaudiani reconnected Connecticut College with New London, the college's home city, whose citizens through grassroots fund raising and donations of land established the college in 1911. Through an emphasis on service-learning, community outreach, and an education not for oneself as well as economic…

76 FR 52269 - Safety Zone; Port Huron Float Down, St. Clair River, Port Huron, MI

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-22

... various social-media sites in which a large number of persons may float down a segment of the St. Clair... rule would have a significant economic impact on a substantial number of small entities. The term ``small entities'' comprises small businesses, not-for-profit organizations that are independently owned...

Developing a Nonsexist/Nongendered Language Policy at the University of Wisconsin-Eau Claire

ERIC Educational Resources Information Center

Benson, Erica J.; Kemp, Theresa D.; Pirlott, Angela; Coughlin, Casey; Forss, Quinn; Becherer, Laura

2013-01-01

This article describes a project initiated in 2011 at the University of Wisconsin-Eau Claire (UWEC) to develop a research-based action plan to justify the need for, and consequently the creation and adoption of, gender-inclusive language policies that aligned with UWEC's equity, diversity, and inclusivity goals and mission. By 2013, six…

An interview with Bill and Melinda Gates. Interviewed by Claire Pomeroy.

PubMed

Gates, Bill; Gates, Melinda

2013-10-01

Bill and Melinda Gates have led a profound transformation in the way we view the world's most pressing health concerns, looking for effective ways to improve the lives of millions of people. Claire Pomeroy, president of the Albert and Mary Lasker Foundation, spoke with them about their current concerns and plans to advance their agenda.

"The Heart of Parenting: Raising an Emotionally Intelligent Child," by John Gottman with Joan DeClaire. Book Review.

ERIC Educational Resources Information Center

Gable, Sara

1999-01-01

Maintains that Gottman and DeClaire's work offers valuable guidance and research-based information to adults who parent, care for, or educate children, focusing on the Emotion Coaching technique. Summarizes important components of each chapter. Notes that individual chapters are well organized and that the author's style reaches a broad audience.…

33 CFR 162.132 - Connecting waters from Lake Huron to Lake Erie; communications rules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (2) Channel 12 (156.60 mhz) between Lake St. Clair Light and Detroit River Light. (b) Radiotelephone... Cut Light “7” Lake Huron Cut Lighted Buoy “1” Report. Report St. Clair/Black River Junction Light Report. Stag Island Upper Light Report. Report Marine City Salt Dock Light Report. Report Grande Pointe...

76 FR 63200 - Safety Zone; The Old Club Cannonade, Lake St. Clair, Muscamoot Bay, Harsens Island, MI

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

.... Department of Transportation, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE... into Lake St. Clair could cause death, serious bodily harm, or property damage. Discussion of Rule....5' N, 082[deg]40.6' W then angling southeast to the point of origin creating a triangle shaped...

Playing with Moon Sand: A Narrative Inquiry into a Teacher's Experiences Teaching Alongside a Student with a Chronic Illness

ERIC Educational Resources Information Center

Davis, Beth; Murphy, M. Shaun

2016-01-01

This paper inquires into the experiences of an early childhood educator named Claire who taught a young girl with a chronic illness at East Willows Elementary School, a western Canadian elementary school. Using narrative inquiry as the methodology, Claire's experiences in her curriculum making alongside Madeline a young girl with Turner syndrome…

A Malaysian Response to "The Traffic in Meaning" by Claire Kramsch

ERIC Educational Resources Information Center

Hashim, Azirah

2006-01-01

In Claire Kramsch's (2004) response to work by Mary Louise Pratt (2002) on multilingualism, identity and language in the U.S., she proposed that the four points made by Pratt be extended to the following: (1) Monolingualism is a handicap, but so is the assumption that one language = one culture = adherence to one cultural community; (2) Heritage…

Feasibility Study of Economics and Performance of Solar Photovoltaics at the Sky Park Landfill Site in Eau Claire, Wisconsin. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

Simon, J.; Mosey, G.

2013-01-01

The U.S. Environmental Protection Agency (EPA), in accordance with the RE-Powering America's Land initiative, selected the Sky Park Landfill site in Eau Claire, Wisconsin, for a feasibility study of renewable energy production. The National Renewable Energy Laboratory (NREL) provided technical assistance for this project. The purpose of this report is to assess the site for a possible photovoltaic (PV) system installation and estimate the cost, performance, and site impacts of different PV options. In addition, the report recommends financing options that could assist in the implementation of a PV system at the site.

Forum: House of Cards--or--Trojan Horse?: A Response to Ralf St. Clair's House of Cards: Analyzing "Making Skills Everyone's Business"

ERIC Educational Resources Information Center

Scully-Russ, Ellen

2015-01-01

In this article, Ellen Scully-Russ responds to St. Clair's analysis (EJ1072357) of the recent policy report from the Office of Career, Technical and Adult Education, "Making Skills Everyone's Business: A Call to Transform Adult Learning in the United States" (MSEB) (United States Department of Education [USDoE], 2015). While Scully-Russ…

CLAIRE: a Canadian Small Satellite Mission for Measurement of Greenhouse Gases

NASA Astrophysics Data System (ADS)

Sloan, James; Grant, Cordell; Germain, Stephane; Durak, Berke; McKeever, Jason; Latendresse, Vincent

2016-07-01

CLAIRE, a Canadian mission operated by GHGSat Inc. of Montreal, is the world's first satellite designed to measure greenhouse gas emissions from single targeted industrial facilities. Claire was launched earlier this year into a 500 km polar sun-synchronous orbit selected to provide an acceptable balance between return frequency and spatial resolution. Extensive simulations of oil & gas facilities, power plants, hydro reservoirs and even animal feedlots were used to predict the mission performance. The principal goal is to measure the emission rates of carbon dioxide and methane from selected targets with greater precision and lower cost than ground-based alternatives. CLAIRE will measure sources having surface areas less than 10 x 10 km2 with a spatial resolution better than 50 m, thereby providing industrial site operators and government regulators with the information they need to understand, manage and ultimately to reduce greenhouse gas emissions more economically. The sensor is based on a Fabry-Perot interferometer, coupled with a 2D InGaAs focal plane array operating in the short-wave infrared with a spectral resolution of about 0.1 nm. The patented, high étendue, instrument design provides signal to noise ratios that permit quantification of emission rates with accuracies adequate for most regulatory reporting thresholds. The very high spatial resolution of the density maps produced by the CLAIRE mission resolves plume shapes and emitter locations so that advanced dispersion models can derive accurate emission rates of multiple sources within the field of view. The satellite bus, provided by the University of Toronto's Space Flight Laboratory, is based on the well-characterized NEMO architecture, including hardware that has significant spaceflight heritage. The mission is currently undergoing initial test and validation measurements in preparation for commercial operation later this year.

Role of Activin A in Immune Responses to Breast Cancer

DTIC Science & Technology

2013-12-01

Demaria. APPENDIX 2 ( PS4 -57) Radiation-induced activin-a fosters tumor-mediated immunosuppression in breast cancer. Claire Vanpouille-Box, Julie...with immunotherapy in the clinic.   APPENDIX 2 ( PS4 -57) Radiation-induced activin-a fosters tumor-mediated immunosuppression in breast cancer...Claire Vanpouille-Box, Julie Diamond, Silvia Formenti and Sandra Demaria. POSTER PRESENTATION – 59th RRS annual Meeting. ( PS4 -57) Radiation-induced

Population-based study of esophageal and small intestinal atresia/stenosis.

PubMed

Takahashi, Daijiro; Hiroma, Takehiko; Takamizawa, Shigeru; Nakamura, Tomohiko

2014-12-01

The aim of this study was to describe the prevalence of esophageal atresia/stenosis and small intestinal atresia/stenosis in Nagano, Japan, together with associated anomalies, prenatal diagnosis and survival. A population-based cohort study of the prevalence of esophageal atresia/stenosis and small intestinal atresia/stenosis was conducted in Nagano in January 1993-December 2011. The Mann-Whitney test, χ(2) test and Kruskal-Wallis test were used to compare variables. P < 0.05 was considered statistically significant. In total, 74 cases of esophageal atresia/stenosis and 87 cases of small intestinal atresia/stenosis (31 duodenal, 56 jejuno-ileal) were identified. Prevalences were 1.97 for esophageal atresia/stenosis and 2.23 for small intestinal atresia/stenosis (0.83 for duodenal atresia/stenosis and 1.49 for jejuno-ileal atresia/stenosis) per 10,000 births, respectively. The prevalence of esophageal atresia/stenosis increased significantly from 1993-2001 to 2002-2011 (relative risk [RR], 1.6), as did the prevalences of duodenal atresia/stenosis (RR, 2.2) and jejuno-ileal atresia/stenosis (RR, 3.1). Chromosomal anomalies, particularly trisomy 21, were seen significantly more often in association with duodenal atresia/stenosis (55%) than with esophageal atresia/stenosis (28%, P < 0.01) or jejuno-ileal atresia/stenosis (2%, P < 0.01). The proportion of patients associated with prenatally diagnosed chromosomal anomaly was higher compared to postnatal diagnosis (P < 0.01) in the esophageal atresia/stenosis group. The prevalence of esophageal and small intestinal atresia/stenosis increased significantly from 1993-2001 to 2002-2011. Prenatally diagnosed esophageal atresia/stenosis is associated with multiple anomalies, particularly chromosomal anomalies, compared to other small intestine atresia/stenosis. © 2014 Japan Pediatric Society.

Potential effects of shipping on submersed macrophytes in the St. Clair and Detroit Rivers of the Great Lakes

USGS Publications Warehouse

Schloesser, Donald W.; Manny, Bruce A.

1989-01-01

An extensive survey of submersed macrophytes in the St. Clair and Detroit rivers revealed statistically significant differences in the composition and density of macrophyte beds in shipping channels (used by commercial vessels passing between Lakes Huron and Erie) and non-shipping channels. Of nine common macrophyte taxa, four (Characae, Potamogeton richardsonii, Potamogeton spp. narrow-leaf forms, and Najas flexilis) were found more frequently and three (Myriophyllum spicatum, Elodea canadensis, and Heteranthera dubia) less frequently in shipping than in non-shipping channels. In general, macrophyte beds were less dense in shipping channels than in non-shipping channels. We postulate that disruption of the prevailing unidirectional current patterns and erosion of suitable substrate or breakage of plant stems by passing vessels caused the observed differences in the composition and density of macrophyte beds in shipping and non-shipping channels in the St. Clair and Detroit rivers.

Occurrence of zebra mussels in near-shore areas of western Lake Erie

USGS Publications Warehouse

Custer, Christine M.; Custer, T.W.

1997-01-01

Zebra mussels (Dreissena polymorpha) invaded the Great Lakes in the mid-1980s and quickly reached high densities. The objective of this study was to determine current consumption of zebra mussels by waterfowl in the Great Lakes region. Feeding Lesser Scaups (Aythya affinis), Greater Scaups (A. marila), Canvasbacks (A. valisineria), Redheads (A. americana), Buffleheads (Bucephala albeola) and Common Goldeneyes (B. clangula) were collected in western Lake Erie and in Lake St. Clair between fall and spring, 1992-1993 to determine food habits. All 10 Redheads, 97% of Lesser Scaups, 83% of Goldeneyes, 60% of Buffleheads and 9% of Canvasbacks contained one or more zebra mussels in their upper gastrointestinal tracts. The aggregate percent of zebra mussels in the diet of Lesser Scaups was higher in Lake Erie (98.6%) than in Lake St. Clair (54.4%). Zebra mussels, (aggregate percent) dominated the diet of Common Goldeneyes (79.2%) but not in Buffleheads (23.5%), Redheads (21%) or Canvasbacks (9%). Lesser Scaups from Lake Erie fed on larger zebra mussels ( = 10.7 i?? 0.66 mm SE) than did Lesser Scaups from Lake St. Clair ( = 4.4 i?? 0.22 mm). Lesser Scaups, Buffleheads and Common Goldeneyes from Lake Erie consumed zebra mussels of similar size.

Temporal variation of energy reserves in mayfly nymphs (Hexagenia spp.) from Lake St. Clair and western Erie

USGS Publications Warehouse

Cavaletto, J.F.; Nalepa, T.F.; Fanslow, D.L.; Schloesser, D.W.

2003-01-01

4. Indicators of potential food (algal fluorescence in the water column and chlorophyll a and chlorophyll a/phaeophytin ratio in sediments) suggest that Hexagenia in Lake St Clair have a food source that is benthic based, especially in early spring, whereas in western Lake Erie nymphs have a food source that is water column based and settles to the lake bottom during late spring and summer.

A Cultural Resources Survey of Proposed Excess Tracts within the Harry S. Truman Reservoir Project Henry, St. Clair, and Bates Counties, Missouri

DTIC Science & Technology

1988-03-01

Survey of Proposed Exccess Tracts within the Harry S. Truman Reservoir Projec :. PERFORMING ORG. REPORT NUMSER Henry. St. Clair- and Bates Counties...region surrounding the Harry S. Truman Reservoir have been set out in several prior reports (LeeDecker et al. 1983:34-53; Killer 1983; Roper 1983a:15...construction of the Harry S. Truman Reservoir recorded 38 prehistoric sites, only 3 of which were previously known and reported to the Archaeological

Environmental Inventory Report. East St. Louis and Vicinity, Cahokia Canal Drainage Area, Madison and St. Clair Counties, Illinois. Volume 4.

DTIC Science & Technology

1981-05-01

successive waves of Indian, French , British, and Americans to what is now Madison and St. Clair Counties. This section of the Cahokia Canal...by the French . In 1673 the Jesuit missionary, Marquette, anda fur-trader, Jol iet, descended the Mississippi by canoe to a point somewhere south of...it. French Settlements The French were also the first to attempt permanent settlements in Illinois. In 1675, at a site near present day Utica in La

Environmental Studies of Macrozoobenthos, Aquatic Macrophytes, and Juvenile Fishes in the St. Clair-Detroit River System, 1983-1984

DTIC Science & Technology

1986-02-01

the world . Sediment particle size and contaminant distribution basically determined the benthic community in the SCDRS. The St. Clair River, with its ...Brown bullhead 2 Olc u iuIs j’tesus 3 264 5 279 Yellow bullhead u It iT 3 231 0 - Black redhorse t -Usnel 3 397 S 459 Northern pike us 2 660 1 775...Ponar Grab Data WI Z I- ll 0 t49~ 0- OD-0 * 0 ( 0 t.- I-- 09r, 0 e 0 z x IU 40 I 0m 4 .- K e- eI 9- 0 a CO U IK0z M 0 It Cz S O lw I n 00 I CIS to 0 z z

Length-weight relationship and a relative condition factor equation for lake sturgeon (Acipenser fulvescens) from the St Clair River system (Michigan, USA)

USGS Publications Warehouse

Craig, J.M.; Thomas, M.V.; Nichols, S.J.

2005-01-01

Several USA state, federal, and Canadian agencies study lake sturgeon (Acipenser fulvescens) within the St Clair River and Lake St Clair, collectively referred to hereafter as the St Clair River (SCR) system. Previously, there has been no set standard for determining condition for SCR system lake sturgeon. Condition measures the variation from the expected weight for length as an indicator of fatness, general well-being, gonad development, etc. The aim of this project was to determine the length weight relationship of lake sturgeon caught from the SCR system, from which a relative condition factor (Kn) equation could be derived. Total length (TL, mm) and weight (W, kg) were measured for 1074 lake sturgeon (101 males and 16 females were identifiable) collected by setline and bottom trawl from the SCR system in May-September, 1997-2002. Analysis of covariance found no difference in the length-weight relationship between sampling gear or sex. Least-squares regression of log10W ?? log10TL produced the overall equation logW = 3.365logTL - 9.320. Using the exponential form of the slope and y-intercept, relative condition factor for lake sturgeon from the SCR system can be calculated as Kn - W/[(4.786 ?? 10-10)(TL3.365)]. Equations for males and females were also developed. Overall, body condition was significantly correlated with both age and girth; no significant difference in Kn by sex was found. In general, the SCR lake sturgeon population was near the upper ends of growth and condition ranges listed in the literature, comparable with those populations that are at similar latitudes. Although condition factors should be interpreted with caution, proper use of a standard equation provides a non-lethal measure of overall fish health that can be used by biologists and managers in ongoing efforts to restore lake sturgeon throughout the Great Lakes. ?? 2005 Blackwell Verlag, Berlin.

Length-weight relationship and a relative condition factor equation for lake sturgeon (Acipenser fulvescens) from the St. Clair River system (Michigan, USA)

USGS Publications Warehouse

Craig, Jaquelyn M.; Thomas, Michael V.; Nichols, S. Jerrine

2005-01-01

Several USA state, federal, and Canadian agencies study lake sturgeon (Acipenser fulvescens) within the St Clair River and Lake St Clair, collectively referred to hereafter as the St Clair River (SCR) system. Previously, there has been no set standard for determining condition for SCR system lake sturgeon. Condition measures the variation from the expected weight for length as an indicator of fatness, general well-being, gonad development, etc. The aim of this project was to determine the length-weight relationship of lake sturgeon caught from the SCR system, from which a relative condition factor (Kn) equation could be derived. Total length (TL, mm) and weight (W, kg) were measured for 1074 lake sturgeon (101 males and 16 females were identifiable) collected by setline and bottom trawl from the SCR system in May-September, 1997-2002. Analysis of covariance found no difference in the length-weight relationship between sampling gear or sex. Least-squares regression of log10W x log10TL produced the overall equation logW = 3.365logTL - 9.320. Using the exponential form of the slope and y-intercept, relative condition factor for lake sturgeon from the SCR system can be calculated as Kn = W/ [(4.786 x 10-10)(TL3.365)]. Equations for males and females were also developed. Overall, body condition was significantly correlated with both age and girth; no significant difference in Kn by sex was found. In general, the SCR lake sturgeon population was near the upper ends of growth and condition ranges listed in the literature, comparable with those populations that are at similar latitudes. Although condition factors should be interpreted with caution, proper use of a standard equation provides a non-lethal measure of overall fish health that can be used by biologists and managers in ongoing efforts to restore lake sturgeon throughout the Great Lakes.

Coupling socioeconomic and lake systems for sustainability: a conceptual analysis using Lake St. Clair region as a case study.

PubMed

Mavrommati, Georgia; Baustian, Melissa M; Dreelin, Erin A

2014-04-01

Applying sustainability at an operational level requires understanding the linkages between socioeconomic and natural systems. We identified linkages in a case study of the Lake St. Clair (LSC) region, part of the Laurentian Great Lakes system. Our research phases included: (1) investigating and revising existing coupled human and natural systems frameworks to develop a framework for this case study; (2) testing and refining the framework by hosting a 1-day stakeholder workshop and (3) creating a causal loop diagram (CLD) to illustrate the relationships among the systems' key components. With stakeholder assistance, we identified four interrelated pathways that include water use and discharge, land use, tourism and shipping that impact the ecological condition of LSC. The interrelationships between the pathways of water use and tourism are further illustrated by a CLD with several feedback loops. We suggest that this holistic approach can be applied to other case studies and inspire the development of dynamic models capable of informing decision making for sustainability.

Characteristics of a refuge for native freshwater mussels (Bivalvia: Unionidae) in Lake St. Clair

USGS Publications Warehouse

McGoldrick, D.J.; Metcalfe-Smith, J. L.; Arts, M.T.; Schloesser, D.W.; Newton, T.J.; Mackie, G.L.; Monroe, E.M.; Biberhofer, J.; Johnson, K.

2009-01-01

The Lake St. Clair delta (??? 100??km2) provides an important refuge for native freshwater mussels (Unionidae) wherein 22 of the ??? 35 historical species co-occur with invasive dreissenids. A total of 1875 live unionids representing 22 species were found during snorkeling surveys of 32 shallow (??? 1??m) sites throughout the delta. Richness and density of unionids and zebra mussel infestation rates varied among sites from 3 to 13 unionid species, 0.02 to 0.12 unionids/m2, and < 1 to 35 zebra mussels/unionid, respectively. Zebra mussel infestation of unionids in the delta appears to be mitigated by dominant offshore currents, which limit densities of zebra mussel veligers in nearshore compared to offshore waters (13,600 vs. 28,000/m3, respectively). Glycogen concentrations in the tissues of a common and widespread species in the delta (Lampsilis siliquoidea) suggest that zebra mussels may be adversely affecting physiological condition of unionids in a portion of the Lake St. Clair delta. Physiological condition and community structure of unionids within the delta may also be influenced by differences in food quantity and quality resulting from the uneven distribution of water flowing from the St. Clair River. The delta likely supports the largest living unionid community in the lower Great Lakes and includes several species that have been listed as Endangered or Threatened in Canada and/or the state of Michigan, making it an important refuge for the conservation of native unionids. Crown Copyright ?? 2009.

Lumbosacral stenosis in Labrador retriever military working dogs - an exomic exploratory study.

PubMed

Mukherjee, Meenakshi; Jones, Jeryl C; Yao, Jianbo

2017-01-01

Canine lumbosacral stenosis is defined as narrowing of the caudal lumbar and/or sacral vertebral canal. A risk factor for neurologic problems in many large sized breeds, lumbosacral stenosis can also cause early retirement in Labrador retriever military working dogs. Though vital for conservative management of the condition, early detection is complicated by the ambiguous nature of clinical signs of lumbosacral stenosis in stoic and high-drive Labrador retriever military working dogs. Though clinical diagnoses of lumbosacral stenosis using CT imaging are standard, they are usually not performed unless dogs present with clinical symptoms. Understanding the underlying genomic mechanisms would be beneficial in developing early detection methods for lumbosacral stenosis, which could prevent premature retirement in working dogs. The exomes of 8 young Labrador retriever military working dogs (4 affected and 4 unaffected by lumbosacral stenosis, phenotypically selected by CT image analyses from 40 dogs with no reported clinical signs of the condition) were sequenced to identify and annotate exonic variants between dogs negative and positive for lumbosacral stenosis. Two-hundred and fifty-two variants were detected to be homozygous for the wild allele and either homozygous or heterozygous for the variant allele. Seventeen non-disruptive variants were detected that could affect protein effectiveness in 7 annotated (SCN1B, RGS9BP, ASXL3, TTR, LRRC16B, PTPRO, ZBBX) and 3 predicted genes (EEF1A1, DNAJA1, ZFX). No exonic variants were detected in any of the canine orthologues for human lumbar spinal stenosis candidate genes. TTR (transthyretin) gene could be a possible candidate for lumbosacral stenosis in Labrador retrievers based on previous human studies that have reported an association between human lumbar spinal stenosis and transthyretin protein amyloidosis. Other genes identified with exonic variants in this study but with no known published association with lumbosacral stenosis and/or lumbar spinal stenosis could also be candidate genes for future canine lumbosacral stenosis studies but their roles remain currently unknown. Human lumbar spinal stenosis candidate genes also cannot be ruled out as lumbosacral stenosis candidate genes. More definitive genetic investigations of this condition are needed before any genetic test for lumbosacral stenosis in Labrador retriever can be developed.

Murmur intensity in adult dogs with pulmonic and subaortic stenosis reflects disease severity.

PubMed

Caivano, D; Dickson, D; Martin, M; Rishniw, M

2018-03-01

The aims of this study were to determine whether murmur intensity in adult dogs with pulmonic stenosis or subaortic stenosis reflects echocardiographic disease severity and to determine whether a six-level murmur grading scheme provides clinical advantages over a four-level scheme. In this retrospective multi-investigator study on adult dogs with pulmonic stenosis or subaortic stenosis, murmur intensity was compared to echocardiographically determined pressure gradient across the affected valve. Disease severity, based on pressure gradients, was assessed between sequential murmur grades to identify redundancy in classification. A simplified four-level murmur intensity classification scheme ('soft', 'moderate', 'loud', 'palpable') was evaluated. In total, 284 dogs (153 with pulmonic stenosis, 131 with subaortic stenosis) were included; 55 dogs had soft, 59 had moderate, 72 had loud and 98 had palpable murmurs. 95 dogs had mild stenosis, 46 had moderate stenosis, and 143 had severe stenosis. No dogs with soft murmurs of either pulmonic or subaortic stenosis had transvalvular pressure gradients greater than 50 mmHg. Dogs with loud or palpable murmurs mostly, but not always, had severe stenosis. Stenosis severity increased with increasing murmur intensity. The traditional six-level murmur grading scheme provided no additional clinical information than the four-level descriptive murmur grading scheme. A simplified descriptive four-level murmur grading scheme differentiated stenosis severity without loss of clinical information, compared to the traditional six-level scheme. Soft murmurs in dogs with pulmonic or subaortic stenosis are strongly indicative of mild lesions. Loud or palpable murmurs are strongly suggestive of severe stenosis. © 2017 British Small Animal Veterinary Association.

Augmenting two-dimensional hydrodynamic simulations with measured velocity data to identify flow paths as a function of depth on Upper St. Clair River in the Great Lakes basin

USGS Publications Warehouse

Holtschlag, D.J.; Koschik, J.A.

2005-01-01

Upper St. Clair River, which receives outflow from Lake Huron, is characterized by flow velocities that exceed 7 feet per second and significant channel curvature that creates complex flow patterns downstream from the Blue Water Bridge in the Port Huron, Michigan, and Sarnia, Ontario, area. Discrepancies were detected between depth-averaged velocities previously simulated by a two-dimensional (2D) hydrodynamic model and surface velocities determined from drifting buoy deployments. A detailed ADCP (acoustic Doppler current profiler) survey was done on Upper St. Clair River during July 1–3, 2003, to help resolve these discrepancies. As part of this study, a refined finite-element mesh of the hydrodynamic model used to identify source areas to public water intakes was developed for Upper St. Clair River. In addition, a numerical procedure was used to account for radial accelerations, which cause secondary flow patterns near channel bends. The refined model was recalibrated to better reproduce local velocities measured in the ADCP survey. ADCP data also were used to help resolve the remaining discrepancies between simulated and measured velocities and to describe variations in velocity with depth. Velocity data from ADCP surveys have significant local variability, and statistical processing is needed to compute reliable point estimates. In this study, velocity innovations were computed for seven depth layers posited within the river as the differences between measured and simulated velocities. For each layer, the spatial correlation of velocity innovations was characterized by use of variogram analysis. Results were used with kriging to compute expected innovations within each layer at applicable model nodes. Expected innovations were added to simulated velocities to form integrated velocities, which were used with reverse particle tracking to identify the expected flow path near a sewage outfall as a function of flow depth. Expected particle paths generated by use of the integrated velocities showed that surface velocities in the upper layers tended to originate nearer the Canadian shoreline than velocities near the channel bottom in the lower layers. Therefore, flow paths to U.S. public water intakes located on the river bottom are more likely to be in the United States than withdrawals near the water surface. Integrated velocities in the upper layers are generally consistent with the surface velocities indicated by drifting-buoy deployments. Information in the 2D hydrodynamic model and the ADCP measurements was insufficient to describe the vertical flow component. This limitation resulted in the inability to account for vertical movements on expected flow paths through Upper St. Clair River. A three dimensional hydrodynamic model would be needed to account for these effects.

Association Between Gout and Aortic Stenosis

PubMed Central

Chang, Kevin; Yokose, Chio; Tenner, Craig; Oh, Cheongeun; Donnino, Robert; Choy-Shan, Alana; Pike, Virginia C.; Shah, Binita D.; Lorin, Jeffrey D.; Krasnokutsky, Svetlana; Sedlis, Steven P.; Pillinger, Michael H.

2017-01-01

Background An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. Methods We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. Results Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and non-aortic stenosis controls (n=224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n=24) of aortic stenosis subjects compared with 12.5% (n=28) of controls (unadjusted OR 1.90, 95% CI 1.05–3.48, p=0.038). Multivariate analysis retained significance only for gout (adjusted OR 2.08, 95% CI 1.00–4.32, p=0.049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs. 75.8 ± 1.0 years old, p=0.16). Conclusions Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications. PMID:27720853

Association Between Gout and Aortic Stenosis.

PubMed

Chang, Kevin; Yokose, Chio; Tenner, Craig; Oh, Cheongeun; Donnino, Robert; Choy-Shan, Alana; Pike, Virginia C; Shah, Binita D; Lorin, Jeffrey D; Krasnokutsky, Svetlana; Sedlis, Steven P; Pillinger, Michael H

2017-02-01

An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications. Published by Elsevier Inc.

Comparison of 5 benthic samplers to collect burrowing mayfly nymphs (Hexagenia spp.:Ephemeroptera:Ephemeridae) in sediments of the Laurentian Great Lakes

USGS Publications Warehouse

Schloesser, Don W.; Nalepa, Thomas F.

2002-01-01

The recent return of burrowing mayfly nymphs (Hexagenia spp.) to western Lake Erie of the Laurentian Great Lakes has prompted a need to find a sampler to obtain the most accurate (i.e., highest mean density) and precise (i.e., lowest mean variance) abundance estimates of nymphs. The abundance of burrowing nymphs is important because it is being used as a measure of ecosystem health to determine management goals for fisheries and pollution abatement programs for waters in both North America and Europe. We compared efficiencies of 5 benthic grab samplers (Ponar, Ekman, petite Ponar, Petersen, and orange-peel) to collect nymphs from sediments of western Lake Erie and Lake St. Clair. Samplers were used at one site with soft substrates in both lakes in 1997 (Ponar, Ekman, petite Ponar, and Petersen) and 1998 (Ponar and Ekman), and at one site with soft and one site with hard substrates in Lake St. Clair in 1999 (Ponar and orange-peel). In addition, the Ponar, Ekman, and Petersen samplers were used at one site with soft substrates of western Lake Erie in 2000 to examine the causes of differences among samplers. The Ponar was more accurate than the other samplers; it collected the highest densities of nymphs for 31 of 32 date and site comparisons. In soft substrates, the order of decreasing overall densities was: Ponar>Petersen>petite Ponar>Ekman in western Lake Erie and Ponar>Petersen> Ekman>petite Ponar in Lake St. Clair in 1997, Ponar>Ekman in both lakes in 1998, and Ponar>orange-peel in Lake St. Clair in 1999. In hard substrates, the Ponar was more accurate than the orange-peel in Lake St. Clair in 1999. Precision of the Ponar was generally greater than the Ekman, petite Ponar, and Petersen but similar to the orange-peel. Higher densities of nymphs obtained with the Ponar than other grabs are attributed to its relatively heavy weight, which allows it to sample deeper in sediments than the Ekman and petite Ponar. Also, the Ponar has a screened top, which allows it to minimize hydraulic shock waves more than the Petersen, and uniform sides, which allow it to sample nymphs more uniformly through sediments than the orange-peel. We recommend that future estimates of burrowing mayfly densities be obtained with a standard Ponar sampler similar to the one used in our study because it will yield the most accurate and precise measurements of burrowing mayfly nymphs such as Hexagenia spp.

Environmental feasibility study for gasoline from coal in New Athens, Illinois

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

Not Available

1981-09-01

Appendix 2 consists mostly of base line ecology of the proposed site in St. Clair County, southwestern Illinois including air quality, geology, stratigraphy, soils, climates, etc. Socio-economic factors are also considered. The environmental impact is considered. (LTN)

Prévention de la transmission mère-enfant du VIH/sida au Bénin: le consentement des femmes au dépistage est-il libre et éclairé ?

PubMed Central

Kêdoté, N.M.; Brousselle, A.; Champagne, F.; Laudy, D.

2016-01-01

Résumé Introduction Dans les politiques internationales et nationales sur le VIH/sida, le consentement libre et éclairé est reconnu comme une composante essentielle des programmes de dépistage. Le consentement libre et éclairé implique pour les femmes enceintes d’obtenir des informations sur le programme de prévention de la transmission du VIH de la mère à l’enfant (PTME), de les comprendre et de faire un choix autonome après avoir évalué les risques et avantages. Cependant, aucune évaluation du programme de PTME ne s’est intéressée au consentement. L’objectif de cet article est d’explorer le caractère libre et éclairé du consentement des femmes enceintes quant au dépistage et à leurs motivations à faire le test. Méthode Nous avons utilisé des données récoltées dans le cadre d’une analyse d’implantation du programme de PTME au Bénin. Cette analyse s’appuie sur un devis d’étude de cas multiples incluant six maternités choisies parmi les 56 sites fonctionnels. Spécifiquement pour l’analyse du consentement, nous avons associé les données provenant d’une enquête à celles d’une recherche qualitative. Résultats Hormis trois cas de dépistage à l’insu, le caractère volontaire du consentement au test est respecté sur les sites de PTME. Vingt-neuf cas de refus ont été identifiés. Les raisons les plus souvent évoquées par les femmes enceintes sont la peur du résultat positif et de ses conséquences sur la vie familiale dans 55,2 % des cas et l’attente de l’accord ou du désaccord du mari dans 27,6 % des cas. Si globalement le consentement a été volontaire sur tous les sites, son caractère éclairé est moins probant. PMID:27840660

Nonstent Combination Interventional Therapy for Treatment of Benign Cicatricial Airway Stenosis

PubMed Central

Qiu, Xiao-Jian; Zhang, Jie; Wang, Ting; Pei, Ying-Hua; Xu, Min

2015-01-01

Background: Benign cicatricial airway stenosis (BCAS) is a life-threatening disease. While there are numerous therapies, all have their defects, and stenosis can easily become recurrent. This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy (NSCIT) when used for the treatment of BCAS of different causes and types. Methods: This study enrolled a cohort of patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other origins. The patients were assigned to three groups determined by their type of stenosis: Web-like stenosis, granulation stenosis, and complex stenosis, and all patients received NSCIT. The efficacy and complications of treatment in each group of patients were observed. The Chi-square test, one-factor analysis of variance (ANOVA), and the paired t-test were used to analyze different parameters. Results: The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%. Among 41 patients with complex stenosis, 36 cases (88%) experienced remission and 29 cases (71%) experienced durable remission. When five patients with airway collapse were eliminated from the analysis, the overall remission rate was 97%. The average treatment durations for patients with web-like stenosis, granulation stenosis, and complex stenosis were 101, 21, and 110 days, respectively, and the average number of treatments was five, two, and five, respectively. Conclusions: NSCIT demonstrated good therapeutic efficacy and was associated with few complications. However, this approach was ineffective for treating patients with airway collapse or malacia. PMID:26265607

Nonstent Combination Interventional Therapy for Treatment of Benign Cicatricial Airway Stenosis.

PubMed

Qiu, Xiao-Jian; Zhang, Jie; Wang, Ting; Pei, Ying-Hua; Xu, Min

2015-08-20

Benign cicatricial airway stenosis (BCAS) is a life-threatening disease. While there are numerous therapies, all have their defects, and stenosis can easily become recurrent. This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy (NSCIT) when used for the treatment of BCAS of different causes and types. This study enrolled a cohort of patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other origins. The patients were assigned to three groups determined by their type of stenosis: Web-like stenosis, granulation stenosis, and complex stenosis, and all patients received NSCIT. The efficacy and complications of treatment in each group of patients were observed. The Chi-square test, one-factor analysis of variance (ANOVA), and the paired t -test were used to analyze different parameters. The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%. Among 41 patients with complex stenosis, 36 cases (88%) experienced remission and 29 cases (71%) experienced durable remission. When five patients with airway collapse were eliminated from the analysis, the overall remission rate was 97%. The average treatment durations for patients with web-like stenosis, granulation stenosis, and complex stenosis were 101, 21, and 110 days, respectively, and the average number of treatments was five, two, and five, respectively. NSCIT demonstrated good therapeutic efficacy and was associated with few complications. However, this approach was ineffective for treating patients with airway collapse or malacia.

Distribution of native mussel (unionidae) assemblages in coastal areas of Lake Erie, Lake St. Clair, and connecting channels, twenty-five years after a dreissenid invasion

USGS Publications Warehouse

Zanatta, David T.; Bossenbroek, Jonathan M.; Burlakova, Lyubov E.; Crail, Todd D.; Szalay, Ferenc de; Griffith, Traci A.; Kapusinski, Douglas; Karatayev, Alexander Y.; Krebs, Robert A.; Meyer, Elizabeth S.; Paterson, Wendy L.; Prescott, Trevor J.; Rowe, Matthew T.; Schloesser, Donald W.; Walsh, Mary C.

2015-01-01

Over the past 25 years, unionid mussels in the Laurentian Great Lakes of North America have been adversely impacted by invasive dreissenid mussels, which directly (e.g., by attachment to unionid shells) and indirectly (e.g., by competing for food) cause mortality. Despite the invasion, unionids have survived in several areas in the presence of dreissenid mussels. We investigated current spatial patterns in these native mussel refuges based on surveys for unionid mussels across 48 sampling locations (141 sites) in 2011 and 2012, and documented species abundance and diversity in coastal areas of lakes St. Clair and Erie. The highest-quality assemblages of native mussels (densities, richness, and diversity) appear to be concentrated in the St. Clair delta, where abundance continues to decline, as well as in in Thompson Bay of Presque Isle in Lake Erie and in just a few coastal wetlands and drowned river-mouths in the western basin of Lake Erie. The discovery of several new refuge areas suggests that unionids have a broader distribution within the region than previously thought.

The critical role of the external carotid artery in cerebral perfusion of patients with total occlusion of the internal carotid artery.

PubMed

Dalainas, I; Avgerinos, E D; Daskalopoulos, M E; Papapetrou, A; Papasideris, C P; Katsikas, V; Xiromeritis, K; Moulakakis, K; Gianakopoulos, T; Liapis, C D

2012-02-01

The ipsilateral external carotid artery (ECA) can potentially provide an important collateral pathway for cerebral blood flow in the presence of occlusion or severe stenosis of the internal carotid artery (ICA), recovering up to 15% of the middle cerebral arterial flow. The aim of the study is to elucidate the role of ECA in cerebral flow of patients with total ICA occlusion. Retrospective study of prospectively collected data of 139 patients with total ICA occlusions. The patients were divided to symptomatic and asymptomatic and were categorized in four subgroups according to the stenosis rates: A) ipsilateral ECA<70% and contralateral internal carotid artery stenosis <70%; B) ipsilateral ECA stenosis <70% and contralateral internal carotid artery stenosis ≥70%; C) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis <70%; D) ipsilateral ECA stenosis ≥70% and contralateral ICA stenosis ≥75%. Fifty eight (41.7%) patients were asymptomatic. The highest rate (48.2%) of asymptomatic patients was in Group A. Among patients with strokes, the highest rate belonged in groups C and D (44.4% and 50% respectively) where ipsilateral ECA stenosis was ≥70% irrespectively of the contralateral ICA patency. Ipsilateral external carotid artery stenosis ≥70% proved to be and independent risk factor for symptom presentation (P=0.013). The study reveals the significant role of ECA patency in cerebral flow in patients with ICA occlusion.

Exploring the impact of a dedicated streetcar right-of-way on pedestrian motor vehicle collisions: a quasi experimental design.

PubMed

Richmond, Sarah A; Rothman, Linda; Buliung, Ron; Schwartz, Naomi; Larsen, Kristian; Howard, Andrew

2014-10-01

The frequency of pedestrian collisions is strongly influenced by the built environment, including road width, street connectivity and public transit design. In 2010, 2159 pedestrian collisions were reported in the City of Toronto, Canada with 20 fatalities. Previous studies have reported that streetcars operating in mixed traffic pose safety risks to pedestrians; however, few studies evaluate the effects on pedestrian-motor vehicle collisions (PMVC). The objective of this study was to examine changes in the rate and spatial patterning of PMVC, pre to post right-of-way (ROW) installation of the St. Clair Avenue West streetcar in the City of Toronto, Canada. A quasi-experimental design was used to evaluate changes in PMVC rate, following implementation of a streetcar ROW. Collision data were extracted from all police-reported PMVC, complied and verified by the City of Toronto, from January 1, 2000 to December 31, 2011. A zero-inflated Poisson regression analysis estimated the change in PMVC, pre to post ROW. Age and injury severity were also examined. Changes in the spatial pattern of collisions were examined by applying the G function to describe the proportion of collision events that shared a nearest neighbor distance less than or equal to a threshold distance. A total of 23,607 PMVC occurred on roadways during the study period; 441 occurring on St. Clair Ave, 153 during the period of analysis. There was a 48% decrease in the rate of collisions on St. Clair [Incidence rate ratio (IRR)=0.52, 95% CI: 0.37-0.74], post ROW installation. There were also decreases noted for children (IRR=0.13, 95% CI: 0.04-0.44), adults (IRR=0.61, 95% CI: 0.38-0.97), and minor injuries (IRR=0.56, 95% CI: 0.40-0.80). Spatial analyses indicated increased dispersion of collision events across each redeveloped route segment following the changes in ROW design. Construction of a raised ROW operating on St. Clair Ave. was associated with a reduction in the rate of collisions. Differences in pre- and post collision spatial structure indicated changes in collision locations. Results from this study suggest that a streetcar ROW may be a safer alternative for pedestrians compared to a mixed traffic streetcar route and should be considered by city planners where appropriate to the street environment. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Teacher Education. Case Studies in TESOL Practice Series.

ERIC Educational Resources Information Center

Johnson, Karen E., Ed.

Chapters in this volume include the following: "Innovations in TESOL Teacher Education: A Quiet Revolution" (Karen E. Johnson); "Building Bridges among University, School, and Community" (Donald F. Hones); "Sustainable Strategies for Professional Development in Education Reform" (Nancy Clair, Carolyn Temple Adger); "Developing Professionals:…

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis.

PubMed

Tsukioka, Takuma; Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

2016-01-01

Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh-Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty.

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

PubMed Central

Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

2015-01-01

Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh–Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty. PMID:26567879

Growth of submersed macrophyte communities in the St. Clair - Detroit River system between Lake Huron and Lake Erie

USGS Publications Warehouse

Schloesser, Donald W.; Edsall, Thomas A.; Manny, Bruce A.

1985-01-01

Growth of submersed aquatic macrophytes was determined from observation and on the basis of biomass of samples collected from April to November 1978 at seven study sites in a major river system of the Great Lakes, the St. Clair – Detroit river system between Lake Huron and Lake Erie. Growth usually began between April and June, peaked between July and October, and decreased by late November. Maximum biomass at six of the seven sites (118–427 g dry weight m−2) was similar or greater than that reported in other rivers at similar latitudes. Seasonal growth of the abundant taxa followed one of three seasonal patterns at each study site: one dominant taxon grew alone; codominant taxa grew sympatrically without species succession; and codominant taxa grew sympatrically with species succession. Differences in growth and seasonal succession of some taxa were apparently caused by the presence or absence of overwintering plant material, competition, and life-cycle differences.

A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies

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

Brown, Paul D.; Foote, Robert L.; McLaughlin, Mark P.

2005-12-01

Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. Methods and Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. Results: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk ofmore » ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. Conclusions: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered.« less

Petition to Object to Detroit Edison's Belle River/St. Clair Power Plant, St. Clair County, Michigan, Title V Permit

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Statistical and Spatial Analysis of Bathymetric Data for the St. Clair River, 1971-2007

USGS Publications Warehouse

Bennion, David

2009-01-01

To address questions concerning ongoing geomorphic processes in the St. Clair River, selected bathymetric datasets spanning 36 years were analyzed. Comparisons of recent high-resolution datasets covering the upper river indicate a highly variable, active environment. Although statistical and spatial comparisons of the datasets show that some changes to the channel size and shape have taken place during the study period, uncertainty associated with various survey methods and interpolation processes limit the statistically certain results. The methods used to spatially compare the datasets are sensitive to small variations in position and depth that are within the range of uncertainty associated with the datasets. Characteristics of the data, such as the density of measured points and the range of values surveyed, can also influence the results of spatial comparison. With due consideration of these limitations, apparently active and ongoing areas of elevation change in the river are mapped and discussed.

The Severity of Coronary Arterial Stenosis in Patients With Acute ST-Elevated Myocardial Infarction: A Thrombolytic Therapy Study

PubMed Central

Kilic, Salih; Kocabas, Umut; Can, Levent Hurkan; Yavuzgil, Oguz; Zoghi, Mehdi

2018-01-01

Background It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT). Methods A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study. Results The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%. Conclusions In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA. PMID:29479380

Conceptual Framework for Conducting Cost Benefit Studies in Wisconsin VTAE and Cost Benefit Studies--VTAE Programs.

ERIC Educational Resources Information Center

Webb, Robert I.; And Others

The step-by-step cost benefit study, confined to measuring and comparing economic costs with economic benefits, is based on the 1971, 1972, and 1973 classes graduating from the Agribusiness-Machinery Partsman-Salesman Program at District One Technical Institute in Eau Claire, Wisconsin. Numerous tables throughout the report contain cost benefit…

Length-weight relationship and a relative condition factor equation for lake sturgeon (Acipenser fulvescens) from the St. Clair River system (Michigan, USA)

USGS Publications Warehouse

Craig, Jaquelyn M.; Thomas, Michael V.; Nichols, Susan Jerrine

2005-01-01

Several USA state, federal, and Canadian agencies study lake sturgeon (Acipenser fulvescens) within the St Clair River and Lake St Clair, collectively referred to hereafter as the St Clair River (SCR) system. Previously, there has been no set standard for determining condition for SCR system lake sturgeon. Condition measures the variation from the expected weight for length as an indicator of fatness, general well-being, gonad development, etc. The aim of this project was to determine the length–weight relationship of lake sturgeon caught from the SCR system, from which a relative condition factor (Kn) equation could be derived. Total length (TL, mm) and weight (W, kg) were measured for 1074 lake sturgeon (101 males and 16 females were identifiable) collected by setline and bottom trawl from the SCR system in May–September, 1997–2002. Analysis of covariance found no difference in the length–weight relationship between sampling gear or sex. Least-squares regression of log10W × log10TL produced the overall equation logW = 3.365logTL − 9.320. Using the exponential form of the slope and y-intercept, relative condition factor for lake sturgeon from the SCR system can be calculated as Kn = W/[(4.786 × 10−10)(TL3.365)]. Equations for males and females were also developed. Overall, body condition was significantly correlated with both age and girth; no significant difference in Kn by sex was found. In general, the SCR lake sturgeon population was near the upper ends of growth and condition ranges listed in the literature, comparable with those populations that are at similar latitudes. Although condition factors should be interpreted with caution, proper use of a standard equation provides a non-lethal measure of overall fish health that can be used by biologists and managers in ongoing efforts to restore lake sturgeon throughout the Great Lakes.

Sediment mobility and bed armoring in the St Clair River: insights from hydrodynamic modeling

USGS Publications Warehouse

Liu, Xiaofeng; Parker, Gary; Czuba, Jonathan A.; Oberg, Kevin; Mier, Jose M.; Best, James L.; Parsons, Daniel R.; Ashmore, Peter; Krishnappan, Bommanna G.; Garcia, Marcelo H.

2012-01-01

The lake levels in Lake Michigan-Huron have recently fallen to near historical lows, as has the elevation difference between Lake Michigan-Huron compared to Lake Erie. This decline in lake levels has the potential to cause detrimental impacts on the lake ecosystems, together with social and economic impacts on communities in the entire Great Lakes region. Results from past work suggest that morphological changes in the St Clair River, which is the only natural outlet for Lake Michigan-Huron, could be an appreciable factor in the recent trends of lake level decline. A key research question is whether bed erosion within the river has caused an increase in water conveyance, therefore, contributed to the falling lake level. In this paper, a numerical modeling approach with field data is used to investigate the possibility of sediment movement in the St Clair River and assess the likelihood of morphological change under the current flow regime. A two-dimensional numerical model was used to study flow structure, bed shear stress, and sediment mobility/armoring over a range of flow discharges. Boundary conditions for the numerical model were provided by detailed field measurements that included high-resolution bathymetry and three-dimensional flow velocities. The results indicate that, without considering other effects, under the current range of flow conditions, the shear stresses produced by the river flow are too low to transport most of the coarse bed sediment within the reach and are too low to cause substantial bed erosion or bed scour. However, the detailed maps of the bed show mobile bedforms in the upper St Clair River that are indicative of sediment transport. Relatively high shear stresses near a constriction at the upstream end of the river and at channel bends could cause local scour and deposition. Ship-induced propeller wake erosion also is a likely cause of sediment movement in the entire reach. Other factors that may promote sediment movement, such as ice cover and dredging in the lower river, require further investigation.

Scarring Airway Stenosis in Chinese Adults: Characteristics and Interventional Bronchoscopy Treatment

PubMed Central

Wang, Ting; Zhang, Jie; Qiu, Xiao-Jian; Wang, Juan; Pei, Ying-Hua; Wang, Yu-Ling

2018-01-01

Background: Scarring airway stenosis is commonly seen in China as compared to other developed countries, due to the high prevalence of tuberculosis. Nowadays, interventional bronchoscopy treatment has been widely used to treat this disease in China. This study demonstrated the characteristics of scarring airway stenosis in Chinese adults and retrospectively evaluated the efficacy of interventional bronchoscopy treatment of this disease. Methods: Patients with scarring airway stenosis from 18 tertiary hospitals were enrolled between January 2013 and June 2016. The causes, site, and length of scarring airway stenosis were analyzed, and the efficacy of the interventional bronchoscopy treatment was evaluated. Results: The final study cohort consisted of 392 patients. Endotracheobronchial tuberculosis (EBTB) was the most common cause of scarring airway stenosis (305/392, 77.8%) in Chinese adults with a high rate of incidence in young women. The left main bronchus was most susceptible to EBTB, and most posttuberculosis airway scarring stenosis length was 1.1–2.0 cm. The average clinical success rate of interventional bronchoscopy treatment for scarring airway stenosis in Chinese patients is 60.5%. The stent was inserted in 8.7% scarring airway stenosis in China. Conclusions: Scarring airway stenosis exhibits specific characteristics in Chinese patients. Interventional bronchoscopy is a useful and safe treatment method for the disease. PMID:29363641

Remote assessment of instantaneous changes in water chemistry after liming in a Nova Scotia catchment

NASA Astrophysics Data System (ADS)

Angelidis, Christine

2013-04-01

Remote assessment of instantaneous changes in water chemistry after liming in a Nova Scotia catchment ANGELIDIS, C.1, STERLING, S.1, BREEN, A.2, BIAGI, K.1., and CLAIR, T.A.1 1Dalhousie University, christine.angelidis@dal.ca, 2Bluenose Coastal Action Foundation, andrew@coastalaction.org Southwestern Nova Scotia has some of the most acidic freshwaters in North America due to its location downwind of the major emission sources in eastern Canada and the US and due to a resistant geology which offers little acid buffering capacity (Clair et al. 2007). Because of the poor buffering and regionally high runoff values, hydrological events such as snowmelt and rain storms are frequent and can cause sudden changes in water chemistry which can have devastating effects on freshwater biota due to increases in acidity and metals (Dennis and Clair in press). Clair et al. (2001) have estimated the potential frequency of acidic episodes in this region based on a number of hydrological factors, though the technology available at the time to monitor short-term changes was not dependable. Recent advances in equipment have made the assessment of the frequency and severity of acidic episodes easier and more accurate, allowing better interpretation and prediction of hydrogeochemical changes with variations in weather and deposition patterns. Here we take advantage of these recent advances to monitor water chemistry in an experimental catchment, and explore the response to catchment liming. Catchment liming is one way of mitigating the effects of acid deposition in sensitive areas. We limed a 50 ha catchment at a rate of 5 t/ha in the Gold River watershed of southwest Nova Scotia to examine the interactions between application of lime with the geological and climatological conditions of this region and acid episode frequency. In order to assess changes of episode frequency caused by liming, we established two mobile environmental monitoring platforms in the catchment: a control site located immediately above the limed area, and a treatment site 10 m below the limed area. We monitored pH, DO, water temperature, conductivity, stage height, air temperature, wind speed and direction as well as precipitation every 15 minutes since November 2011 with the data being accessed in real-time. The high frequency measurements were supplemented by a full chemical analysis of bi-weekly to monthly grab-samples at the site since December 2010. Pre-treatment stream chemistry and hydrology data at the control and treatment sites show identical patterns. pH values before treatment were as low as 4.9 and Ca2+ as low as 0.7 mg•L-1 demonstrating the need for the lime treatment. In this work, we show real-time outputs of pre- and post-treatment stream chemistry and present the short-term effects of liming on this uniquely acid sensitive ecosystem. Clair, T.A., Bobba, A.G., & Miller, K. 2001. Yearly changes in the seasonal frequency and duration of short-term acid pulses in Nova Scotia, Canada streams. Env. Geol. 40: 582-591. Clair, T.A., Dennis, I.F., Scruton, D.A., & Gilliss, M. 2007. Freshwater acidification research in Atlantic Canada: a review of results and predictions for the future. Env. Reviews 15: 153-167. Dennis, I.F. & Clair, T.A. (in press) The distribution of dissolved aluminum in Atlantic salmon (Salmo salar) rivers of Atlantic Canada and its potential effect on aquatic populations. Can. J.Fish Aquat. Sci.

Surgical treatment of anal stenosis

PubMed Central

Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio

2009-01-01

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms. PMID:19399922

Preliminary data on ASP2215: tolerability and efficacy in acute myeloid leukemia patients.

PubMed

Thom, Claire

2015-09-01

Claire Thom speaks to Gemma Westcott, Commissioning Editor: Claire Thom joined Astellas in 2013 as the Therapeutic Area Head for Oncology in Global Development. In that role, she also serves as the STAR leader for Oncology for Astellas. Prior to Astellas, she spent 12 years with Takeda. Her last position was Senior Vice President, Portfolio Management, Drug Development Management and Medical Informatics and Strategic Operations within the Medical Division (the Division within Millennium responsible for oncology clinical drug development within Takeda). During her 4 years at Millennium, at various times, she had responsibility within the Medical Division for leading portfolio management, business operations (medical finance, annual and mid-range financial planning, space planning and operations, headcount resourcing, development goals process), clinical development operations (clinical operations, programming, data management, statistics, medical writing, clinical outsourcing), drug development management (project management), medical informatics (technology support for the division) and the strategic project management office for the division. Prior to joining Millennium, Claire Thom spent 18 months working in Osaka, Japan, during which she was responsible for developing the oncology strategy for Takeda that culminated in the acquisition of Millennium. Before going to Japan, she held positions of varying responsibility within the Takeda US development organization including the management of regulatory affairs, safety, biometrics and data management, clinical research and quality assurance. Claire Thom has particular expertise in organizational design and efficiency; she has successfully worked through integrations across multiple functions and redesigned business processes. She has a PharmD from University of Illinois (IL, USA) and over 20 years of pharmaceutical experience including positions in medical affairs and new product planning (over 11 years at Searle) and drug development (over 12 years at Takeda/Millennium).

Impact of MCA stenosis on the early outcome in acute ischemic stroke patients

PubMed Central

Jeng, Jiann-Shing; Hsieh, Fang-I; Yeh, Hsu-Ling; Chen, Wei-Hung; Chiu, Hou-Chang; Tang, Sung-Chun; Liu, Chung-Hsiang; Lin, Huey-Juan; Hsu, Shih-Pin; Lo, Yuk-Keung; Chan, Lung; Chen, Chih-Hung; Lin, Ruey-Tay; Chen, Yu-Wei; Lee, Jiunn-Tay; Yeh, Chung-Hsin; Sun, Ming-Hui; Lai, Ta-Chang; Sun, Yu; Sun, Mu-Chien; Chen, Po-Lin; Chiang, Tsuey-Ru; Lin, Shinn-Kuang; Yip, Bak-Sau; Chen, Chin-I; Bai, Chi-Huey; Chen, Sien-Tsong; Chiou, Hung-Yi; Lien, Li-Ming; Hsu, Chung Y.

2017-01-01

Background Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR). Methods Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups. Results Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440–3.374; p<0.001) at 3 months after stroke than those without MCA stenosis. Conclusions In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome. PMID:28388675

Carotid stenosis and cognitive impairment amongst older Chinese adults living in a rural area: a population-based study.

PubMed

Yan, Z; Liang, Y; Shi, J; Cai, C; Jiang, H; Song, A; Qiu, C

2016-01-01

The possible association between carotid stenosis and cognitive impairment in the Chinese population has been rarely investigated. The association between the severity of carotid stenosis and cognitive impairment amongst older Chinese people living in a rural area was assessed. This cross-sectional study included 1375 participants (age ≥60 years) from the Confucius Hometown Aging Project in Shandong. In 2010-2011, data were collected through interviews and clinical examinations. Carotid stenosis was assessed using ultrasonography. Cognitive impairment was defined according to the education-specific cutoff scores of the Mini-Mental State Examination. Data were analyzed using multinomial logistic models. The overall prevalence was 7.0% for moderate carotid stenosis, 2.0% for severe stenosis and 6.0% for cognitive impairment. The multi-adjusted odds ratio of cognitive impairment was 1.43 (95% confidence interval 0.63-3.22) for moderate carotid stenosis and 3.75 (1.24-11.40) for severe carotid stenosis (P(trend) = 0.023). Similar results were obtained in people without a history of cerebrovascular disease. Severe carotid stenosis, even asymptomatic, is associated with cognitive impairment independent of atherosclerotic risk factors and disorders amongst older Chinese people. © 2015 EAN.

Impact of Hypertriglyceridemia on Carotid Stenosis Progression under Normal Low-Density Lipoprotein Cholesterol Levels.

PubMed

Kitagami, Masayuki; Yasuda, Ryuta; Toma, Naoki; Shiba, Masato; Nampei, Mai; Yamamoto, Yoko; Nakatsuka, Yoshinari; Sakaida, Hiroshi; Suzuki, Hidenori

2017-08-01

Dyslipidemia is a well-known risk factor for carotid stenosis progression, but triglycerides have attracted little attention. The aim of this study was to assess if serum triglycerides affect progression of carotid stenosis in patients with well-controlled low-density lipoprotein cholesterol (LDL-C) levels. This is a retrospective study in a single hospital consisting of 71 Japanese patients with internal carotid artery stenosis greater than or equal to 50% and normal serum LDL-C levels who underwent angiographic examination with or without the resultant carotid artery stenting or endarterectomy from 2007 to 2011, and were subsequently followed up for 4 years. Clinical factors including fasting serum triglyceride values were compared between the progression (≥10% increase in degree of carotid stenosis on ultrasonography) and the nonprogression groups. During 4 years, 15 patients (21.1%) had carotid stenosis progression on either side. Cox regression analysis demonstrated that symptomatic cases (hazard ratio [HR], 4.327; P = .019), coexisting intracranial arteriosclerotic stenosis (HR, 5.341; P = .005), and hypertriglyceridemia (HR, 6.228; P = .011) were associated with subsequent progression of carotid stenosis. Kaplan-Meier plots demonstrated that the progression-free survival rate was significantly higher in patients without hypertriglyceridemia and intracranial arteriosclerotic stenosis at baseline. Among patients with moderate to severe carotid stenosis and well-controlled LDL-C, hypertriglyceridemia was an important risk factor for progression of carotid stenosis irrespective of surgical treatments. It would be worthwhile to test if triglyceride-lowering medications suppress carotid stenosis progression. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Clinical, morphologic, and morphometric features of cranial thoracic spinal stenosis in large and giant breed dogs.

PubMed

Johnson, Philippa; De Risio, Luisa; Sparkes, Andrew; McConnell, Fraser; Holloway, Andrew

2012-01-01

The clinical, morphologic, and morphometric features of cranial thoracic spinal stenosis were investigated in large and giant breed dogs. Seventy-nine magnetic resonance imaging studies of the cranial thoracic spine were assessed. Twenty-six were retrieved retrospectively and 53 were acquired prospectively using the same inclusion criteria. Images were evaluated using a modified compression scale as: no osseous stenosis (grade 0), osseous stenosis without spinal cord compression (grade 1), and osseous stenosis with spinal cord compression (grade 2). Morphometric analysis was performed and compared to the subjective grading system. Grades 1 and 2 cranial thoracic spinal stenosis were identified on 24 imaging studies in 23 dogs. Sixteen of 23 dogs had a conformation typified by Molosser breeds and 21/23 were male. The most common sites of stenosis were T2-3 and T3-4. The articular process joints were enlarged with abnormal oblique orientation. Stenosis was dorsolateral, lateralized, or dorsoventral. Concurrent osseous cervical spondylomyelopathy was recognized in six dogs and other neurologic disease in five dogs. Cranial thoracic spinal stenosis was the only finding in 12 dogs. In 9 of these 12 dogs (all grade 2) neurolocalization was to the T3-L3 spinal segment. The median age of these dogs was 9.5 months. In the remaining three dogs neurologic signs were not present. Stenosis ratios were of limited benefit in detecting stenotic sites. Grade 2 cranial thoracic spinal stenosis causing direct spinal cord compression may lead to neurologic signs, however milder stenosis (grade 1) is likely to be subclinical or incidental. © 2012 Veterinary Radiology & Ultrasound.

Quaternary Geologic Framework of the St. Clair River between Michigan and Ontario, Canada

USGS Publications Warehouse

Foster, David S.; Denny, Jane F.

2009-01-01

Concern about the effect of geomorphic changes in the St. Clair River on water levels in the Upper Great Lakes resulted in the need for information on the geologic framework of the river. A geophysical survey of the Upper St. Clair River between Port Huron, MI, and Sarnia, Ontario, Canada, was conducted to determine the Quaternary geologic framework of the region. Previously available and new sediment samples and photographic and video data support the interpretation of the seismic stratigraphy and surficial geology. Three seismic stratigraphic units and two unconformities were identified. Glacial drift, consisting of interbedded till and glaciolacustrine deposits, overlies shale. Glaciofluvial and modern fluvial processes have eroded the glacial drift. Glaciofluvial, glaciolacustrine, fluvial, and lacustrine deposits overlie this unconformity. Seismic facies were interpreted to identify areas where these geologic facies exist; however, in the absence of distinct boundaries between facies, these deposits were mapped as one undifferentiated unit. This unit is thickest in the northernmost 3 kilometers of the river, where it consists of relatively coarse-grained fluvial, reworked glaciofluvial, and possibly glaciofluvial deposits. To the south, this coarse-grained unit thins or is absent. The undifferentiated unit comprises most of the surficial deposits in the northernmost river area. Some areas of glacial drift, predominantly till, are exposed at the lake and riverbed. The shale is not exposed anywhere in the region. Geophysical surveys at sites downriver, together with the results of previous studies, indicate that the geologic framework is similar to that in the northernmost river area except for the absence or reduced thickness of the coarse-grained fluvial deposits. Instead, glacial drift is exposed at the riverbed or is covered by a veneer of sediment. This information on the substrate is important for ongoing sediment transport studies.

Factors Influencing the Trilingual Education in Leshan Ebian Yi Autonomous County

ERIC Educational Resources Information Center

Jian, Huang

2013-01-01

Language is symbolic of nationality culture (Claire, 2000). Trilingual education to the minority students is necessity for inheriting and developing their national culture. This survey studies the trilingual education in practice, analyses the existing trilingual education problems in Sichuan Leshan minority areas and indicates the prospect of the…

Redefining the Boundaries of Language Study. Issues in Language Program Direction: A Series of Annual Volumes.

ERIC Educational Resources Information Center

Kramsch, Claire, Ed.

The papers in this volume fall into five categories. After "Introduction: Making the Invisible Visible" (Claire Kramsch), Part 1, "Theoretical Boundaries," includes "The Metamorphosis of the Foreign Language Director, or: Waking Up to Theory" (Mark Webber) and "Subjects-in-Process: Revisioning TA Development…

In the Flow of Media, Religion, and Culture: A Case Study with TVbyGIRLS

ERIC Educational Resources Information Center

Bischoff, Claire; Bullen, Rebecca Richards; Nemer, Molly; Quednau, Rachel

2011-01-01

This article introduces TVbyGIRLS, a nonprofit organization supporting girls in the development of critical thinking, digital literacy and storytelling, leadership, compassionate collaboration, and social justice engagement. Religious educator Claire Bischoff interviews Rebecca Richards Bullen, TVbyGIRLS mentor, and Molly Nemer and Rachel Quednau,…

Accuracy of Carotid Duplex Criteria in Diagnosis of Significant Carotid Stenosis in Asian Patients.

PubMed

Dharmasaroja, Pornpatr A; Uransilp, Nattaphol; Watcharakorn, Arvemas; Piyabhan, Pritsana

2018-03-01

Extracranial carotid stenosis can be diagnosed by velocity criteria of carotid duplex. Whether they are accurately applied to define severity of internal carotid artery (ICA) stenosis in Asian patients needs to be proved. The purpose of this study was to evaluate the accuracy of 2 carotid duplex velocity criteria in defining significant carotid stenosis. Carotid duplex studies and magnetic resonance angiography were reviewed. Criteria 1 was recommended by the Society of Radiologists in Ultrasound; moderate stenosis (50%-69%): peak systolic velocity (PSV) 125-230 cm/s, diastolic velocity (DV) 40-100 cm/s; severe stenosis (>70%): PSV greater than 230 cm/s, DV greater than 100 cm/s. Criteria 2 used PSV greater than 140 cm/s, DV less than 110 cm/s to define moderate stenosis (50%-75%) and PSV greater than 140 cm/s, DV greater than 110 cm/s for severe stenosis (76%-95%). A total of 854 ICA segments were reviewed. There was moderate stenosis in 72 ICAs, severe stenosis in 50 ICAs, and occlusion in 78 ICAs. Criteria 2 had slightly lower sensitivity, whereas higher specificity and accuracy than criteria 1 were observed in detecting moderate stenosis (criteria 1: sensitivity 95%, specificity 83%, accuracy 84%; criteria 2: sensitivity 92%, specificity 92%, and accuracy 92%). However, in detection of severe ICA stenosis, no significant difference in sensitivity, specificity, and accuracy was found (criteria 1: sensitivity 82%, specificity 99.57%, accuracy 98%; criteria 2: sensitivity 86%, specificity 99.68%, and accuracy 99%). In the subgroup of moderate stenosis, the criteria using ICA PSV greater than 140 cm/s had higher specificity and accuracy than the criteria using ICA PSV 125-230 cm/s. However, there was no significant difference in detection of severe stenosis or occlusion of ICA. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study

PubMed Central

Zhu, Runxiu; Yan, Zhongrui; Zheng, Shouhuan; Wang, Jingwei; Huo, Jia; Liu, Yunlin; Li, Xin; Ji, Yong

2016-01-01

To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE) at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale) score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05–2.11, p<0.001). Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery. PMID:26751070

Phenotyping of lumbosacral stenosis in Labrador retrievers using computed tomography.

PubMed

Mukherjee, Meenakshi; Jones, Jeryl C; Holásková, Ida; Raylman, Raymond; Meade, Jean

2017-09-01

Deep phenotyping tools for characterizing preclinical morphological conditions are important for supporting genetic research studies. Objectives of this retrospective, cross-sectional, methods comparison study were to describe and compare qualitative and quantitative deep phenotypic characteristics of lumbosacral stenosis in Labrador retrievers using computed tomography (CT). Lumbosacral CT scans and medical records were retrieved from data archives at three veterinary hospitals. Using previously published qualitative CT diagnostic criteria, a board-certified veterinary radiologist assigned dogs as either lumbosacral stenosis positive or lumbosacral stenosis negative at six vertebral locations. A second observer independently measured vertebral canal area, vertebral fat area, and vertebral body area; and calculated ratios of vertebral canal area/vertebral body area and vertebral fat area/vertebral body area (fat area ratio) at all six locations. Twenty-five dogs were sampled (lumbosacral stenosis negative, 11 dogs; lumbosacral stenosis positive, 14 dogs). Of the six locations, cranial L6 was the most affected by lumbosacral stenosis (33%). Five of six dogs (83%) with clinical signs of lumbosacral pain were lumbosacral stenosis positive at two or more levels. All four quantitative variables were significantly smaller at the cranial aspects of the L6 and L7 vertebral foramina than at the caudal aspects (P < 0.0001). Fat area ratio was a significant predictor of lumbosacral stenosis positive status at all six locations with cranial L6 having the greatest predictive value (R 2 = 0.43) and range of predictive probability (25-90%). Findings from the current study supported the use of CT as a deep phenotyping tool for future research studies of lumbosacral stenosis in Labrador retrievers. © 2017 American College of Veterinary Radiology.

Changes in the Flow-Volume Curve According to the Degree of Stenosis in Patients With Unilateral Main Bronchial Stenosis

PubMed Central

Yoo, Jung-Geun; Yi, Chin A; Lee, Kyung Soo; Jeon, Kyeongman; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung

2015-01-01

Objectives The shape of the flow-volume (F-V) curve is known to change to showing a prominent plateau as stenosis progresses in patients with tracheal stenosis. However, no study has evaluated changes in the F-V curve according to the degree of bronchial stenosis in patients with unilateral main bronchial stenosis. Methods We performed an analysis of F-V curves in 29 patients with unilateral bronchial stenosis with the aid of a graphic digitizer between January 2005 and December 2011. Results The primary diseases causing unilateral main bronchial stenosis were endobronchial tuberculosis (86%), followed by benign bronchial tumor (10%), and carcinoid (3%). All unilateral main bronchial stenoses were classified into one of five grades (I, ≤25%; II, 26%-50%; III, 51%-75%; IV, 76%-90%; V, >90% to near-complete obstruction without ipsilateral lung collapse). A monophasic F-V curve was observed in patients with grade I stenosis and biphasic curves were observed for grade II-IV stenosis. Both monophasic (81%) and biphasic shapes (18%) were observed in grade V stenosis. After standardization of the biphasic shape of the F-V curve, the breakpoints of the biphasic curve moved in the direction of high volume (x-axis) and low flow (y-axis) according to the progression of stenosis. Conclusion In unilateral bronchial stenosis, a biphasic F-V curve appeared when bronchial stenosis was >25% and disappeared when obstruction was near complete. In addition, the breakpoint moved in the direction of high volume and low flow with the progression of stenosis. PMID:26045916

Obstruction after Self-expanding Metallic Stents in Tuberculous Bronchial Stenosis

PubMed Central

Kim, Won; Lee, Youg Chul; Rhee, Yang Keun

1995-01-01

Expandable metallic stents seemed to be a good method in tuberculous bronchial stenosis that does not respond to medical therapy. But there was no long-term follow-up study after stents insertion in tuberculous bronchial stenosis. We report a case of obstruction after successful Gianturco metallic stents insertion due to tuberculous bronchial stenosis. PMID:7542914

A scientific basis for restoring fish spawning habitat in the St. Clair and Detroit Rivers of the Laurentian Great Lakes

USGS Publications Warehouse

Manny, Bruce A.; Roseman, Edward F.; Kennedy, Gregory W.; Boase, James C.; Craig, Jaquelyn; Bennion, David H.; Read, Jennifer; Vaccaro, Lynn; Chiotti, Justin A.; Drouin, Richard; Ellison, Roseanne

2015-01-01

Loss of functional habitat in riverine systems is a global fisheries issue. Few studies, however, describe the decision-making approach taken to abate loss of fish spawning habitat. Numerous habitat restoration efforts are underway and documentation of successful restoration techniques for spawning habitat of desirable fish species in large rivers connecting the Laurentian Great Lakes are reported here. In 2003, to compensate for the loss of fish spawning habitat in the St. Clair and Detroit Rivers that connect the Great Lakes Huron and Erie, an international partnership of state, federal, and academic scientists began restoring fish spawning habitat in both of these rivers. Using an adaptive management approach, we created 1,100 m2 of productive fish spawning habitat near Belle Isle in the Detroit River in 2004; 3,300 m2 of fish spawning habitat near Fighting Island in the Detroit River in 2008; and 4,000 m2 of fish spawning habitat in the Middle Channel of the St. Clair River in 2012. Here, we describe the adaptive-feedback management approach that we used to guide our decision making during all phases of spawning habitat restoration, including problem identification, team building, hypothesis development, strategy development, prioritization of physical and biological imperatives, project implementation, habitat construction, monitoring of fish use of the constructed spawning habitats, and communication of research results. Numerous scientific and economic lessons learned from 10 years of planning, building, and assessing fish use of these three fish spawning habitat restoration projects are summarized in this article.

A model to locate potential areas for lake sturgeon spawning habitat construction in the St. Clair–Detroit River System

USGS Publications Warehouse

Bennion, David; Manny, Bruce A.

2014-01-01

In response to a need for objective scientific information that could be used to help remediate loss of fish spawning habitat in the St. Clair River and Detroit River International Areas of Concern, this paper summarizes a large-scale geographic mapping investigation. Our study integrates data on two variables that many riverine fishes respond to in selecting where to spawn in these waters (water flow velocity and water depth) with available maps of the St. Clair–Detroit River System (SC–DRS). Our objectives were to locate and map these two physical components of fish habitat in the St. Clair and Detroit rivers and Lake St. Clair using a geographic information system (GIS) and to identify where, theoretically, fish spawning habitat could be remediated in these rivers. The target fish species to which this model applies is lake sturgeon (Acipenser fulvescens), but spawning reefs constructed for lake sturgeon in this system have been used for spawning by 17 species of fish. Our analysis revealed areas in each river that possessed suitable water velocity and depth for fish spawning and therefore could theoretically be remediated by the addition of rock-rubble substrate like that used at two previously remediated sites in the Detroit River at Belle Isle and Fighting Island. Results of our analysis revealed that only 3% of the total area of the SC–DRS possesses the necessary combination of water depth and high flow velocity to be indicated by the model as potential spawning habitat for lake sturgeon.

Flow characteristics around a deformable stenosis under pulsatile flow condition

NASA Astrophysics Data System (ADS)

Choi, Woorak; Park, Jun Hong; Byeon, Hyeokjun; Lee, Sang Joon

2018-01-01

A specific portion of a vulnerable stenosis is deformed periodically under a pulsatile blood flow condition. Detailed analysis of such deformable stenosis is important because stenotic deformation can increase the likelihood of rupture, which may lead to sudden cardiac death or stroke. Various diagnostic indices have been developed for a nondeformable stenosis by using flow characteristics and resultant pressure drop across the stenosis. However, the effects of the stenotic deformation on the flow characteristics remain poorly understood. In this study, the flows around a deformable stenosis model and two different rigid stenosis models were investigated under a pulsatile flow condition. Particle image velocimetry was employed to measure flow structures around the three stenosis models. The deformable stenosis model was deformed to achieve high geometrical slope and height when the flow rate was increased. The deformation of the stenotic shape enhanced jet deflection toward the opposite vessel wall of the stenosis. The jet deflection in the deformable model increased the rate of jet velocity and turbulent kinetic energy (TKE) production as compared with those in the rigid models. The effect of stenotic deformation on the pulsating waveform related with the pressure drop was analyzed using the TKE production rate. The deformable stenosis model exhibited a phase delay of the peak point in the waveform. These results revealed the potential use of pressure drop waveform as a diagnostic index for deformable stenosis.

FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis

PubMed Central

Nangole, Ferdinand Wanjala; Khainga, Stanley Ominde

2014-01-01

Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx. PMID:25328699

Venous thrombosis and stenosis after peripherally inserted central catheter placement in children.

PubMed

Shin, H Stella; Towbin, Alexander J; Zhang, Bin; Johnson, Neil D; Goldstein, Stuart L

2017-11-01

Peripherally inserted central catheters (PICCs) can lead to development of venous thrombosis and/or stenosis. The presence of venous thrombosis and/or stenosis may preclude children with chronic medical conditions from receiving lifesaving therapies, from hemodialysis in end-stage renal disease to total parenteral nutrition in short bowel syndrome. Several adult studies have found an association between PICCs and venous thrombosis and/or stenosis, but none has evaluated for this association in children. To determine the incidence of venous thrombosis and/or stenosis after PICC placement and identify factors that increase the risk of venous thrombosis and/or stenosis after PICC placement in children. We conducted a retrospective review of children ages 1-18 years with a PICC placed between January 2010 and July 2013 at our center, and included those who had at least one vascular imaging study of the ipsilateral extremity (Doppler ultrasound, venogram or MR angiogram) after PICC placement. Logistic regression was applied to determine risk factors for development of venous thrombosis and/or stenosis. One thousand, one hundred and ten upper extremity PICCs were placed, with 703 PICCs in the right and 407 PICCs in the left. Eight hundred fifty-one imaging studies (609 Doppler ultrasounds, 193 contrast venograms and 49 MR angiograms) were performed in 376 patients. The incidence of venous thrombosis and/or stenosis in the imaged cohort was 26.3%. PICC laterality, insertion site, duration, patient height to PICC diameter ratio, and number of PICCs per patient were not associated with development of venous thrombosis and/or stenosis. Additionally, primary diagnosis and symptoms at the time of imaging did not predict findings of venous thrombosis and/or stenosis. However, patients exposed to non-PICC central venous catheters (CVC) were more likely to develop venous thrombosis and/or stenosis (odds ratio 1.95, 1.10-3.45). More than a quarter of the vascular imaging studies performed in this study cohort showed previously unknown venous thrombosis and/or stenosis, irrespective of PICC laterality, insertion site, duration and size and the number of PICCs. A history of CVC was associated with a nearly two-fold increase in risk of venous thrombosis and/or stenosis after PICC placement. We suggest that PICCs and CVCs should be placed judiciously in all children, but especially in those with lifelong medical conditions who are more likely to incur direct consequences from limited vascular access.

Examining Material Culture through American Memory.

ERIC Educational Resources Information Center

Singleton, Laurel R., Ed.

2002-01-01

This publication contains teaching ideas generated by classroom teachers. For grades K-5, newsletter editor Laurel R. Singleton explains how students can explore the quilt as a metaphor used in literature to represent American values and ideals (the lesson is adaptable for all age groups). For grades 5-8, social studies teacher Claire McCaffery…

Teaching Women's Rights and the Imperialist Agenda

ERIC Educational Resources Information Center

Long, Alex

2014-01-01

The author is a graduate student studying English at the University of Wisconsin-Eau Claire, and recently concluded co-teaching a course called The Human Experience of War. The course consisted of reading various works of British literature that spanned World Wars I and II. Through the experience of teaching this course, one recurring theme that…

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.

PubMed

Sirvanci, Mustafa; Bhatia, Mona; Ganiyusufoglu, Kursat Ali; Duran, Cihan; Tezer, Mehmet; Ozturk, Cagatay; Aydogan, Mehmet; Hamzaoglu, Azmi

2008-05-01

Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed.

Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis.

PubMed

Vizzardi, Enrico; D'Aloia, Antonio; Sciatti, Edoardo; Bonadei, Ivano; Gelsomino, Sandro; Lorusso, Roberto; Metra, Marco

2015-01-01

The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography. We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)). A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01). This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis. © 2015 by the American Institute of Ultrasound in Medicine.

Progressively heterogeneous mismatch of regional oxygen delivery to consumption during graded coronary stenosis in pig left ventricle.

PubMed

Alders, David J C; Groeneveld, A B Johan; Binsl, Thomas W; van Beek, Johannes H G M

2015-11-15

In normal hearts, myocardial perfusion is fairly well matched to regional metabolic demand, although both are distributed heterogeneously. Nonuniform regional metabolic vulnerability during coronary stenosis would help to explain nonuniform necrosis during myocardial infarction. In the present study, we investigated whether metabolism-perfusion correlation diminishes during coronary stenosis, indicating increasing mismatch of regional oxygen supply to demand. Thirty anesthetized male pigs were studied: controls without coronary stenosis (n = 11); group I, left anterior descending (LAD) coronary stenosis leading to coronary perfusion pressure reduction to 70 mmHg (n = 6); group II, stenosis with perfusion pressure of about 35 mmHg (n = 6); and group III, stenosis with perfusion pressure of 45 mmHg combined with adenosine infusion (n = 7). [2-(13)C]- and [1,2-(13)C]acetate infusion was used to calculate regional O2 consumption from glutamate NMR spectra measured for multiple tissue samples of about 100 mg dry mass in the LAD region. Blood flow was measured with microspheres in the same regions. In control hearts without stenosis, regional oxygen extraction did not correlate with basal blood flow. Average myocardial O2 delivery and consumption decreased during coronary stenosis, but vasodilation with adenosine counteracted this. Regional oxygen extraction was on average decreased during stenosis, suggesting adaptation of metabolism to lower oxygen supply after half an hour of ischemia. Whereas regional O2 delivery correlated with O2 consumption in controls, this relation was progressively lost with graded coronary hypotension but partially reestablished by adenosine infusion. Therefore, coronary stenosis leads to heterogeneous metabolic stress indicated by decreasing regional O2 supply to demand matching in myocardium during partial coronary obstruction. Copyright © 2015 the American Physiological Society.

Problem: Heart Valve Stenosis

MedlinePlus

... valve . Learn about the different types of stenosis: Aortic stenosis Tricuspid stenosis Pulmonary stenosis Mitral stenosis Outlook for ... Disease "Innocent" Heart Murmur Problem: Valve Stenosis - Problem: Aortic Valve Stenosis - Problem: Mitral Valve Stenosis - Problem: Tricuspid Valve Stenosis - ...

[Aqueductal stenosis in the neurofibromatosis type 1. Presentation of 19 infantile patients].

PubMed

Pascual-Castroviejo, I; Pascual-Pascual, S I; Velázquez-Fragua, R; Viaño, J; Carceller-Benito, F

To present a series of infantile patients with aqueductal stenosis associated with neurofibromatosis type 1 (NF1). Nineteen patients with ages below 16 years, 11 girls and 8 boys, with NF1 presented hydrocephalus due to aqueductal stenosis. All patients, except one who died before the imaging study was performed and was diagnosed by autopsy, were studied by pneumoencephalography (since 1965 to 1974), computerized tomography (CT) (since 1975 to 1984), magnetic resonance (MR) or MR and CT (since 1985 to 2004) (two children had been studied by pneumoencephalography some years before) most times to discard optic pathway tumor and, in few patients, because of intracranial hypertension. All patients showed three ventricular hydrocephalus with aqueductal stenosis. Eleven patients showed optic pathway tumor. One patient had a benign aqueductal tumor that impaired the normal flow of cerebrospinal fluid. Neurological features of hydrocephalus occurred very rapidly in some patients and after several years of evolution in others. Two boys showed precocious puberty. All patients were treated with shunt. In our series, aqueductal stenosis occurred in about 5% of children with NF1. Aqueductal stenosis and hydrocephalus were identified at a short age because many patients were studied suspecting optic pathway tumor. Eleven patients (about 60%) associated optic pathway tumor and aqueductal stenosis.

High frequency/ultrasonic communication in a critically endangered nocturnal primate, Claire's mouse lemur (Microcebus mamiratra).

PubMed

Hasiniaina, Alida F; Scheumann, Marina; Rina Evasoa, Mamy; Braud, Diane; Rasoloharijaona, Solofonirina; Randrianambinina, Blanchard; Zimmermann, Elke

2018-05-02

The critically endangered Claire's mouse lemur, only found in the evergreen rain forest of the National Park Lokobe (LNP) and a few lowland evergreen rain forest fragments of northern Madagascar, was described recently. The present study provides the first quantified information on vocal acoustics of calls, sound associated behavioral context, acoustic niche, and vocal activity of this species. We recorded vocal and social behavior of six male-female and six male-male dyads in a standardized social-encounter paradigm in June and July 2016 at the LNP, Nosy Bé island. Over six successive nights per dyad, we audio recorded and observed behaviors for 3 hr at the beginning of the activity period. Based on the visual inspection of spectrograms and standardized multiparametric sound analysis, we identified seven different call types. Call types can be discriminated based on a combination of harmonicity, fundamental frequency variation, call duration, and degree of tonality. Acoustic features of tonal call types showed that for communication, mouse lemurs use the cryptic, high frequency/ultrasonic frequency niche. Two call types, the Tsak and the Grunt call, were emitted most frequently. Significant differences in vocal activity of the Tsak call were found between male-female and male-male dyads, linked primarily to agonistic conflicts. Dominant mouse lemurs vocalized more than subdominant ones, suggesting that signaling may present an honest indicator of fitness. A comparison of our findings of the Claire's mouse lemur with published findings of five bioacoustically studied mouse lemur species points to the notion that a complex interplay between ecology, predation pressure, and phylogenetic relatedness may shape the evolution of acoustic divergence between species in this smallest-bodied primate radiation. Thus, comparative bioacoustic studies, using standardized procedures, are promising to unravel the role of vocalization for primate species diversity and evolution and for identifying candidates for vocalization-based non-invasive monitoring for conservation purposes. © 2018 Wiley Periodicals, Inc.

Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis

PubMed Central

Dilu, VP; George, Raju

2017-01-01

Introduction An integrated approach that incorporates two dimensional, M mode and Doppler echocardiographic evaluation has become the standard means for accurate quantification of severity of valvular aortic stenosis. Maximal separation of the aortic valve cusps during systole has been shown to correlate well with the severity of aortic stenosis measured by other echocardiographic parameters. Aim To study the correlation between Maximal Aortic valve Cusp Separation (MACS) and severity of aortic valve stenosis and to find cut-off values of MACS for detecting severe and mild aortic stenosis. Materials and Methods In the present prospective observational study, we have compared the accuracy of MACS distance and the aortic valve area calculated by continuity equation in 59 patients with varying degrees of aortic valve stenosis. Aortic leaflet separation in M mode was identified as the distance between the inner edges of the tips of these structures at mid systole in the parasternal long axis view. Cuspal separation was also measured in 2D echocardiography from the parasternal long axis view and the average of the two values was taken as the MACS. Patients were grouped into mild, moderate and severe aortic stenosis based on the aortic valve area calculated by continuity equation. The resultant data regarding maximal leaflet separation on cross-sectional echocardiogram was then subjected to linear regression analysis in regard to correlation with the peak transvalvular aortic gradient as well as the calculated aortic valve area. A cut-off value for each group was derived using ROC curve. Results There was a strong correlation between MACS and aortic valve area measured by continuity equation and the peak and mean transvalvular aortic gradients. Mean MACS was 6.89 mm in severe aortic stenosis, 9.97 mm in moderate aortic stenosis and 12.36 mm in mild aortic stenosis. MACS below 8.25 mm reliably predicted severe aortic stenosis, with high sensitivity, specificity and positive predictive value. MACS above 11.25 mm practically ruled out significant aortic stenosis. Conclusion Measurement of MACS is a simple echocardio-graphic method to assess the severity of valvular aortic stenosis, with high sensitivity and specificity. MACS can be extremely useful in two clinical situations as a simple screening tool for assessment of stenosis severity and also helps in decision making non invasively when there is discordance between the other echocardiographic parameters of severity of aortic stenosis. PMID:28764221

Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative cases.

PubMed

Le Huec, J C; Cogniet, A; Mazas, S; Faundez, A

2016-10-01

Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis. The aetiology, prevalence, biomechanics, classification, symptomatology, and treatment of idiopathic and degenerative lumbar scoliosis in association with spinal stenosis are reviewed. Review study is based on a review of pertinent but non-exhaustive literature of the last 20 years in PubMed in English language. Retrospective analysis of studies focused on all parameters concerning scoliosis associated with stenosis. Very few publications have focused specifically on idiopathic scoliosis and stenosis, and this was before the advent of modern segmental instrumentation. On the other hand, many papers were found for degenerative scoliosis and stenosis with treatment methods based on aetiology of spinal canal stenosis and analysis of global sagittal and frontal parameters. Satisfactory clinical results after operative treatment range from 83 to 96 % but with increased percentage of complications. Recent literature analysed the importance of stabilizing or not the spine after decompression in such situation knowing the increasing risk of instability after facet resection. No prospective randomized studies were found to support short instrumentation. Long instrumentation and fusion to prevent distabilization after decompression were always associated with higher complication rates. Imbalance patients with unsatisfactory compensation capacities were at risk of complications. Operative treatment using newly proposed classification system of lumbar scoliosis with associated canal stenosis is useful. Sagittal balance and rotatory dislocation are the main parameters to analyse to determine the length of fusion.

Growth and overwinter survival of the Asiatic clam, Corbicula fluminea, in the St. Clair River, Michigan

USGS Publications Warehouse

French, John R. P.; Schloesser, Donald W.

1991-01-01

We report the discovery in April 1986 of the first population of Asiatic clam, Corbicula fluminea, known to occupy a lotic environment in the Laurentian Great Lakes system. This population occupied a 3.8 km long sandy shoal in the discharge plume of a steam-electric power plant on the St. Clair River (Michigan), the outflow of Lake Huron. Samples collected April 1986 to April 1987 revealed the growth of one-year-old Corbicula (1985 cohort) began after mid-May and ended by mid-November, while water temperatures were higher than 9°C. Maximum growth (0.78 mm wk-1) occurred between mid-August and mid-September, while water temperatures were about 16-23°C. We recorded a substantial overwinter mortality of the 1986 cohort, but not the 1985 cohort; this was particularly evident at sampling locations more remote from the heated discharge of the power plant, suggesting low water temperature wast the major mortality agent. The available information suggests low water temperature in the St. Clair River may limit the success of Corbicula in the river, including portions of populations inhabiting thermal plumes, by reducing growth, delaying the onset of sexual maturity and reproduction, and causing heavy overwinter mortality in the first year of life.

Management of Severe and Complex Hypopharyngeal and/or Laryngotracheal Stenoses by Various Open Surgical Procedures: A Retrospective Study of Seventeen Patients.

PubMed

Chen, Wenxian; Gao, Pengfei; Cui, Pengcheng; Ruan, Yanyan; Liu, Zhi; Sun, Yongzhu; Bian, Ka

2016-01-01

To systematically study various surgical approaches for treating complex hypopharyngeal and/or laryngotracheal stenoses at a variety of sites and levels. We retrospectively analyzed the treatment of 17 patients with severe and complex hypopharyngeal and/or laryngotracheal stenosis at various sites and levels of severity. All of the 17 patients initially had a tracheostomy. Thirteen had failed the previous laser lysis and/or dilation treatment. Given the high severity and complexity of stenosis, all of these patients were treated by open surgical reconstruction techniques using repairing grafts (flaps), followed by stenting. Thirteen of 17 patients had successful decannulation 1-8 months post-operation and had stable airway and adequate vocal and swallow function. Two patients with complex hypopharyngeal and esophageal stenosis had unsuccessful decannulation. Follow-up was lost in 1 patient with complex hypopharyngeal and esophageal stenosis and 1 patient with original hypopharyngeal stenosis and recurrent thoracotracheal stenosis. Despite the failure by the regular treatments using laser lysis and/or dilation therapy, severe and complex hypopharyngeal and/or laryngotracheal stenosis may be successfully treated by variable open surgical reconstruction techniques using different grafts (flaps) depending on the site and severity of the stenosis. © 2016 S. Karger AG, Basel.

Changing abundance of Hexagenia mayfly nymphs in western Lake Erie of the Laurentian Great Lakes: Impediments to assessment of lake recovery?

USGS Publications Warehouse

Schloesser, D.W.; Nalepa, T.F.

2001-01-01

After an absence of 40 years, mayfly nymphs of the genus Hexagenia were found in sediments of western Lake Erie of the Laurentian Great Lakes in 1993 and, by 1997, were abundant enough to meet a mayfly-density management goal (ca. 350 nymphs m—2) based on pollution-abatement programs. We sampled nymphs in western Lake Erie and Lake St. Clair, located upstream of western Lake Erie, to determine the importance of seasonal abundance and life-history characteristics of nymphs (e.g., emergence and recruitment) on density estimates relative to the mayfly-density management goal. Two types of density patterns were observed: (1) densities were relatively high in spring and gradually decreased through late summer (observed in Lake Erie and Lake St. Clair in 1997 and Lake St. Clair in 1999) and (2) densities were relatively high in spring, gradually decreased to mid summer, abruptly decreased in mid summer, and then increased between summer and late fall (Lake Erie and Lake St. Clair in 1998 and Lake Erie in 1999). Length-frequency distributions of nymphs and observations of adults indicate that the primary cause for the two density patterns was attributed to failed (first pattern) and successful (second pattern) reproduction and emergence of nymphs into adults in mid summer. Gradual declines in densities were attributed to mortality of nymphs. Our results indicate that caution should be used when evaluating progress of pollution-abatement programs based on mayfly densities because recruitment success is variable both between and within years. Additionally, the interpretation of progress toward management goals, relative to the restoration of Hexagenia populations in the Great Lakes and possibly other water bodies throughout the world, is influenced by the number of years in which consequtive collections are made.

Compensatory patterns of collateral flow in stroke patients with unilateral and bilateral carotid stenosis.

PubMed

Fang, Hui; Song, Bo; Cheng, Bo; Wong, Ka Sing; Xu, Yu Ming; Ho, Stella Sin Yee; Chen, Xiang Yan

2016-03-18

Collateral pathways are important in maintaining adequate cerebral blood flow in patients with carotid stenosis. We aimed to evaluate the hemodynamic patterns in relation to carotid stenosis in acute stroke patients. Consecutive 586 stroke patients in a hospital based cohort were included in the present study. Carotid duplex was performed to identify patients with absolute minimal diameter reductions of 50% or greater in their internal carotid arteries (ICAs). Color velocity imaging quantification ultrasound (CVIQ) was used to measure extracranial arterial blood flow volume (BFV) in bilateral common carotid arteries (CCAs) and bilateral vertebral arteries (VAs). The absolute values of BFV and the ratios were compared between patients with and without ICA stenosis. Among 586 acute ischemic stroke patients (mean age: 67.5 ± 12.4y), ICA stenosis was detected in 112 patients (19.1%), including unilateral ICA stenosis in 81 patients (13.8%) and bilateral ICA stenosis in 31 patients (5.3%). Among patients with unilateral ICA stenosis, the BFV in contralateral CCA was significantly higher than that in ipsilateral CCA (325.5 ± 99.8 mL/min vs. 242.2 ± 112.2 mL/min, P < 0.001). Among patients with bilateral ICA stenosis, the sum of BFV in bilateral VAs accounted for 22% of the whole cerebral blood flow, which was significantly higher than that in those without ICA stenosis (14.8%, P < 0.001) or with unilateral ICA stenosis (16.9%, P = 0.007). In patients with unilateral carotid stenosis, contralateral carotid blood flow increases to compensate decreased blood flow, while posterior circulation may compensate for the decreased brain perfusion in those with bilateral carotid stenosis.

Association of Brachial-Ankle Pulse Wave Velocity with Asymptomatic Intracranial Arterial Stenosis in Hypertension Patients.

PubMed

Wang, Yan; Zhang, Jin; Qain, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

2016-08-01

Intracranial arterial stenosis is a common cause of ischemic stroke in Asians. We therefore sought to explore the relationship of brachial-ankle pulse wave velocity and intracranial arterial stenosis in 834 stroke-free hypertensive patients. Intracranial arterial stenosis was evaluated through computerized tomographic angiography. Brachial-ankle pulse wave velocity was measured by an automated cuff device. The top decile of brachial-ankle pulse wave velocity was significantly associated with intracranial arterial stenosis (P = .027, odds ratio = 1.82; 95% confidence interval: 1.07-3.10). The patients with the top decile of brachial-ankle pulse wave velocity showed 56% higher risk for the presence of intracranial arterial stenosis to the whole population, which was more significant in patients younger than 65 years old. We also found that brachial-ankle pulse wave velocity related to both intracranial arterial stenosis and homocysteine. Our study showed the association of brachial-ankle pulse wave velocity with asymptomatic intracranial arterial stenosis in hypertension patients, especially in relative younger subjects. Brachial-ankle pulse wave velocity might be a relatively simple and repeatable measurement to detect hypertension patients in high risk of intracranial arterial stenosis. Copyright © 2016. Published by Elsevier Inc.

Putting a Face on Hunger: A Community-Academic Research Project

ERIC Educational Resources Information Center

Coffey, Nancy; Canales, Mary K.; Moore, Emily; Gullickson, Melissa; Kaczmarski, Brenda

2014-01-01

Food insecurity is a growing concern for Eau Claire County residents in Western Wisconsin. A community-academic partnership studied food insecurity through the voices of families struggling to access food and institutions that assist with hunger related problems. Data were collected through focus groups held in urban and rural parts of the county.…

Elemental Study on Auscultaiting Diagnosis Support System of Hemodialysis Shunt Stenosis by ANN

NASA Astrophysics Data System (ADS)

Suzuki, Yutaka; Fukasawa, Mizuya; Mori, Takahiro; Sakata, Osamu; Hattori, Asobu; Kato, Takaya

It is desired to detect stenosis at an early stage to use hemodailysis shunt for longer time. Stethoscope auscultation of vascular murmurs is useful noninvasive diagnostic approach, but an experienced expert operator is necessary. Some experts often say that the high-pitch murmurs exist if the shunt becomes stenosed, and some studies report that there are some features detected at high frequency by time-frequency analysis. However, some of the murmurs are difficult to detect, and the final judgment is difficult. This study proposes a new diagnosis support system to screen stenosis by using vascular murmurs. The system is performed using artificial neural networks (ANN) with the analyzed frequency data by maximum entropy method (MEM). The author recorded vascular murmurs both before percutaneous transluminal angioplasty (PTA) and after. Examining the MEM spectral characteristics of the high-pitch stenosis murmurs, three features could be classified, which covered 85 percent of stenosis vascular murmurs. The features were learnt by the ANN, and judged. As a result, a percentage of judging the classified stenosis murmurs was 100%, and that of normal was 86%.

Assessment of insulin-like growth factor-1 (IGF-I) level in patients with rheumatic mitral stenosis.

PubMed

Deveci, Onur S; Yavuz, Bunyamin; Sen, Omer; Deniz, Ali; Ozkan, Selcuk; Dal, Kursat; Ata, Naim; Baser, Salih; Akin, Kadir O; Kucukazman, Metin; Beyan, Esin; Ertugrul, Derun T

2015-03-01

Insulin-like growth factor-1 may serve some regulatory function in the immune system. Rheumatic mitral stenosis is related to autoimmune heart valve damage after streptococcal infection. The aim of this study was to assess the level of insulin-like growth factor-1 and its correlation with the Wilkins score in patients with rheumatic mitral stenosis. A total of 65 patients with rheumatic mitral stenosis and 62 age- and sex-matched control subjects were enrolled in this study. All subjects underwent transthoracic echocardiography. The mitral valve area and Wilkins score were evaluated for all patients. Biochemical parameters and serum insulin-like growth factor-1 levels were measured. Demographic data were similar in the rheumatic mitral stenosis and control groups. The mean mitral valve area was 1.6±0.4 cm2 in the rheumatic mitral stenosis group. The level of insulin-like growth factor-1 was significantly higher in the rheumatic mitral stenosis group than in the control group (104 (55.6-267) versus 79.1 (23.0-244.0) ng/ml; p=0.039). There was a significant moderate positive correlation between insulin-like growth factor-1 and thickening of leaflets score of Wilkins (r=0.541, p<0.001). The present study demonstrated that serum insulin-like growth factor-1 levels were significantly higher in the rheumatic mitral stenosis group compared with control subjects and that insulin-like growth factor-1 level was also correlated with the Wilkins score. It can be suggested that there may be a link between insulin-like growth factor-1 level and immune pathogenesis of rheumatic mitral stenosis.

Distribution and winter survival health of Asian clams, Corbicula fluminea, in the St. Clair River, Michigan

USGS Publications Warehouse

French, John R. P.; Schloesser, Don W.

1996-01-01

We studied the distribution and winter survival of the Asian clam, Corbicula fluminea, in the St. Clair River from the fall of 1988 to the spring of 1990. Between fall of 1988 and spring of 1989, distribution of Corbicula was extended from 5.5 to 11.5 km downstream from an electric power plant. However, total abundance of clams decreased during the winter. By fall of 1989, Corbicula was found 14.5 km from the power plant, and the mean density of clams was 27 individuals/m2. Between fall of 1989 and spring of 1990, distribution was reduced to 7.5 km from the power plant and abundance decreased 97%. During the winter of 1988-1989, we collected clams monthly from one station 2.2 km from the power plant, and we observed that clams survived the harsh winter for two months after the water temperature dropped about 1.5°C below the reported lethal level for Corbicula in midwinter. During the winer of 1989-1990, we held clams at the sediment-water interface in enclosures, and we observed that condition indices (dry body weight; dry shell weight) of clams remained stable (mean = 0.05 ± 0.01) in December and January and then declined significantly (p < 0.05) to 0.04 ± 0.01 in February. All clams perished by late March. The deteriorating physiological state of clams, as indicated by declining condition index, seemingly is a factor in late winter mortalities of Corbicula in the St. Clair River. In contrast to the rapid geographic spread and population increases in the southern United States, Corbicula likely will not spread rapidly throughout the Great Lakes beyond shoreline thermal refugia of heated-water discharge plumes from power plants.

Association Of Tricuspid Regurgitation And Severity Of Mitral Stenosis In Patients With Rheumatic Heart Disease.

PubMed

Ahmed, Rehan; Kazmi, Nasir; Naz, Farhat; Malik, Saqib; Gillani, Saima

2016-01-01

Rheumatic heart disease is a common ailment in Pakistan and Mitral stenosis is its flag bearer Severity of mitral stenosis is the key factor in deciding for mitral valve surgery. This case series study was conducted at Ayub Teaching Hospital .Cases of Rheumatic heart disease with mitral stenosis were diagnosed clinically. 2D echocardiography was used to find severity of mitral stenosis. Data was entered into SPSS-17.0 and results were recorded and analysed. Pearson's two tailed correlation was used to find the correlation between presence of tricuspid regurgitation in patients with severe mitral stenosis, p was <0.05. A total 35 patients with pure mitral stenosis were included in study, out of which 8 were male and 27 were females. Mean age in males was 34.5±15.85 years while in females it was 31±8 years. Twenty-two out of 35 (62.86%) patients had tricuspid regurgitation while 13 out 35 (37.14%) had no tricuspid regurgitation. Mean (MVA) mitral valve area in patients with tricuspid regurgitation was 0.84±0.3 cm2 while mean (MVA) mitral valve area in patients without tricuspid regurgitation was 1.83±0.7 cm2. Mean left atrial (L.A) size was 45.23±1.5 mm2 in patients with tricuspid regurgitation, while it was 44.13±6.14 mm2 in patients without tricuspid regurgitation. Mean RSVP was 57.5mmHg in patients with tricuspid regurgitation while RSVP could not be calculated in patients without tricuspid regurgitation. It was concluded that tricuspid regurgitation was strongly associated with severe mitral stenosis as almost all patients with severe mitral stenosis had tricuspid regurgitation and none of the patients with mild mitral stenosis had tricuspid regurgitation.

Esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer: frequency and prediction.

PubMed

Atsumi, Kazushige; Shioyama, Yoshiyuki; Arimura, Hidetaka; Terashima, Kotaro; Matsuki, Takaomi; Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji; Nakamura, Katsumasa; Honda, Hiroshi

2012-04-01

To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Copyright © 2012 Elsevier Inc. All rights reserved.

Effect of Blood Shear Forces on Platelet Mediated Thrombosis Inside Arterial Stenosis.

NASA Astrophysics Data System (ADS)

Maalej, Nabil

Shear induced activation of platelets plays a major role in the onset of thrombosis in atherosclerotic arteries. Blood hemodynamics and its effect on platelet kinetics has been studied mainly in in vitro and in ex vivo experiments. We designed new in vivo methods to study blood hemodynamic effects on platelet kinetics in canine stenosed carotid arteries. A carotid artery-jugular vein anastomotic shunt was produced. Intimal damage and controlled variations in the degree of stenosis were produced on the artery. An inflatable cuff was placed around the jugular vein to control vascular resistance. An electromagnetic flowmeter was used to measure blood flow. Doppler ultrasound crystals were used to measure the velocity profiles inside and distal to the stenosis. Stenosis geometry was obtained using digital subtraction angiography and quantitative arteriography. Using these measurements we calculated the wall shear stress using the finite difference solution of the Navier-Stokes equations. To study platelet kinetics, autologous platelets were labeled with Indium Oxine and injected IV. A collimated Nal gamma counter was placed over the stenosis to detect radio-labeled platelet accumulation as platelet mediated thrombi formed in the stenosis. The radioactive count rate increased in an inverse parallel fashion to the decline in flow rate during thrombus formation. The platelet accumulation increased with the increase of percent stenosis and was maximal at the narrow portion of the stenosis. Acute thrombus formation leading to arterial occlusion was only observed for stenosis higher than 70 +/- 5%. Platelet accumulation rate was not significant until the pressure gradient across the stenosis exceeded 40 +/- 10 mmHg. Totally occlusive thrombus formation was only observed for shear stresses greater than a critical value of 100 +/- 10 Pa. Beyond this critical value acute platelet thrombus formation increased exponentially with shear. Increased shear stresses were found to overcome the antithrombotic effect of aspirin. Critical levels of shear might be produced clinically at sites of arterial lesions by a sudden change in blood hemodynamics or flow geometry. This may put a patient with arterial stenosis at greater risk of acute thrombus formation leading to stroke or myocardial infarction.

Long-term outcome of vertebral artery origin stenosis in patients with acute ischemic stroke

PubMed Central

2013-01-01

Background Vertebral artery origin (VAO) stenosis is occasionally observed in patients who have acute ischemic stroke. We investigated the long-term outcomes and clinical significance of VAO stenosis in patients with acute ischemic stroke. Methods We performed a prospective observational study using a single stroke center registry to investigate the risk of recurrent stroke and vascular outcomes in patients with acute ischemic stroke and VAO stenosis. To relate the clinical significance of VAO stenosis to the vascular territory of the index stroke, patients were classified into an asymptomatic VAO stenosis group and a symptomatic VAO stenosis group. Results Of the 774 patients who had acute ischemic stroke, 149 (19.3%) of them had more than 50% stenosis of the VAO. During 309 patient-years of follow-up (mean, 2.3 years), there were 7 ischemic strokes, 6 hemorrhagic strokes, and 2 unknown strokes. The annual event rates were 0.97% for posterior circulation ischemic stroke, 4.86% for all stroke, and 6.80% for the composite cardiovascular outcome. The annual event rate for ischemic stroke in the posterior circulation was significantly higher in patients who had symptomatic VAO stenosis than in patients who had asymptomatic stenosis (1.88% vs. 0%, p = 0.046). In a multivariate analysis, the hazard ratio, per one point increase of the Essen Stroke Risk Score (ESRS) for the composite cardiovascular outcome, was 1.46 (95% CI, 1.02-2.08, p = 0.036). Conclusions Long-term outcomes of more than 50% stenosis of the VAO in patients with acute ischemic stroke were generally favorable. Additionally, ESRS was a predictor for the composite cardiovascular outcome. Asymptomatic VAO stenosis may not be a specific risk factor for recurrent ischemic stroke in the posterior circulation. However, VAO stenosis may require more clinical attention as a potential source of recurrent stroke when VAO stenosis is observed in patients who have concurrent ischemic stroke in the posterior circulation. PMID:24215371

Effects of vascular structures on the pressure drop in stenotic coronary arteries

NASA Astrophysics Data System (ADS)

Kim, Jaerim; Choi, Haecheon; Kweon, Jihoon; Kim, Young-Hak; Yang, Dong Hyun; Kim, Namkug

2016-11-01

A stenosis, which is a narrowing of a blood vessel, of the coronary arteries restricts the flow to the heart and it may lead to sudden cardiac death. Therefore, the accurate determination of the severity of a stenosis is a critical issue. Due to the convenience of visual assessments, geometric parameters such as the diameter stenosis and area stenosis have been used, but the decision based on them sometimes under- or overestimates the functional severity of a stenosis, i.e., pressure drop. In this study, patient-specific models that have similar area stenosis but different pressure drops are considered, and their geometries are reconstructed from the coronary computed tomography angiography (CCTA). Both steady and pulsatile inflows are considered for the simulations. Comparison between two models that have a bifurcation right after a stenosis shows that the parent to daughter vessel angle results in different secondary flow patterns and wall shear stress distributions which affect the pressure downstream. Thus, the structural features of the lower and upper parts of a stenosis significantly affect the pressure drop. Supported by 20152020105600.

Long-Term Risk of Cardiovascular Disease among Type 2 Diabetic Patients with Asymptomatic Intracranial Atherosclerosis: A Prospective Cohort Study

PubMed Central

Duan, Jian Gang; Chen, Xiang Yan; Lau, Alex; Wong, Adrian; Thomas, G. Neil; Tomlinson, Brian; Liu, Roxanna; Chan, Juliana C. N.; Leung, Thomas W.; Mok, Vincent; Wong, Ka Sing

2014-01-01

Objective To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes. Methods In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994–1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death. Results Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05–1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04–1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04–2.33; P = 0.03). Conclusions Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common. PMID:25192283

Correlation of ascending aorta elasticity and the severity of coronary artery stenosis in hypertensive patients with coronary heart disease assessed by M-mode and tissue Doppler echocardiography.

PubMed

Lu, Qixiu; Liu, Houlin

2015-03-01

The main objective of this study is to investigate the relationship between ascending aorta elasticity and the severity of coronary artery stenosis in essential hypertensive patients with coronary heart disease (CHD) using M-mode and tissue Doppler echocardiography. A total of 184 hypertensive patients with CHD were enrolled. Patients were divided into three groups based on the severity of coronary stenosis measured by coronary arteriography (CAG): slight stenosis (group 1), moderate stenosis (group 2) and serious stenosis (group 3). M-mode and tissue Doppler echocardiography were performed, and elasticity indexes of ascending aorta including stiffness index, distensibility index, and S wave speed of anterior wall were calculated and correlated with the severity of coronary stenosis. Ascending aorta stiffness index was increased, whereas distensibility index and S wave speed of anterior wall were decreased in moderate and severe stenosis groups compared with slight stenosis group (P < 0.01). Elasticity indexes change in a stepwise pattern with the narrowness of coronary artery, and there was a significant correlation between aortic elasticity and severity of coronary artery by Pearson correlation analysis (P < 0.01). Elasticity indexes of ascending aorta correlate well with severity of coronary stenosis. Elasticity indexes of ascending aorta can serve as predictors for coronary arterial lesion in hypertensive patients.

Detection of common carotid artery stenosis using duplex ultrasonography: a validation study with computed tomographic angiography.

PubMed

Slovut, David P; Romero, Javier M; Hannon, Kathleen M; Dick, James; Jaff, Michael R

2010-01-01

Severe stenosis of the common carotid artery (CCA), while uncommon, is associated with increased risk of transient ischemic attack and stroke. To date, no validated duplex ultrasound criteria have been established for grading the severity of CCA stenosis. The goal of this study was to use receiver-operating curve (ROC) analysis with computed tomographic angiography as the reference standard to establish duplex ultrasound criteria for diagnosing >or=50% CCA stenosis. The study cohort included 64 patients (42 men, 22 women) with a mean age of 65 +/- 12 years (range, 16-89 years) who had CCA peak systolic velocity (PSV) >or=150 cm/sec and underwent computed tomographic angiography (CTA) of the cervical and intracerebral vessels within 1 month of the duplex examination. One study was excluded because the CTA was technically inadequate, whereas another was excluded because the patient underwent bilateral CCA stenting. The CCA ipsilateral to any of the following was excluded from the analysis: innominate artery occlusion (n = 1), previous stenting of the ICA or CCA (n = 7), carotid endarterectomy (n = 1), or carotid-to-carotid bypass (n = 1). Thus, the data set included 62 patients and 115 vessels. Bland-Altman analysis was used to examine the agreement between two measures of luminal reduction measured by CTA: percent diameter stenosis and percent area stenosis. Receiver operating characteristic (ROC) analysis was used to determine optimal PSV and EDV thresholds for diagnosing >or=50% CCA stenosis. Severity of CCA stenosis was <50% in 76 vessels, 50%-59% in eight, 60%-69% in eight, 70%-79% in nine, 80%-89% in three, 90%-99% in five, and occluded in six. Duplex ultrasonography identified six of six (100%) patients with 100% CCA occlusion by CTA. Bland-Altman analysis showed poor agreement between percent stenosis determined by vessel diameter compared with percent stenosis determined by reduction in lumen area. Therefore, subsequent analysis was performed using percent stenosis by area. ROC analysis of different PSV thresholds for detecting stenosis >or=50% showed that >182 cm/sec was the most accurate with a sensitivity of 64% and specificity of 88% (P < .0001). Sensitivity, specificity, and accuracy of carotid duplex were higher when the stenosis was located in the mid or distal aspects of the CCA (sensitivity 76%, specificity 89%, area under curve 0.84, P < .001) than in the intrathoracic and proximal segment of the artery (P = NS). ROC analysis of different EDV thresholds for detecting CCA stenosis >or=50% showed that >30 cm/sec was the most accurate with a sensitivity of 54% and a specificity of 74% (P < .0239). Duplex ultrasonography is highly sensitive, specific, and accurate for detecting CCA lesions in the mid and distal CCA. Use of peak systolic velocity may lead to improved detection of CCA disease and initiation of appropriate therapy to reduce the risk of stroke. Copyright 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Use of navigation channels by Lake Sturgeon: Does channelization increase vulnerability of fish to ship strikes?

PubMed

Hondorp, Darryl W; Bennion, David H; Roseman, Edward F; Holbrook, Christopher M; Boase, James C; Chiotti, Justin A; Thomas, Michael V; Wills, Todd C; Drouin, Richard G; Kessel, Steven T; Krueger, Charles C

2017-01-01

Channelization for navigation and flood control has altered the hydrology and bathymetry of many large rivers with unknown consequences for fish species that undergo riverine migrations. In this study, we investigated whether altered flow distributions and bathymetry associated with channelization attracted migrating Lake Sturgeon (Acipenser fulvescens) into commercial navigation channels, potentially increasing their exposure to ship strikes. To address this question, we quantified and compared Lake Sturgeon selection for navigation channels vs. alternative pathways in two multi-channel rivers differentially affected by channelization, but free of barriers to sturgeon movement. Acoustic telemetry was used to quantify Lake Sturgeon movements. Under the assumption that Lake Sturgeon navigate by following primary flow paths, acoustic-tagged Lake Sturgeon in the more-channelized lower Detroit River were expected to choose navigation channels over alternative pathways and to exhibit greater selection for navigation channels than conspecifics in the less-channelized lower St. Clair River. Consistent with these predictions, acoustic-tagged Lake Sturgeon in the more-channelized lower Detroit River selected the higher-flow and deeper navigation channels over alternative migration pathways, whereas in the less-channelized lower St. Clair River, individuals primarily used pathways alternative to navigation channels. Lake Sturgeon selection for navigation channels as migratory pathways also was significantly higher in the more-channelized lower Detroit River than in the less-channelized lower St. Clair River. We speculated that use of navigation channels over alternative pathways would increase the spatial overlap of commercial vessels and migrating Lake Sturgeon, potentially enhancing their vulnerability to ship strikes. Results of our study thus demonstrated an association between channelization and the path use of migrating Lake Sturgeon that could prove important for predicting sturgeon-vessel interactions in navigable rivers as well as for understanding how fish interact with their habitat in landscapes altered by human activity.

Use of navigation channels by Lake Sturgeon: Does channelization increase vulnerability of fish to ship strikes?

PubMed Central

Bennion, David H.; Roseman, Edward F.; Holbrook, Christopher M.; Boase, James C.; Chiotti, Justin A.; Thomas, Michael V.; Wills, Todd C.; Drouin, Richard G.; Kessel, Steven T.; Krueger, Charles C.

2017-01-01

Channelization for navigation and flood control has altered the hydrology and bathymetry of many large rivers with unknown consequences for fish species that undergo riverine migrations. In this study, we investigated whether altered flow distributions and bathymetry associated with channelization attracted migrating Lake Sturgeon (Acipenser fulvescens) into commercial navigation channels, potentially increasing their exposure to ship strikes. To address this question, we quantified and compared Lake Sturgeon selection for navigation channels vs. alternative pathways in two multi-channel rivers differentially affected by channelization, but free of barriers to sturgeon movement. Acoustic telemetry was used to quantify Lake Sturgeon movements. Under the assumption that Lake Sturgeon navigate by following primary flow paths, acoustic-tagged Lake Sturgeon in the more-channelized lower Detroit River were expected to choose navigation channels over alternative pathways and to exhibit greater selection for navigation channels than conspecifics in the less-channelized lower St. Clair River. Consistent with these predictions, acoustic-tagged Lake Sturgeon in the more-channelized lower Detroit River selected the higher-flow and deeper navigation channels over alternative migration pathways, whereas in the less-channelized lower St. Clair River, individuals primarily used pathways alternative to navigation channels. Lake Sturgeon selection for navigation channels as migratory pathways also was significantly higher in the more-channelized lower Detroit River than in the less-channelized lower St. Clair River. We speculated that use of navigation channels over alternative pathways would increase the spatial overlap of commercial vessels and migrating Lake Sturgeon, potentially enhancing their vulnerability to ship strikes. Results of our study thus demonstrated an association between channelization and the path use of migrating Lake Sturgeon that could prove important for predicting sturgeon-vessel interactions in navigable rivers as well as for understanding how fish interact with their habitat in landscapes altered by human activity. PMID:28678798

Radiology-guided forceps biopsy and airway stenting in severe airway stenosis.

PubMed

Li, Zong Ming; Wu, Gang; Han, Xin Wei; Ren, Ke Wei; Zhu, Ming

2014-01-01

We aimed to determine the feasibility, safety, and effectiveness of radiology-guided forceps biopsy and airway stenting in patients with severe airway stenosis. This study involved 28 patients with severe airway stenosis who underwent forceps biopsy between October 2006 and September 2011. Chest multislice computed tomography was used to determine the location and extent of stenosis. Sixteen patients had tracheal stenosis, two patients had stenosis of the tracheal carina, six patients had stenosis of the left main bronchus, and four patients had stenosis of the right main bronchus. Forceps biopsy and stenting of the stenosed area were performed under fluoroscopic guidance in digital subtraction angiography and the biopsy specimens were analyzed histopathologically. We contacted the patients via phone call and utilized a standardized questionnaire to determine their medical condition during a postoperative three-month follow-up. The technical success rate of radiology-guided forceps biopsy was 100%. Biopsy specimens were obtained in all patients. Dyspnea was relieved immediately after stent placement. No serious complications, such as tracheal hemorrhage or perforation, mediastinal emphysema, or asphyxia, occurred. Radiology-guided forceps biopsy and airway stenting can be used for the emergency treatment of severe airway stenosis. This method appears to be safe and effective, and it may be an alternative therapeutic option in patients who cannot tolerate fiberoptic bronchoscopy.

Carotid stenosis assessment with multi-detector CT angiography: comparison between manual and automatic segmentation methods.

PubMed

Zhu, Chengcheng; Patterson, Andrew J; Thomas, Owen M; Sadat, Umar; Graves, Martin J; Gillard, Jonathan H

2013-04-01

Luminal stenosis is used for selecting the optimal management strategy for patients with carotid artery disease. The aim of this study is to evaluate the reproducibility of carotid stenosis quantification using manual and automated segmentation methods using submillimeter through-plane resolution Multi-Detector CT angiography (MDCTA). 35 patients having carotid artery disease with >30 % luminal stenosis as identified by carotid duplex imaging underwent contrast enhanced MDCTA. Two experienced CT readers quantified carotid stenosis from axial source images, reconstructed maximum intensity projection (MIP) and 3D-carotid geometry which was automatically segmented by an open-source toolkit (Vascular Modelling Toolkit, VMTK) using NASCET criteria. Good agreement among the measurement using axial images, MIP and automatic segmentation was observed. Automatic segmentation methods show better inter-observer agreement between the readers (intra-class correlation coefficient (ICC): 0.99 for diameter stenosis measurement) than manual measurement of axial (ICC = 0.82) and MIP (ICC = 0.86) images. Carotid stenosis quantification using an automatic segmentation method has higher reproducibility compared with manual methods.

Spinal stenosis presenting as "the postpolio syndrome". Review of four cases.

PubMed

LaBan, M M; Sanitate, S S; Taylor, R S

1993-12-01

The diagnosis of postpolio syndrome is based primarily on a thorough history supported by both clinical and laboratory examination. Similarly, the presence of an occult spinal stenosis may be suspected initially by a history of progressive lumbar or cervical radicular pain, as well as concomitant extremity weakness and/or myelopathic signs. Appropriate electrodiagnostic examinations, including somatosensory spinal-evoked potentials and electroneuromyography, as well as imaging studies, computer-assisted tomography scan, magnetic resonance imaging and/or myelography are all useful in confirming the clinical diagnosis of either cervical spinal stenosis or lumbar spinal stenosis in patients who also may have had a history of poliomyelitis. Four patients (three men and one woman) previously diagnosed as having postpolio syndrome were referred with predominate complaints of spinal and extremity pain as well as associated motor weakness. It was subsequently recognized that these patients, ranging in age from 45-65 yr, were actually presenting with symptomatic spinal stenosis. It was discovered that two patients had cervical spinal stenosis; the other two had lumbar spinal stenosis.

Intracranial stenosis in cognitive impairment and dementia.

PubMed

Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

2017-06-01

Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

Association of Low-Density Lipoprotein Cholesterol–Related Genetic Variants With Aortic Valve Calcium and Incident Aortic Stenosis

PubMed Central

Smith, J. Gustav; Luk, Kevin; Schulz, Christina-Alexandra; Engert, James C.; Do, Ron; Hindy, George; Rukh, Gull; Dufresne, Line; Almgren, Peter; Owens, David S.; Harris, Tamara B.; Peloso, Gina M.; Kerr, Kathleen F.; Wong, Quenna; Smith, Albert V.; Budoff, Matthew J.; Rotter, Jerome I.; Cupples, L. Adrienne; Rich, Stephen; Kathiresan, Sekar; Orho-Melander, Marju; Gudnason, Vilmundur; O’Donnell, Christopher J.; Post, Wendy S.; Thanassoulis, George

2014-01-01

IMPORTANCE Plasma low-density lipoprotein cholesterol (LDL-C) has been associated with aortic stenosis in observational studies; however, randomized trials with cholesterol-lowering therapies in individuals with established valve disease have failed to demonstrate reduced disease progression. OBJECTIVE To evaluate whether genetic data are consistent with an association between LDL-C, high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG) and aortic valve disease. DESIGN, SETTING, AND PARTICIPANTS Using a Mendelian randomization study design, we evaluated whether weighted genetic risk scores (GRSs), a measure of the genetic predisposition to elevations in plasma lipids, constructed using single-nucleotide polymorphisms identified in genome-wide association studies for plasma lipids, were associated with aortic valve disease. We included community-based cohorts participating in the CHARGE consortium (n = 6942), including the Framingham Heart Study (cohort inception to last follow-up: 1971-2013; n = 1295), Multi-Ethnic Study of Atherosclerosis (2000-2012; n = 2527), Age Gene/Environment Study-Reykjavik (2000-2012; n = 3120), and the Malmö Diet and Cancer Study (MDCS, 1991-2010; n = 28 461). MAIN OUTCOMES AND MEASURES Aortic valve calcium quantified by computed tomography in CHARGE and incident aortic stenosis in the MDCS. RESULTS The prevalence of aortic valve calcium across the 3 CHARGE cohorts was 32% (n = 2245). In the MDCS, over a median follow-up time of 16.1 years, aortic stenosis developed in 17 per 1000 participants (n = 473) and aortic valve replacement for aortic stenosis occurred in 7 per 1000 (n = 205). Plasma LDL-C, but not HDL-C or TG, was significantly associated with incident aortic stenosis (hazard ratio [HR] per mmol/L, 1.28; 95% CI, 1.04-1.57; P = .02; aortic stenosis incidence: 1.3% and 2.4% in lowest and highest LDL-C quartiles, respectively). The LDL-C GRS, but not HDL-C or TG GRS, was significantly associated with presence of aortic valve calcium in CHARGE (odds ratio [OR] per GRS increment, 1.38; 95% CI, 1.09-1.74; P = .007) and with incident aortic stenosis in MDCS (HR per GRS increment, 2.78; 95% CI, 1.22-6.37; P = .02; aortic stenosis incidence: 1.9% and 2.6% in lowest and highest GRS quartiles, respectively). In sensitivity analyses excluding variants weakly associated with HDL-C or TG, the LDL-C GRS remained associated with aortic valve calcium (P = .03) and aortic stenosis (P = .009). In instrumental variable analysis, LDL-C was associated with an increase in the risk of incident aortic stenosis (HR per mmol/L, 1.51; 95% CI, 1.07-2.14; P = .02). CONCLUSIONS AND RELEVANCE Genetic predisposition to elevated LDL-C was associated with presence of aortic valve calcium and incidence of aortic stenosis, providing evidence supportive of a causal association between LDL-C and aortic valve disease. Whether earlier intervention to reduce LDL-C could prevent aortic valve disease merits further investigation. PMID:25344734

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

Wehrschuetz, M., E-mail: martin.wehrschuetz@klinikum-graz.at; Aschauer, M.; Portugaller, H.

The purpose of this study was to assess interobserver variability and accuracy in the evaluation of renal artery stenosis (RAS) with gadolinium-enhanced MR angiography (MRA) and digital subtraction angiography (DSA) in patients with hypertension. The authors found that source images are more accurate than maximum intensity projection (MIP) for depicting renal artery stenosis. Two independent radiologists reviewed MRA and DSA from 38 patients with hypertension. Studies were postprocessed to display images in MIP and source images. DSA was the standard for comparison in each patient. For each main renal artery, percentage stenosis was estimated for any stenosis detected by themore » two radiologists. To calculate sensitivity, specificity and accuracy, MRA studies and stenoses were categorized as normal, mild (1-39%), moderate (40-69%) or severe ({>=}70%), or occluded. DSA stenosis estimates of 70% or greater were considered hemodynamically significant. Analysis of variance demonstrated that MIP estimates of stenosis were greater than source image estimates for both readers. Differences in estimates for MIP versus DSA reached significance in one reader. The interobserver variance for MIP, source images and DSA was excellent (0.80< {kappa}{<=} 0.90). The specificity of source images was high (97%) but less for MIP (87%); average accuracy was 92% for MIP and 98% for source images. In this study, source images are significantly more accurate than MIP images in one reader with a similar trend was observed in the second reader. The interobserver variability was excellent. When renal artery stenosis is a consideration, high accuracy can only be obtained when source images are examined.« less

Increased Expression of Interleukin-18 mRNA is Associated with Carotid Artery Stenosis

PubMed

Arapi, Berk; Bayoğlu, Burcu; Cengiz, Müjgan; Dirican, Ahmet; Deser, Serkan Burç; Junusbekov, Yerik; Arslan, Caner

2018-05-29

Carotid artery stenosis is the atherosclerotic narrowing of the proximal internal carotid artery and one of the primary causes of stroke. Elevated expression of the pleiotropic proinflammatory cytokine interleukin-18 has been demonstrated in human atherosclerotic plaques. To investigate whether the mRNA expression levels of interleukin-18 and interleukin-18-binding protein and interleukin-18 −137 G/C (rs187238) variants are associated with carotid artery stenosis development. Case-control study. The mRNA expression levels of interleukin-18 and interleukin-18-binding protein and interleukin-18 rs187238 variants were evaluated by quantitative real-time polymerase chain reaction and real-time polymerase chain reaction, respectively, in the peripheral blood mononuclear cells of 70 patients with carotid artery stenosis (36 symptomatic, 34 asymptomatic) and 75 healthy controls. Interleukin-18 mRNA expression was significantly increased in carotid artery stenosis patients compared to that in healthy controls (p=0.01). However, no significant difference was observed between interleukin-18-binding protein mRNA expression levels in patients with carotid artery stenosis and those in controls (p=0.101). Internal carotid artery stenosis severity was significantly higher in symptomatic patients than that in asymptomatic patients (p<0.001). A significant relationship was identified between interleukin-18 expression and internal carotid artery stenosis severity in patients with carotid artery stenosis (p=0.051). Interleukin-18 rs187238 polymorphism genotype frequencies did not significantly differ between patients with carotid artery stenosis and controls (p=0.246). A significant difference was identified between interleukin-18-binding protein gene expression and symptomatic and asymptomatic patients (p=0.026), but there was no difference in interleukin-18 expression between the symptomatic and asymptomatic subgroups (p=0.397). Interleukin-18 mRNA expression may affect carotid artery stenosis etiopathogenesis and internal carotid artery stenosis severity and also may play a mechanistic role in the pathogenesis of carotid artery stenosis, influencing the appearance of symptoms.

Carotid Artery Stenting: Review of Technique and Update of Recent Literature

PubMed Central

Ahn, Sun Ho; Prince, Ethan A.; Dubel, Gregory J.

2013-01-01

Stroke is the fourth leading cause of death and the number one cause of long-term disability in the United States. Carotid stenosis is an important cause of ischemic strokes, accounting for 20 to 25%. Previous studies have established carotid endarterectomy as standard of care of symptomatic patients with > 50% stenosis and asymptomatic patients with > 60% stenosis; recently, carotid artery stenting has emerged as an alternative treatment for carotid stenosis. Several studies have been published comparing carotid artery stenting with endarterectomy with mixed results. In this article, the authors discuss carotid artery stenting technique, the results from the most recent trials, and future directions. PMID:24436551

Effects of artificial tracheal fixation on tracheal epithelial regeneration and prevention of tracheal stenosis.

PubMed

Nakaegawa, Yuta; Nakamura, Ryosuke; Tada, Yasuhiro; Suzuki, Ryo; Takezawa, Toshiaki; Nakamura, Tatsuo; Omori, Koichi

2017-06-01

Tight fixation of the artificial trachea is important for epithelialization and tracheal stenosis. The authors have developed an artificial trachea and have used it for tracheal reconstruction. Although various studies on tracheal reconstruction have been conducted, no studies have examined the effect of artificial tracheal fixation on tracheal stenosis and regeneration. Therefore, the purpose of the present study was to evaluate the effect of artificial tracheal fixation. Preliminary animal experiment. Artificial tracheae were implanted into rabbits with partial tracheal defects. Tracheal stenosis and regeneration of the tracheal epithelium on the artificial tracheae were evaluated by endoscopic examination, scanning electron microscopic analysis, and histological examination. The artificial tracheae fixed to the tracheal defects were classified into three groups (0-point, 4-point, and 8-point) by the number of fixation points. At 14 and 28 days post-implantation, the luminal surface of the implantation area was mostly covered with epithelium in all fixation groups. However, a small amount of granulation tissue was observed in the 0-point fixation group at 14 days post-implantation. Moreover, tracheal stenosis did not occur in the 8-point fixation group, but stenosis was detected in the other groups.

Characterization of contaminants in snapping turtles (Chelydra serpentina) from Canadian Lake Erie Areas of Concern: St. Clair River, Detroit River, and Wheatley Harbour.

PubMed

de Solla, Shane R; Fernie, Kimberly J

2004-11-01

PCBs, organochlorine pesticides and dioxins/furans in snapping turtle eggs and plasma (Chelydra serpentina) were evaluated at three Areas of Concern (AOCs) on Lake Erie and its connecting channels (St. Clair River, Detroit River, and Wheatley Harbour), as well as two inland reference sites (Algonquin Provincial Park and Tiny Marsh) in 2001-2002. Eggs from the Detroit River and Wheatley Harbour AOCs had the highest levels of p,p'-DDE (24.4 and 57.9 ng/g) and sum PCBs (928.6 and 491.0 ng/g) wet weight, respectively. Contaminant levels in eggs from St. Clair River AOC were generally higher than those from Algonquin Park, but similar to those from Tiny Marsh. Dioxins appeared highest from the Detroit River. The PCB congener pattern in eggs suggested that turtles from the Detroit River and Wheatley Harbour AOCs were exposed to Aroclor 1260. TEQs of sum PCBs in eggs from all AOCs and p,p'-DDE levels in eggs from the Wheatley Harbour and the Detroit River AOCs exceeded the Canadian Environmental Quality Guidelines. Furthermore, sum PCBs in eggs from Detroit River and Wheatley Harbour exceeded partial restriction guidelines for consumption. Although estimated PCB body burdens in muscle tissue of females were well below consumption guidelines, estimated residues in liver and adipose were above guidelines for most sites.

A two-dimensional hydrodynamic model of the St. Clair-Detroit River waterway in the Great Lakes basin

USGS Publications Warehouse

Holtschlag, David J.; Koschik, John A.

2002-01-01

The St. Clair–Detroit River Waterway connects Lake Huron with Lake Erie in the Great Lakes basin to form part of the international boundary between the United States and Canada. A two-dimensional hydrodynamic model is developed to compute flow velocities and water levels as part of a source-water assessment of public water intakes. The model, which uses the generalized finite-element code RMA2, discretizes the waterway into a mesh formed by 13,783 quadratic elements defined by 42,936 nodes. Seven steadystate scenarios are used to calibrate the model by adjusting parameters associated with channel roughness in 25 material zones in sub-areas of the waterway. An inverse modeling code is used to systematically adjust model parameters and to determine their associated uncertainty by use of nonlinear regression. Calibration results show close agreement between simulated and expected flows in major channels and water levels at gaging stations. Sensitivity analyses describe the amount of information available to estimate individual model parameters, and quantify the utility of flow measurements at selected cross sections and water-level measurements at gaging stations. Further data collection, model calibration analysis, and grid refinements are planned to assess and enhance two-dimensional flow simulation capabilities describing the horizontal flow distributions in St. Clair and Detroit Rivers and circulation patterns in Lake St. Clair.

Retrospective analysis of co-occurrence of congenital aortic stenosis and pulmonary artery stenosis in dogs.

PubMed

Kander, M; Pasławska, U; Staszczyk, M; Cepiel, A; Pasławski, R; Mazur, G; Noszczyk-Nowak, A

2015-01-01

The study has focused on the retrospective analysis of cases of coexisting congenital aortic stenosis (AS) and pulmonary artery stenosis (PS) in dogs. The research included 5463 dogs which were referred for cardiological examination (including clinical examination, ECG and echocardiography) between 2004 and 2014. Aortic stenosis and PS stenosis were detected in 31 dogs. This complex defect was the most commonly diagnosed in Boxers - 7 dogs, other breeds were represented by: 4 cross-breed dogs, 2 Bichon Maltais, 3 Miniature Pinschers, 2 Bernese Mountain Dogs, 2 French Bulldogs, and individuals of following breeds: Bichon Frise, Bull Terrier, Czech Wolfdog, German Shepherd, Hairless Chinese Crested Dog, Miniature Schnauzer, Pug, Rottweiler, Samoyed, West Highland White Terrier and Yorkshire Terrier. In all the dogs, the murmurs could be heard, graded from 2 to 5 (on a scale of 1-6). Besides, in 9 cases other congenital defects were diagnosed: patent ductus arteriosus, mitral valve dysplasia, pulmonary or aortic valve regurgitation, tricuspid valve dysplasia, ventricular or atrial septal defect. The majority of the dogs suffered from pulmonary valvular stenosis (1 dog had supravalvular pulmonary artery stenosis) and subvalvular aortic stenosis (2 dogs had valvular aortic stenosis). Conclusions and clinical relevance - co-occurrence of AS and PS is the most common complex congenital heart defect. Boxer breed was predisposed to this complex defect. It was found that coexisting AS and PS is more common in male dogs and the degree of PS and AS was mostly similar.

Influence of vestibulovaginal stenosis, pelvic bladder, and recessed vulva on response to treatment for clinical signs of lower urinary tract disease in dogs: 38 cases (1990-1999).

PubMed

Crawford, Jason T; Adams, William M

2002-10-01

To determine influence of vestibulovaginal stenosis, pelvic bladder, and recessed vulva on response to treatment for clinical signs of lower urinary tract disease in dogs. Retrospective study. 38 spayed female dogs. Medical records and client follow-up were reviewed for dogs evaluated via excretory urography because of clinical signs of lower urinary tract disease. Clinical signs, results of radiography, and response to surgical or medical treatment were analyzed. Clinical signs included urinary tract infection (n = 24), urinary incontinence (20), vaginitis (11), pollakiuria or stranguria (10), and perivulvar dermatitis (4). Vaginocystourethrographic findings included vestibulovaginal stenosis (n = 28), pelvic bladder (17), and ureteritis or pyelonephritis (4). Ten dogs had a vestibulovaginal ratio of < 0.20 (severe stenosis), 9 dogs had a ratio of 0.20 to 0.25 (moderate stenosis), 9 dogs had a ratio of 0.26 to 0.35 (mild stenosis), and 10 dogs had a ratio of > 0.35 (anatomically normal). Lower urinary tract infection, incontinence, and pelvic bladder were not associated with response to treatment for recessed vulva. Vestibulovaginal stenosis with a ratio < 0.20 was significantly associated negatively with response to treatment. Dogs without severe vestibulovaginal stenosis that received vulvoplasty for a recessed vulva responded well to treatment. Vestibulovaginal stenosis is likely an important factor in dogs with vestibulovaginal ratio < 0.20. Vaginectomy or resection and anastomosis should be considered in dogs with severe vestibulovaginal stenosis and signs of lower urinary tract disease.

[The cause and efficacy of benign tracheal stenosis].

PubMed

Su, Zhu-quan; Wei, Xiao-qun; Zhong, Chang-hao; Chen, Xiao-bo; Luo, Wei-zhan; Guo, Wen-liang; Wang, Ying-zhi; Li, Shi-yue

2013-09-01

To analysis the causes of benign tracheal stenosis and evaluate the curative effect of intraluminal bronchoscopic treatment. 158 patients with benign tracheal stenosis in our hospital from September 2005 to September 2012 were collected to retrospectively analysis the causes and clinic features of tracheal stenosis. Interventional treatments through bronchoscopy were used to treat the benign tracheal stenosis and the curative effects were evaluated. 158 cases of benign tracheal stenosis were recruited to our study, 69.6% of them were young and middle-aged. The main causes of benign tracheal stenosis were as follows: secondary to postintubation or tracheotomy in 61.4% (97/158), tuberculosis in 16% (26/158), benign tumor in 5.1% (8/158) and other 27 cases. 94.3% patients improved in symptoms with alleviation immediately after bronchoscopic treatment, the average tracheal diameter increased form (4.22 ± 2.06) mm to (10.16 ± 2.99) mm (t = 21.48, P < 0.01), dyspnea index decreased from 2.29 ± 0.75 to 0.63 ± 0.67 (t = 19.85, P < 0.01). The recurrence rate in 1 and 3 month after interventional treatment were 38.3% and 26.8%, respectively. The cases of benign tracheal stenosis were increasing year by year. The most common cause of benign tracheal stenosis was postintubation and tracheotomy. Interventional treatments through bronchoscopy is effective in treating benign tracheal stenosis, but repeated interventional procedures may be required to maintain the favorable long-term effects.

Numerical analysis of urine flow through the side holes of a double J stent in a ureteral stenosis.

PubMed

Kim, Hyoung-Ho; Choi, Young Ho; Lee, Seung Bae; Baba, Yasutaka; Kim, Kyung-Wuk; Suh, Sang-Ho

2017-07-20

Ureteral stenosis presents with a narrowing in the ureter, due to an intrinsic or extrinsic ureteral disease, such as ureter cancer or retroperitoneal fibrosis. The placement of a double J stent in the upper urinary system is one of the most common treatments of ureteral stenosis, along with the insertion of a percutaneous nephrostomy tube into the renal pelvis. The effect that the side holes in a double J stent have on urine flow has been evaluated in a few studies using straight ureter models. In this study, urine flow through a double J stent's side holes was analyzed in curved ureter models, which were based on human anatomy. In ureteral stenosis, especially in severe ureteral stenosis, a stent with side holes had a positive effect on the luminal and total flow rates, compared with the rates for a stent without side holes. The more side holes a stent has, the greater the luminal and total flow rates. However, the angular positions of the side holes did not affect flow rate. In conclusion, the side holes in a double J stent had a positive effect on ureteral stenosis, and the effect became greater as the ureteral stenosis became more severe.

Long-term follow-up of the experimental replacement of the esophagus with a collagen-silicone composite tube.

PubMed

Takimoto, Y; Okumura, N; Nakamura, T; Natsume, T; Shimizu, Y

1993-01-01

This study investigated ways of preventing late stenosis after replacing the esophagus with a prosthetic device and increasing survival time in an animal model. In a previous study, the authors induced neoesophageal formation and re-epithelialization at an early stage, although stenosis in the chronic stage remained a problem, and long-term survival was prevented. The authors developed an artificial esophagus made from a collagen-silicone composite tube. The silicone tube (25 mm in diameter, 50 mm long, and 1 mm thick) was covered with collagen sponge (5 mm thick). The collagen sponge was intended to be replaced by host tissue, leading to neoesophageal regeneration. The authors thought stenosis was caused primarily by poor regeneration of submucosal tissue, rather than reepithelialization. Thus, they examined the grade of stenosis relative to the time the stent became dislodged. They concluded that the occurrence of stenosis after anastomosis depends upon the duration of stenting and that stenosis did not develop when the portion replaced by the artificial esophagus was stented for at least 4 weeks.

[Clinical and histological study of 25 cases of hydronephrosis caused by primary stenosis of the pyeloureteral junction].

PubMed

Bernheim, J; Aronheim, M; Griffel, B

1983-01-01

The authors report 25 cases of primary stenosis of the pyelo-ureteric junction (PUJ) in terms of their clinical and histological features. Based on a semi-quantitative study of the histological modifications, the authors attempt to determine whether these modifications are primary and therefore responsible for the stenosis of the PUJ or wether, on the contrary, these changes are secondary to the stenosis. After studying 25 children and adults, it appears that these histological signs are primary and responsible for the malformation: rarefaction of the muscle layers (24 cases out of 25), fibrosis of the sub-mucosa or intermuscular layer in every case, presence of valvular mucosal folds in every case but one.

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

Atsumi, Kazushige; Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp; Arimura, Hidetaka

Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors andmore » therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.« less

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

Mann, S.J.; Pickering, T.G.; Sos, T.A.

The purpose of this study was to determine the sensitivity, specificity, and clinical usefulness of renography performed in combination with captopril administration (captopril renography) in diagnosing renal artery stenosis. Fifty-five patients with suspected renal artery stenosis underwent renography prior to performance of renal angiography. Renography was performed on two consecutive days using technetium-99m-diethylenetiamine pentaacetic acid (DTPA) as an index of glomerular filtration rate and iodine-131-orthoiodohippurate (OIH) as an index of renal blood flow. Captopril (25 mg orally, crushed) was administered 1 hour before the second study. Renal artery stenosis was defined as a stenosis exceeding 70%. Renographic criteria were thenmore » established, retrospectively, to differentiate renal artery stenosis from essential hypertension based on (1) asymmetry of function and (2) the presence of captopril-induced changes. Renal artery stenosis was detected in 35 of 55 patients (21 with unilateral and 14 with bilateral stenosis). Three criteria were established for diagnosing renal artery stenosis: (1) a percent uptake of DTPA by the affected kidney of less than 40% of the combined bilateral uptake, (2) a delayed time to peak uptake of DTPA, which was more than 5 minutes longer in the affected kidney than in the contralateral kidney, (3) a delayed excretion of DTPA, with retention at 15 minutes, as a fraction of peak activity, more than 20% greater than in the contralateral kidney. The presence of one or more of these criteria was diagnostic of renal artery stenosis, with a sensitivity and specificity of 71% and 75%, respectively before captopril administration, and 94% and 95% after captopril administration. Lesser degrees of asymmetry (i.e., uptake of 40% to 50%) had very poor diagnostic specificity.« less

Modeling of the aorta artery aneurysms and renal artery stenosis using cardiovascular electronic system

PubMed Central

Hassani, Kamran; Navidbakhsh, Mahdi; Rostami, Mostafa

2007-01-01

Background The aortic aneurysm is a dilatation of the aortic wall which occurs in the saccular and fusiform types. The aortic aneurysms can rupture, if left untreated. The renal stenosis occurs when the flow of blood from the arteries leading to the kidneys is constricted by atherosclerotic plaque. This narrowing may lead to the renal failure. Previous works have shown that, modelling is a useful tool for understanding of cardiovascular system functioning and pathophysiology of the system. The present study is concerned with the modelling of aortic aneurysms and renal artery stenosis using the cardiovascular electronic system. Methods The geometrical models of the aortic aneurysms and renal artery stenosis, with different rates, were constructed based on the original anatomical data. The pressure drop of each section due to the aneurysms or stenosis was computed by means of computational fluid dynamics method. The compliance of each section with the aneurysms or stenosis is also calculated using the mathematical method. An electrical system representing the cardiovascular circulation was used to study the effects of these pressure drops and the compliance variations on this system. Results The results showed the decreasing of pressure along the aorta and renal arteries lengths, due to the aneurysms and stenosis, at the peak systole. The mathematical method demonstrated that compliances of the aorta sections and renal increased with the expansion rate of the aneurysms and stenosis. The results of the modelling, such as electrical pressure graphs, exhibited the features of the pathologies such as hypertension and were compared with the relevant experimental data. Conclusion We conclude from the study that the aortic aneurysms as well as renal artery stenosis may be the most important determinant of the arteries rupture and failure. Furthermore, these pathologies play important rules in increase of the cardiovascular pulse pressure which leads to the hypertension. PMID:17559685

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging.

PubMed

Eguchi, Yawara; Ohtori, Seiji; Suzuki, Munetaka; Oikawa, Yasuhiro; Yamanaka, Hajime; Tamai, Hiroshi; Kobayashi, Tatsuya; Orita, Sumihisa; Yamauchi, Kazuyo; Suzuki, Miyako; Aoki, Yasuchika; Watanabe, Atsuya; Kanamoto, Hirohito; Takahashi, Kazuhisa

2016-02-01

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Airborne profiling of ice thickness using a short pulse radar

NASA Technical Reports Server (NTRS)

Vickers, R. S.; Heighway, J. E.; Gedney, R. T.

1973-01-01

This paper describes helicopter-borne measurements of ice thickness in Lake Superior, Lake St. Clair, and the St. Clair river as part of NASA's program to develop an ice information system. The profiler described is a high resolution, nonimaging, short pulse radar, operating at a carrier frequency of 2.7 GHz. The system can resolve reflective surfaces separated by as little as 10 cm and permits measurement of the distance between resolvable surfaces with an accuracy of about 1 cm. Data samples are given for measurements both in a static (helicopter hovering), and a traverse mode. Ground truth measurements taken by an ice auger team traveling with the helicopter are compared with the remotely sensed data and the accuracy of the profiler is discussed based on these measurements.

Lipoprotein(a) in patients with aortic stenosis: Insights from cardiovascular magnetic resonance

PubMed Central

Vassiliou, Vassilios S.; Flynn, Paul D.; Raphael, Claire E.; Newsome, Simon; Khan, Tina; Ali, Aamir; Halliday, Brian; Studer Bruengger, Annina; Malley, Tamir; Sharma, Pranev; Selvendran, Subothini; Aggarwal, Nikhil; Sri, Anita; Berry, Helen; Donovan, Jackie; Lam, Willis; Auger, Dominique; Cook, Stuart A.; Pennell, Dudley J.; Prasad, Sanjay K.

2017-01-01

Background Aortic stenosis is the most common age-related valvular pathology. Patients with aortic stenosis and myocardial fibrosis have worse outcome but the underlying mechanism is unclear. Lipoprotein(a) is associated with adverse cardiovascular risk and is elevated in patients with aortic stenosis. Although mechanistic pathways could link Lipoprotein(a) with myocardial fibrosis, whether the two are related has not been previously explored. In this study, we investigated whether elevated Lipoprotein(a) was associated with the presence of myocardial replacement fibrosis. Methods A total of 110 patients with mild, moderate and severe aortic stenosis were assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance to identify fibrosis. Mann Whitney U tests were used to assess for evidence of an association between Lp(a) and the presence or absence of myocardial fibrosis and aortic stenosis severity and compared to controls. Univariable and multivariable linear regression analysis were undertaken to identify possible predictors of Lp(a). Results Thirty-six patients (32.7%) had no LGE enhancement, 38 (34.6%) had midwall enhancement suggestive of midwall fibrosis and 36 (32.7%) patients had subendocardial myocardial fibrosis, typical of infarction. The aortic stenosis patients had higher Lp(a) values than controls, however, there was no significant difference between the Lp(a) level in mild, moderate or severe aortic stenosis. No association was observed between midwall or infarction pattern fibrosis and Lipoprotein(a), in the mild/moderate stenosis (p = 0.91) or severe stenosis patients (p = 0.42). Conclusion There is no evidence to suggest that higher Lipoprotein(a) leads to increased myocardial midwall or infarction pattern fibrosis in patients with aortic stenosis. PMID:28704465

Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?

PubMed

Lansley, J A; Tucker, W; Eriksen, M R; Riordan-Eva, P; Connor, S E J

2017-09-01

Pulsatile tinnitus is experienced by most patients with idiopathic intracranial hypertension. The pathophysiology remains uncertain; however, transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence have been proposed as potential etiologies. We aimed to determine whether the prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence was increased in patients with idiopathic intracranial hypertension and pulsatile tinnitus relative to those without pulsatile tinnitus and a control group. CT vascular studies of patients with idiopathic intracranial hypertension with pulsatile tinnitus ( n = 42), without pulsatile tinnitus ( n = 37), and controls ( n = 75) were independently reviewed for the presence of severe transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence according to published criteria. The prevalence of transverse sinus stenosis and sigmoid sinus diverticulum/dehiscence in patients with idiopathic intracranial hypertension with pulsatile tinnitus was compared with that in the nonpulsatile tinnitus idiopathic intracranial hypertension group and the control group. Further comparisons included differing degrees of transverse sinus stenosis (50% and 75%), laterality of transverse sinus stenosis/sigmoid sinus diverticulum/dehiscence, and ipsilateral transverse sinus stenosis combined with sigmoid sinus diverticulum/dehiscence. Severe bilateral transverse sinus stenoses were more frequent in patients with idiopathic intracranial hypertension than in controls ( P < .001), but there was no significant association between transverse sinus stenosis and pulsatile tinnitus within the idiopathic intracranial hypertension group. Sigmoid sinus dehiscence (right- or left-sided) was also more common in patients with idiopathic intracranial hypertension compared with controls ( P = .01), but there was no significant association with pulsatile tinnitus within the idiopathic intracranial hypertension group. While our data corroborate previous studies demonstrating increased prevalence of sigmoid sinus diverticulum/dehiscence and transverse sinus stenosis in idiopathic intracranial hypertension, we did not establish an increased prevalence in patients with idiopathic intracranial hypertension with pulsatile tinnitus compared with those without. It is therefore unlikely that these entities represent a direct structural correlate of pulsatile tinnitus in patients with idiopathic intracranial hypertension. © 2017 by American Journal of Neuroradiology.

[Feasibility of sonography in the diagnosis of congenital heart diseases in dogs].

PubMed

Schneider, M; Schneider, I; Neu, H

1998-05-01

In ultrasound examination of the heart it is useful to combine the following techniques: echocardiography (in 2D and M-mode) gives information about morphology and motion of the heart. By using Doppler echocardiography (black and white or preferably colour) it is possible to evaluate bloodstreams and with contrast echocardiography shunts in the heart can be demonstrated. In our study (1994-1996) the following congenital heart defects were the most common in dogs: subaortic stenosis (SAS, 41%), pulmonic stenosis (PS, 19%), patent ductus arteriosus (PDA, 11%) and the combination of subaortic stenosis with pulmonic stenosis (11%). Echocardiography allows the morphologic evaluation of the primary defect in detail, for example the differentiation between aortic valve stenosis and subaortic stenosis. However the exact identification of the patent ductus arterious and of the morphology in pulmonic stenosis can remain difficult, especially in patients showing dyspnoe. In heart sonography quantitative measurements are available to graduate the defects, but guidelines for these measurements are not yet defined. The demonstration of secondary and combined defects, which are important for therapy is easily possible with heart ultrasound examination. Secondary insufficiencies are often seen at the mitral valve because of primary subaortic stenosis or patent ductus arteriosus and at the tricuspid valve because of pulmonic stenosis. For differentiation of combined heart defects (SAS with PS; SAS with PDA; PS with atrium septum defect) heart ultrasound is extremely valuable.

Radiology-guided forceps biopsy and airway stenting in severe airway stenosis

PubMed Central

Li, Zong-Ming; Wu, Gang; Han, Xin-Wei; Ren, Ke-Wei; Zhu, Ming

2014-01-01

PURPOSE We aimed to determine the feasibility, safety, and effectiveness of radiology-guided forceps biopsy and airway stenting in patients with severe airway stenosis. MATERIALS AND METHODS This study involved 28 patients with severe airway stenosis who underwent forceps biopsy between October 2006 and September 2011. Chest multislice computed tomography was used to determine the location and extent of stenosis. Sixteen patients had tracheal stenosis, two patients had stenosis of the tracheal carina, six patients had stenosis of the left main bronchus, and four patients had stenosis of the right main bronchus. Forceps biopsy and stenting of the stenosed area were performed under fluoroscopic guidance in digital subtraction angiography and the biopsy specimens were analyzed histopathologically. We contacted the patients via phone call and utilized a standardized questionnaire to determine their medical condition during a postoperative three-month follow-up. RESULTS The technical success rate of radiology-guided forceps biopsy was 100%. Biopsy specimens were obtained in all patients. Dyspnea was relieved immediately after stent placement. No serious complications, such as tracheal hemorrhage or perforation, mediastinal emphysema, or asphyxia, occurred. CONCLUSION Radiology-guided forceps biopsy and airway stenting can be used for the emergency treatment of severe airway stenosis. This method appears to be safe and effective, and it may be an alternative therapeutic option in patients who cannot tolerate fiberoptic bronchoscopy. PMID:24808434

Surgical reconstruction for tuberculous airway stenosis: management for patients with concomitant tracheal malacia.

PubMed

Tsukioka, Takuma; Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Tei, Keiko; Yamamoto, Ryoji

2015-07-01

Surgical reconstruction is commonly recommended for the treatment of tuberculous airway stenosis. The clinical conditions underlying tuberculous airway stenosis often involve both cicatricial stenosis and malacia. Surgical reconstruction alone may not improve the respiratory symptoms of patients with both types of airway stenosis. This study retrospectively reviewed patients who underwent surgical reconstruction for tuberculous airway stenosis to investigate the most appropriate treatment for this complicated condition. Twelve patients with tuberculous airway stenosis underwent surgical reconstruction at our institute from January 2003 to December 2013. The clinical courses of these patients were retrospectively reviewed. The 12 patients were 2 men and 10 women with a mean age of 36 years (range 17-61 years). The site of stenosis was the left main bronchus in six patients, trachea in four patients, and right main bronchus in two patients. The procedure performed was sleeve lobectomy in five patients, bronchial resection in four patients, and tracheal resection in three patients. Additional airway stenting was performed in two patients with concomitant malacia of the lower trachea. The performance status and Hugh-Jones classification improved postoperatively in all patients. The forced expiratory volume in 1 s as a percent of forced vital capacity and percent of forced expiratory volume in 1 s improved significantly. Surgical reconstruction is an acceptable treatment for tuberculous airway stenosis. Additional airway stenting may be needed in patients with symptomatic malacia.

Surgeon Reliability for the Assessment of Lumbar Spinal Stenosis on MRI: The Impact of Surgeon Experience.

PubMed

Marawar, Satyajit V; Madom, Ian A; Palumbo, Mark; Tallarico, Richard A; Ordway, Nathaniel R; Metkar, Umesh; Wang, Dongliang; Green, Adam; Lavelle, William F

2017-01-01

Treating surgeon's visual assessment of axial MRI images to ascertain the degree of stenosis has a critical impact on surgical decision-making. The purpose of this study was to prospectively analyze the impact of surgeon experience on inter-observer and intra-observer reliability of assessing severity of spinal stenosis on MRIs by spine surgeons directly involved in surgical decision-making. Seven fellowship trained spine surgeons reviewed MRI studies of 30 symptomatic patients with lumbar stenosis and graded the stenosis in the central canal, the lateral recess and the foramen at T12-L1 to L5-S1 as none, mild, moderate or severe. No specific instructions were provided to what constituted mild, moderate, or severe stenosis. Two surgeons were "senior" (>fifteen years of practice experience); two were "intermediate" (>four years of practice experience), and three "junior" (< one year of practice experience). The concordance correlation coefficient (CCC) was calculated to assess inter-observer reliability. Seven MRI studies were duplicated and randomly re-read to evaluate inter-observer reliability. Surgeon experience was found to be a strong predictor of inter-observer reliability. Senior inter-observer reliability was significantly higher assessing central(p<0.001), foraminal p=0.005 and lateral p=0.001 than "junior" group.Senior group also showed significantly higher inter-observer reliability that intermediate group assessing foraminal stenosis (p=0.036). In intra-observer reliability the results were contrary to that found in inter-observer reliability. Inter-observer reliability of assessing stenosis on MRIs increases with surgeon experience. Lower intra-observer reliability values among the senior group, although not clearly explained, may be due to the small number of MRIs evaluated and quality of MRI images.Level of evidence: Level 3.

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

PubMed

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

1979-03-01

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

[Congenital esophageal stenosis: a case report].

PubMed

Oquendo, Raquel; Resumil, Gisela; Villafañe, Vanesa; Flores, Mariana; Navacchia, Daniel; Quintana, Carlos

2014-03-01

Congenital esophageal stenosis, a rare disease of unknown cause which reports have increased in the last few years, requires a high index of suspicion for its diagnosis and treatment. It can be classified in three types based on the etiology of the stenosis: tracheobronchial rest, fibromuscular hypertrophy and membranous diaphragm. Symptoms may vary depending on location and severity of the stenosis. Treatment options are based on clinical suspicion of the histologic type and they can be balloon dilation or surgical resection of the stenotic segment. The definitive diagnosis is the histological study.

Potential and Limitations of Neural Decompression in Extreme Lateral Interbody Fusion-A Systematic Review.

PubMed

Lang, Gernot; Perrech, Moritz; Navarro-Ramirez, Rodrigo; Hussain, Ibrahim; Pennicooke, Brenton; Maryam, Farah; Avila, Mauricio J; Härtl, Roger

2017-05-01

Extreme lateral interbody fusion (ELIF) is a powerful tool for interbody fusion and coronal deformity correction. However, evidence regarding the success of ELIF in decompressing foraminal, lateral recess, and central canal stenosis is lacking. We performed a systematic review of current literature on the potential and limitations of ELIF to indirectly decompress neural elements. A literature search using PubMed, Cochrane, and ScienceDirect databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Information on study design, sample size, population, procedure, number and location of involved levels, follow-up time, and complications as well as information on conflict of interest was extracted and evaluated. We selected 20 publications including 1080 patients for review. Most publications (90%) were retrospective case series. Most frequent indications for ELIF included degenerative disc disease, spinal stenosis, spondylolisthesis, and degenerative scoliosis. Most studies revealed significant improvement in radiographic and clinical outcome after ELIF. Mean foraminal area, central canal area, and subarticular diameter increased by 31.6 mm 2 , 28.5 mm 2 , and 0.85 mm. ELIF successfully improved foraminal stenosis. Contradictory results were found for indirect decompression of central canal stenosis. Data on lateral recess stenosis were scarce. Current data suggest ELIF to be an efficient technique in decompression of foraminal stenosis. Evidence on decompression of central canal or lateral recess stenosis via ELIF is low, and results are inconsistent. Most studies are limited by study design, sample size, and potential conflicts of interest. Copyright © 2017 Elsevier Inc. All rights reserved.

Atrial contribution to ventricular filling in mitral stenosis.

PubMed

Meisner, J S; Keren, G; Pajaro, O E; Mani, A; Strom, J A; Frater, R W; Laniado, S; Yellin, E L

1991-10-01

The importance of the contribution of atrial systole to ventricular filling in mitral stenosis is controversial. The cause of reduced cardiac output following the onset of atrial fibrillation may be due to an increased heart rate, a loss of booster pump function, or both. We studied the atrial contribution to filling under a variety of conditions by combining noninvasive studies of patients with computer modeling. Thirty patients in sinus rhythm with mild-to-severe stenosis were studied with two-dimensional and Doppler echocardiography for measurement of mitral flow velocity and mitral valve area (MVA). The mean +/- SD atrial contribution to left ventricular filling volume was 18 +/- 10% and varied inversely with mitral resistance. Patients with mild mitral stenosis (MVA, 1.8 +/- 0.7 cm2) and severe mitral stenosis (MVA, 0.9 +/- 0.2 cm2) had atrial contributions of 29 +/- 4% and 9 +/- 5%, respectively. The pathophysiological mechanisms responsible for these trends were further investigated by the computer model. In modeled severe mitral stenosis, increasing heart rate from 75 to 150 beats/min caused an increase of 5.2 mm Hg in mean left atrial pressure, whereas loss of atrial contraction at a heart rate of 150 beats/min caused only a 1.3 mm Hg increase. The atrial booster pump contributes less to ventricular filling in mitral stenosis than in the normal heart, and the loss of atrial pump function is less important than the effect of increasing heart rate as the cause of decompensation during atrial fibrillation.

The left ventricle in aortic stenosis--imaging assessment and clinical implications.

PubMed

Călin, Andreea; Roşca, Monica; Beladan, Carmen Cristiana; Enache, Roxana; Mateescu, Anca Doina; Ginghină, Carmen; Popescu, Bogdan Alexandru

2015-04-29

Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement.This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients.

A bronchoscopic approach to benign subglottic stenosis.

PubMed

Raman, Tuhina; Chatterjee, Kshitij; Alzghoul, Bashar N; Innabi, Ayoub A; Tulunay, Ozlem; Bartter, Thaddeus; Meena, Nikhil K

2017-01-01

Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.

Stenosis of esophago-jejuno anastomosis after gastric surgery.

PubMed

Fukagawa, Takeo; Gotoda, Takuji; Oda, Ichiro; Deguchi, Yasunori; Saka, Makoto; Morita, Shinji; Katai, Hitoshi

2010-08-01

Stenosis of esophago-jejuno anastomosis is one of the postoperative complications of gastric surgery. This complication usually manifests with the symptom of dysphagia and is treated by endoscopic dilatation. No large-scale studies have been conducted to determine the incidence of this complication after surgery. The data of a total of 1478 consecutive patients who underwent total, proximal, or completion gastrectomy, including esophago-jejuno anastomosis, between 2000 and 2008 were analyzed retrospectively with a view to determining the incidence of anastomotic stenosis. Sixty patients (4.1%) developed stenosis of the esophago-jejuno anastomosis which needed to be treated by endoscopic balloon dilatation. The average interval between the surgery and detection of stenosis was 67.4 days (median = 58.0). Multivariate analysis identified female gender, proximal gastrectomy, use of a narrow-sized stapler, and the choice of the stapling device as significant factors influencing the risk of development of anastomotic stenosis. Esophago-jejuno anastomotic stenosis appears to be a common late postoperative complication after gastric surgery. Endoscopic examination and treatment yielded favorable outcomes in patients complaining of dysphagia after gastric surgery.

Community Problems in Five West Central Counties. Report No. 7 of a Series on Quality of Life and Development in Northwestern Wisconsin, February 1976.

ERIC Educational Resources Information Center

Lambert, Virginia; Linn, Gary

As part of a study on development and the quality of life in northwestern Wisconsin, questions concerning important problems, public services, and environmental issues were asked of samples of 150 people in each of 4 west central counties (Clark, Dunn, Eau Claire, and Polk) in 1974. Responses to similar questions asked in a 1973 study of St. Croix…

Asymptomatic carotid stenosis is associated with cognitive impairment.

PubMed

Lal, Brajesh K; Dux, Moira C; Sikdar, Siddhartha; Goldstein, Carly; Khan, Amir A; Yokemick, John; Zhao, Limin

2017-10-01

Cerebrovascular risk factors (eg, hypertension, coronary artery disease) and stroke can lead to vascular cognitive impairment. The Asymptomatic Carotid Stenosis and Cognitive Function study evaluated the isolated impact of asymptomatic carotid stenosis (no prior ipsilateral or contralateral stroke or transient ischemic attack) on cognitive function. Cerebrovascular hemodynamic and carotid plaque characteristics were analyzed to elucidate potential mechanisms affecting cognition. There were 82 patients with ≥50% asymptomatic carotid stenosis and 62 controls without stenosis but matched for vascular comorbidities who underwent neurologic, National Institutes of Health Stroke Scale, and comprehensive neuropsychological examination. Overall cognitive function and five domain-specific scores were computed. Duplex ultrasound with Doppler waveform and B-mode imaging defined the degree of stenosis, least luminal diameter, plaque area, and plaque gray-scale median. Breath-holding index (BHI) and microembolization were measured using transcranial Doppler. We assessed cognitive differences between stenosis patients and control patients and of stenosis patients with low vs high BHI and correlated cognitive function with microembolic counts and plaque characteristics. Stenosis and control patients did not differ in vascular risk factors, education, estimated intelligence, or depressive symptoms. Stenosis patients had worse composite cognitive scores (P = .02; Cohen's d = 0.43) and domain-specific scores for learning/memory (P = .02; d = 0.42) and motor/processing speed (P = .01; d = 0.65), whereas scores for executive function were numerically lower (P = .08). Approximately 49.4% of all stenosis patients were impaired in at least two cognitive domains. Precisely 50% of stenosis patients demonstrated a reduced BHI. Stenosis patients with reduced BHI performed worse on the overall composite cognitive score (t = -2.1; P = .02; d = 0.53) and tests for learning/memory (t = -2.7; P = .01; d = 0.66). Cognitive function did not correlate with measures of plaque burden (degree of stenosis, least luminal diameter, and plaque area) or with plaque gray-scale median. Asymptomatic carotid stenosis is associated with cognitive impairment independent of known vascular risk factors for vascular cognitive impairment. Approximately 49.4% of these patients demonstrate impairment in at least two neuropsychological domains. The deficit is driven primarily by reduced motor/processing speed and learning/memory and is mild to moderate in severity. The mechanism for impairment is likely to be hemodynamic as evidenced by reduced cerebrovascular reserve and the likely result of hypoperfusion from a pressure drop across the stenosis in the presence of inadequate collateralization. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Spinal stenosis

MedlinePlus

... stenosis; LBP - stenosis Patient Instructions Spine surgery - discharge Images Sciatic nerve Spinal stenosis Spinal stenosis References Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J ...

Report Of Environmental Security Technology Certification Program (ESTCP) UXO Discrimination Study Support Activities: Former Camp Sibert, Etowah and St. Clair Counties, Alabama

DTIC Science & Technology

2007-11-01

PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) PARSONS 4890 University Square Suite 2 Huntsville, Alabama 35816 8 . PERFORMING ORGANIZATION REPORT NUMBER...PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8 -98) Prescribed by ANSI Std Z39-18...Intrusive Investigation Results ...................................................................................... 8 8.2 CLUSTER ANOMALIES

Water resources of the Detroit area, Michigan

USGS Publications Warehouse

Wisler, Chester Owen; Stramel, G.J.; Laird, Leslie Bostwick

1952-01-01

The water used for all purposes in the Detroit area is obtained from three sources: Lake St. Clair and the Detroit River, their tributary streams and inland lakes, and ground water. During 1950 Lake St. Clair and the Detroit River provided 2,896 million gallons per day (mgd), or 98.3 percent of the total usage of 2,949 mgd. Tributary streams and inland lakes supplied about 10 mgd, or 0.3 percent, and ground water contributed43 mgd, or 1.4 percent of the total. These rates of use represent the following percentages of the total supply available from each source: From Lake St. Clair and Detroit River, 2.5 percent; from tributary streams, 1.2 percent; from ground water, probably about 15 percent.Of the above total usage, about 2,500 mgd was raw water that was drawn directly from the Detroit River by adjacent industrial plants, used for cooling, processing, and other similar purposes, and immediately returned to the river. Of the remaining 449 mgd, 383 mgd was drawn from Lake St. Clair by the Detroit Department of Water Supply and, after purification, was distributed for domestic and commercial use throughout Detroit and its environs; 23 mgd was obtained from additional surface stream supplies; and 43 mgd was derived from wells.An abundant supply of raw water may be obtained from the Detroit River. The practicability of its utilization at any particular site is beyond the scope of this report.The Detroit Department of Water Supply can supply potable water of good quality and in any reasonable quantity anywhere in the area which it serves. Throughout the remainder of the Detroit area the Detroit Department of Water Supply can supply any normal demand, if distribution and storage facilities are provided. In outlying areas where the main source of supply is ground water and tributary streams, the water is hard and contains greater amounts of dissolved solids.There will be no serious shortage of water supplies at their source in the foreseeable future although local shortages owing to lack of adequate distribution systems will occur.

Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis.

PubMed

de la Cruz Cosme, C; Dawid Milner, M S; Ojeda Burgos, G; Gallardo Tur, A; Márquez Martínez, M; Segura, T

2017-03-24

Most of the cases of ischaemic stroke in our setting are of atherothrombotic origin. Detecting intracranial and cervical carotid artery stenosis in patients with ischaemic stroke is therefore essential. Ultrasonography has become the tool of choice for diagnosing carotid artery stenosis because it is both readily accessibility and reliable. However, use of this technique must be validated in each laboratory. The purpose of this study is to validate Doppler ultrasound in our laboratory as a means of detecting severe carotid artery stenosis. We conducted an observational descriptive study to evaluate diagnostic tests. The results from transcranial and cervical carotid Doppler ultrasound scans conducted by neurologists were compared to those from carotid duplex scans performed by radiologists in patients diagnosed with stroke. Arteriography was considered the gold standard (MR angiography, CT angiography, or conventional arteriography). Our sample included 228 patients. Transcranial and cervical carotid Doppler ultrasound showed a sensitivity of 95% and specificity of 100% for detection of carotid artery stenosis > 70%, whereas carotid duplex displayed a sensitivity of 87% and a specificity of 94%. Transcranial carotid Doppler ultrasound achieved a sensitivity of 78% and a specificity of 98% for detection of intracranial stenosis. Doppler ultrasound in our neurosonology laboratory was found to be a useful diagnostic tool for detecting cervical carotid artery stenosis and demonstrated superiority to carotid duplex despite the lack of B-mode. Furthermore, this technique was found to be useful for detecting intracranial stenosis. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Carotid bruit for detection of hemodynamically significant carotid stenosis: the Northern Manhattan Study

PubMed Central

Ratchford, Elizabeth V.; Jin, Zhezhen; Di Tullio, Marco R.; Salameh, Maya J.; Homma, Shunichi; Gan, Robert; Boden-Albala, Bernadette; Sacco, Ralph L.; Rundek, Tatjana

2009-01-01

Objective The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods The Northern Manhattan Study (NOMAS) is a prospective multiethnic community-based cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the stroke-free cohort (n=3298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60% carotid stenosis as detected by ultrasound was 2.2% and the prevalence of carotid bruits was 4.1%. For detection of carotid stenosis, sensitivity of auscultation was 56%, specificity was 98%, positive predictive value was 25%, negative predictive value was 99% and overall accuracy was 97.5%. Discussion In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44% false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation. PMID:19133168

The role of mitomycin C in preventing synechia and stenosis after endoscopic sinus surgery.

PubMed

Anand, Vijay K; Tabaee, Abtin; Kacker, Ashutosh; Newman, Jason G; Huang, Clark

2004-01-01

Synechia and stenosis formation after endoscopic sinus surgery (ESS) represents a potential source of surgical failure. Mitomycin C (MMC) has been used successfully in other fields to decrease postoperative scar formation. We hypothesize that the topical application of MMC reduces the incidence of stenosis and synechia formation after ESS. This study is a randomized, controlled, single-blinded study based in a tertiary care teaching hospital. After routine ESS, a pledget soaked in MMC (0.5%) was randomly placed into the middle meatus of one nasal cavity for 5 minutes and a pledget soaked in saline was placed in the contralateral side in each patient. A blinded observer followed the patients for any evidence of stenosis or synechia formation. The medical records of enrolled patients were reviewed for demographics, diagnosis, prior surgery, type of sinus surgery, complications, incidence of stenosis/synechia, and need for further procedures. Twenty-nine patients were included in the final analysis. The mean follow-up period was 15 months (range, 3-32 months). There were no complications in this series. Eight patients experienced 10 episodes of synechia formation and one patient experienced 1 episode of synechia formation and 1 episode of stenosis of the maxillary sinus ostium. Seven of the 12 episodes of synechia/stenosis occurred on the side of the MMC application and the remaining 5 episodes occurred on the side opposite to the MMC application. This difference was not statistically significant. The topical application of MMC did not decrease the incidence of stenosis and synechia formation after ESS.

Effects of Neck Radiation Therapy on Extra-Cranial Carotid Arteries Atherosclerosis Disease Prevalence: Systematic Review and a Meta-Analysis

PubMed Central

Bashar, Khalid; Healy, Donagh; Clarke-Moloney, Mary; Burke, Paul; Kavanagh, Eamon; Walsh, Stewart-Redmond

2014-01-01

Introduction Radiation arteritis following neck irradiation as a treatment for head and neck malignancy has been well documented. The long-term sequelae of radiation exposure of the carotid arteries may take years to manifest clinically, and extra-cranial carotid artery (ECCA) stenosis is a well-recognised vascular complication. These carotid lesions should not be regarded as benign and should be treated in the same manner as standard carotid stenosis. Previous studies have noted increased cerebrovascular events such as stroke in this cohort of patients because of high-grade symptomatic carotid stenosis resulting in emboli. Aim To evaluate the effect of radiation therapy on ECCA atherosclerosis progression. Methods Online search for case-control studies and randomised clinical trials that reported on stenosis in extra-cranial carotid arteries in patients with neck malignancies who received radiation therapy (RT) comparing them to patients with neck malignancies who did not receive RT. Results Eight studies were included in the final analysis with total of 1070 patients – 596 received RT compared to 474 in the control group. There was statistically significant difference in overall stenosis rate (Pooled risk ratio  =  4.38 [2.98, 6.45], P  =  0.00001) and severe stenosis (Pooled risk ratio  =  7.51 [2.78, 20.32], P <0.0001), both being higher in the RT group. Pooled analysis of the five studies that reported on mild stenosis also showed significant difference (Pooled risk ratio  =  2.74 [1.75, 4.30], 95% CI, P  =  0.0001). Conclusion The incidence of severe ECCA stenosis is higher among patients who received RT for neck malignancies. Those patients should be closely monitored and screening programs should be considered in all patients who receive neck RT. PMID:25329500

Turbulence intensity measurements using particle image velocimetry in diseased carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

PubMed

Kefayati, Sarah; Holdsworth, David W; Poepping, Tamie L

2014-01-03

Clinical decision-making for the treatment of patients with diseased carotid artery is mainly based on the severity of the stenosis. However, stenosis severity alone is not a sensitive indicator, and other local factors for the assessment of stroke risk are required. Flow disturbance is of particular interest due to its proven association with increased thromboembolic activities. The objective of this study was to investigate the level of turbulence intensity (TI) with regards to certain geometrical features of the plaque - namely stenosis severity, eccentricity, and ulceration. A family of eight carotid-artery bifurcation models was examined using particle image velocimetry. Results showed a marked difference in turbulence intensity among these models; increasing degree of stenosis severity resulted in increased turbulence intensity, going from 0.12 m/s for mild stenosis to 0.37 m/s for severe stenosis (with concentric geometry). Moreover, independent of stenosis severity, eccentricity led to further elevations in turbulence intensity, increasing TI by 0.05-0.10 m/s over the counterpart concentric plaque. The presence of ulceration (in a 50% eccentric plaque) produced a larger portion of moderate turbulence intensity (~0.10 m/s) compared to the non-ulcerated model, more proximal to the bifurcation apex in the post-stenotic recirculation zone. The effect of plaque eccentricity and ulceration in enhancing the downstream turbulence has potential clinical implications for a more sensitive assessment of stroke risk beyond stenosis severity alone. © 2013 Elsevier Ltd. All rights reserved.

Prevalence of pharyngeal and esophageal stenosis following radiation for head and neck cancer.

PubMed

Nguyen, Nam P; Smith, Herbert J; Moltz, Candace C; Frank, Cheryl; Millar, Carrie; Dutta, Suresh; Lee, Howard; North, Debra; Karlsson, Ulf; Vos, Paul; Nguyen, Ly M; Sallah, Sabah

2008-04-01

To evaluate the risk and outcome of pharyngoesophageal stenosis in patients who complained of dysphagia following radiation for head and neck cancer. Retrospective study. Veterans Administration hospital. Patients who complained of persistent dysphagia following radiation alone or combined with surgery or chemotherapy for head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. All patients had modified barium swallow (MBS) and an endoscopic examination for initial evaluation of their dysphagia. Traditional barium swallow was requested when there was a suspicion of pharyngoesophageal stenosis on MBS. Two hundred twenty-two patients underwent MBS for evaluation of dysphagia posttreatment. Traditional barium swallow confirmed the diagnosis of pharyngeal (n = 2) or esophageal (n = 14) stenosis in 16 patients. Eight patients had esophageal stenosis on endoscopic examination. All patients underwent dilatation for relief of their dysphagia. The number of dilatations performed was, respectively, one in 12 patients, two in 4 patients, three in 3 patients, four in 3 patients, five in one patient, and six in one patient. Pharyngeal and/or cervical esophageal stenosis may be the cause of dysphagia following radiation for head and neck cancer. Esophageal dilatations often offer temporary relief of the dysphagia.

Physical examination, magnetic resonance image, and electrodiagnostic study in patients with lumbosacral disc herniation or spinal stenosis.

PubMed

Lee, Jung Hwan; Lee, Sang-Ho

2012-10-01

To compare the clinical implications of electro-diagnostic study with those of magnetic resonance imaging in patients with lumbosacral intervertebral herniated disc or spinal stenosis. Retrospective study of clinical data. Patients with lumbosacral intervertebral herniated disc or spinal stenosis, diagnosed by clinical assessment and magnetic resonance imaging (MRI), were selected. A total of 753 patients (437 with lumbosacral intervertebral herniated disc and 316 with spinal stenosis) were included in the study. Clinical data for electrodiagnostic study (EDX)and MRI were compared and the sensitivity and specificity of these studies were evaluated. Among all subjects, 267 had radiculopathy on EDX (EDX (+)) and 486 no radiculopathy (EDX(-)). Furthermore, 391 had root compression on MRI (MRI (+)) and 362 no root compression on MRI (MRI (-)). Patients with radioculopathy on EDX (+) showed a significantly higher visual analogue scale score for radiating pain and a higher Oswestry Disability Index than those with negative findings by EDX (-) in the total subjects group and the lumbosacral intervertebral herniated disc subgroup, and there was a trend toward higher Oswestry Disability Index in the spinal stenosis subgroup. Although patients with radioculopathy on root compression on MRI (+) also had a higher visual analogue scale for radiating pain than patients with negative findings by MRI (-) in the total subjects group and the lumbosacral intervertebral herniated disc subgroup, no significant difference was seen in the Oswestry Disability Index. EDX revealed a significant correlation with muscle weakness in the total subjects group and the lumbosacral intervertebral herniated disc subgroup, and trends toward muscle weakness in the spinal stenosis subgroup, whereas there was no such significant correlation for MRI findings in any group. Electrodiagnostic study had a higher specificity in terms of physical examination data than MRI, in spite of its lower sensitivity. Electrodiagnostic study was significantly more correlated with clinical data, especially leg muscle weakness and functional status, and showed a higher specificity than MRI in patients with lumbosacral intervertebral herniated disc or spinal stenosis.

The influence of artery wall curvature on the anatomical assessment of stenosis severity derived from fractional flow reserve: a computational fluid dynamics study.

PubMed

Govindaraju, Kalimuthu; Viswanathan, Girish N; Badruddin, Irfan Anjum; Kamangar, Sarfaraz; Salman Ahmed, N J; Al-Rashed, Abdullah A A A

2016-11-01

This study aims to investigate the influence of artery wall curvature on the anatomical assessment of stenosis severity and to identify a region of misinterpretation in the assessment of per cent area stenosis (AS) for functionally significant stenosis using fractional flow reserve (FFR) as standard. Five artery models of different per cent AS severity (70, 75, 80, 85 and 90%) were considered. For each per cent AS severity, the angle of curvature of the arterial wall varied from straight to an increasingly curved model (0°, 30°, 60°, 90° and 120°). Computational fluid dynamics was performed under transient physiologic hyperemic flow conditions to investigate the influence of artery wall curvature on the pressure drop and the FFR. The findings in this study may be useful in in vitro anatomical assessment of functionally significant stenosis. The FFR decreased with increasing stenosis severity for a given curvature of the artery wall. Moreover, a significant decrease in FFR was found between straight and curved models discussed for a given severity condition. These findings indicate that the curvature effect was included in the FFR assessment in contrast to minimum lumen area (MLA) or per cent AS assessment. The MLA or per cent AS assessment may lead to underestimation of stenosis severity. From this numerical study, an uncertainty region could be evaluated using the clinical FFR cutoff value of 0.8. This value was observed at 81.98 and 79.10% AS for arteries with curvature angles of 0° and 120° respectively. In conclusion, the curvature of the artery should not be neglected in in vitro anatomical assessment.

Carotid artery stenting vs. carotid endarterectomy in the management of carotid artery stenosis: Lessons learned from randomized controlled trials

PubMed Central

Salem, Mohamed M.; Alturki, Abdulrahman Y.; Fusco, Matthew R.; Thomas, Ajith J.; Carter, Bob S.; Chen, Clark C.; Kasper, Ekkehard M.

2018-01-01

Background: Carotid artery stenosis, both symptomatic and asymptomatic, has been well studied with several multicenter randomized trials. The superiority of carotid endarterectomy (CEA) to medical therapy alone in both symptomatic and asymptomatic carotid artery stenosis has been well established in previous trials in the 1990s. The consequent era of endovascular carotid artery stenting (CAS) has offered another option for treating carotid artery stenosis. A series of randomized trials have now been conducted to compare CEA and CAS in the treatment of carotid artery disease. The large number of similar trials has created some confusion due to inconsistent results. Here, the authors review the trials that compare CEA and CAS in the management of carotid artery stenosis. Methods: The PubMed database was searched systematically for randomized controlled trials published in English that compared CEA and CAS. Only human studies on adult patients were assessed. The references of identified articles were reviewed for additional manuscripts to be included if inclusion criteria were met. The following terms were used during search: carotid stenosis, endarterectomy, stenting. Retrospective or single-center studies were excluded from the review. Results: Thirteen reports of seven large-scale prospective multicenter studies, comparing both interventions for symptomatic or asymptomatic extracranial carotid artery stenosis, were identified. Conclusions: While the superiority of intervention to medical management for symptomatic patients has been well established in the literatures, careful selection of asymptomatic patients for intervention should be undertaken and only be pursued after institution of appropriate medical therapy until further reports on trials comparing medical therapy to intervention in this patient group are available. PMID:29740506

[Severe asymptomatic carotid stenosis: a neurological perspective].

PubMed

de la Cruz-Cosme, Carlos; Segura, Tomás

2012-09-01

Asymptomatic carotid stenosis is a relatively frequent pathology, although when considering the possibility of managing it surgically, there is still an important amount of disagreement concerning the criteria to be taken into account. This study conducts a broad examination of the condition, from its concept and epidemiology to the studies that triggered the boom in its surgical treatment during the nineties. The research also reviews the tools available for a better selection of cases that could potentially benefit most from surgery, the presence of silent brain lesions, the severity of the stenosis, its progression, the characteristics of the plaque, colaterality and vasoreactivity studies, the detection of micro-emboli, the presence of risk factors independently associated to the symptomatic conversion of the stenosis, and other elements that have recently been reported either clinically or experimentally. Finally, the article outlines the current state of the surgical technique and the advances being made in its pharmacological treatment. This review is not intended to be a set of clinical practice guidelines, but to offer a global integrating overview of the management of high-grade asymptomatic carotid stenosis.

Correlation of C-Reactive Protein and Cardiac Enzymes with Angiographic Severity of Coronary Artery Disease in Pakistani Patients with Acute Coronary Syndrome.

PubMed

Saleem, Ayesha; Ali, Azmat

2017-02-01

To determine the correlation of C-reactive protein (CRP) levels with the severity of coronary stenosis on angiography and the association of cardiac enzymes with the degree of stenosis in acute coronary syndrome (ACS) patients. Secondly, to compare association of angiographic severity of vascular stenosis with CRP in patients with ST segment elevation myocardial infarction (STEMI) and non-STEMI / Unstable angina (UA). Prospective, descriptive study. Khan Research Laboratories (KRL) Hospital, from October 2014 to March 2015. CRP was measured on diagnosis of ACS in 70 patients. Cardiac enzymes were measured 6 hours after the onset of chest pain. Angiographic scoring for degree of stenosis and number of culprit vessels was done. Two groups consisting of patients with STEMI (group 1) and with NSTEMI/UA (group 2) were made. No correlation was found between CRP levels and angiographic stenosis in patients with ACS (r=0.162, p>0.05). No association was found between eosinophil count and severity of stenosis (p=0.88). Rise of cardiac enzymes and degree of coronary stenosis showed a positive correlation (p <0.001). There was significant difference in the means of coronary artery stenosis scores between the two groups (Gensini score of groups 1 and 2: 35.9 ±4 and 14 ±8, respectively) p<0.001, but there was no significant difference in CRP levels. CRP is a marker of inflammation in ACS rather than a risk factor for determining the severity of vascular stenosis. Rise in cardiac enzymes still grade high in predicting severity of vascular stenosis than eosinophil count or CRP levels.

Complementarity between 18F-FDG PET/CT and Ultrasonography or Angiography in Carotid Plaque Characterization

PubMed Central

Noh, Sang-Mi; Choi, Won Jun; Kang, Byeong-Teck; Jeong, Sang-Wuk; Lee, Dong Kun; Schellingerhout, Dawid; Yeo, Jeong-Seok

2013-01-01

Background and Purpose To estimate clinical roles of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) versus angiography and ultrasonography in carotid plaque characterization. Methods We characterized two groups of patients with recently (<1 month) symptomatic (n=14; age=71.8±8.6 years, mean±SD) or chronic (n=13, age=68.9±9.0 years) carotid stenosis using a battery of imaging tests: diffusion magnetic resonance (MR) imaging, MR or transfemoral angiography, duplex ultrasonography (DUS), and carotid FDG-PET/computed tomography. Results The degree of angiographic stenosis was greater in patients with recently symptomatic carotid plaques (67.5±21.5%) than in patients with chronic carotid plaques (32.4±26.8%, p=0.001). Despite the significant difference in the degree of stenosis, lesional maximum standardized uptake values (maxSUVs) on the carotid FDG-PET did not differ between the recently symptomatic (1.56±0.53) and chronic (1.56±0.34, p=0.65) stenosis groups. However, lesional-to-contralesional maxSUV ratios were higher in the recently symptomatic stenosis group (113±17%) than in the chronic stenosis group (98±10%, p=0.017). The grayscale median value of the lesional DUS echodensities was lower in the recently symptomatic stenosis group (28.2±10.0, n=9) than in the chronic stenosis group (53.9±14.0, n=8; p=0.001). Overall, there were no significant correlations between angiographic stenosis, DUS echodensity, and FDG-PET maxSUV. Case/subgroup analyses suggested complementarity between imaging modalities. Conclusions There were both correspondences and discrepancies between the carotid FDG-PET images and DUS or angiography data. Further studies are required to determine whether FDG-PET could improve the clinical management of carotid stenosis. PMID:23894241

Transverse sinus stenosis in adult patients with Chiari malformation type I.

PubMed

Saindane, Amit M; Bruce, Beau B; Desai, Nilesh K; Roller, Lauren A; Newman, Nancy J; Biousse, Valérie

2014-10-01

Transverse sinus stenosis is an imaging finding very highly associated with elevated intracranial pressure (ICP). Patients with the Chiari I malformation may potentially have elevated ICP due to impairment of CSF flow at the foramen magnum. This study evaluated whether patients with Chiari I malformation have transverse sinus stenosis and other imaging findings indicative of elevated ICP. Thirty patients with Chiari I malformation treated surgically and 76 control subjects were identified retrospectively. All control subjects and all patients with Chiari I malformation (preoperatively) underwent standardized contrast-enhanced brain MRI including a contrast-enhanced 3D T1-weighted sequence from which curved reformats of the transverse sinuses were generated. Two different readers blinded to the diagnosis then independently evaluated these curved reformats for severity of transverse sinus stenosis. Orbital and skull-base findings previously described in association with elevated ICP were also evaluated. Frequency of MRI findings between the two groups was compared. Patients with Chiari I malformation had significantly greater frequency of unilateral or bilateral transverse sinus stenosis than did control subjects (p < 0.001). There was complete interreader agreement on presence or absence of transverse sinus stenosis by patient (κ = 1.0 [95% CI, 0.89-1.0]). Logistic regression analysis controlling for age, sex, and body mass index found that transverse sinus stenosis significantly predicted Chiari I malformation versus control status (odds ratio, 11.2 [95% CI, 2.1-59.0]; p = 0.004) but that no other features were significantly associated with the Chiari I malformation. Patients with Chiari I malformation who had transverse sinus stenosis had significantly greater pituitary flattening than did those without transverse sinus stenosis (p = 0.02). Patients with Chiari I malformation have higher likelihood of transverse sinus stenosis, which may reflect associated elevated ICP.

Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer.

PubMed

Atsumi, Kazushige; Shioyama, Yoshiyuki; Nakamura, Katsumasa; Nomoto, Satoshi; Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Ueda, Masanobu; Hirata, Hideki; Honda, Hiroshi

2010-01-01

The purpose of this retrospective study was to clarify the predictive factors correlated with esophageal stenosis within three months after radiation therapy for locally advanced esophageal cancer. We enrolled 47 patients with advanced esophageal cancer with T2-4 and stage II-III who were treated with definitive radiation therapy and achieving complete response of primary lesion at Kyushu University Hospital between January 1998 and December 2005. Esophagography was performed for all patients before treatment and within three months after completion of the radiation therapy, the esophageal stenotic ratio was evaluated. The stenotic ratio was used to define four levels of stenosis: stenosis level 1, stenotic ratio of 0-25%; 2, 25-50%; 3,50-75%; 4,75-100%. We then estimated the correlation between the esophageal stenosis level after radiation therapy and each of numerous factors. The numbers and total percentages of patients at each stenosis level were as follows: level 1: n = 14 (30%); level 2: 8 (17%); level 3: 14 (30%); and level 4: 11 (23%). Esophageal stenosis in the case of full circumference involvement tended to be more severe and more frequent. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. The extent of involved circumference and wall thickness of tumor region were significantly correlated with esophageal stenosis associated with tumor regression in radiation therapy (p = 0.0006, p = 0.005). For predicting the possibility of esophageal stenosis with tumor regression within three months in radiation therapy, the extent of involved circumference and esophageal wall thickness of the tumor region may be useful.

Gadolinium-enhanced magnetic resonance angiography in renal artery stenosis: comparison with digital subtraction angiography.

PubMed

Law, Y M; Tay, K H; Gan, Y U; Cheah, F K; Tan, B S

2008-04-01

To evaluate the accuracy of gadolinium-enhanced magnetic resonance angiography in assessing renal artery stenosis compared to catheter digital subtraction angiography. Retrospective study. Singapore General Hospital. Records of patients who underwent magnetic resonance angiography as well as digital subtraction angiography for assessment of renal artery stenosis from January 2003 to December 2005 were reviewed. There were 27 patients (14 male, 13 female) with a mean age of 62 (range, 44-77) years. There were 10 patients with renal transplants; their native renal arteries were not evaluated. Each of the two experienced interventional and body magnetic resonance radiologists, who were blinded to the results, reviewed the digital subtraction angiography and magnetic resonance angiography images respectively. Digital subtraction angiography was used as the standard of reference. A total of 39 renal arteries from these 27 patients were evaluated. One of the arteries was previously stented and could not be assessed with magnetic resonance angiography due to severe artefacts. Of the remaining 38 renal arteries, two were graded as normal, seven as having mild stenosis (<50%), eight as having moderate stenosis (> or =50% but <75%), and 21 as having severe stenosis (> or =75%). Magnetic resonance angiography and digital subtraction angiography were concordant in 89% of the arteries; magnetic resonance angiography overestimated the degree of stenosis in 8% and underestimated it in 3% of them. In the evaluation of clinically significant renal artery stenosis (> or =50%) with magnetic resonance angiography, the overall sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 67%, 90%, and 86% respectively. The sensitivity and specificity of magnetic resonance angiography in transplant renal artery stenosis was 100%. CONCLUSION. Our experience suggested that gadolinium-enhanced magnetic resonance angiography is a sensitive non-invasive modality useful in the assessment of clinically significant renal artery stenosis.

National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis.

PubMed

Arous, Edward J; Simons, Jessica P; Flahive, Julie M; Beck, Adam W; Stone, David H; Hoel, Andrew W; Messina, Louis M; Schanzer, Andres

2015-10-01

Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA. The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at >300 centers by >2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery. Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a <80% asymptomatic carotid artery stenosis is from 0% to 100%. Similarly, at the center level, institutions range in the percentage of CEA procedures performed for a <80% asymptomatic carotid artery stenosis from 0% to 100%. Despite CEA being an extremely common procedure, there is widespread variation in the three primary determinants-preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery-of whether CEA is performed for asymptomatic carotid stenosis. Standardizing the approach to care for asymptomatic carotid artery stenosis will mitigate the significant downstream effects of this variation on health care costs. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

RCN adds crosses in remembrance.

PubMed

2014-11-18

Outgoing RCN president Andrea Spyropoulos (left) and RCN student council member Claire Jeeves planted crosses at the Field of Remembrance at Westminster last week to honour all nurses who have died in times of conflict.

White House Science Fair

NASA Image and Video Library

2014-05-27

Girl Scout troop 2612 members from Tulsa, OK take photos of one another with Google Glass at the White House Science Fair Tuesday, May 27, 2014. Avery Dodson, 6; Natalie Hurley, 8; Miriam Schaffer, 8; Claire Winton, 8; and Lucy Claire Sharp, 8 participated in the Junior FIRST Lego League's Disaster Blaster Challenge, which invites elementary-school-aged students from across the country to explore how simple machines, engineering, and math can help solve problems posed by natural disasters. The girls invented the "Flood Proof Bridge" and built a model mechanizing the bridge using motors and developing a computer program to automatically retract the bridge when flood conditions are detected. The fourth White House Science Fair was held at the White House and included 100 students from more than 30 different states who competed in science, technology, engineering, and math (STEM) competitions. (Photo Credit: NASA/Aubrey Gemignani)

Lake St. Clair zooplankton: Evidence for post-Dreissena changes

USGS Publications Warehouse

David, Katherine A.; Davis, Bruce M.; Hunter, R. Douglas

2009-01-01

We surveyed the zooplankton of Lake St. Clair at 12 sites over ten dates from May to October 2000. Mean zooplankton density by site and date was 168.6 individuals/L, with Dreissena spp. veligers the most abundant taxon at 122.7 individuals/L. Rotifers, copepods, and cladocerans were far lower in mean abundance than in the early 1970s (rotifers, 20.9/L; copepods, 18.1/L; and cladocerans, 6.8/L). Species richness of zooplankton taxa in 2000 was 147, which was virtually unchanged from that of the first reported survey in 1894. Overall, the decline in abundance was greatest for rotifers (-90%) and about equal for cladocerans (-69%) and copepods (-66%). The decrease in abundance of Daphnia spp. was especially dramatic in Canadian waters. The decline in the southeastern region was significant for all three major groups of zooplankton, whereas in the northwestern region the decline was significant only for rotifers. From June to August 2000, Lake St. Clair open waters were numerically dominated by Dreissena spp. veligers, with a reduced abundance of rotifers and crustaceans compared to pre-Dreissena spp. surveys. Mean nutrient concentrations were not different from the 1970s, but Secchi depth (greater) and chlorophyll a concentration (lower) were. Disproportionate reduction in rotifer abundance is consistent with hypotheses implicating direct consumption by settled Dreissena spp. Reduction of crustaceans is likely due to more complex interactions including removal of nauplii as well as resource competition for phytoplankton.

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

Dondi, M.; Franchi, R.; Levorato, M.

One-hundred five hypertensive patients underwent conventional renal scintigraphy followed 2 or 3 days later by Captopril-enhanced renal scintigraphy, performed 1 hr after premedication with 50 mg of Captopril per os. All patients were then submitted to renal arteriography, performed within 15-30 days. Fifty-five patients had no renal artery stenosis, 29 had unilateral disease, and 21 bilateral. Overall, 34/37 patients were diagnosed by the provocative test as having at least one renal artery affected by a stenosis greater than 50%. Of those with no stenosis (n = 55) or stenosis less than 50% (n = 13) only two cases were falselymore » positive. Thus sensitivity was 92% and specificity 97%. For single kidney identification with stenosis greater than 50%, sensitivity of renal scintigraphy after Captopril administration was 94% and specificity 98%. Captopril enhanced renal scintigraphy is thus suggested as the first test to be performed in hypertensive patients referred for renal scintigraphic studies. Only those cases with equivocal results require a baseline study for better assessment.« less

Esophageal luminal stenosis is an independent prognostic factor in esophageal squamous cell carcinoma.

PubMed

Yang, Yu-Shang; Hu, Wei-Peng; Ni, Peng-Zhi; Wang, Wen-Ping; Yuan, Yong; Chen, Long-Qi

2017-06-27

Predictive value of preoperative endoscopic characteristic of esophageal tumor has not been fully evaluated. The aim of this study is to investigate the impact of esophageal luminal stenosis on survival for patients with resectable esophageal squamous cell carcinoma (ESCC). The clinicopathologic characteristics of 623 ESCC patients who underwent curative resection as the primary treatment between January 2005 and April 2009 were retrospectively reviewed. The esophageal luminal stenosis measured by endoscopy was defined as a uniform measurement preoperatively. The impact of esophageal luminal stenosis on patients' overall survival (OS) and relation with other clinicopathological features were assessed. A Cox regression model was used to identify prognostic factors. The results showed that OS significantly decreased in patients with manifest stenotic tumor compared with patients without luminal obstruction (P<0.05). Considerable esophageal luminal stenosis was associated with a higher T stage, longer tumor length, and poorer differentiation (all P<0.05). In multivariate survival analysis, esophageal luminal stenosis remained as an independent prognostic factor for OS (P= 0.036). Esophageal luminal stenosis could have a significant impact on the OS in patients with resected ESCC and may provide additional prognostic value to the current staging system before any cancer-specific treatment.

Section 905(B) WRDA 86, Reconnaissance Study of Ecosystem Restoration for the Clinton River and Anchor Bay Watersheds, Macomb County and St. Clair County, Michigan

DTIC Science & Technology

2012-07-01

water quality, potential for growth of invasive species , and fish and wildlife habitat . Clinton River and Anchor Bay Watersheds Reconnaissance...However, the study area provides important habitat for many rare species , with the most abundant being wooded areas. In addition, the study area features...animal life and provide spawning grounds for fish. These areas provide habitat for numerous species , including rare species such as black- crowned

Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

PubMed

Bonati, Leo H; Ederle, Jörg; Dobson, Joanna; Engelter, Stefan; Featherstone, Roland L; Gaines, Peter A; Beard, Jonathan D; Venables, Graham S; Markus, Hugh S; Clifton, Andrew; Sandercock, Peter; Brown, Martin M

2014-04-01

The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and carotid endarterectomy [2.43 (1.03-5.73), P = 0.04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1.68 (1.12-2.53), P = 0.01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Endoscopic Cold Incision, Balloon Dilation, Mitomycin C Application, and Steroid Injection for Adult Laryngotracheal Stenosis

PubMed Central

Parker, Noah P.; Bandyopadhyay, Dipankar; Misono, Stephanie; Goding, George S.

2017-01-01

Objectives/Hypothesis To describe the presentation, stenosis characteristics, etiological differences, and outcomes of adult laryngotracheal stenosis treated with endoscopic cold incision, balloon dilation, topical mitomycin C application, and steroid injection. Study Design Retrospective chart review. Methods Demographic and clinical data were extracted for patients treated between March 2000 and December 2010. Prolonged intubation and idiopathic patient data were utilized for comparative analysis. Results Eighty patients (65 females; 15 males; 220 procedures; 2.9 years mean follow-up) presented with dyspnea (81%) and/or exercise intolerance (40%). Most commonly, etiologies were idiopathic (53 of 80; 66%) or prolonged intubation (14 of 80; 18%). Mean procedures per patient and interval between procedures were 2.8 procedures and 405 days, respectively. Mean stenosis length and distance from the caudal phonating edge of the true vocal folds were 9 mm and 19 mm. Complication, tracheotomy, and open-procedure rates were 1.8%, 1.4%, and 10.0%, respectively. Patients with more than two procedures demonstrated a mean 4-mm reduction in stenosis length and a 2-mm cephalad progression of stenosis over time. More caudal stenoses required more frequent procedures. Procedures were less frequent as more procedures were performed. Stenosis characteristics, interval between procedures, and total procedures were similar between idiopathic patients with or without intubation histories, but different between idiopathic and prolonged intubation patients. Conclusions This procedure was shown to be a viable option in adult laryngotracheal stenosis. Repeat dilation was likely, but was performed without adversely affecting stenosis characteristics. Stenoses farther from the vocal folds required procedures more frequently. Idiopathic patients with a history of brief, elective intubation had stenosis characteristics and responses to therapy similar to idiopathic patients without an intubation history. Both idiopathic groups together demonstrated stenosis characteristics and responses to therapy dissimilar to patients with a history of prolonged intubation. PMID:23086662

Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

PubMed Central

Tosteson, Anna N.A.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Herkowitz, Harry; Albert, Todd; Boden, Scott D.; Bridwell, Keith; Longley, Michael; Andersson, Gunnar B.; Blood, Emily A.; Grove, Margaret R.; Weinstein, James N.

2009-01-01

Background The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design Prospective cohort study. Data Sources Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon 2 years. Perspective Societal. Intervention Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus non-operative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis Surgery cost markedly affected the value of surgery. Limitation The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment non-adherence among randomly assigned participants. Conclusion The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon. PMID:19075203

The IMPACT Study (Influence of Sensor-Equipped Microcatheters on Coronary Hemodynamics and the Accuracy of Physiological Indices of Functional Stenosis Severity).

PubMed

Wijntjens, Gilbert W M; van de Hoef, Tim P; Kraak, Robin P; Beijk, Marcel A; Sjauw, Krischan D; Vis, M Marije; Madera Cambero, Maribel I; Brinckman, Stijn L; Plomp, Jacobus; Baan, Jan; Koch, Karel T; Wykrzykowska, Joanna J; Henriques, José P; de Winter, Robbert J; Piek, Jan J

2016-12-01

The Navvus pressure sensor-equipped microcatheter allows to measure functional stenosis severity over a work-horse guidewire and is used as a more feasible alternative to regular sensor-equipped wires. However, Navvus is larger in diameter than contemporary sensor-equipped guidewires and may, thereby, influence functional measurements. The present study evaluates the hemodynamic influence of the Navvus microcatheter. In patients with intermediate coronary stenosis, coronary pressure and flow velocity were measured using a dual sensor-equipped guidewire before and after introduction of Navvus. Patients were randomized to microcatheter-first or guidewire-first measurement. The primary end point was the difference in hyperemic stenosis resistance index between measurements before and after introduction of Navvus. Measurements were completed in 28 patients (28 stenoses). Mean hyperemic stenosis resistance was 0.37±0.19 Hg/cm/s for wire-only assessment and 0.48±0.26 Hg/cm/s after Navvus introduction (P<0.001). Bland-Altman analysis documented a mean bias of +0.11 Hg/cm/s (limits of agreement: -0.13 to 0.36), proportional to mean hyperemic stenosis resistance (Spearman ρ =0.61; P=0.001). Passing-Bablok analysis revealed absence of a constant difference but significant proportional difference between the methods. Mean fractional flow reserve was 0.86±0.06 for wire-only assessment and 0.82±0.07 after Navvus introduction (P<0.001). Bland-Altman analysis documented a mean bias of -0.033 (limits of agreement: -0.09 to 0.03), proportional to mean fractional flow reserve (Spearman ρ =0.40; P=0.036). Passing-Bablok analysis revealed significant constant and proportional differences between methods. Similar results were documented for resting indices of stenosis severity. Introduction of the Navvus microcatheter leads to clinically relevant stenosis severity overestimation in intermediate stenosis. © 2016 American Heart Association, Inc.

Esophagram findings in cervical esophageal stenosis: A case-controlled quantitative analysis.

PubMed

West, Jacob; Kim, Cherine H; Reichert, Zachary; Krishna, Priya; Crawley, Brianna K; Inman, Jared C

2018-01-04

Cervical esophageal stenosis is often diagnosed with a qualitative evaluation of a barium esophagram. Although the esophagram is frequently the initial screening exam for dysphagia, a clear objective standard for stenosis has not been defined. In this study, we measured esophagram diameters in order to establish a quantitative standard for defining cervical esophageal stenosis that requires surgical intervention. Single institution case-control study. Patients with clinically significant cervical esophageal stenosis defined by moderate symptoms of dysphagia (Functional Outcome Swallowing Scale > 2 and Functional Oral Intake Scale < 6) persisting for 6 months and responding to dilation treatment were matched with age, sex, and height controls. Both qualitative and quantitative barium esophagram measurements for the upper, mid-, and lower vertebral bodies of C5 through T1 were analyzed in lateral, oblique, and anterior-posterior views. Stenotic patients versus nonstenotic controls showed no significant differences in age, sex, height, body mass index, or ethnicity. Stenosis was most commonly at the sixth cervical vertebra (C 6) lower border and C7 upper border. The mean intraesophageal minimum/maximum ratios of controls and stenotic groups in the lateral view were 0.63 ± 0.08 and 0.36 ± 0.12, respectively (P < 0.0001). Receiver operating characteristic analysis of the minimum/maximum ratios, with a <0.50 ratio delineating stenosis, demonstrated that lateral view measurements had the best diagnostic ability. The sensitivity of the radiologists' qualitative interpretation was 56%. With application of lateral intraesophageal minimum/maximum ratios, we observed improved sensitivity to 94% of the esophagram, detecting clinically significant stenosis. Applying quantitative determinants in esophagram analysis may improve the sensitivity of detecting cervical esophageal stenosis in dysphagic patients who may benefit from surgical therapy. IIIb. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

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

Saba, Luca, E-mail: lucasaba@tiscali.it; Sanfilippo, Roberto; Montisci, Roberto

Purpose: The purpose of this work was to determine whether it is possible to identify a reliable carotid stenosis threshold-measured in millimeters (mm)-that is associated with cerebrovascular symptoms. Methods: Written, informed consent was obtained for each patient; 149 consecutive patients (98 men; median age, 68 years) were studied for suspected pathology of the carotid arteries by using MDCTA. In each patient, carotid artery stenosis was quantified using the mm-method. Continuous data were described as the mean value {+-} standard deviation (SD), and they were compared by using the Student's t test. A ROC curve was calculated to test the studymore » hypothesis and identify a specific mm-stenosis threshold. Logistic regression analysis was performed to include other MDCTA findings, such as plaque type and ulcerations. A P value < 0.05 was considered to indicate statistical significance. Results: Twenty-six patients were excluded. Of those remaining, 75 patients suffered cerebrovascular symptoms (61%). There was a statistically significant difference (P = 0.0046) in the mm-carotid stenosis between patients with symptoms (1.31 {+-} 0.64 mm SD) and without symptoms (1.68 {+-} 0.79 mm SD). Multiple logistic regression analysis confirmed that symptoms were associated with increased luminal stenosis (P = 0.013) and with the presence of fatty plaques (P = 0.0491). Moreover, the ROC curve (Az = 0.669; {+-}0.051 SD; P = 0.0009) indicated that a threshold of 1.6 mm stenosis was associated with a sensitivity to symptoms of 76%. Conclusions: The results of our study suggest an association between luminal stenosis (measure in mm) and the presence of cerebrovascular symptoms. Luminal stenosis of 1.6 mm is associated, with a sensitivity of 76%, with cerebrovascular symptoms.« less

Is there a rural gradient in the diagnosis of aortic stenosis? An analysis of a remote Scottish cohort.

PubMed

Maycock, Matthew I; Farman, Colin; Mort, Alasdair; Turpie, David; Leslie, Stephen J

2013-01-01

Calcific aortic stenosis is the most common cardiac valve lesion and is becoming increasingly prevalent as life expectancy rises. There is evidence that patients in remote and rural areas with certain diseases have worse outcomes and present to specialist services later than their urban counterparts. It is not known whether patients with aortic stenosis follow a similar pattern. The aim of this study was to investigate whether increasing rurality was associated with later presentation to healthcare services at a more advanced stage of aortic stenosis. This was a retrospective cohort study. Using ICD-10 discharge codes and local databases, 605 patients with aortic stenosis who presented between 31 November 1999 and 1 December 2008 were identified. Aortic stenosis was defined as a pressure gradient across the aortic valve of 25 mmHg or more. Patients with prior aortic valve replacement were excluded. Clinical notes were reviewed for all patients. Gender, age and pressure gradient across the aortic valve at presentation and patient GP-practice location were recorded. Patients were then assigned a Clinical Peripherality Index score based on the postcode of their GP's practice to define rurality. Patient data were compared across the six defined levels of clinical peripherality by ANOVA. Mean patient age was 73 ± 13 years, and 336 (54%) were male. The peak gradient across the valve was 41.1 ± 26.7 mmHg. There was no association between the level of clinical peripherality and the stage of aortic stenosis at presentation, age or gender (all p >0.05). There was no urban-rural gradient in the severity of aortic stenosis at presentation in this remote Scottish cohort. This suggests that patients with this condition in remote areas do not present later in their disease trajectory.

Decreased left ventricular torsion in patients with isolated mitral stenosis.

PubMed

Kirilmaz, B; Asgun, F; Saygi, S; Ercan, E

2015-02-01

Left ventricular (LV) torsion is a sensitive indicator of myocardial contractility and cardiac structure, and has recently been recognized as a sensitive indicator of cardiac performance. The aim of our study was to assess the effect of isolated mitral stenosis on LV torsion. We enrolled 19 patients with isolated mitral stenosis and 19 age- and gender-matched healthy subjects in the study. All patients had a normal sinus rhythm. All study subjects underwent two-dimensional echocardiography. Basal and apical LV rotations and LV torsion were evaluated using speckle-tracking echocardiography. Demographic characteristics, basic echocardiographic measures of LV ejection fraction, LV wall thickness, and LV mass index were similar between the two groups. The degrees of LV torsion (11.3 ± 4.7, 15.4 ± 4.9°, p=0.014) and LV basal rotation (- 3.7 ± 1.9, - 6.5 ± 2.1°, p< 0.001) were significantly decreased in the mitral stenosis group. There was a moderate positive correlation between mitral valve area and LV torsion (r=0.531, p=0.019). We showed significant reductions in LV torsion and LV basal rotation in patients with mitral valve stenosis. Structural and anatomical changes occurring during the progression of mitral stenosis may be responsible for these impaired movements.

Building Local and Transnational Feminisms: An Interview with Noelia Corrales and Lussiana Salazar of la Escuela de Español Colibrí in Matagalpa, Nicaragua

ERIC Educational Resources Information Center

Kemp, Theresa D.

2016-01-01

In 2009, the University of Wisconsin-Eau Claire's (UWEC) women's studies program offered its first iteration of the faculty-led international immersion course Women's Lives and Experiences in Nicaragua. This program was created and initially led by Dr. Rose-Marie Avin, a faculty member in the economics department and an affiliate member of both…

Directional atherectomy facilitates the interventional procedure and leads to a low rate of recurrent stenosis in left anterior descending and left circumflex artery ostium stenoses: subgroup analysis of the FLEXI‐CUT study

PubMed Central

Dahm, J B; Ruppert, J; Hartmann, S; Vogelgesang, D; Hummel, A; Felix, S B

2006-01-01

Objectives To examine by retrospective analysis of data from the FLEXI‐CUT monocentre registry whether atherectomy can effectively simplify complex stent implantation in ostial bifurcation lesions by reducing the procedure to stenting of the left anterior descending (LAD) or left circumflex (LCX) artery ostium alone. Patients and methods All patients who had been enrolled in the prospective FLEXI‐CUT study (directional atherectomy with adjunctive balloon angioplasty) were retrospectively analysed on the basis of significant LAD or LCX ostial stenosis (⩾ 70% stenosis) deriving from an undiseased left main stem. The primary combined end point was the rate of target lesion revascularisation (TLR) and binary restenosis; secondary end points were procedural success and major adverse cardiac events (MACE) at the six‐month follow up. Results Of 30 patients enrolled with significant LAD or LCX ostium stenosis, 29 were effectively treated with directional atherectomy (96.7% procedural success). All patients underwent single‐vessel stenting procedures of solely the LAD or LCX ostium. At follow up, binary stenosis was 25% (6 of 24), TLR (angiographic plus clinical) 10.3% (3 of 29) and total MACE 6.9% (2 of 29). Conclusions Directional atherectomy with single‐vessel stenting procedures facilitates the interventional treatment of LAD and LCX ostium stenosis, and leads to remarkably low TLR and binary stenosis at follow up. PMID:16449510

Prevalence of middle cerebral artery stenosis in asymptomatic subjects of more than 40 years age group: a transcranial Doppler study.

PubMed

Sada, Sujay; Reddy, Yugandhar; Rao, Sampath; Alladi, Suvarna; Kaul, Subash

2014-01-01

Middle cerebral artery (MCA) disease is the most common vascular lesion in stroke. Transcranial Doppler (TCD) is a non-invasive bedside screening method for assessing cerebral blood flow. To investigate the prevalence of MCA stenosis in asymptomatic but high-risk individuals for stroke. Prospective study between December 2011 and December 2013. Vascular risk factors considered included: hypertension (HTN), diabetes mellitus, smoking, alcohol consumption, coronary artery disease (CAD), peripheral vascular disease (PVD), hypercholesterolemia and obesity. TCD was performed with portable machine through the temporal windows by use of a standardized protocol. Of the 427 subjects, 374 were analyzed; males 264 (70.6%) and females 110 (29.4%). Mean age was 54.2 ± 7.6 years. The frequency of the risk factors was: HTN 287 (76.7%), diabetes 220 (58.8%), CAD 120 (32.1%), hypercholesterolemia 181 (48.4%), smoking 147 (39.3%), alcohol 99 (26.5%), obesity 198 (52.9%) and PVD 8 (2.1%). Of the 374 subjects, 27 (7.2%) had intracranial arterial stenosis and the rest had normal intracranial arteries. On univariate analysis, subjects with higher age, HTN, CAD, smoking and hypercholesterolemia had higher risk of having intracranial arterial stenosis (P < 0.05). Multivariate analysis showed HTN and CAD are independent risk factors for intracranial arterial stenosis. Overall prevalence of intracranial arterial stenosis is 7.2% in high-risk population sample from Hyderabad in South India. HTN and CAD are independent risk factors for the development of intracranial arterial stenosis.

Lumbar paraspinal muscle transverse area and symmetry in dogs with and without degenerative lumbosacral stenosis.

PubMed

Henderson, A L; Hecht, S; Millis, D L

2015-10-01

To investigate whether dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle transverse area and symmetry compared with control dogs. Retrospective cross-sectional study comparing muscles in transverse T2-weighted magnetic resonance images for nine dogs with and nine dogs without degenerative -lumbosacral stenosis. Mean transverse area was measured for the lumbar multifidus and sacrocaudalis dorsalis lateralis muscles bilaterally and the L7 vertebral body at the level of the caudal endplate. Transverse areas of both muscle groups relative to L7 and asymmetry indices were compared between study populations using independent t tests. Mean muscle-to-L7 transverse area ratios were significantly smaller in the degenerative lumbosacral stenosis group compared with those in the control group in both lumbar multifidus (0·84 ±0·26 versus 1·09 ±0·25; P=0·027) and sacrocaudalis dorsalis lateralis (0·5 ±0·15 versus 0·68 ±0·12; P=0·005) muscles. Mean asymmetry indices were higher for both muscles in the group with degenerative lumbosacral stenosis than in the control group, but highly variable and the difference was not statistically significant. These findings suggest that dogs with degenerative lumbosacral stenosis have decreased lumbar paraspinal muscle mass that may be a cause or consequence of the -syndrome. Understanding altered paraspinal muscle characteristics may improve understanding of the -pathophysiology and management options for degenerative lumbosacral stenosis. © 2015 British Small Animal Veterinary Association.

A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease.

PubMed

Raper, Daniel M S; Buell, Thomas J; Ding, Dale; Pomeraniec, I Jonathan; Crowley, R Webster; Liu, Kenneth C

2018-01-01

Safety and efficacy of superior sagittal sinus (SSS) stenting for non-thrombotic intracranial venous occlusive disease (VOD) is unknown. The aim of this retrospective cohort study is to evaluate outcomes after SSS stenting. We evaluated an institutional database to identify patients who underwent SSS stenting. Radiographic and clinical outcomes were analyzed and a novel angiographic classification of the SSS was proposed. We identified 19 patients; 42% developed SSS stenosis after transverse sinus stenting. Pre-stent maximum mean venous pressure (MVP) in the SSS of 16.2 mm Hg decreased to 13.1 mm Hg after stenting (p=0.037). Preoperative trans-stenosis pressure gradient of 4.2 mm Hg decreased to 1.5 mm Hg after stenting (p<0.001). No intraprocedural complication or junctional SSS stenosis distal to the stent construct was noted. Improvement in headache, tinnitus, and visual obscurations was reported by 66.7%, 63.6%, and 50% of affected patients, respectively, at mean follow-up of 5.2 months. We divided the SSS into four anatomically equal segments, numbered S1-S4, from the torcula to frontal pole. SSS stenosis typically occurs in the S1 segment, and the anterior extent of SSS stents was deployed at the S1-S2 junction in all but one case. SSS stenting is reasonably safe, may improve clinical symptoms, and significantly reduces maximum MVP and trans-stenosis pressure gradients in patients with VOD with SSS stenosis. The S1 segment is most commonly stenotic, and minimum pressure gradients for symptomatic SSS stenosis may be lower than for transverse or sigmoid stenosis. Additional studies and follow-up are necessary to better elucidate appropriate clinical indications and long-term efficacy of SSS stenting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Assessment of branch pulmonary artery stenosis in children after repair of tetralogy of Fallot using lung perfusion scintigraphy comparison with echocardiography.

PubMed

Chien, Kuang-Jen; Huang, Hurng-Wern; Huang, Ta-Cheng; Lee, Cheng-Liang; Weng, Ken-Pen; Lin, Chu-Chuan; Shieh, Po-Chuen; Wu, Ming-Ting; Hsieh, Kai-Sheng

2016-01-01

The aim of this study was to compare the usefulness of lung perfusion scintigraphy and echocardiogram in the evaluation of the branch pulmonary arteries stenosis in children with tetralogy of Fallot (TOF). From February 2006 to November 2008, 74 children (mean age 7.8 years, range 1–18 years) who underwent repair of TOF at ages from 10 months to 13 years were suspected to have unilateral or bilateral branch pulmonary artery stenosis. In all patients, cardiac angiography was performed to confirm the diagnosis of branch pulmonary artery stenosis. Lung perfusion scintigraphy and two-dimensional transthoracic echocardiography were performed in all patients to compare their abilities to diagnose branch pulmonary artery stenosis. Of the 74 patients, 51 cases were found to have branch pulmonary artery stenosis by cardiac angiography. There was agreement between the scintigraphic and angiographic findings in 44 (86%) patients and there were discrepancies in 11 (15%) patients. The positive predictive value of our lung perfusion scintigraphy in detecting the branch pulmonary artery stenosis was 92 %. The positive and negative likelihood ratios of lung perfusion scintigraphy were 4.96 and 0.17, respectively. There was conformity between the echocardiographic and angiographic findings in 40 (78%) patients with discrepancies in 16 (21%) patients. The positive predictive value of our echocardiography in detecting the branch pulmonary artery stenosis was 89%. The positive and negative likelihood ratios of echocardiography were 3.61 and 0.28, respectively. Lung perfusion scintigraphy is a valuable, non-invasive screening tool in the assessment of branch pulmonary artery stenosis in children after TOF.

Severe ipsilateral carotid stenosis and middle cerebral artery disease in lacunar ischaemic stroke: innocent bystanders?

PubMed

Mead, G E; Lewis, S C; Wardlaw, J M; Dennis, M S; Warlow, C P

2002-03-01

Lacunar infarcts are thought to be mostly due to intracranial small vessel disease. Therefore, when a stroke patient with a relevant lacunar infarct does have severe ipsilateral internal carotid artery (ICA) or middle cerebral artery (MCA) disease, it is unclear whether the arterial disease is causative or coincidental. If causative, we would expect ICA/MCA disease to be more severe on the symptomatic side than on the asymptomatic side. Therefore, our aim was to compare the severity of ipsilateral with contralateral ICA and MCA disease in patients with lacunar ischaemic stroke. We studied 259 inpatients and outpatients with a recent lacunar ischaemic stroke and no other prior stroke. We used carotid Duplex ultrasound and transcranial Doppler (TCD) ultrasound to identify ICA and MCA disease, and compared our results with previously published data. In our study, there was no difference between the severity of ipsilateral and contralateral ICA stenosis within individuals (median difference 0%, Wilcoxon paired data p=0.24, comparing severity of ipsilateral and contralateral stenosis). The overall prevalence of severe ipsilateral stenosis was 5%, and the prevalence of severe contralateral stenosis was 4% (OR 1.6, 95% CI 0.6, 4.8). There was no difference in the prevalence of ipsilateral and contralateral MCA disease. A systematic review of the other available studies strengthened this conclusion. Carotid stenosis in patients with a lacunar ischaemic stroke may be coincidental. Further studies are required to elucidate the causes of lacunar stroke, and to evaluate the role of carotid endarterectomy.

75 FR 19891 - Suspension of Community Eligibility

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

..., St. Clair County. Emerg; December 15, 1978, Reg; May 3, 2010, Susp. Ira, Township of, St. 260199... 310191 April 13, 1973, ......do -Do-. County. Emerg; January 16, 1980, Reg; May 3, 2010, Susp. La Vista...

400-420 N St Clair St, May 2014, Lindsay Light Radiological Survey

EPA Pesticide Factsheets

The field gamma measurements within the excavation and the spoil materials generatedduring the excavation process did not exceed the respective instrument threshold previously stated witha maximum of 8,000 cpm unshielded.

76 FR 20757 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-13

... Education, Christine Lazaro, Esq., Supervising Attorney, Clair S. Seu, Student Intern, and Stephen Chou, Student Intern, St. John's University School of Law Securities Arbitration Clinic, dated March 15, 2011...

455 N St Clair St, August 2012, Lindsay Light Radiological Survey

EPA Pesticide Factsheets

The field gamma measurements within the spoil materials generated during the drilling process did not exceed the respective threshold values previously stated withthe maximum unshielded gamma reading observed being 5,500 cpm.

Plaque Echolucency and Stroke Risk in Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis

PubMed Central

Gupta, Ajay; Kesavabhotla, Kartik; Baradaran, Hediyeh; Kamel, Hooman; Pandya, Ankur; Giambrone, Ashley E.; Wright, Drew; Pain, Kevin J.; Mtui, Edward E.; Suri, Jasjit S.; Sanelli, Pina C.; Mushlin, Alvin I.

2014-01-01

Background and Purpose Ultrasonographic plaque echolucency has been studied as a stroke risk marker in carotid atherosclerotic disease. We performed a systematic review and meta-analysis to summarize the association between ultrasound determined carotid plaque echolucency and future ipsilateral stroke risk. Methods We searched the medical literature for studies evaluating the association between carotid plaque echolucency and future stroke in asymptomatic patients. We included prospective observational studies with stroke outcome ascertainment after baseline carotid plaque echolucency assessment. We performed a meta-analysis and assessed study heterogeneity and publication bias. We also performed subgroup analyses limited to patients with stenosis ≥50%, studies in which plaque echolucency was determined via subjective visual interpretation, studies with a relatively lower risk of bias, and studies published after the year 2000. Results We analyzed data from 7 studies on 7557 subjects with a mean follow up of 37.2 months. We found a significant positive relationship between predominantly echolucent (compared to predominantly echogenic) plaques and the risk of future ipsilateral stroke across all stenosis severities (0-99%) (relative risk [RR], 2.31, 95% CI, 1.58-3.39, P<.001) and in subjects with ≥50% stenosis (RR, 2.61 95% CI, 1.47-4.63, P=.001). A statistically significant increased RR for future stroke was preserved in all additional subgroup analyses. No statistically significant heterogeneity or publication bias was present in any of the meta-analyses. Conclusions The presence of ultrasound-determined carotid plaque echolucency provides predictive information in asymptomatic carotid artery stenosis beyond luminal stenosis. However, the magnitude of the increased risk is not sufficient on its own to identify patients likely to benefit from surgical revascularization. PMID:25406150

Two cases of electrocautery incision therapy using an insulated-tip knife for treatment of symptomatic benign short-segment colonic stenosis following colonic resection.

PubMed

Kwon, Jang Hoon; Han, Koon Hee; Kim, Moon Ho; Jang, Woo Sung; Yun, Jung Ho; Song, Yun A; Park, Jong Kyu; Cheon, Gab Jin

2014-09-25

Anastomotic stenosis of the colon is not an uncommon finding; however, its frequency varies from one study to another. Traditionally, postoperative colonic stenosis is managed surgically. However, endoscopic therapy has recently become the preferred treatment modality over traditional surgery. Good short-term success has been achieved with use of endoscopic balloon dilation; however, restenosis may occur over time in 14% to 25% of patients. The current report showed the effectiveness and usefulness of an insulated-tip knife (IT-knife) for electrocautery therapy of a patient with symptomatic anastomotic colonic stenosis.

Mathematical modeling of pulsatile flow of non-Newtonian fluid in stenosed arteries

NASA Astrophysics Data System (ADS)

Sankar, D. S.; Lee, Usik

2009-07-01

The pulsatile flow of blood through mild stenosed artery is studied. The effects of pulsatility, stenosis and non-Newtonian behavior of blood, treating the blood as Herschel-Bulkley fluid, are simultaneously considered. A perturbation method is used to analyze the flow. The expressions for the shear stress, velocity, flow rate, wall shear stress, longitudinal impedance and the plug core radius have been obtained. The variations of these flow quantities with different parameters of the fluid have been analyzed. It is found that, the plug core radius, pressure drop and wall shear stress increase with the increase of yield stress or the stenosis height. The velocity and the wall shear stress increase considerably with the increase in the amplitude of the pressure drop. It is clear that for a given value of stenosis height and for the increasing values of the stenosis shape parameter from 3 to 6, there is a sharp increase in the impedance of the flow and also the plots are skewed to the right-hand side. It is observed that the estimates of the increase in the longitudinal impedance increase with the increase of the axial distance or with the increase of the stenosis height. The present study also brings out the effects of asymmetric of the stenosis on the flow quantities.

Levonorgestrel-releasing intrauterine system placement for severe uterine cervical stenosis after conization: two case reports.

PubMed

Motegi, Emi; Hasegawa, Kiyoshi; Kawai, Satoshi; Kiuchi, Kaori; Kosaka, Nobuaki; Mochizuki, Yoshiko; Fukasawa, Ichio

2016-03-09

Several approaches for treating severe uterine cervical stenosis after conization for cervical intraepithelial neoplasia have been reported; yet, the condition can still be difficult to treat successfully. We performed uterine cervical dilation surgery in two patients with severe stenosis, followed by insertion of the levonorgestrel-releasing intrauterine system, which is used for dysmenorrhea or endometriosis-related pain because of its strong progesterone activity. Patient 1 was a 34-year-old Japanese woman who was diagnosed with dysmenorrhea caused by recurrent uterine cervical stenosis and hematometra after laser conization. Patient 2 was a 44-year-old Japanese woman who developed dysmenorrhea and prolonged menstruation caused by uterine cervical stenosis without hematometra. After providing informed consent, they underwent cervical dilation surgery followed by insertion of the levonorgestrel-releasing intrauterine system. After treatment, their symptoms immediately improved, and after removal of their devices, they remained asymptomatic. To the best of our knowledge, this is the first report to confirm the usefulness and easy applicability of the levonorgestrel-releasing intrauterine system for uterine cervical stenosis. Although we had success with the method, this study of two patients is preliminary. Further study with larger numbers of patients is necessary to confirm the usefulness of our technique.

The association of the metalloproteinase-3 gene promoter polymorphisms and the middle cerebral artery stenosis.

PubMed

Fu, Chunli; Xing, Yingqi; Song, Xiaonan

2011-04-01

To investigate the association of single nucleotide polymorphism in the matrix metalloproteinase-3 (MMP3) gene promoter with the susceptibility to the middle cerebral artery stenosis. A case-control study was performed by determining the genotype of MMP3 gene promoter region using polymerase chain reaction-restriction fragment length polymorphism in 119 patients with middle cerebral artery stenosis documented by transcranial Doppler compared to 92 control patients. The frequencies of 5A and 6A alleles in MMP3 promoter region were 16.0 and 84.0% respectively in case group compared to 15.8 and 84.2% in control group with no significant difference between the two groups (P > 0.05). No significant difference was also observed in the distribution of genotypes 5A/5A,5A/6A, and 6A/6A between middle cerebral artery stenosis and control groups. Compared to 5A/5A + 5A/6A genotypes,the 6A/6A genotype did not significantly modify the risk of developing the middle cerebral artery stenosis. The MMP3-1171 dupA promoter polymorphisms are not valuable markers of susceptibility of the middle cerebral artery stenosis in this sample of population studied.

Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer.

PubMed

Lainas, P; Fuks, D; Gaujoux, S; Machroub, Z; Fregeville, A; Perniceni, T; Mal, F; Dousset, B; Gayet, B

2017-09-01

Oesophageal conduit necrosis following oesophagectomy is a rare but life-threatening complication. The present study aimed to assess the impact of coeliac axis stenosis on outcomes after oesophagectomy for cancer. The study included consecutive patients who had an Ivor Lewis procedure with curative intent for middle- and lower-third oesophageal cancer at two tertiary referral centres. All patients underwent preoperative multidetector CT with arterial phase to detect coeliac axis stenosis. The coeliac artery was classified as normal, with extrinsic stenosis due to a median arcuate ligament or with intrinsic stenosis caused by atherosclerosis. Some 481 patients underwent an Ivor Lewis procedure. Of these, ten (2·1 per cent) developed oesophageal conduit necrosis after surgery. Coeliac artery evaluation revealed a completely normal artery in 431 patients (91·5 per cent) in the group without conduit necrosis and in one (10 per cent) with necrosis (P < 0·001). Extrinsic stenosis of the coeliac artery due to a median arcuate ligament was found in two patients (0·4 per cent) without conduit necrosis and five (50 per cent) with necrosis (P < 0·001). Intrinsic stenosis of the coeliac artery was found in 11 (2·3 per cent) and eight (80 per cent) patients respectively (P < 0·001). Eight patients without (1·7 per cent) and five (50 per cent) with conduit necrosis had a single and thin left gastric artery (P < 0·001). This study suggests that oesophageal conduit necrosis after oesophagectomy for cancer may be due to pre-existing coeliac axis stenosis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Metoprolol vs ivabradine in patients with mitral stenosis in sinus rhythm.

PubMed

Agrawal, Vikas; Kumar, Niraj; Lohiya, Balalji; Sihag, Bhupendra K; Prajapati, Rajpal; Singh, T B; Subramanian, Geetha

2016-10-15

Severe mitral stenosis is usually symptomatic and is treated by BMV or surgery, whereas mild to moderate mitral stenosis is usually asymptomatic or mildly symptomatic and managed medically. Patients in the later group may become symptomatic during episodes of exercise and increased heart rate. Beta-blockers are frequently used in patients with mitral stenosis to control the heart rate and alleviate exercise-related symptoms. The objective of our study was to investigate the comparative efficacy of ivabradine versus metoprolol in patients with mitral stenosis in sinus rhythm. We studied 97 patients of mitral stenosis in sinus rhythm presented with exertional symptoms. The effectiveness of Metoprolol was compared with ivabradine in alleviating these exertional symptoms in a randomized, open label non crossover study. We also assessed various stress ECG parameters, 24 hour Holter parameters and 2D Echo parameters to objectively compare the effects of ivabradine and metoprolol in these patients. Ivabradine and metoprolol both were effective in controlling exertional symptoms. Significant improvement in objective parameters like TMT (work capacity, baseline heart rate and maximal heart rate) and 2D echocardiography (right ventricular systolic pressure) are seen with both drugs. Ivabradine controls the exertional symptoms significantly more than metoprolol. On head to head comparison there was a significant benefit of working capacity and heart rate at maximal exercise in favour of ivabradine. Ivabradine should be strongly considered in medical management of mitral stenosis patients where beta blockers are contraindicated such as reactive airway disease. The cost of ivabradine is higher than metoprolol which might possess constraints as most of the rheumatic heat disease patients belong to low socio economic status. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Value of the mitral valve resistance in evaluation of symptomatic patients with mild and moderate mitral stenosis--a dobutamine stress echocardiographic study.

PubMed

Roshdy, Hisham S; Meshrif, Amir M; El-Dosouky, Ibtesam I

2014-03-01

Conventional stenosis indexes poorly reflect the major hemodynamic consequence of mitral stenosis (MS). Valve resistance (VR) is a physiologic expression of stenosis. This study aimed to demonstrate whether the mitral valve resistance (MVR) and its changes, relate to restricted exercise capacity in patients with mild and moderate mitral stenosis. Twenty-four patients with rheumatic mild-to-moderate MS underwent transthoracic echocardiographic study (resting and dobutamine stress echocardiography [DSE]), divided into two groups; group I: symptomatic (12 patients) and group II: asymptomatic (12 patients). Mitral valve area (MVA), mean transmitral diastolic pressure gradient (TMPG), cardiac output (CO), and MVR were measured in all patients at rest and at peak DSE. Changes (∆) in MVA, TMPG, CO, and MVR were calculated. Data underwent statistical analysis. From resting to peak dobutamine infusion, the MVR significantly decreased from 111.4 ± 28.2 to 83.6 ± 27.0 dynes sec/cm(5) in group II (P < 0.001). The increase in MVR in group I (13.8 ± 10.3 dynes sec/cm(5)) compared with its reduction (-27.8 ± 15.6 dynes sec/cm(5)) in group II were highly significant different (P < 0.001). A reduction in MVR by less than 21.5 dynes sec/cm(5) at peak dobutamine infusion reflect a cutoff value considered to detect the hemodynamic significance of mild-to-moderate MS with a sensitivity of 92% and a specificity of 73%. The changes in the MVR can be used as a DSE parameter for expression of stenosis severity and to describe discrepancy in symptom status in patients with mild-to-moderate mitral stenosis. © 2013, Wiley Periodicals, Inc.

An acoustic doppler current profiler survey of flow velocities in Detroit River, a connecting channel of the Great Lakes

USGS Publications Warehouse

Holtschlag, David J.; Koschik, John A.

2003-01-01

Acoustic Doppler current profilers (ADCP) were used to survey flow velocities in Detroit River from July 8-19, 2002, as part of a study to assess the susceptibility of public water intakes to contaminants on the St. Clair-Detroit River Waterway. More than 3.5 million point velocities were measured at 130 cross sections. Cross sections were generally spaced about 1,800 ft apart along the river from the head of Detroit River at the outlet of Lake St. Clair to the mouth of Detroit River on Lake Erie. Two transects were surveyed at each cross section, one in each direction across the river. Along each transect, velocity profiles were generally obtained 0.8-2.2 ft apart. At each velocity profile, average water velocity data were obtained at 1.64 ft intervals of depth. The raw position and velocity data from the ADCP field survey were adjusted for local magnetic anomalies using global positioning system (GPS) measurements at the end points of the transects. The adjusted velocity and ancillary data can be retrieved though the internet and extracted to column-oriented data files.

Recreational fishing in surface mine lakes - a case study in St. Clair County, Illinois

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

Mannz, R.H.

1985-12-09

Recent mining legislation mandates the reclamation of surface-mined areas to the pre-mining contour, eliminating the potential of many new lakes. However, many pre-law mine lakes have considerable recreational value benefiting the surrounding regions. During 1983, 5296 anglers participated in Peabody Coal Company's Coal Company's recreational fishing program in St. Clair County, Illinois. A random sample of participants were mailed a questionnaire designed to identify user/area characteristics economic implications, and sport fishing resources of the program lakes. Sample data indicated 62,760 angling days spent on 600 acres of program waters during 1983. The single most sought after fish was the largemore » mouth bass. Expenditures by 1983 program users were estimated at $753,120 or $1255 per acre of surface water. Opportunity cost calculations indicated that recreational fishing was an equal or better trade-off to the regional economy when compared to income that could have been produced from rowcrop agriculture. Reclamation techniques designed for fish and wildlife purposes and leaving such areas should be encouraged. Returning surface-mined areas to the pre-mining contour and use is not necessarily the most cost effective or desirable method of reclamation. 14 references, 4 tables.« less

Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery.

PubMed

Baril, Donald T; Rhee, Robert Y; Kim, Justine; Makaroun, Michel S; Chaer, Rabih A; Marone, Luke K

2009-01-01

Endovascular intervention is considered first-line therapy for most superficial femoral artery (SFA) occlusive disease. Duplex ultrasound (DU) criteria for SFA in-stent stenosis and correlation with angiographic data remain poorly defined. This study evaluated SFA-specific DU criteria for the assessment of SFA in-stent stenosis. From May 2003 to May 2008, 330 limbs underwent SFA angioplasty and stenting and were monitored by serial DU imaging. Suspected stenotic lesions underwent angiography and intervention when appropriate. Data pairs of DU and angiographically estimated stenosis or=50% in-stent stenosis, a PSV >or=190 had 88% sensitivity, 95% specificity, a 98% positive predictive value (PPV), and a 72% negative predictive value (NPV); for Vr, a ratio of >1.50 had 93% sensitivity, 89% specificity, a 96% PPV, and a 81% NPV. To detect >or=80% in-stent stenosis, a PSV >or=275 had 97% sensitivity, 68% specificity, a 67% PPV, and a 97% NPV; a Vr ratio >or=3.50 had 74% sensitivity, 94% specificity, a 77% PPV, and a 88% NPV. Combining a PSV >or=275 and a Vr >or=3.50 to determine >or=80% in-stent stenosis had 74% sensitivity, 94% specificity, a 88% PPV, and a 85% NPV; odds ratio was 42.17 (95% confidence interval, 10.20-174.36, P < .001) to predict >or=80% in-stent stenosis. A significant drop in ABI (>0.15) correlated with a >62% in-stent stenosis, although the adjusted correlation coefficients was low (R(2) = 0.31, P = .02). PSV and Vr appear to have a significant role in predicting in-stent stenosis. To determine >or=80% stenosis, combining PSV >or=275 cm/s and Vr >or=3.50 is highly specific and predictive.

Experimental study of hemodynamics in the Circle of Willis.

PubMed

Zhu, Guangyu; Yuan, Qi; Yang, Jian; Yeo, Joon

2015-01-01

The Circle of Willis (CoW) is an important collateral pathway of the cerebral blood flow. An experimental study of the cerebral blood flow (CBF) distribution in different anatomical variations may help to a better understanding of the collateral mechanism of the CoW. An in-vitro test rig was developed to simulate the physiological cerebral blood flow in the CoW. Ten anatomical variations were considered in this study, include a set of different degrees of stenosis in L-ICA and L-ICA occlusion coexist with common anatomical variations. Volume flow rates of efferent arteries and pressure signals at the end of communicating arteries of each case were recorded. Physiological pressure waveforms were applied as inlet boundary condition. In the development of L-ICA stenosis, the total CBF decreases with the increase of stenosis degree. The blood supply of ipsilateral middle cerebral artery (MCA) was affected most by the stenosis of L-ICA. Anterior communicating artery (ACoA) and ipsilateral posterior communicating artery (PCoA) function as important collateral pathways of cerebral collateral circulation when unilateral stenosis occurred. The blood supply of anterior cerebral circulation was compensated by the posterior cerebral circulation through ipsilateral PCoA when L-ICA stenosis degree is greater than 40% and the affected side was compensated immediately by the unaffected side through ACoA. Blood flow of the anterior circulation and the total CBF reached the minimum among all cases studied when L-ICA occlusion coexist with the absence of PCoA. The results demonstrated the flow distribution patterns of the CoW under anatomical variations and clarified the collateral mechanism of the CoW. The flow ACoA is the most sensitive indexes to the morphology change of ipsilateral ICA. The relative independence of the circulation in anterior and posterior sections of the CoW is not broken and the function of ipsilateral PCoA is not activated until a severe stenosis of unilateral ICA occurs. PCoA is the most important collateral pathway of the collateral circulation and the missing of PCoA has the highest risk of stroke when the ipsilateral ICA has severe stenosis. These findings may provide the basis for future therapeutic and diagnosis applications.

Proteomic analysis of human plasma in chronic rheumatic mitral stenosis reveals proteins involved in the complement and coagulation cascade.

PubMed

Mukherjee, Somaditya; Jagadeeshaprasad, Mashanipalya G; Banerjee, Tanima; Ghosh, Sudip K; Biswas, Monodeep; Dutta, Santanu; Kulkarni, Mahesh J; Pattari, Sanjib; Bandyopadhyay, Arun

2014-01-01

Rheumatic fever in childhood is the most common cause of Mitral Stenosis in developing countries. The disease is characterized by damaged and deformed mitral valves predisposing them to scarring and narrowing (stenosis) that results in left atrial hypertrophy followed by heart failure. Presently, echocardiography is the main imaging technique used to diagnose Mitral Stenosis. Despite the high prevalence and increased morbidity, no biochemical indicators are available for prediction, diagnosis and management of the disease. Adopting a proteomic approach to study Rheumatic Mitral Stenosis may therefore throw some light in this direction. In our study, we undertook plasma proteomics of human subjects suffering from Rheumatic Mitral Stenosis (n = 6) and Control subjects (n = 6). Six plasma samples, three each from the control and patient groups were pooled and subjected to low abundance protein enrichment. Pooled plasma samples (crude and equalized) were then subjected to in-solution trypsin digestion separately. Digests were analyzed using nano LC-MS(E). Data was acquired with the Protein Lynx Global Server v2.5.2 software and searches made against reviewed Homo sapiens database (UniProtKB) for protein identification. Label-free protein quantification was performed in crude plasma only. A total of 130 proteins spanning 9-192 kDa were identified. Of these 83 proteins were common to both groups and 34 were differentially regulated. Functional annotation of overlapping and differential proteins revealed that more than 50% proteins are involved in inflammation and immune response. This was corroborated by findings from pathway analysis and histopathological studies on excised tissue sections of stenotic mitral valves. Verification of selected protein candidates by immunotechniques in crude plasma corroborated our findings from label-free protein quantification. We propose that this protein profile of blood plasma, or any of the individual proteins, could serve as a focal point for future mechanistic studies on Mitral Stenosis. In addition, some of the proteins associated with this disorder may be candidate biomarkers for disease diagnosis and prognosis. Our findings might help to enrich existing knowledge on the molecular mechanisms involved in Mitral Stenosis and improve the current diagnostic tools in the long run.

Diagnostic yield and accuracy of coronary CT angiography after abnormal nuclear myocardial perfusion imaging.

PubMed

Meinel, Felix G; Schoepf, U Joseph; Townsend, Jacob C; Flowers, Brian A; Geyer, Lucas L; Ebersberger, Ullrich; Krazinski, Aleksander W; Kunz, Wolfgang G; Thierfelder, Kolja M; Baker, Deborah W; Khan, Ashan M; Fernandes, Valerian L; O'Brien, Terrence X

2018-06-15

We aimed to determine the diagnostic yield and accuracy of coronary CT angiography (CCTA) in patients referred for invasive coronary angiography (ICA) based on clinical concern for coronary artery disease (CAD) and an abnormal nuclear stress myocardial perfusion imaging (MPI) study. We enrolled 100 patients (84 male, mean age 59.6 ± 8.9 years) with an abnormal MPI study and subsequent referral for ICA. Each patient underwent CCTA prior to ICA. We analyzed the prevalence of potentially obstructive CAD (≥50% stenosis) on CCTA and calculated the diagnostic accuracy of ≥50% stenosis on CCTA for the detection of clinically significant CAD on ICA (defined as any ≥70% stenosis or ≥50% left main stenosis). On CCTA, 54 patients had at least one ≥50% stenosis. With ICA, 45 patients demonstrated clinically significant CAD. A positive CCTA had 100% sensitivity and 84% specificity with a 100% negative predictive value and 83% positive predictive value for clinically significant CAD on a per patient basis in MPI positive symptomatic patients. In conclusion, almost half (48%) of patients with suspected CAD and an abnormal MPI study demonstrate no obstructive CAD on CCTA.

Patient specific 3-d modeling of blood flow in a multi-stenosed left coronary artery.

PubMed

Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Ameer Ahamad, N; Soudagar, Manzoor Elahi M; Govindaraju, Kalimuthu; Nik-Ghazali, N; Salman Ahmed, N J; Yunus Khan, T M

2017-01-01

The current study investigates the effect of multi stenosis on the hemodynamic parameters such as wall pressure, velocity and wall shear stress in the realistic left coronary artery. Patients CT scan image data of normal and diseased left coronary artery was chosen for the reconstruction of 3D coronary artery models. The diseased 3D model of left coronary artery shows a narrowing of more than 70% and 80% of area stenosis (AS) at the left main stem (LMS) and left circumflex (LCX) respectively. The results show that the decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. The maximum pressure drop was noted across the 80% AS at the left circumflex branch. The recirculation zone was also observed immediate to the stenosis and highest wall shear stress was found across the 80% area stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding on the hemodynamics in realistic coronary artery.

Idiopathic Supraglottic Stenosis Refractory to Multiple Interventions Improved With Serial Office-based Steroid Injections.

PubMed

Hoffman, Matthew R; Mai, Johnny P; Dailey, Seth H

2017-10-30

The objective of this study was to describe a patient with idiopathic supraglottic stenosis who experienced persistent disease despite multiple office-based and operative interventions, whose disease is now better controlled with scheduled serial office-based steroid injections. This is a case report and literature review. A 42-year-old female was referred for worsening supraglottic stenosis despite systemic steroids. She underwent awake tracheotomy. A thorough historical, histologic, and laboratory workup did not reveal an etiology to her stenosis. She later underwent endoscopic partial laryngectomy and was able to be decannulated. She underwent a second endoscopic partial laryngectomy two years later for worsening disease and then was managed over the next seven years with intermittent systemic steroids. Over the last year, she has undergone eight office-based steroid injections with improvement in her degree of stenosis and symptom burden. There are only four prior reported cases of idiopathic supraglottic stenosis, none of which has been managed with serial office-based steroid injections. This case report adds to the small body of literature on the management of this rare disease and proposes a new office-based treatment pathway that may help induce regression of stenosis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Acute renal haemodynamic and renin-angiotensin system responses to graded renal artery stenosis in the dog.

PubMed Central

Anderson, W P; Johnston, C I; Korner, P I

1979-01-01

1. The acute renal haemodynamic and renin-angiotensin system responses to graded renal artery stenosis were studied in chronically instrumented, unanaesthetized dogs. 2. Stenosis was induced over 30 sec by inflation of a cuff around the renal artery to lower distal pressure to 60, 40 or 20 mmHg, with stenosis maintained for 1 hr. This resulted in an immediate fall in renal vascular resistance, but over the next 5--30 min both resistance and renal artery pressure were restored back towards prestenosis values. Only transient increases in systemic arterial blood pressure and plasma renin and angiotensin levels were seen with the two milder stenoses. Despite restoration of renal artery pressure, renal blood flow remained reduced at all grades of stenosis. 3. Pre-treatment with angiotensin I converting enzyme inhibitor or sarosine1, isoleucone8 angiotensin II greatly attenuated or abolished the restoration of renal artery pressure and renal vascular resistance after stenosis, and plasma renin and angiotensin II levels remained high. Renal dilatation was indefinitely maintained, but the normal restoration of resistance and pressure could be simulated by infusing angiotensin II into the renal artery. 4. The effective resistance to blood flow by the stenosis did not remain constant but varied with changes in the renal vascular resistance. PMID:219182

Esophageal luminal stenosis is an independent prognostic factor in esophageal squamous cell carcinoma

PubMed Central

Yang, Yu-Shang; Hu, Wei-Peng; Ni, Peng-Zhi; Wang, Wen-Ping; Yuan, Yong; Chen, Long-Qi

2017-01-01

Background Predictive value of preoperative endoscopic characteristic of esophageal tumor has not been fully evaluated. The aim of this study is to investigate the impact of esophageal luminal stenosis on survival for patients with resectable esophageal squamous cell carcinoma (ESCC). Methods The clinicopathologic characteristics of 623 ESCC patients who underwent curative resection as the primary treatment between January 2005 and April 2009 were retrospectively reviewed. The esophageal luminal stenosis measured by endoscopy was defined as a uniform measurement preoperatively. The impact of esophageal luminal stenosis on patients’ overall survival (OS) and relation with other clinicopathological features were assessed. A Cox regression model was used to identify prognostic factors. Results The results showed that OS significantly decreased in patients with manifest stenotic tumor compared with patients without luminal obstruction (P<0.05). Considerable esophageal luminal stenosis was associated with a higher T stage, longer tumor length, and poorer differentiation (all P<0.05). In multivariate survival analysis, esophageal luminal stenosis remained as an independent prognostic factor for OS (P= 0.036). Conclusions Esophageal luminal stenosis could have a significant impact on the OS in patients with resected ESCC and may provide additional prognostic value to the current staging system before any cancer-specific treatment. PMID:28118615

Brazil: Rondonia

Atmospheric Science Data Center

2016-12-30

... Places where clouds or other factors precluded an aerosol retrieval are shown in dark grey.   The main measurement site for the ... within World Reference System-2 path 231.   Further information about the CLAIRE campaign, and the Large-scale-Biosphere-Atmosphere ...

40 CFR 81.350 - Wisconsin.

Code of Federal Regulations, 2011 CFR

2011-07-01

... County X Buffalo County X Chippewa County X Clark County X Crawford County X Dunn County X Eau Claire... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment...

40 CFR 81.350 - Wisconsin.

Code of Federal Regulations, 2010 CFR

2010-07-01

... County X Buffalo County X Chippewa County X Clark County X Crawford County X Dunn County X Eau Claire... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment...

COMBINATION SUMMER KITCHEN AND SMOKE HOUSE, VIEW TO EAST/NORTHEAST ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

COMBINATION SUMMER KITCHEN AND SMOKE HOUSE, VIEW TO EAST/NORTHEAST - Kiel Farmstead, Summer Kitchen & Smokehouse, East side State Route 4, one half mile south of U.S. Route 64, Mascoutah, St. Clair County, IL

SUMMER KITCHEN AND SMOKE HOUSE AND HOUSE, VIEW TO WEST/ ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

SUMMER KITCHEN AND SMOKE HOUSE AND HOUSE, VIEW TO WEST/ SOUTHWEST - Kiel Farmstead, Summer Kitchen & Smokehouse, East side State Route 4, one half mile south of U.S. Route 64, Mascoutah, St. Clair County, IL

PERSPECTIVE FROM SOUTH SHOWING WEATHERED BOARD AND BATTEN SIDING. NOTE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

PERSPECTIVE FROM SOUTH SHOWING WEATHERED BOARD AND BATTEN SIDING. NOTE BRIDGE SITS ON ONE CONCRETEFACED ABUTMENT AND ONE STONE PIER. - Beaverkill Bridge, Spanning Beaver Kill, TR 30 (Craigie Claire Road), Roscoe, Sullivan County, NY

5 CFR Appendix B to Subpart B of... - Nationwide Schedule of Nonappropriated Fund Regular Wage Surveys

Code of Federal Regulations, 2014 CFR

2014-01-01

... April Even. St. Clair April Even. Kansas Leavenworth-Jackson-Johnson April Even. Sedgwick April Odd... Juan February Even. Rhode Island Newport July Even. South Carolina Charleston February Even. Richland...

THE CENTER FOR URBAN ENVIRONMENTAL RESEARCH AND EDUCATION - UMBC

EPA Science Inventory

EPA GRANT NUMBER: R831058
Title: The Center for Urban Environmental Research and Education - UMBC
Investigator: Claire Welty
Institution: University of Maryland - Baltimore County
EPA Project Officer: Brandon Jones
Project...

Le consentement libre et éclairé aux soins en psychiatrie

PubMed Central

Neilson, Grainne; Chaimowitz, Gary

2015-01-01

Résumé Le patient a le droit d’être informé sur les soins de santé qui lui sont proposés et de participer activement à la prise de décisions relativement à ces soins. Le respect de la dignité et de l’autonomie de la personne passe par le respect de son droit de prendre des décisions à propos de ses soins psychiatriques, notamment de refuser un traitement, pour autant qu’elle soit apte à prendre des décisions. Il importe que le psychiatre connaisse les fondements éthiques du consentement libre et éclairé et les exigences prévues par le droit en cette matière, y compris la jurisprudence. Le consentement n’est pas immuable, pouvant changer avec le temps, au fil de l’évolution des conditions et des circonstances. Par conséquent, le consentement doit être un processus continu.

Intervention Therapy for Portal Vein Stenosis/Occlusion After Pediatric Liver Transplantation.

PubMed

Gao, Haijun; Wang, Hao; Chen, Guang; Yi, Zhengjia

2017-04-18

BACKGROUND The aim of this study was to investigate the outcomes and stent implantation timing of portal vein stenosis intervention after pediatric liver transplantation (pLT). MATERIAL AND METHODS The clinical data of 30 children with post-liver transplantation portal vein stenosis/occlusion (PVS/O) between Jan 2008 and Jun 2015 were retrospectively analyzed. The successfully re-opened cases used balloon angioplasty or stent implantation. SPSS13.0 software was used for statistical analysis and paired t test of the pressure gradient at both ends of the stenosis, diameter and flow rate within the stenosis, platelet count, and albumin in the PVS children before and after balloon angioplasty, with p<0.05 considered as statistically significant. Among the 30 patients, 6 received a stent implant in their first treatment, 22 received balloon angioplasty in their first treatment, and in 2 the re-opening could not be achieved. RESULTS The diameter of the stenotic segment, portal vein velocity, pressure gradient at both ends of the stenosis, and platelet count in these children with portal vein stenosis/occlusion (PVS/O) showed statistically significant differences when comparing values before and after intervention (p<0.05), but albumin showed no statistically significant difference (p>0.05). CONCLUSIONS Intervention therapy for portal vein stenosis after pediatric liver transplantation (pLT-PVS) is a safe and effective treatment, and patients with portal vein torsion, intimal tearing, or long portal vein segment occlusion should undergo stent implantation.

Internal Carotid Artery Stenosis and Collateral Recruitment in Stroke Patients.

PubMed

Dankbaar, Jan W; Kerckhoffs, Kelly G P; Horsch, Alexander D; van der Schaaf, Irene C; Kappelle, L Jaap; Velthuis, Birgitta K

2017-04-24

Leptomeningeal collaterals improve outcome in stroke patients. There is great individual variability in their extent. Internal carotid artery (ICA) stenosis may lead to more extensive recruitment of leptomeningeal collaterals. The purpose of this study was to evaluate the association of pre-existing ICA stenosis with leptomeningeal collateral filling visualized with computed tomography perfusion (CTP). From a prospective acute ischemic stroke cohort, patients were included with an M1 middle cerebral artery (MCA) occlusion and absent ipsilateral, extracranial ICA occlusion. ICA stenosis was determined on admission CT angiography (CTA). Leptomeningeal collaterals were graded as good (>50%) or poor (≤50%) collateral filling in the affected MCA territory on CTP-derived vessel images of the admission scan. The association between ipsilateral ICA stenosis ≥70% and extent of collateral filling was analyzed using logistic regression. In a multivariable analysis the odds ratio (OR) of ICA stenosis ≥70% was adjusted for complete circle of Willis, gender and age. We included 188 patients in our analyses, 50 (26.6%) patients were classified as having poor collateral filling and 138 (73.4%) as good. Of the patients 4 with poor collateral filling had an ICA stenosis ≥70% and 14 with good collateral filling. Unadjusted and adjusted ORs of ICA stenosis ≥70% for good collateral filling were 1.30 (0.41-4.15) and 2.67 (0.81-8.77), respectively. Patients with poor collateral filling had a significantly worse outcome (90-day modified Rankin scale 3-6; 80% versus 52%, p = 0.001). No association was found between pre-existing ICA stenosis and extent of CTP derived collateral filling in patients with an M1 occlusion.

Correlation between carotid bifurcation calcium burden on non-enhanced CT and percentage stenosis, as confirmed by digital subtraction angiography

PubMed Central

Sarikaya, B; Lohman, B; Mckinney, A M; Gadani, S; Irfan, M; Lucato, L

2012-01-01

Objectives Previous evidence supports a direct relationship between the calcium burden (volume) on post-contrast CT with the percent internal carotid artery (ICA) stenosis at the carotid bifurcation. We sought to further investigate this relationship by comparing non-enhanced CT (NECT) and digital subtraction angiography (DSA). Methods 50 patients (aged 41–82 years) were retrospectively identified who had undergone cervical NECT and DSA. A 64-multidetector array CT (MDCT) scanner was utilised and the images reviewed using preset window widths/levels (30/300) optimised to calcium, with the volumes measured via three-dimensional reconstructive software. Stenosis measurements were performed on DSA and luminal diameter stenoses >40% were considered “significant”. Volume thresholds of 0.01, 0.03, 0.06, 0.09 and 0.12 cm3 were utilised and Pearson'S correlation coefficient (r) was calculated to correlate the calcium volume with percent stenosis. Results Of 100 carotid bifurcations, 88 were available and of these 7 were significantly stenotic. The NECT calcium volume moderately correlated with percent stenosis on DSA r=0.53 (p<0.01). A moderate–strong correlation was found between the square root of calcium volume on NECT with percent stenosis on DSA (r=0.60, p<0.01). Via a receiver operating characteristic curve, 0.06 cm3 was determined to be the best threshold (sensitivity 100%, specificity 90.1%, negative predictive value 100% and positive predictive value 46.7%) for detecting significant stenoses. Conclusion This preliminary investigation confirms a correlation between carotid bifurcation calcium volume and percent ICA stenosis and is promising for the optimal threshold for stenosis detection. Future studies could utilise calcium volumes to create a “score” that could predict high grade stenosis. PMID:21896662

Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography

PubMed Central

Kim, Jae Woon; Lee, Jae Kyo

2012-01-01

Objective To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. Materials and Methods The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. Results Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. Conclusion Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra. PMID:22778561

Evaluation of coronary stenosis with the aid of quantitative image analysis in histological cross sections.

PubMed

Dulohery, Kate; Papavdi, Asteria; Michalodimitrakis, Manolis; Kranioti, Elena F

2012-11-01

Coronary artery atherosclerosis is a hugely prevalent condition in the Western World and is often encountered during autopsy. Atherosclerotic plaques can cause luminal stenosis: which, if over a significant level (75%), is said to contribute to cause of death. Estimation of stenosis can be macroscopically performed by the forensic pathologists at the time of autopsy or by microscopic examination. This study compares macroscopic estimation with quantitative microscopic image analysis with a particular focus on the assessment of significant stenosis (>75%). A total of 131 individuals were analysed. The sample consists of an atherosclerotic group (n=122) and a control group (n=9). The results of the two methods were significantly different from each other (p=0.001) and the macroscopic method gave a greater percentage stenosis by an average of 3.5%. Also, histological examination of coronary artery stenosis yielded a difference in significant stenosis in 11.5% of cases. The differences were attributed to either histological quantitative image analysis underestimation; gross examination overestimation; or, a combination of both. The underestimation may have come from tissue shrinkage during tissue processing for histological specimen. The overestimation from the macroscopic assessment can be attributed to the lumen shape, to the examiner observer error or to a possible bias to diagnose coronary disease when no other cause of death is apparent. The results indicate that the macroscopic estimation is open to more biases and that histological quantitative image analysis only gives a precise assessment of stenosis ex vivo. Once tissue shrinkage, if any, is accounted for then histological quantitative image analysis will yield a more accurate assessment of in vivo stenosis. It may then be considered a complementary tool for the examination of coronary stenosis. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Transverse Sinus Stenosis in Adult Patients With Chiari Malformation Type I

PubMed Central

Saindane, Amit M.; Bruce, Beau B.; Desai, Nilesh K.; Roller, Lauren A.; Newman, Nancy J.; Biousse, Valérie

2014-01-01

OBJECTIVE Transverse sinus stenosis is an imaging finding very highly associated with elevated intracranial pressure (ICP). Patients with the Chiari I malformation may potentially have elevated ICP due to impairment of CSF flow at the foramen magnum. This study evaluated whether patients with Chiari I malformation have transverse sinus stenosis and other imaging findings indicative of elevated ICP. MATERIALS AND METHODS Thirty patients with Chiari I malformation treated surgically and 76 control subjects were identified retrospectively. All control subjects and all patients with Chiari I malformation (preoperatively) underwent standardized contrast-enhanced brain MRI including a contrast-enhanced 3D T1-weighted sequence from which curved reformats of the transverse sinuses were generated. Two different readers blinded to the diagnosis then independently evaluated these curved reformats for severity of transverse sinus stenosis. Orbital and skull-base findings previously described in association with elevated ICP were also evaluated. Frequency of MRI findings between the two groups was compared. RESULTS Patients with Chiari I malformation had significantly greater frequency of unilateral or bilateral transverse sinus stenosis than did control subjects (p < 0.001). There was complete interreader agreement on presence or absence of transverse sinus stenosis by patient (κ = 1.0 [95% CI, 0.89–1.0]). Logistic regression analysis controlling for age, sex, and body mass index found that transverse sinus stenosis significantly predicted Chiari I malformation versus control status (odds ratio, 11.2 [95% CI, 2.1–59.0]; p = 0.004) but that no other features were significantly associated with the Chiari I malformation. Patients with Chiari I malformation who had transverse sinus stenosis had significantly greater pituitary flattening than did those without transverse sinus stenosis (p = 0.02). CONCLUSION Patients with Chiari I malformation have higher likelihood of trans-verse sinus stenosis, which may reflect associated elevated ICP. PMID:25247957

Validation of computational fluid dynamics-based analysis to evaluate hemodynamic significance of access stenosis.

PubMed

Hoganson, David M; Hinkel, Cameron J; Chen, Xiaomin; Agarwal, Ramesh K; Shenoy, Surendra

2014-01-01

Stenosis in a vascular access circuit is the predominant cause of access dysfunction. Hemodynamic significance of a stenosis identified by angiography in an access circuit is uncertain. This study utilizes computational fluid dynamics (CFD) to model flow through arteriovenous fistula to predict the functional significance of stenosis in vascular access circuits. Three-dimensional models of fistulas were created with a range of clinically relevant stenoses using SolidWorks. Stenoses diameters ranged from 1.0 to 3.0 mm and lengths from 5 to 60 mm within a fistula diameter of 7 mm. CFD analyses were performed using a blood model over a range of blood pressures. Eight patient-specific stenoses were also modeled and analyzed with CFD and the resulting blood flow calculations were validated by comparison with brachial artery flow measured by duplex ultrasound. Predicted flow rates were derived from CFD analysis of a range of stenoses. These stenoses were modeled by CFD and correlated with the ultrasound measured flow rate through the fistula of eight patients. The calculated flow rate using CFD correlated within 20% of ultrasound measured flow for five of eight patients. The mean difference was 17.2% (ranged from 1.3% to 30.1%). CFD analysis-generated flow rate tables provide valuable information to assess the functional significance of stenosis detected during imaging studies. The CFD study can help in determining the clinical relevance of a stenosis in access dysfunction and guide the need for intervention.

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

Ni, Nina, E-mail: nina.ni@yale.edu; Mojibian, Hamid; Pollak, Jeffrey

To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A {chi}{sup 2} test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venousmore » stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P < 0.01, {chi}{sup 2} test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P < 0.01, {chi}{sup 2} test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.« less

Assessment of Subvalvular Apparatus in Patients with Rheumatic Mitral Stenosis: Comparison between 2D and 3D Echocardiography.

PubMed

Shakil, S S; Ahmed, C M; Khaled, F I; Nahar, S; Perveen, R; Pandit, H; Osmani, D M

2017-10-01

Mitral valve is the most involved valve in rheumatic heart disease especially in the form of mitral stenosis. Treatment options of mitral stenosis depend upon pattern, extent & the severity of disease and echocardiography has the key role in this area. Severity of involvement of subvalvular apparatus (SVA) is an important factor for determining the treatment option. 2D echocardiography (2DE) is conventionally used. With the advancement of echocardiographic technology 3D echocardiography (3DE) would offer better assessment of subvalvular apparatus. This study compared transthoracic 2D versus 3D echocardiography for assessment of SVA in chronic rheumatic mitral valve disease. This cross sectional observational study was done in University cardiac centre, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2012 to October 2012. In this study, considering all ethical issues, data were collected from 50 subjects who underwent transthoracic 2D and 3D echocardiography for the assessment of extent and severity of mitral stenosis. Accurate measurement of Mitral valvular area is very important in assessment of severity, which is found similar by both 2DE (0.98±0.24cm²) and 3DE (0.92 ±0.23cm²). But assessment of subvalvular involvement especially chordal adhesion can be done better by 3DE (p<0.001). This observation suggests superiority of 3DE for assessment of SVA in chronic rheumatic mitral stenosis. The result of the study demonstrates that 3DE is superior to 2DE for the assessment of SVA in chronic rheumatic mitral stenosis.

Mechanisms of Breast Carcinogenesis Involving Wild-Type p53

DTIC Science & Technology

1999-09-01

Gryka , M . A., Litwak, G., Gebhardt, M ., level of p53 that was expressed in the cells in both these studies Bressac, B., Ozturk, M ., Baker, S. J...research: Tang, H., Zhao, K., Pizzolato, J.F., Fonarev, M ., Langer, J.C., and Manfredi, J.J. (1998) Constitutive expression of the cyclin-dependent...Biol. Chem. 274: 33747-33755. Meeting abstracts resulting from this, research: Resnick-Silverman, L., St. Clair, S., Thornborrow, E., Maurer, M

Numerical and experimental analysis of the transitional flow across a real stenosis.

PubMed

Agujetas, R; Ferrera, C; Marcos, A C; Alejo, J P; Montanero, J M

2017-08-01

In this paper, we present a numerical study of the pulsatile transitional flow crossing a severe real stenosis located right in front of the bifurcation between the right subclavian and right common carotid arteries. The simulation allows one to determine relevant features of this subject-specific flow, such as the pressure waves in the right subclavian and right common carotid arteries. We explain the subclavian steal syndrome suffered by the patient in terms of the drastic pressure drop in the right subclavian artery. This pressure drop is caused by both the diverging part of the analyzed stenosis and the reverse flow in the bifurcation induced by another stenosis in the right internal carotid artery.

Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain.

PubMed

Mor-Avi, Victor; Patel, Mita B; Maffessanti, Francesco; Singh, Amita; Medvedofsky, Diego; Zaidi, S Javed; Mediratta, Anuj; Narang, Akhil; Nazir, Noreen; Kachenoura, Nadjia; Lang, Roberto M; Patel, Amit R

2018-06-01

Combined evaluation of coronary stenosis and the extent of ischemia is essential in patients with chest pain. Intermediate-grade stenosis on computed tomographic coronary angiography (CTCA) frequently triggers downstream nuclear stress testing. Alternative approaches without stress and/or radiation may have important implications. Myocardial strain measured from echocardiographic images can be used to detect subclinical dysfunction. The authors recently tested the feasibility of fusion of three-dimensional (3D) echocardiography-derived regional resting longitudinal strain with coronary arteries from CTCA to determine the hemodynamic significance of stenosis. The aim of the present study was to validate this approach against accepted reference techniques. Seventy-eight patients with chest pain referred for CTCA who also underwent 3D echocardiography and regadenoson stress computed tomography were prospectively studied. Left ventricular longitudinal strain data (TomTec) were used to generate fused 3D displays and detect resting strain abnormalities (RSAs) in each coronary territory. Computed tomographic coronary angiographic images were interpreted for the presence and severity of stenosis. Fused 3D displays of subendocardial x-ray attenuation were created to detect stress perfusion defects (SPDs). In patients with stenosis >25% in at least one artery, fractional flow reserve was quantified (HeartFlow). RSA as a marker of significant stenosis was validated against two different combined references: stenosis >50% on CTCA and SPDs seen in the same territory (reference standard A) and fractional flow reserve < 0.80 and SPDs in the same territory (reference standard B). Of the 99 arteries with no stenosis >50% and no SPDs, considered as normal, 19 (19%) had RSAs. Conversely, with stenosis >50% and SPDs, RSAs were considerably more frequent (17 of 24 [71%]). The sensitivity, specificity, and accuracy of RSA were 0.71, 0.81, and 0.79, respectively, against reference standard A and 0.83, 0.81, and 0.82 against reference standard B. Fusion of CTCA and 3D echocardiography-derived resting myocardial strain provides combined displays, which may be useful in determination of the hemodynamic or functional impact of coronary abnormalities, without additional ionizing radiation or stress testing. Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study.

PubMed

Liu, Kenneth C; Starke, Robert M; Durst, Christopher R; Wang, Tony R; Ding, Dale; Crowley, R Webster; Newman, Steven A

2017-11-01

OBJECTIVE Idiopathic intracranial hypertension (IIH) may cause blindness due to elevated intracranial pressure (ICP). Venous sinus stenosis has been identified in select patients, leading to stenting as a potential treatment, but its effects on global ICP have not been completely defined. The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH. METHODS Ten patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement. RESULTS All patients had elevated venous pressure (mean 39.5 ± 14.9 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 ± 13.2 mm Hg), and elevated ICP (42.2 ± 15.9 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 ± 1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 ± 8.3 mm Hg), and further decreased overnight (to a mean of 8 ± 4.2 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up (median 23.4 months; range 15.7-31.6 months). Two patients developed stent-adjacent stenosis; retreatment abolished the stenosis and gradient in both cases. Patients presenting with papilledema had resolution on follow-up funduscopic imaging and optical coherence tomography (OCT) and improvement on visual field testing. Patients presenting with optic atrophy had optic nerve thinning on follow-up OCT, but improved visual fields. CONCLUSIONS For selected patients with IIH and venous sinus stenosis with an elevated pressure gradient and elevated ICP, venous sinus stenting results in resolution of the venous pressure gradient, reduction in ICP, and functional, neurological, and ophthalmological improvement. As patients are at risk for stent-adjacent stenosis, further follow-up is necessary to determine long-term outcomes and gain an understanding of venous sinus stenosis as a primary or secondary pathological process behind elevated ICP.

Dynamic Cerebral Autoregulation in Asymptomatic Patients With Unilateral Middle Cerebral Artery Stenosis

PubMed Central

Wang, Shuang; Guo, Zhen-Ni; Xing, Yingqi; Ma, Hongyin; Jin, Hang; Liu, Jia; Yang, Yi

2015-01-01

Abstract The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis. Fifty-seven patients with asymptomatic mild, moderate, and severe unilateral MCA stenosis and 8 patients with symptomatic severe unilateral MCA stenosis diagnosed by transcranial Doppler were enrolled. Twenty-four healthy volunteers served as controls. The noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each subject in the supine position. Transfer function analysis was applied to determine the autoregulatory parameters (phase difference [PD] and gain). The PD values in the severe stenosis groups were significantly lower than those of the control group (60.71 ± 18.63°), the asymptomatic severe stenosis group was impaired ipsilaterally (28.94 ± 27.43°, P < 0.001), and the symptomatic severe stenosis group was impaired bilaterally (13.74 ± 19.21°, P < 0.001; 19.68 ± 14.50°, P = 0.006, respectively). The PD values in the mild and moderate stenosis groups were not significantly different than the controls (44.49 ± 27.93°; 48.65 ± 25.49°, respectively). The gain values in the mild and moderate groups were higher than in the controls (1.00 ± 0.58 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, and 1.20 ± 0.59 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, respectively). The gain values in the severe stenosis groups were significantly lower than that in the control group: the asymptomatic severe stenosis group was lower bilaterally (0.56 ± 0.32 cm/s/mm Hg, P = 0.003; 0.60 ± 0.32 cm/s/mm Hg, P < 0.05, respectively), whereas the symptomatic severe group was lower unilaterally (on the contralateral side) (0.53 ± 0.43 cm/s/mm Hg, P < 0.05). In asymptomatic patients with unilateral MCA stenosis, only the dCA of the severe stenosis was ipsilaterally impaired. Acute stroke may aggravate the impaired dCA and even spread contralaterally. PMID:26717363

A randomized trial comparing primary angioplasty versus stent placement for symptomatic intracranial stenosis

PubMed Central

Qureshi, Adnan I; Chaudhry, Saqib A; Siddiq, Farhan; Majidi, Shahram; Rodriguez, Gustavo J; Suri, M Fareed K

2013-01-01

Background: Both primary angioplasty alone and angioplasty with a self-expanding stent have been compared in non-randomized concurrent clinical studies that suggest equivalent results. However, there is no randomized trial that has compared the two procedures in patients with symptomatic high grade intracranial stenosis. Objective: The primary aim of the randomized trial was to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic intracranial stenosis. Methods: The study prospectively evaluated efficacy and safety of the two existing neurointerventional techniques for treatment of moderate intracranial stenosis (stenosis ≥ 50%) with documented failure of medical treatment or severe stenosis (≥70%) with or without failure of medical treatment. Results: A total of 18 patients were recruited in the study (mean age [±SD] was 64.7 ± 15.1 years); out of these, 12 were men. Of these 18, 10 were treated with primary angioplasty and 8 were treated with angioplasty followed by self-expanding stent. The technical success rates of intracranial angioplasty and stent placements defined as ability to achieve <30% residual stenosis when assessed by immediate post-procedure angiography was 5 of 10 and 5 of 8 patients, respectively. The total fluoroscopic time (mean [±SD]) was lower in patients undergoing primary angioplasty 37 [±11] min versus those undergoing angioplasty followed by self-expanding stent 42 [±15] min, P = 0.4321. The stroke and death rate within 1 month was very low in both patient groups (1 of 10 versus 0 of 8 patients). One patient randomized to stent placement continued to have recurrent ischemic symptoms requiring another angioplasty in the vertebral artery on post-procedure Day 2. Conclusions: The trial suggests that a randomized trial comparing primary angioplasty to angioplasty followed by stent placement is feasible. The immediate procedural outcomes with primary angioplasty are comparable to stent placement and warrant further studies. PMID:24358415

Estimation of nonpoint-source loads of total nitrogen, total phosphorous, and total suspended solids in the Black, Belle, and Pine River basins, Michigan, by use of the PLOAD model

USGS Publications Warehouse

Syed, Atiq U.; Jodoin, Richard S.

2006-01-01

The Lake St. Clair Regional Monitoring Project partners planned a 3-year assessment study of the surface water in the Lake St. Clair drainage basins in Michigan. This study included water-quality monitoring and analysis, collection of discrete (grab) and automatic water-quality samples, monitoring of bacteria, and the creation of a database to store all relevant data collected from past and future field-data-collection programs. In cooperation with the Lake St. Clair Monitoring Project, the U.S. Geological Survey assessed nonpoint-source loads of nutrients and total suspended solids in the Black, Belle, and Pine River basins. The principal tool for the assessment study was the USEPA’s PLOAD model, a simplified GIS-based numerical program that generates gross estimates of pollutant loads. In this study, annual loads were computed for each watershed using the USEPA’s Simple Method, which is based on scientific studies showing a correlation between different land-use types and loading rates. The two land-use data sets used in the study (representing 1992 and 2001) show a maximum of 0.02-percent change in any of the 15 land use categories between the two timeframes. This small change in land use is reflected in the PLOAD results of the study area between the two time periods. PLOAD model results for the 2001 land-use data include total-nitrogen loads from the Black, Belle, and Pine River basins of approximately 495,599 lb/yr, 156,561 lb/yr, and 121,212 lb/yr, respectively; total-phosphorus loads of 80,777 lb/yr, 25,493 lb/yr, and 19,655 lb/yr, respectively; and total-suspended-solids loads of 5,613,282 lb/yr, 1,831,045 lb/yr, and 1,480,352 lb/yr, respectively. The subbasins in the Black, Belle, and Pine River basin with comparatively high loads are characterized by comparatively high percentages of industrial, commercial, transportation, or residential land use. The results from the PLOAD model provide useful information about the approximate average annual loading rates from the three study basins. In particular, the results identify subbasins with comparatively high loading rates per square mile. This could aid water-resources managers and planners in evaluation of the effectiveness of public expenditures for water-quality improvements, assessment of progress towards achieving established water-quality goals, and planning of preventive actions.

Field, Formon, Superspace, and Inceptive Cyborg: A Paraphysical Theory of Noncausal Phenomena

DTIC Science & Technology

1974-12-01

Mikhailova is able to accomplish psychokinesis;*^ psychic healing can indeed be accomplished; telepathy and clairvoyance can be accomplished even in a...passes extrasensory perception, telekinesis, teleportation, firewalking, acupuncture, psychic phenomena, telepathy , clair- voyance, psionlc

Documents related to Proposed Class II injection well permit modification MI-147-2D-0014

EPA Pesticide Factsheets

Public notice for proposed modification of permit number MI-147-2D-0014 (St. Clair County, MI). The proposed modification would change the injection zone, the construction, and reduce the injection pressure.

1. HOUSE, VIEW TO NORTHEAST, SUMMER KITCHEN AND SMOKE HOUSE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. HOUSE, VIEW TO NORTHEAST, SUMMER KITCHEN AND SMOKE HOUSE ARE IN THE BACKGROUND - Kiel Farmstead, House, East side State Route 4, one half mile south of U.S. Route 64, Mascoutah, St. Clair County, IL

5 CFR Appendix B to Subpart B of... - Nationwide Schedule of Nonappropriated Fund Regular Wage Surveys

Code of Federal Regulations, 2011 CFR

2011-01-01

...-Elmore July Odd. Illinois Lake April Even. St. Clair April Even. Kansas Leavenworth-Jackson-Johnson April...-San Juan February Even. Rhode Island Newport July Even. South Carolina Charleston February Even...

5 CFR Appendix B to Subpart B of... - Nationwide Schedule of Nonappropriated Fund Regular Wage Surveys

Code of Federal Regulations, 2013 CFR

2013-01-01

... Lake April Even. St. Clair April Even. Kansas Leavenworth-Jackson-Johnson April Even. Sedgwick April.... York May Even. Puerto Rico Guaynabo-San Juan February Even. Rhode Island Newport July Even. South...

Sally Ride Tribute

NASA Image and Video Library

2013-05-20

The Maryland Classic Youth Orchestras performs "Clair du Lune" with Guest Conductor Emil de Cou during the National Tribute to Sally Ride at the John F. Kennedy Center for the Performing Arts, Monday, May 20, 2013 in Washington. Photo Credit: (NASA/Bill Ingalls)

3. View of entrance to cellar and heavy timber framing ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. View of entrance to cellar and heavy timber framing of the wine press building, looking southeast. - Merkel Farmstead, Wine Press Building, 8570 Louella Lane, south side of U.S. Route 64, Shiloh, St. Clair County, IL

19. Detail of original leveraction rim lock, downstairs door between ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

19. Detail of original lever-action rim lock, downstairs door between central hall and southwest room, looking northwest - Merkel Farmstead, House, 8570 Louella Lane, south side of U.S. Route 64, Shiloh, St. Clair County, IL

The Application of Liquid Nitrogen Spray Cryotherapy in Treatment of Bronchial Stenosis.

PubMed

Janke, Kelly J; Abbas, Abbas El-Sayed; Ambur, Vishnu; Yu, Daohai

Spray cryotherapy (SCT), the application of liquid nitrogen in a noncontact form, has been demonstrated to have efficacy in treating various types of pathologic lesions of the airway when used as an adjunct with bronchoscopy. The purpose of the study was to evaluate the results of the use of bronchoscopic SCT on the airway in a single institution. We performed a retrospective review of data collected on all patients who underwent SCT to re-establish or improve airway patency in an 11-month period. Patients were classified based on the nature of their disease into benign or malignant. Demographic data, change in luminal patency, and clinical outcomes were recorded. The percent of stenosis was divided into grades according to the following classification: 1, ≤25%; 2, 26% to 50%; 3, 51% to 75%; and 4, ≥76%. We defined successful completion of treatment as obtaining a final patency of grade 1. Twenty-two patients met inclusion criteria, with 45.5% (10 patients) having benign stenosis and 54.5% (12 patients) malignant. At initial bronchoscopic evaluation, the median grade of stenosis was 4 for malignant disease and 3.5 for benign disease. The median final posttreatment grade of stenosis was 2 for malignant disease and 1 for benign. The median improvement in grade of stenosis after treatment was 2 for both malignant and benign causes (Wilcoxon test, P = 0.92). Final patency of grade 1 was achieved in 42% of malignant stenosis and 80% of benign. Overall, 86.4% of patients had an improvement in grade of stenosis after treatment. The rate of morbidity was 4.5% (1/22) of all patients. The median change in grade after treatment was 2 grades of improvement for both the benign and malignant groups. These results provide evidence that the use of SCT is equally efficacious for both types of stenosis with an expectation of overall improvement in luminal patency, offering a safe and effective method of achieving airway patency in a minimally invasive fashion. This study contributes to the small but growing body of literature supporting the use of SCT in benign and malignant disease.

Surgical Treatment of Anal Stenosis with Diamond Flap Anoplasty Performed in a Calibrated Fashion.

PubMed

Gülen, Merter; Leventoğlu, Sezai; Ege, Bahadir; Menteş, B Bülent

2016-03-01

Regarding anoplasty for anal stenosis, it is not clear to what extent the final anal caliber should be targeted. The aim of this study was to investigate the results of diamond-flap anoplasty performed in a calibrated manner for the treatment of severe anal stenosis due to a previous hemorrhoidectomy. Prospectively prepared standard forms were evaluated retrospectively. Anoplasty with unilateral or bilateral diamond flaps was performed for moderate or severe anal stenosis, targeting a final anal caliber of 25 to 26 mm. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis staging (Milsom and Mazier), anal calibers (millimeter), the Cleveland Clinic Incontinence Score, and the modified obstructed defecation syndrome Longo score were recorded on pre-prepared standard forms, as well as postoperative complications and the time of return to work. From January 2011 to July 2013, 18 patients (12 males, 67%) with a median age of 39 years (range, 27-70) were treated. All of the patients had a history of previous hemorrhoidectomy. The number of previous corrective interventions was 2.1 ± 1.8 (range, 0-4), and 2 patients had a history of failed anoplasty. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24-26), and 25 ± 1 mm (range, 23-27) (p < 0.0001, for immediate postoperative and 12-month postoperative anal calibers compared with the intraoperative). Preoperative and 12-month postoperative Cleveland Clinic Incontinence Scores were 0.83 ± 1.15 (range, 0-4) and 0.39 ± 0.70 (range, 0-2) (p = 1.0). The clinical success rate was 88.9%. No severe postoperative complications were observed. This study was limited because it was a single-armed, retrospective analysis of prospectively designed data. Diamond-flap anoplasty performed in a standardized and calibrated manner is a highly successful method for the treatment of anal stenosis caused by previous hemorrhoidectomy.

Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis.

PubMed

Dalar, Levent; Karasulu, Levent; Abul, Yasin; Özdemir, Cengiz; Sökücü, Sinem Nedime; Tarhan, Merve; Altin, Sedat

2016-04-01

Bronchoscopic treatment is 1 of the treatment choices for both palliative and definitive treatment of benign tracheal stenosis. There is no consensus on the management of these patients, however, especially patients having complex stenoses. The aim of the present study was to assess, in the largest group of patients with complex stenoses yet reported, which types of tracheal stenosis are amenable to optimal management by bronchoscopic treatment. The present study was a retrospective cohort study including 132 consecutive patients with benign tracheal stenoses diagnosed between August 2005 and January 2013. The mean age of the study population was 52 ± 18 years; 62 (47%) were women and 70 (53%) were men. Their lesions were classified as simple and complex stenoses. Simple stenoses (n = 6) were treated with 12 rigid and flexible bronchoscopic procedures (mean of 2 per patient); 5 stents were placed. The total success rate was 100%. Among the 124 complex stenoses, 4 were treated directly with surgical intervention. In total, 481 rigid and 487 flexible bronchoscopic procedures were performed in these patients. In this group, the success rate was 69.8%. From the present study, we propose that after accurate classification, interventional bronchoscopic management may have an important role in the treatment of benign tracheal stenosis. Bronchoscopic treatment should be considered as first-line therapy for simple stenoses, whereas complex stenoses need a multidisciplinary approach and often require surgical intervention. However, bronchoscopic treatment may be a valid conservative approach in the management of patients with complex tracheal stenosis who are not eligible for operative treatment. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis.

PubMed

Oliveira, J F; Moura, E G H; Bernardo, W M; Ide, E; Cheng, S; Sulbaran, M; Santos, C M L; Sakai, P

2016-07-01

Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68). The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.

Dysfunction Screening in Experimental Arteriovenous Grafts for Hemodialysis Using Fractional-Order Extractor and Color Relation Analysis.

PubMed

Wu, Ming-Jui; Chen, Wei-Ling; Kan, Chung-Dann; Yu, Fan-Ming; Wang, Su-Chin; Lin, Hsiu-Hui; Lin, Chia-Hung

2015-12-01

In physical examinations, hemodialysis access stenosis leading to dysfunction occurs at the venous anastomosis site or the outflow vein. Information from the inflow stenosis, such as blood pressure, pressure drop, and flow resistance increases, allows dysfunction screening from the stage of early clots and thrombosis to the progression of outflow stenosis. Therefore, this study proposes dysfunction screening model in experimental arteriovenous grafts (AVGs) using the fractional-order extractor (FOE) and the color relation analysis (CRA). A Sprott system was designed using an FOE to quantify the differences in transverse vibration pressures between the inflow and outflow sites of an AVG. Experimental analysis revealed that the degree of stenosis (DOS) correlated with an increase in fractional-order dynamic errors (FODEs). Exponential regression was used to fit a non-linear curve and can be used to quantify the relationship between the FODEs and DOS (R (2) = 0.8064). The specific ranges were used to evaluate the stenosis degree, such as DOS: <50, 50-80, and >80%. A CRA-based screening method was derived from the hue angle-saturation-value color model, which describes perceptual color relationships for the DOS. It has a flexibility inference manner with color visualization to represent the different stenosis degrees, which has average accuracy >90% superior to the traditional methods. This in vitro experimental study demonstrated that the proposed model can be used for dysfunction screening in stenotic AVGs.

Evaluation of carotid stenosis with axial high-resolution black-blood MR imaging.

PubMed

U-King-Im, Jean M; Trivedi, Rikin A; Sala, Evis; Graves, Martin J; Gaskarth, Mathew; Higgins, Nicholas J; Cross, Justin C; Hollingworth, William; Coulden, Richard A; Kirkpatrick, Peter J; Antoun, Nagui M; Gillard, Jonathan H

2004-07-01

High-resolution axial black-blood MR imaging (BB MRI) has been shown to be able to characterise carotid plaque morphology. The aim of this study was to explore the accuracy of this technique in quantifying the severity of carotid stenosis. A prospective study of 54 patients with symptomatic carotid disease was conducted, comparing BB MRI to the gold standard, conventional digital subtraction X-ray angiography (DSA). The BB MRI sequence was a fast-spin echo acquisition (TE = 42 ms, ETL = 24, field of view = 100 x 100 mm, slice thickness = 3.0 mm) at 1.5 T using a custom-built phased-array coil. Linear measurements of luminal and outer carotid wall diameter were made directly from the axial BB MRI slices by three independent blinded readers and stenosis was calculated according to European Carotid Surgery Trial (ECST) criteria. There was good agreement between BB MRI and DSA (intraclass correlation = 0.83). Inter-observer agreement was good (average kappa = 0.77). BB MRI was accurate for detection of severe stenosis (> or = 80%) with sensitivity and specificity of 87 and 81%, respectively. Eight cases of "DSA-defined" moderate stenosis were overestimated as severe by BB MRI and this may be related to non-circular lumens. Axial imaging with BB MRI could potentially be used to provide useful information about severity of carotid stenosis. Copyright 2004 Springer-Verlag

Preliminary application of hybrid operation in the treatment of carotid artery stenosis in patients with complex ischemic cerebrovascular diseases

PubMed Central

Zhang, Liyong; Xing, Tao; Geng, Fenyang; Du, Lixin; Wang, Jiyue

2014-01-01

Along with the recent development of intraluminal interventional techniques and correlated imaging methods, one-stop hybrid operation has become a new focus in clinical settings. The aim of this study is to discuss the clinical significance of the one-stop hybrid endarterectomy surgery in the treatment of complex ischemic cerebrovascular diseases. In this study, clinical data from 10 patients with complex ischemic cerebrovascular diseases (including multi-vessel severe stenosis of the internal extracranial carotid artery, single vessel series stenosis of the internal extracranial carotid artery, in-stent restenosis, complete occlusion of the common carotid or the internal carotid artery) admitted to Beijing Xuanwu Hospital and Liaocheng Brain Hospital, were retrospectively analyzed. All enrolled subjects underwent three types of hybrid operations. The clinical efficacy of this surgery was subsequently assessed in this clinical trial. The results indicated that no related surgical complications were noted during the perioperative period. Intraoperative and postoperative imaging revealed no signs of vascular stenosis, the blood supply recovered, and clinical symptoms were alleviated. The follow-up lasted for 6 to 12 months. Imaging re-examination showed no evidence of re-stenosis and good blood circulation was present in the recanalized blood vessels. Favorable treatment efficacy was achieved. The intracranial blood supply was significantly improved postoperatively. In conclusion, one-stop hybrid operation plays an important role in treating complex stenosis cerebrovascular diseases. PMID:25197423

Thirty-Day Outcome of a Multicenter Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China.

PubMed

Miao, Zhongrong; Zhang, Yong; Shuai, Jie; Jiang, Changchun; Zhu, Qiyi; Chen, Kangning; Liu, Li; Li, Baomin; Shi, Xiangqun; Gao, Lianbo; Liu, Yajie; Wang, Feng; Li, Yongli; Liu, Tieyan; Zheng, Hongbo; Wang, Yilong; Wang, Yongjun

2015-10-01

Although recent trials have suggested that stenting is worse than medical therapy for patients with severe symptomatic intracranial atherosclerotic stenosis, it is not clear whether this conclusion applies to a subset of patients with hypoperfusion symptoms. To justify for a new trial in China, we performed a multicenter prospective registry study to evaluate the safety and efficacy of endovascular stenting within 30 days for patients with severe symptomatic intracranial atherosclerotic stenosis. Patients with symptomatic intracranial atherosclerotic stenosis caused by 70% to 99% stenosis combined with poor collaterals were enrolled. The patients were treated either with balloon-mounted stent or with balloon predilation plus self-expanding stent as determined by the operators following a guideline. The primary outcome within 30 days is stroke, transient ischemic attack, and death after stenting. The secondary outcome is successful revascularization. The baseline characteristics and outcomes of the 2 treatment groups were compared. From September 2013 to January 2015, among 354 consecutive patients, 300 patients (aged 58.3±9.78 years) were recruited, including 159 patients treated with balloon-mounted stent and 141 patients with balloon plus self-expanding stent. The 30-day rate of stroke, transient ischemic attack, and death was 4.3%. Successful revascularization was 97.3%. Patients treated with balloon-mounted stent were older, less likely to have middle cerebral artery lesions, more likely to have vertebral artery lesions, more likely to have Mori A lesions, less likely to have Mori C lesions, and likely to have lower degree of residual stenosis than patients treated with balloon plus self-expanding stent. The short-term safety and efficacy of endovascular stenting for patients with severe symptomatic intracranial atherosclerotic stenosis in China is acceptable. Balloon-mounted stent may have lower degree of residual stenosis than self-expanding stent. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01968122. © 2015 American Heart Association, Inc.

Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study.

PubMed

Guo, W-Y; Lee, C-C J; Lin, C-J; Yang, H-C; Wu, H-M; Wu, C-C; Chung, W-Y; Liu, K-D

2017-01-01

Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases. © 2017 by American Journal of Neuroradiology.

Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics.

PubMed

Cheng, Tracy; Carpenter, David; Cohen, Seth; Witsell, David; Frank-Ito, Dennis O

2018-04-01

Very little is known about the impact of laryngotracheal stenosis (LTS) on inspiratory airflow and resistance, especially in air hunger states. This study investigates the effect of LTS on airway resistance and volumetric flow across three different inspiratory pressures. Head-and-neck computed tomography scans of 11 subjects from 2010 to 2016 were collected. Three-dimensional reconstructions of the upper airway from the nostrils to carina, including the oral cavity, were created for one subject with a normal airway and for 10 patients with LTS. Airflow simulations were conducted using computational fluid dynamics modeling at three different inspiratory pressures (10, 25, 40 pascals [Pa]) for all subjects under two scenarios: 1) inspiration through nostrils only (MC), and 2) through both nostrils and mouth (MO). Volumetric flows in the normal subject at the three inspiratory pressures were considerably higher (MC: 11.8-26.1 L/min; MO: 17.2-36.9 L/min) compared to those in LTS (MC: 2.86-6.75 L/min; MO: 4.11-9.00 L/min). Airway resistances in the normal subject were 0.051 to 0.092 pascal seconds per milliliter (Pa.s)/mL (MC) and 0.035-0.065 Pa.s/mL (MO), which were approximately tenfold lower than those of subjects with LTS: 0.39 to 0.89 Pa.s/mL (MC) and 0.45 to 0.84 Pa.s/mL (MO). Furthermore, subjects with glottic stenosis had the greatest resistance, whereas subjects with subglottic stenosis had the greatest variability in resistance. Subjects with tracheal stenosis had the lowest resistance. This pilot study demonstrates that LTS increases resistance and decreases airflow. Mouth breathing significantly improved airflow and resistance but cannot completely compensate for the effects of stenosis. Furthermore, location of stenosis appears to modulate the effect of the stenosis on resistance differentially. NA. Laryngoscope, 128:E141-E149, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

[Congenital esophageal stenosis owing to ectopic tracheobronchial remnants: report of four cases and review of the literature].

PubMed

Zhong, Xue-mei; Zhang, Yan-ling; Li, Long

2012-08-01

Congenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. This study was conducted to understand the clinical features of TBR. The data of the four cases with TBR admitted to our hospital and 76 patients identified from the literature were reviewed. The clinical manifestation, X-ray, endoscopy, biopsy and treatment were studied retrospectively. Of the total of 80 cases, 45 were male, 33 were female, and for 2 cases the gender was unknown. Symptoms of dysphagia and regurgitation developed at the age of 1-day to 12-month. Definitive treatment was carried out at the age of 1-month to 16-year. Twenty-seven patients had associated anomalies with esophageal atresia being the most prevalent. X-ray esophagography showed segmental stenosis at the distal third of the esophagus in all patients except three. An abrupt narrow segment at the lower esophagus with marked proximal dilatation was found in 32 cases. Esophagography of 12 cases showed distal esophageal stenosis with tapered narrowing. Esophagography of 20 cases showed flask-shaped shadow of distal esophageal stenosis and one patient showed linear projection of barium at the level of stenosis. Endoscopy found almost complete obstruction of the lower esophageal lumen without signs of the esophagitis or reflux. Esophagoscopic dilatation of the stenosis was attempted in 24 cases, but was ineffective, and 3 patients suffered esophageal perforation. Seventy-nine patients underwent resection of the stenotic segment. Histologic examination of the resected specimen showed cartilage, mucus glands, resembling bronchal tissue. Post-operative complication included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux. TBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food. Esophagography and esophagoscopy are the essential means for diagnosis. TBR should be different from achalasia and should be diagnosed by biopsy. Operation is the only choice of treatment.

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial.

PubMed

Schneider, Michael; Ammendolia, Carlo; Murphy, Donald; Glick, Ronald; Piva, Sara; Hile, Elizabeth; Tudorascu, Dana; Morton, Sally C

2014-01-01

Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. ClinicalTrials.gov identifier: NCT01943435.

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435 PMID:24872875

Statins for aortic valve stenosis.

PubMed

Thiago, Luciana; Tsuji, Selma Rumiko; Nyong, Jonathan; Puga, Maria Eduarda Dos Santos; Góis, Aécio Flávio Teixeira de; Macedo, Cristiane Rufino; Valente, Orsine; Atallah, Álvaro Nagib

2016-01-01

Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality evidence showed no effect on freedom from valve replacement with statins (risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies = 4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75 to 1.09; participants = 2204; studies = 3; moderate-quality evidence). Low- and very low-quality evidence showed uncertainty around the effect of statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15; participants = 2297; studies = 3; low-quality evidence) and hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants = 155; study = 1; very low-quality evidence). None of the four included studies reported on overall mortality and patient quality of life. Result findings showed uncertainty surrounding the effect of statins for aortic valve stenosis. The quality of evidence from the reported outcomes ranged from moderate to very low. These results give support to European and USA guidelines (2012 and 2014, respectively) that so far there is no clinical treatment option for aortic valve stenosis.

Utility of 3-dimensional ultrasound imaging to evaluate carotid artery stenosis: comparison with magnetic resonance angiography.

PubMed

Igase, Keiji; Kumon, Yoshiaki; Matsubara, Ichiro; Arai, Masamori; Goishi, Junji; Watanabe, Hideaki; Ohnishi, Takanori; Sadamoto, Kazuhiko

2015-01-01

We evaluated the utility of 3-dimensional (3-D) ultrasound imaging for assessment of carotid artery stenosis, as compared with similar assessment via magnetic resonance angiography (MRA). Subjects comprised 58 patients with carotid stenosis who underwent both 3-D ultrasound imaging and MRA. We studied whether abnormal findings detected by ultrasound imaging could be diagnosed using MRA. Ultrasound images were generated using Voluson 730 Expert and Voluson E8. The degree of stenosis was mild in 17, moderate in 16, and severe in 25 patients, according to ultrasound imaging. Stenosis could not be recognized using MRA in 4 of 17 patients diagnosed with mild stenosis using ultrasound imaging. Ultrasound imaging showed ulceration in 13 patients and mobile plaque in 6 patients. When assessing these patients, MRA showed ulceration in only 2 of 13 patients and did not detect mobile plaque in any of these 6 patients. Static 3-D B mode images demonstrated distributions of plaque, ulceration, and mobile plaque, and static 3-D flow images showed flow configuration as a total structure. Real-time 3-D B mode images demonstrated plaque and vessel movement. Carotid artery stenting was not selected for patients diagnosed with ulceration or mobile plaque. Ultrasound imaging was necessary to detect mild stenosis, ulcerated plaque, or mobile plaque in comparison with MRA, and 3-D ultrasound imaging was useful to recognize carotid stenosis and flow pattern as a total structure by static and real-time 3-D demonstration. This information may contribute to surgical planning. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Intramural location and size of arterial calcification are associated with stenosis at carotid bifurcation.

PubMed

Yamada, Shigeki; Oshima, Marie; Watanabe, Yoshihiko; Ogata, Hideki; Hashimoto, Kenji; Miyake, Hidenori

2014-06-01

The purpose of this study was to investigate the association between internal carotid artery (ICA) stenosis and intramural location and size of calcification at the ICA origins and the origins of the cervical arteries proximal to the ICA. A total of 1139 ICAs were evaluated stenosis and calcification on the multi-detector row CT angiography. The intramural location was categorized into none, outside and inside location. The calcification size was evaluated on the 4-point grading scale. The multivariate analyses were adjusted for age, serum creatinine level, hypertension, hyperlipidemia, diabetes mellitus, smoking and alcohol habits. Outside calcification at the ICA origins showed the highest multivariate odds ratio (OR) for the presence of ICA stenosis (30.0) and severe calcification (a semicircle or more of calcification at the arterial cross-sectional surfaces) did the second (14.3). In the subgroups of >70% ICA stenosis, the multivariate OR of outside location increased to 44.8 and that of severe calcification also increased to 32.7. Four of 5 calcified carotid plaque specimens extracted by carotid endarterectomy were histologically confirmed to be calcified burdens located outside the internal elastic lamia which were defined as arterial medial calcification. ICA stenosis was strongly associated with severe calcification located mainly outside the carotid plaque. Outside calcification at the ICA origins should be evaluated separately from inside calcification, as a marker for the ICA stenosis. Additionally, we found that calcification at the origins of the cervical arteries proximal to the ICA was significantly associated with the ICA stenosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Comparative Review of the Treatment Methodologies of Carotid Stenosis

PubMed Central

Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

2015-01-01

The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

Should conventional angiography be the gold standard for carotid stenosis?

PubMed

Zhang, Wayne W; Harris, Linda M; Dryjski, Maciej L

2006-12-01

To compare conventional angiography (CA) and rotational angiography (RA) to assess the degree of angiographically-measured stenosis versus cross-sectional area (CSA) stenosis in an in vitro carotid model. Various grades of stenosis were created by adhering different amounts of silicone rubber sealant onto the inner wall of clear, radiolucent tubes. Following 2- and 3-projection CA and 20-projection RA, the tubes were transected at the actual maximum stenosis. The cross-sectional areas were digitally photographed, and CSA stenosis was calculated using ImageJ planimeter software. The differences among CA, RA, and CSA stenosis measurements were compared statistically. There was no significant difference between RA and CSA stenosis measurements (p=0.46). Conventional angiography with 2 or 3 projections between 0 degrees and 90 degrees underestimated the severity of disease in 19 (63%) of 30 samples. The maximum stenosis percentage was significantly lower in CA versus RA (p<0.0001 in 2-projection, p<0.0003 in 3-projection) and in CA versus CSA stenosis (p<0.0004 in 2-projection, p<0.001 in 3-projection). The maximum stenosis percentages measured by RA were less than CSA stenosis in 5 (71.4%) of 7 tubes (p=NS) containing 50% to 69% stenoses. Eight tubes had mountain-shaped lesions, which was significantly overestimated by RA (11.5%+/-9.7%, p<0.012). CA with 2 or 3 projections significantly underestimates the maximum stenosis in an in vitro model. RA may overestimate disease in patients with mountain-shaped plaques and may underestimate disease if the stenosis is <70%. Our data suggest that CA should not be the gold standard for the qualification of carotid endarterectomy in asymptomatic patients, nor for vascular laboratory quality assurance analysis.

Aortic Valve Stenosis Increases Helical Flow and Flow Complexity: A Study of Intra-Operative Cardiac Vector Flow Imaging.

PubMed

Hansen, Kristoffer Lindskov; Møller-Sørensen, Hasse; Kjaergaard, Jesper; Jensen, Maiken Brit; Jensen, Jørgen Arendt; Nielsen, Michael Bachmann

2017-08-01

Aortic valve stenosis alters blood flow in the ascending aorta. Using intra-operative vector flow imaging on the ascending aorta, secondary helical flow during peak systole and diastole, as well as flow complexity of primary flow during systole, were investigated in patients with normal, stenotic and replaced aortic valves. Peak systolic helical flow, diastolic helical flow and flow complexity during systole differed between the groups (p < 0.0001), and correlated to peak systolic velocity (R = 0.94, 0.87 and 0.88, respectively). The study indicates that aortic valve stenosis increases helical flow and flow complexity, which are measurable with vector flow imaging. For assessment of aortic stenosis and optimization of valve surgery, vector flow imaging may be useful. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

[Locomotive syndrome and frailty. Lumbar canal stenosis as an underlying disorder in the locomotive syndrome].

PubMed

Sakai, Yoshihito

2012-04-01

Lumbar canal stenosis most commonly affects the elderly population by entrapment of the cauda equine roots surrounding the spinal canal often associated with pain in the back and lower extremities, difficulty ambulating. The locomotive syndrome refers to high-risk conditions under requiring care services, and lumbar canal stenosis is an important underlying disease. As one of the key capacities of frailty identified muscluloskeletal function, the locomotive syndrome is considered to musculoskeletal frail syndrome. Surgical treatment should be recommended to take the pressure off the nerves in the lumbar spine when the conservative treatments failed, and several studies revealed that the surgery generally resulted in a preferable outcome in the lumbar canal stenosis patients. Among lumbar canal stenosis patients treated with surgery, locomotive syndrome was contained 44% and many of which were seen in thin females. The patients with locomotive syndrome had lower muscle volume both in the extremities and the trunk than those without locomotive syndrome, and surgical results were poorer in the activity of daily life whereas the pain relief was adequately obtained. Treatment of the lumbar canal stenosis should be attended to locomotive frailty, and muscle strengthening training should be incorporated into pre and postoperative therapy.

Treatment of congenital tracheal stenosis by balloon-expandable metallic stents in paediatric intensive care unit

PubMed Central

Xu, Xuan; Li, Dandan; Zhao, Shuyu; Liu, Xicheng; Feng, Zhichun; Ding, Hui

2012-01-01

The aim of this study was to evaluate the use of balloon-expandable metallic stents in the treatment of children with congenital tracheal stenosis in whom conventional therapy has failed. From 2010 to 2011, balloon-expandable metallic stents were implanted into the trachea of eight infants aged 2–20 months in the paediatric intensive care unit. The infants had severe airway obstruction caused by congenital tracheal stenosis. Tracheal stents were placed after intraluminal balloon dilatation of the tracheal stenosis, inserted with balloon catheters and implanted into the desired position bronchoscopically. The stents were 12 to 29 mm long and 4 mm in diameter. Seven children were relieved of airway obstruction after this procedure. However, a child died due to severe sepsis after the placement of bronchial stents. No granulation tissue developed over the stents in any of the children. Stents have been in place for 1–6 months after insertion without any other complication. Balloon-expandable metallic stents are effective in relieving airway obstruction by congenital tracheal stenosis in children. This technique may provide an important remedy for congenital tracheal stenosis in children. PMID:22361127

Prediction of blood pressure and blood flow in stenosed renal arteries using CFD

NASA Astrophysics Data System (ADS)

Jhunjhunwala, Pooja; Padole, P. M.; Thombre, S. B.; Sane, Atul

2018-04-01

In the present work an attempt is made to develop a diagnostive tool for renal artery stenosis (RAS) which is inexpensive and in-vitro. To analyse the effects of increase in the degree of severity of stenosis on hypertension and blood flow, haemodynamic parameters are studied by performing numerical simulations. A total of 16 stenosed models with varying degree of stenosis severity from 0-97.11% are assessed numerically. Blood is modelled as a shear-thinning, non-Newtonian fluid using the Carreau model. Computational Fluid Dynamics (CFD) analysis is carried out to compute the values of flow parameters like maximum velocity and maximum pressure attained by blood due to stenosis under pulsatile flow. These values are further used to compute the increase in blood pressure and decrease in available blood flow to kidney. The computed available blood flow and secondary hypertension for varying extent of stenosis are mapped by curve fitting technique using MATLAB and a mathematical model is developed. Based on these mathematical models, a quantification tool is developed for tentative prediction of probable availability of blood flow to the kidney and severity of stenosis if secondary hypertension is known.

29 CFR 1410.3 - Individual access requests.

Code of Federal Regulations, 2014 CFR

2014-07-01

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Code of Federal Regulations, 2012 CFR

2012-07-01

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Code of Federal Regulations, 2011 CFR

2011-07-01

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Code of Federal Regulations, 2010 CFR

2010-07-01

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5 CFR Appendix B to Subpart B of... - Nationwide Schedule of Nonappropriated Fund Regular Wage Surveys

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2012-01-01

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University Challenge

ERIC Educational Resources Information Center

Adults Learning, 2010

2010-01-01

The Browne review of higher education funding and student finance has been welcomed as "fair and progressive" by some and condemned as "elitist" and "socially disastrous" by others. In this article, some of the leading commentators and stakeholders from across the sector--Claire Callender, John Widdowson, Andy…

Accuracy of computed tomographic angiography for stenosis quantification using quantitative coronary angiography or intravascular ultrasound as the gold standard.

PubMed

Joshi, Subodh B; Okabe, Teruo; Roswell, Robert O; Weissman, Gaby; Lopez, Cristian F; Lindsay, Joseph; Pichard, Augusto D; Weissman, Neil J; Waksman, Ron; Weigold, Wm Guy

2009-10-15

Computed tomographic angiography (CTA) is considered to have limited accuracy for quantifying exact percent diameter stenosis in coronary arteries. However, most studies evaluating CTA use quantitative coronary angiography (QCA) as the gold standard, a technique with its own limitations. We sought to determine whether CTA measurements of stenosis severity correlate better with intravascular ultrasound (IVUS) than with QCA. Luminal dimensions of 67 de novo coronary lesions were measured by CTA, IVUS, and QCA. IVUS was performed when lesion severity by angiography was equivocal. Mean percent diameter stenosis by QCA was 51 +/- 9.8% and mean IVUS minimal luminal area was 3.8 +/- 1.8 mm(2). There was a moderate correlation between CTA minimal luminal area and IVUS minimal luminal area (r(2) = 0.41, p <0.001), but no relation between CTA and QCA measurements of minimal luminal diameter (r(2) = 0.01, p = 0.57) or diameter stenosis (r(2) = 0.02, p = 0.31). There was also no relation between IVUS minimal luminal area and QCA diameter stenosis (r(2) = 0.01, p = 0.50). When lesions with moderate or severe calcification were excluded, the correlation between CTA minimal luminal area and IVUS minimal luminal area was good (r(2) = 0.68, p <0.001). In conclusion, in this cohort of patients with intermediate-grade lesions on cardiac catheterization, absolute measurements of stenosis severity on CTA correlated with IVUS but not with QCA. Our findings suggest that limitations of quantitative coronary angiography as a gold standard need to be considered in studies evaluating the accuracy of coronary CTA.

In vitro shear stress measurements using particle image velocimetry in a family of carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

PubMed

Kefayati, Sarah; Milner, Jaques S; Holdsworth, David W; Poepping, Tamie L

2014-01-01

Atherosclerotic disease, and the subsequent complications of thrombosis and plaque rupture, has been associated with local shear stress. In the diseased carotid artery, local variations in shear stress are induced by various geometrical features of the stenotic plaque. Greater stenosis severity, plaque eccentricity (symmetry) and plaque ulceration have been associated with increased risk of cerebrovascular events based on clinical trial studies. Using particle image velocimetry, the levels and patterns of shear stress (derived from both laminar and turbulent phases) were studied for a family of eight matched-geometry models incorporating independently varied plaque features - i.e. stenosis severity up to 70%, one of two forms of plaque eccentricity, and the presence of plaque ulceration). The level of laminar (ensemble-averaged) shear stress increased with increasing stenosis severity resulting in 2-16 Pa for free shear stress (FSS) and approximately double (4-36 Pa) for wall shear stress (WSS). Independent of stenosis severity, marked differences were found in the distribution and extent of shear stress between the concentric and eccentric plaque formations. The maximum WSS, found at the apex of the stenosis, decayed significantly steeper along the outer wall of an eccentric model compared to the concentric counterpart, with a 70% eccentric stenosis having 249% steeper decay coinciding with the large outer-wall recirculation zone. The presence of ulceration (in a 50% eccentric plaque) resulted in both elevated FSS and WSS levels that were sustained longer (∼20 ms) through the systolic phase compared to the non-ulcerated counterpart model, among other notable differences. Reynolds (turbulent) shear stress, elevated around the point of distal jet detachment, became prominent during the systolic deceleration phase and was widely distributed over the large recirculation zone in the eccentric stenoses.

Pulmonary vein stenosis in patients with Smith-Lemli-Opitz syndrome.

PubMed

Prosnitz, Aaron R; Leopold, Jane; Irons, Mira; Jenkins, Kathy; Roberts, Amy E

2017-07-01

To describe a group of children with co-incident pulmonary vein stenosis and Smith-Lemli-Opitz syndrome and to generate hypotheses as to the shared pathogenesis of these disorders. Retrospective case series. Five subjects in a pulmonary vein stenosis cohort of 170 subjects were diagnosed with Smith-Lemli-Opitz syndrome soon after birth. All five cases were diagnosed with Smith-Lemli-Opitz syndrome within 6 weeks of life, with no family history of either disorder. All cases had pathologically elevated 7-dehydrocholesterol levels and two of the five cases had previously reported pathogenic 7-dehydrocholesterol reductase mutations. Smith-Lemli-Opitz syndrome severity scores ranged from mild to classical (2-7). Gestational age at birth ranged from 35 to 39 weeks. Four of the cases were male by karyotype. Pulmonary vein stenosis was diagnosed in all cases within 2 months of life, earlier than most published cohorts. All cases progressed to bilateral disease and three cases developed atresia of at least one vein. Despite catheter and surgical interventions, all subjects' pulmonary vein stenosis rapidly recurred and progressed. Three of the subjects died, at 2 months, 3 months, and 11 months. Survival at 16 months after diagnosis was 43%. Patients with pulmonary vein stenosis who have a suggestive syndromic presentation should be screened for Smith-Lemli-Opitz syndrome with easily obtainable serum sterol tests. Echocardiograms should be obtained in all newly diagnosed patients with Smith-Lemli-Opitz syndrome, with a low threshold for repeating the study if new respiratory symptoms of uncertain etiology arise. Further studies into the pathophysiology of pulmonary vein stenosis should consider the role of cholesterol-based signaling pathways in the promotion of intimal proliferation. © 2017 Wiley Periodicals, Inc.

Intimal Hyperplasia, Stenosis, and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study.

PubMed

Cheung, Alfred K; Imrey, Peter B; Alpers, Charles E; Robbin, Michelle L; Radeva, Milena; Larive, Brett; Shiu, Yan-Ting; Allon, Michael; Dember, Laura M; Greene, Tom; Himmelfarb, Jonathan; Roy-Chaudhury, Prabir; Terry, Christi M; Vazquez, Miguel A; Kusek, John W; Feldman, Harold I

2017-10-01

Intimal hyperplasia and stenosis are often cited as causes of arteriovenous fistula maturation failure, but definitive evidence is lacking. We examined the associations among preexisting venous intimal hyperplasia, fistula venous stenosis after creation, and clinical maturation failure. The Hemodialysis Fistula Maturation Study prospectively observed 602 men and women through arteriovenous fistula creation surgery and their postoperative course. A segment of the vein used to create the fistula was collected intraoperatively for histomorphometric examination. On ultrasounds performed 1 day and 2 and 6 weeks after fistula creation, we assessed fistula venous stenosis using pre-specified criteria on the basis of ratios of luminal diameters and peak blood flow velocities at certain locations along the vessel. We determined fistula clinical maturation using criteria for usability during dialysis. Preexisting venous intimal hyperplasia, expressed per 10% increase in a hyperplasia index (range of 0%-100%), modestly associated with lower fistula blood flow rate (relative change, -2.5%; 95% confidence interval [95% CI], -4.6% to -0.4%; P =0.02) at 6 weeks but did not significantly associate with stenosis (odds ratio [OR], 1.07; 95% CI, 1.00 to 1.16; P =0.07) at 6 weeks or failure to mature clinically without procedural assistance (OR, 1.07; 95% CI, 0.99 to 1.15; P =0.07). Fistula venous stenosis at 6 weeks associated with maturation failure (OR, 1.98; 95% CI, 1.25 to 3.12; P =0.004) after controlling for case mix factors, dialysis status, and fistula location. These findings suggest that postoperative fistula venous stenosis associates with fistula maturation failure. Preoperative venous hyperplasia may associate with maturation failure but if so, only modestly. Copyright © 2017 by the American Society of Nephrology.

Prevalence of congenital heart disease in 76,301 mixed-breed dogs and 57,025 mixed-breed cats.

PubMed

Schrope, Donald P

2015-09-01

Assess the prevalence of congenital heart disease (CHD) in a large population of mixed-breed dogs and cats. 76,301 mixed-breed dogs and 57,025 mixed-breed cats. Retrospective review of records and examinations based on specified diagnostic criteria. Among mixed-breed dogs, the prevalence of CHD was 0.13% (51.4% female) and of innocent murmurs was 0.10% (53.0% male). Pulmonic stenosis was the most common defect followed by patent ductus arteriosus, aortic stenosis, and ventricular septal defect. Among mixed-breed cats, prevalence of CHD was 0.14% (55.2% male) and of innocent murmurs was 0.16% (54.4% male). When the 25 cats with dynamic left or right ventricular outflow obstruction were counted with cases of innocent murmurs, the overall prevalence was 0.2%. Ventricular septal defects were the most common feline CHD followed closely by aortic stenosis and hypertrophic obstructive cardiomyopathy. There was no overall sex predilection for CHD in mixed-breed cats or dogs, and no significant difference in CHD prevalence between cats or dogs. Among dogs, subvalvular aortic stenosis and mitral valve dysplasia had a male predisposition while patent ductus arteriosus had a female predisposition. Among cats, valvular pulmonic stenosis, subvalvular and valvular aortic stenosis, and ventricular septal defects had a male predisposition while pulmonary artery stenosis had a female predisposition. The prevalence of CHD in a mixed-breed dogs and cats is lower than for prior studies, perhaps due to the lack of purebreds in the study population or actual changes in disease prevalence. Copyright © 2015 Elsevier B.V. All rights reserved.

Clinical analysis of aqueductal stenosis in patients with hydrocephalus in a Kenyan setting.

PubMed

Kaur, Loyal Poonamjeet; Munyiri, Nderitu Joseph; Dismus, Wekesa Vincent

2017-01-01

Aqueductal stenosis is the commonest cause of congenital hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting. In a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Patients age, sex, mode of delivery, associated comorbidities, presenting complaints, neurosurgical intervention performed, Kafarnosky score were recorded. Data were divided into 2 sets based on the patient's age i.e. whether < 1 year or > 12 years. Data were recorded on google data collection form and analyzed using Google spreadsheets. Out of 258 cases of hydrocephalus, 52 had aqueductal stenosis. Male to female sex ratio for this condition was 3:2. There were 25 cases < 1year and 27 cases > 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. The presenting complaints differed according to the age groups. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. The Kafanosky score improve from < 50 pre-op to 19 cases achieving a score of 100, six months post-op. Aqueductal stenosis contributes a significant burden of morbidity in patients with hydrocephalus. Clinical presentation differs according to patients age. Accurate diagnosis and treatment remain a cardinal to improving patient outcome.

Calculation of pressure half-time.

PubMed

Oyama, Mark A; Weidman, Jess A; Cole, Steven G

2008-06-01

Doppler echocardiography is useful in assessing the severity of obstructive cardiac lesions, such as mitral valve stenosis. The Doppler study can be used to calculate pressure half-time (PHT), which is defined as the time required for the pressure gradient across an obstruction to decrease to half of its maximal value. Thus, PHT increases as the severity of stenosis increases. In this report, we describe the methodology involved in measuring PHT in a dog with mitral valve stenosis before and after balloon valvuloplasty.

Prevention and Treatment of Esophageal Stenosis after Endoscopic Submucosal Dissection for Early Esophageal Cancer

PubMed Central

Wen, Jing; Lu, Zhongsheng; Liu, Qingsen

2014-01-01

Endoscopic submucosal dissection (ESD) for the treatment of esophageal mucosal lesions is associated with a risk of esophageal stenosis, especially for near-circumferential or circumferential esophageal mucosal defects. Here, we review historic and modern studies on the prevention and treatment of esophageal stenosis after ESD. These methods include prevention via pharmacological treatment, endoscopic autologous cell transplantation, endoscopic esophageal dilatation, and stent placement. This short review will focus on direct prevention and treatment, which may help guide the way forward. PMID:25386186

High Blood Pressure Increases the Risk of Poor Outcome at Discharge and 12-month Follow-up in Patients with Symptomatic Intracranial Large Artery Stenosis and Occlusions: Subgroup analysis of the CICAS Study.

PubMed

Yu, Dan-Dan; Pu, Yue-Hua; Pan, Yue-Song; Zou, Xin-Ying; Soo, Yannie; Leung, Thomas; Liu, Li-Ping; Wang, David Z; Wong, Ka-Sing; Wang, Yi-Long; Wang, Yong-Jun

2015-06-01

The purpose of this study was to discuss the relationship between blood pressure and prognosis of patients with symptomatic intracranial arterial stenosis. Data on 2426 patients with symptomatic intracranial large artery stenosis and occlusion who participated in the Chinese Intracranial Atherosclerosis (CICAS) study were analyzed. According to the JNC 7 criteria, blood pressure of all patients was classified into one of the four subgroups: normal, prehypertension, hypertension stage I, and hypertension stage II. Poor outcomes were defined as death and functional dependency (mRS 3-5) at discharge or at 1 year. For patients with intracranial stenosis of 70% to 99%, the rate of poor outcome at discharge was 19.3%, 23.5%, 26.8%, and 39.8% (P = 0.001) for each blood pressure subgroup. For patients with intracranial large artery occlusion, the rates were 17.6%, 22.1%, 29.5%, and 49.8%, respectively (P < 0.0001). The rate of poor outcome at 12-month follow-up was 12.6%, 15.3%, 28.5%, and 27.9% (P = 0.0038) in patients with stenosis of 70% to 99% for each blood pressure subgroup and 11.6%, 21.5%, 23.9%, 35.1% (P < 0.0001) in patients with occlusion. For patients with severe intracranial arterial stenosis or occlusion, higher hypertension stages are associated with an increased risk of poor outcome at discharge and 12-month follow-up. © 2015 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Study of the collateral capacity of the circle of Willis of patients with severe carotid artery stenosis by 3D computational modeling.

PubMed

Long, Quan; Luppi, Luca; König, Carola S; Rinaldo, Vittorio; Das, Saroj K

2008-08-28

This numerical study aims to investigate the capacity of the circle of Wills (CoW) to provide collateral blood supply for patients with unilateral carotid arterial stenosis. The basic 3D geometry of the CoW was reconstructed based on a magnetic resonance angiogram of a normal human subject. A total of 52 computational fluid dynamics simulations were performed for four geometry configurations of the CoW with an artificially inserted axisymmetric stenosis of different luminal area reductions in an internal carotid artery (ICA) under a variety of boundary conditions. The CoW geometric configurations included (a) a normal CoW with all communicating arteries; (b) as model (a) but with enlarged communicating arterial diameters; (c) as (a) but with the ipsilateral posterior communicating artery missing, and (d) as (c) but with enlarged communicating arteries. It is found that the blood perfusion pressure drop between the ipsilateral ICA and the middle cerebral artery (MCA) only becomes significant when the degree of stenosis is greater than 86%. The cerebral autoregulation range varied significantly between the different CoW configurations for the severe stenosis cases. Without causing the flow rates to decrease at the efferent arterial ends, the mean perfusion pressure in the ipsilateral ICA can drop from 100 to 73, 67, 92 and 84 mmHg for the CoW models (a)-(d) with 96% luminal area reduction stenosis, respectively. The additional pathways are able to raise the ipsilateral MCA pressure significantly without reducing the total flow perfusion. Cerebral autoregulation effects were not directly included in the study. Therefore, the findings in the study should be interpreted with cautions when comes to the biological and clinical significance.

Assessment of coronary artery stenosis pressure gradient by quantitative coronary arteriography in patients with coronary artery disease.

PubMed

Atar, D; Ramanujam, P S; Saunamäki, K; Haunsø, S

1994-01-01

The aim of the study described here was to correlate coronary artery (CA) stenosis pressure gradients calculated by quantitative coronary arteriography (QCA) to invasively measured transstenotic pressure drops in patients with anginal symptoms and with known or suspected coronary artery disease. Furthermore, the known mathematical models are improved by introducing (1) pressure catheter-corrected minimal stenosis area, (2) modification of flow assumptions, and (3) stenosis exit angle. Included in the study were 45 patients with 61 stenoses. The visually estimated CA lesion severity in these non-complex stenoses was in the equivocal range of 40-70%. All measurements were performed after intracoronary administration of nifedipine and nitroglycerin. Stenosis dimensions were assessed from magnified cinefilms, using hand-held calipers. Highly significant overall correlation was found between measured and calculated pressure gradients with correction for the impact of the intracoronary catheter (P < 0.00001, r = 0.84). In particular, a substantial number of stenoses with haemodynamically-insignificant pressure gradients were identified by hydrodynamic calculations. In conclusion, the great majority of the coronary artery stenoses could be classified reliably by QCA as being haemodynamically insignificant or significant, respectively.

Mechanisms of Breast Carcinogenesis Involving Wild-Type p53

DTIC Science & Technology

2001-09-01

Nelson, C. E., Gryka , M . A., Litwak, G., Gebhardt, M ., level of p53 that was expressed in the cells in both these studies Bressac, B., Ozturk, M ., Baker...14 Publication resulting from this research: 1. Resnick-Silverman, L., S. St Clair, M . Maurer, K...activation by the tumor suppressor protein p53. Genes Dev 12:2102-7. 2. Tang, H. Y., K. Zhao, J. F. Pizzolato, M . Fonarev, J. C. Langer, and J. J

Preferences for Expansion of Public Services in Five West Central Wisconsin Counties. Report No. 8 of a Series on Quality of Life and Development in Northwestern Wisconsin, February 1976.

ERIC Educational Resources Information Center

Lambert, Virginia

As part of a study of the quality of life in northwestern Wisconsin, 1974 sample populations (N=150 residents per county) from each of 4 west central counties (Dunn, Clark, Eau Claire, and Polk) were presented with a list of public service programs and asked if they should be "expanded", "kept the same", or "cut…

Experimental study of hemodynamics in the circle of willis

PubMed Central

2015-01-01

Background The Circle of Willis (CoW) is an important collateral pathway of the cerebral blood flow. An experimental study of the cerebral blood flow (CBF) distribution in different anatomical variations may help to a better understanding of the collateral mechanism of the CoW. Methods An in-vitro test rig was developed to simulate the physiological cerebral blood flow in the CoW. Ten anatomical variations were considered in this study, include a set of different degrees of stenosis in L-ICA and L-ICA occlusion coexist with common anatomical variations. Volume flow rates of efferent arteries and pressure signals at the end of communicating arteries of each case were recorded. Physiological pressure waveforms were applied as inlet boundary condition. Results In the development of L-ICA stenosis, the total CBF decreases with the increase of stenosis degree. The blood supply of ipsilateral middle cerebral artery (MCA) was affected most by the stenosis of L-ICA. Anterior communicating artery (ACoA) and ipsilateral posterior communicating artery (PCoA) function as important collateral pathways of cerebral collateral circulation when unilateral stenosis occurred. The blood supply of anterior cerebral circulation was compensated by the posterior cerebral circulation through ipsilateral PCoA when L-ICA stenosis degree is greater than 40% and the affected side was compensated immediately by the unaffected side through ACoA. Blood flow of the anterior circulation and the total CBF reached the minimum among all cases studied when L-ICA occlusion coexist with the absence of PCoA. Conclusion The results demonstrated the flow distribution patterns of the CoW under anatomical variations and clarified the collateral mechanism of the CoW. The flow ACoA is the most sensitive indexes to the morphology change of ipsilateral ICA. The relative independence of the circulation in anterior and posterior sections of the CoW is not broken and the function of ipsilateral PCoA is not activated until a severe stenosis of unilateral ICA occurs. PCoA is the most important collateral pathway of the collateral circulation and the missing of PCoA has the highest risk of stroke when the ipsilateral ICA has severe stenosis. These findings may provide the basis for future therapeutic and diagnosis applications. PMID:25603138

Construction and geometric stability of physiological flow rate wall-less stenosis phantoms.

PubMed

Ramnarine, K V; Anderson, T; Hoskins, P R

2001-02-01

Wall-less flow phantoms are preferred for ultrasound (US) because tissue-mimicking material (TMM) with good acoustical properties can be made and cast to form anatomical models. The construction and geometrical stability of wall-less TMM flow phantoms is described using a novel method of sealing to prevent leakage of the blood-mimicking fluid (BMF). Wall-less stenosis flow models were constructed using a robust agar-based TMM and sealed using reticulated foam at the inlet and outlet tubes. There was no BMF leakage at the highest flow rate of 2.8 L/min in 0%, 35% and 57% diameter reduction stenoses models. Failure of the 75% stenosis model, due to TMM fracture, occurred at maximum flow rate of 2 L/min (mean velocity 10 m/s within the stenosis). No change of stenosis geometry was measured over 4 days. The construction is simple and effective and extends the possibility for high flow rate studies using robust TMM wall-less phantoms.

Surgical treatment of severe pulmonic stenosis under cardiopulmonary bypass in small dogs.

PubMed

Fujiwara, M; Harada, K; Mizuno, T; Nishida, M; Mizukoshi, T; Mizuno, M; Uechi, M

2012-02-01

The aim of this study was to report the long-term outcome of the surgical palliation of pulmonic stenosis in dogs. The subjects comprised three female and six male dogs, mean (±sd) age: 23 (±25) months, mean (±sd) weight: 3·4 (±2·1) kg, diagnosed with severe pulmonic stenosis and right ventricular hypertrophy, with an average preoperative pressure gradient of 153 (±43) mmHg on echocardiography. The pressure overload with severe pulmonic stenosis was reduced by valvotomy, i.e., open pulmonary valve commissurotomy, with/without biomembrane patch grafting, under cardiopulmonary bypass. The postoperative pressure gradient at 1 to 7 days was significantly decreased to 65 (±39) mmHg (P<0·05). The reduced pressure gradient was maintained at 58 (±38) mmHg at final follow-up. Open valvotomy, pulmonary valve commissurotomy and biomembrane patch grafting were effective in reducing obstruction in severe pulmonic stenosis in dogs. © 2012 British Small Animal Veterinary Association.

Surgical management of benign tracheal stenosis in Basrah

PubMed Central

Almudhafer, Muayyad M.; AI-Hassani, Fouzi A.A.; Benyan, Abdul-Khalik Z.

2013-01-01

Background: Tracheal stenosis is more frequent as a result of wide-spread use of endotracheal intubation and tracheostomy. Resection and tracheal reconstruction remain the treatment of choice in benign tracheal stenosis. Objectives: To report our experience in Basra and to identify the result of anastomosis after tracheal resection and management of those patients preoperatively and postoperatively. Methodology: A descriptive study of sixteen patients (aged 11–28 years, 10 male and 6 female) with tracheal stenosis who underwent tracheal resection and reconstruction in Basrah thoracic unit (Basra teaching hospital) from January 2008 to January 2011. Results: The result was excellent in 62.5%, good in 25%, and satisfactory in 12.5%. Postoperative complication occurred in 25% and treated successfully with no mortality. Follow-up was every 3 months for an average of 3.6 years. Conclusion: Resection and tracheal reconstruction is the treatment of choice in benign tracheal stenosis and achieved excellent results in management of the patients. PMID:25003058

Assessment of carotid stenosis using three-dimensional T2-weighted dark blood imaging: Initial experience.

PubMed

Mihai, Georgeta; Winner, Marshall W; Raman, Subha V; Rajagopalan, Sanjay; Simonetti, Orlando P; Chung, Yiu-Cho

2012-02-01

To evaluate the use of a T2-weighted SPACE sequence (T2w-SPACE) to assess carotid stenosis via several methods and compare its performance with contrast-enhanced magnetic resonance angiography (ceMRA). Fifteen patients with carotid atherosclerosis underwent dark blood (DB)-MRI using a 3D turbo spin echo with variable flip angles sequence (T2w-SPACE) and ceMRA. Images were coregistered and evaluated by two observers. Comparisons were made for luminal diameter, luminal area, degree of luminal stenosis (NASCET: North American Symptomatic Endarterectomy Trial; ECST: European Carotid Surgery Trial, and area stenosis), and vessel wall area. Degree of NASCET stenosis was clinically classified as mild (<50%), moderate (50%-69%), or severe (>69%). Excellent agreement was seen between ceMRA and T2w-SPACE and between observers for assessment of lumen diameter, lumen area, vessel wall area, and degree of NASCET stenosis (r > 0.80, P < 0.001). ECST stenosis was consistently higher than NASCET stenosis (48 ± 14% vs. 24 ± 22%, P < 0.001). Area stenosis (72 ± 2%) was significantly higher (P < 0.001) than both ESCT and NASCET stenosis. DB-MRI of carotid arteries using T2w-SPACE is clinically feasible. It provides accurate measurements of lumen size and degree of stenosis in comparison with ceMRA and offers a more reproducible measure of ECST stenosis than ceMRA. Copyright © 2011 Wiley Periodicals, Inc.

Decompression Surgery Alone Versus Decompression Plus Fusion in Symptomatic Lumbar Spinal Stenosis: A Swiss Prospective Multicenter Cohort Study With 3 Years of Follow-up.

PubMed

Ulrich, Nils H; Burgstaller, Jakob M; Pichierri, Giuseppe; Wertli, Maria M; Farshad, Mazda; Porchet, François; Steurer, Johann; Held, Ulrike

2017-09-15

Retrospective analysis of a prospective, multicenter cohort study. To estimate the added effect of surgical fusion as compared to decompression surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis. The optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial. Patients of the Lumbar Stenosis Outcome Study with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24, and 36 months follow-up. In order to quantify the effect of fusion surgery as compared to decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion and the chi-square test. Confounders were adjusted with fixed effects for age, sex, body mass index, diabetes, Cumulative Illness Rating Scale musculoskeletal disorders, and duration of symptoms. One hundred thirty-one patients undergoing decompression surgery alone (n = 85) or decompression with fusion surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion compared with decompression alone surgery on SSM symptoms was 0.06 (95% confidence interval: -0.16-0.27) and -0.07 (95% confidence interval: -0.25-0.10) on SSM function, respectively. Among the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, decompression alone and decompression with fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion surgery was not associated with a more favorable outcome in both SSM scores as compared to decompression alone surgery. 3.

Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up

PubMed Central

Smith, Lucy; Becker, Ingrid; Schroeder, Wolfgang; Hoelscher, Arnulf H; Haneder, Stefan; Maintz, David; Spiro, Judith Eva

2018-01-01

Purpose Anastomotic leakage is a major surgical complication following esophagectomy and gastric pull-up. Specific risk factors such as celiac trunk (TC) stenosis and high calcification score of the aorta have been identified, but no data are available on their relative prognostic values. This retrospective study aimed to compare and evaluate calcification score versus stenosis quantification with regards to prognostic impact on anastomotic leakage. Patients and methods Preoperative contrast-enhanced computed tomography scans of 164 consecutive patients with primary esophageal cancer were evaluated by two radiologists to apply a calcification score (0–3 scale) assessing the aorta, the celiac axis and the right and left postceliac arteries. Concurrently, the presence and degree of stenosis of TC and superior mesenteric artery were recorded for stenosis quantification. Results Anastomotic leakage was noted in 14/164 patients and 12/14 showed stenosis of TC (n=11). The presence of TC stenosis was found to have a significant impact on anastomotic healing (p=0.004). The odds ratio for the prediction of anastomotic leakage by the degree of stenosis was 1.04 (95% CI, 1.02–1.07). Ten of 14 patients had aortic calcification scores of 1 or 2, but calcification scores of the aorta, the celiac axis and the right and left postceliac arteries did not correlate with the corresponding TC stenosis values and showed no influence on patient outcome as defined by the occurrence of anastomotic insufficiency (p=0.565, 0.855, 0.518 and 1.000, respectively). Inter-reader reliability of computed tomography analysis and absolute agreement on calcium scoring was mostly over 90%. No significant differences in preoperative comorbidities and patient characteristics were found between those with and without anastomotic leakage. Conclusion Measurement of TC stenosis in preoperative contrast-enhanced computed tomography scans proved to be more reliable than calcification scores in predicting anastomotic leakage and should, therefore, be used in the risk assessment of patients undergoing esophagectomy and gastric pull-up. PMID:29713180

Clinical Guideline for Treatment of Symptomatic Thoracic Spinal Stenosis.

PubMed

Chen, Zhong-qiang; Sun, Chui-guo

2015-08-01

Thoracic spinal stenosis is a relatively common disorder causing paraplegia in the population of China. Until nowadays, the clinical management of thoracic spinal stenosis is still demanding and challenging with lots of questions remaining to be answered. A clinical guideline for the treatment of symptomatic thoracic spinal stenosis has been created by reaching the consensus of Chinese specialists using the best available evidence as a tool to aid practitioners involved with the care of this disease. In this guideline, many fundamental questions about thoracic spinal stenosis which were controversial have been explained clearly, including the definition of thoracic spinal stenosis, the standard procedure for diagnosing symptomatic thoracic spinal stenosis, indications for surgery, and so on. According to the consensus on the definition of thoracic spinal stenosis, the soft herniation of thoracic discs has been excluded from the pathological factors causing thoracic spinal stenosis. The procedure for diagnosing thoracic spinal stenosis has been quite mature, while the principles for selecting operative procedures remain to be improved. This guideline will be updated on a timely schedule and adhering to its recommendations should not be mandatory because it does not have the force of law. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Genetics Home Reference: supravalvular aortic stenosis

MedlinePlus

... Twitter Home Health Conditions Supravalvular aortic stenosis Supravalvular aortic stenosis Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Supravalvular aortic stenosis (SVAS) is a heart defect that develops before ...

A systematic review to assess comparative effectiveness studies in epidural steroid injections for lumbar spinal stenosis and to estimate reimbursement amounts.

PubMed

Bresnahan, Brian W; Rundell, Sean D; Dagadakis, Marissa C; Sullivan, Sean D; Jarvik, Jeffrey G; Nguyen, Hiep; Friedly, Janna L

2013-08-01

To systematically appraise published comparative effectiveness evidence (clinical and economic) of epidural steroid injections (ESI) for lumbar spinal stenosis and to estimate Medicare reimbursement amounts for ESI procedures. TYPE: Systematic review. PubMed, Embase, and CINAHL were searched through August 2012 for key words that pertain to low back pain, spinal stenosis or sciatica, and epidural steroid injection. We used institutional and Medicare reimbursement amounts for our cost estimation. Articles published in English that assessed ESIs for adults with lumbar spinal stenosis versus a comparison intervention were included. Our search identified 146 unique articles, and 138 were excluded due to noncomparative study design, not having a study population with lumbar spinal stenosis, not having an appropriate outcome, or not being in English. We fully summarized 6 randomized controlled trials and 2 large observational studies. Randomized controlled trial articles were reviewed, and the study population, sample size, treatment groups, ESI dosage, ESI approaches, concomitant interventions, outcomes, and follow-up time were reported. Descriptive resource use estimates for ESIs were calculated with use of data from our institution during 2010 and Medicare-based reimbursement amounts. ESIs or anesthetic injections alone resulted in better short-term improvement in walking distance compared with control injections. However, there were no longer-term differences. No differences between ESIs versus anesthetic in self-reported improvement in pain were reported. Transforaminal approaches had better improvement in pain scores (≤4 months) compared with interlaminar injections. Two observational studies indicated increased rates of lumbar ESI in Medicare beneficiaries. Our sample included 279 patients who received at least 1 ESI during 2010, with an estimated mean total outpatient reimbursement for one ESI procedure "event" to be $637, based on 2010 Medicare reimbursement amounts ($505 technical and $132 professional payments). This systematic review of ESI for treating lumbar spinal stenosis found a limited amount of data that suggest that ESI is effective in some patients for improving select short-term outcomes, but results differed depending on study design, outcome measures used, and comparison groups evaluated. Overall, there are relatively few comparative clinical or economic studies for ESI procedures for lumbar spinal stenosis in adults, which indicated a need for additional evidence. Copyright © 2013. Published by Elsevier Inc.

Distribution of tissue characteristics of coronary plaques evaluated by integrated backscatter intravascular ultrasound: Differences between the inner and outer vessel curvature.

PubMed

Sato, Hironobu; Kawasaki, Masanori; Morita, Norihiko; Fujiwara, Hisayoshi; Minatoguchi, Shinya

2015-12-01

The purpose of the present study was to evaluate the tissue characteristics of plaques with moderate or mild stenosis in the inner and outer curvature of the left anterior descending artery (LAD) using integrated backscatter intravascular ultrasound. We evaluated 66 plaques with moderate stenosis (plaque burden >50% but ≤75%) and 49 plaques with mild stenosis (plaque burden >30% but ≤50%) in 66 patients undergoing percutaneous intervention to the LAD. All plaques were >10mm away from any side branch or previously implanted stents. We divided vessel cross-sections into four quadrants (inner curvature, outer curvature, clockwise lateral side, and counterclockwise lateral side) using the septal branch as a landmark for the inner curvature. We averaged relative lipid area, relative fibrous area, and relative calcified area in minimal lumen area (MLA), three cross-sections proximal to the site of MLA, and three cross-sections distal to the site of MLA. In plaques with moderate stenosis, the relative lipid area in the inner curvature was significantly greater than in the outer curvature and lateral sides, whereas there was no significant difference in plaques with mild stenosis. The present study provides new findings that lipid pool is clustered in the inner curvature and fibrous tissue is clustered in the outer curvature of plaques with moderate stenosis in non-branching LAD lesions. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Analysis of the pathological severity degree of aortic stenosis (AS) and mitral stenosis (MS) using the discrete wavelet transform (DWT).

PubMed

Meziani, F; Debbal, S M; Atbi, A

2013-01-01

The heart is the principal organ that circulates blood. In normal conditions it produces four sounds for each cardiac cycle. However, most often only two sounds appear essential: S1 and S2. Two other sounds: S3 and S4, with lower amplitude than S1 or S2, appear occasionally in the cardiac cycle by the effect of disease or age. The presence of abnormal sounds in one cardiac cycle provide valuable information on various diseases. The aortic stenosis (AS), as being a valvular pathology, is characterized by a systolic murmur due to a narrowing of the aortic valve. The mitral stenosis (MS) is characterized by a diastolic murmur due to a reduction in the mitral valve. Early screening of these diseases is necessary; it's done by a simple technique known as: phonocardiography. Analysis of phonocardiograms signals using signal processing techniques can provide for clinicians useful information considered as a platform for significant decisions in their medical diagnosis. In this work two types of diseases were studied: aortic stenosis (AS) and mitral stenosis (MS). Each one presents six different cases. The application of the discrete wavelet transform (DWT) to analyse pathological severity of the (AS and MS was presented. Then, the calculation of various parameters was performed for each patient. This study examines the possibility of using the DWT in the analysis of pathological severity of AS and MS.

78 FR 26368 - Change in Bank Control Notices; Acquisitions of Shares of a Bank or Bank Holding Company

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

...; Jackson Duane Fager Trust; Gabrielle Elizabeth Fager Trust; Kaitlin Elizabeth Hiestand Trust; Ella Claire... Trust; and the Jane Anderson Trust, all as members of the Fager Family Group; to retain voting shares of...

Complex Microbial Communities: We’re not in Kansas Anymore

ScienceCinema

Fraser-Liggett, Claire M.

2018-05-08

Claire Fraser-Liggett, Director of the Institute for Genome Sciences and professor at the University of Maryland School of Medicine, gives the June 2, 2010 keynote at the "Sequencing, Finishing, Analysis in the Future" meeting in Santa Fe, NM.

75 FR 21042 - Notice of Determinations Terminating Investigations of Petitions Regarding Eligibility To Apply...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

..., Michigan. TA-W-72,042: Align Technology, Santa Clara, California. TA-W-72,173: Reliant Machine, Inc., Green...: Hutchinson Technology, Eau Claire, Wisconsin. TA-W-72,685: First Data Corp., Daytona Beach, Florida. TA-W-72...

76 FR 48834 - Michigan Consolidated Gas Company and Dawn Gateway Pipeline, LLC; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-09

...'s Belle River-St. Clair Pipeline into the new 21-mile long Dawn Gateway Pipeline system, which... & Optimization, DTE Pipeline/Dawn Gateway LLC, One Energy Plaza, Detroit, MI 48226, phone (313) 235-6531 or e...

Higher Education Exchange.

ERIC Educational Resources Information Center

Brown, David W., Ed.; Witte, Deborah, Ed.

This collection of 10 articles and stories highlights ongoing experiments in colleges and universities which address the relationship of higher education institutions and citizenship responsibility. Following a foreword by Deborah White, articles are: "The Civic Roots of Academic Social Science Scholarship in American" (R. Claire Snyder), which…

33 CFR 162.136 - Connecting waters from Lake Huron to Lake Erie; anchorage grounds.

Code of Federal Regulations, 2011 CFR

2011-07-01

...: There is an authorized anchorage in Canadian waters just above Fighting Island and an authorized anchorage in U.S. waters south of Belle Isle (33 CFR 110.206). (b) In the St. Clair River, vessels shall be...

15. Photographic copy of sepia of original construction drawing dated ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. Photographic copy of sepia of original construction drawing dated September 15, 1938 (original sepia in plan room of Base Civil Engineer, Scott AFB) Elevations - Scott Air Force Base, General Officer Quarters, 229 Birchard Street, O'Fallon, St. Clair County, IL

Mitomycin C and endoscopic sinus surgery: where are we?

PubMed

Tabaee, Abtin; Brown, Seth M; Anand, Vijay K

2007-02-01

Mitomycin C has been used successfully in various ophthalmologic and, more recently, otolaryngologic procedures. Its modulation of fibroblast activity allows for decreased scarring and fibrosis. Several recent trials have examined the efficacy of mitomycin C in reducing synechia and stenosis following endoscopic sinus surgery. Basic science studies using fibroblast cell lines have demonstrated a dose-dependent suppression of activity with the use of mitomycin C. This is further supported by animal studies that have shown lower rates of maxillary ostial restenosis following application of mitomycin C. No human trial, however, has demonstrated a statistically significant impact of mitomycin C on the incidence of postoperative synechia or stenosis following sinus surgery. The limitations of the literature are discussed. The antiproliferative properties of mitomycin C may theoretically decrease the incidence of synechia and stenosis following endoscopic sinus surgery. Although this is supported by basic science studies and its successful use in other fields, the clinical evidence to date has not shown the application of mitomycin C to be effective in preventing stenosis after endoscopic sinus surgery. Future prospective studies are required before definitive conclusions can be made.

An investigation of correlation between left coronary bifurcation angle and hemodynamic changes in coronary stenosis by coronary computed tomography angiography-derived computational fluid dynamics

PubMed Central

Chaichana, Thanapong

2017-01-01

Background To investigate the correlation between left coronary bifurcation angle and coronary stenosis as assessed by coronary computed tomography angiography (CCTA)-generated computational fluid dynamics (CFD) analysis when compared to the CCTA analysis of coronary lumen stenosis and plaque lesion length with invasive coronary angiography (ICA) as the reference method. Methods Thirty patients (22 males, mean age: 59±6.9 years) with calcified plaques at the left coronary artery were included in the study with all patients undergoing CCTA and ICA examinations. CFD simulation was performed to analyze hemodynamic changes to the left coronary artery models in terms of wall shear stress, wall pressure and flow velocity, with findings correlated to the coronary stenosis and degree of bifurcation angle. Calcified plaque length was measured in the left coronary artery with diagnostic value compared to that from coronary lumen and bifurcation angle assessments. Results Of 26 significant stenosis at left anterior descending (LAD) and 13 at left circumflex (LCx) on CCTA, only 14 and 5 of them were confirmed to be >50% stenosis at LAD and LCx respectively on ICA, resulting in sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 52%, 49% and 100%. The mean plaque length was measured 5.3±3.6 and 4.4±1.9 mm at LAD and LCx, respectively, with diagnostic sensitivity, specificity, PPV and NPV being 92.8%, 46.7%, 61.9% and 87.5% for extensively calcified plaques. The mean bifurcation angle was measured 83.9±13.6º and 83.8±13.3º on CCTA and ICA, respectively, with no significant difference (P=0.98). The corresponding sensitivity, specificity, PPV and NPV were 100%, 78.6%, 84.2% and 100% based on bifurcation angle measurement on CCTA, 100%, 73.3%, 78.9% and 100% based on bifurcation angle measurements on ICA, respectively. Wall shear stress was noted to increase in the LAD and LCx models with significant stenosis and wider angulation (>80º), but demonstrated little or no change in most of the coronary models with no significant stenosis and narrower angulation (<80º). Conclusions This study further clarifies the relationship between left coronary bifurcation angle and significant stenosis, with angulation measurement serving as a more accurate approach than coronary lumen assessment or plaque lesion length for determining significant coronary stenosis. Left coronary bifurcation angle is suggested to be incorporated into coronary artery disease (CAD) assessment when diagnosing significant CAD. PMID:29184766

Mathematical, numerical and experimental study in the human aorta with coexisting models of bicuspid aortic stenosis and coarctation of the aorta.

PubMed

Keshavarz-Motamed, Z; Garcia, J; Kadem, L

2011-01-01

Coarctation of the aorta is an obstruction of the aorta and is usually associated with other concomitant cardiovascular abnormalities especially with bicuspid aortic valve stenosis. The objectives of this study are, (1) to investigate the effects of coarctation on the hemodynamics in the aorta to gain a better understanding of the cause of certain post-surgical coarctation problems, (2) to develop and introduce a new lumped parameter model, mainly based on non-invasive data, allowing the description of the interaction between left ventricle, coarctation of the aorta, aortic valve stenosis, and the arterial system.

Numerical simulation of heat transfer in power law fluid flow through a stenosed artery

NASA Astrophysics Data System (ADS)

Talib, Amira Husni; Abdullah, Ilyani

2017-11-01

A numerical study of heat transfer in a power law fluid is investigated in this paper. The blood flow is treated as power law fluid with a presence of cosine shaped stenosis. This study reveals the effect of stenosis on the heat transfer and velocity of blood flowing in the constricted artery. The governing and energy equations are formulated in a cylindrical coordinate system. Hence, the set of equations and boundary conditions are solved numerically by Marker and Cell (MAC) method. The graphical result shows the profile of blood temperature is increased while the blood velocity is decreased at the critical height of stenosis.

Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

PubMed

Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

2017-09-01

The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis <50%) and thirty gender- and age-matched patients (control group) without coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic AS rest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) were decreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (P<.05). In patients with mild single vessel coronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

Common iliac vein stenosis and risk of symptomatic pulmonary embolism: an inverse correlation.

PubMed

Chan, Keith T; Popat, Rita A; Sze, Daniel Y; Kuo, William T; Kothary, Nishita; Louie, John D; Hovsepian, David M; Hwang, Gloria L; Hofmann, Lawrence V

2011-02-01

To test the hypothesis that a common iliac vein (CIV) stenosis may impair embolization of a large deep venous thrombosis (DVT) to the lungs, decreasing the incidence of a symptomatic pulmonary embolism (PE). Between January 2002 and August 2007, 75 patients diagnosed with unilateral DVT were included in a single-institution case-control study. Minimum CIV diameters were measured 1 cm below the inferior vena cava (IVC) bifurcation on computed tomography (CT) images. A significant stenosis in the CIV ipsilateral to the DVT was defined as having either a diameter 4 mm or less or a greater than 70% reduction in lumen diameter. A symptomatic PE was defined as having symptoms and imaging findings consistent with a PE. The odds of symptomatic PE versus CIV stenosis were assessed using logistic regression models. The associations between thrombus location, stenosis, and symptomatic PE were assessed using a stratified analysis. Of 75 subjects, 49 (65%) presented with symptomatic PE. There were 17 (23%) subjects with a venous lumen 4 mm or less and 12 (16%) subjects with a greater than 70% stenosis. CIV stenosis of 4 mm or less resulted in a decreased odds of a symptomatic PE compared with a lumen greater than 4 mm (odds ratio [OR] 0.17, P = .011), whereas a greater than 70% stenosis increased the odds of DVT involving the CIV (OR 7.1, P = .047). Among patients with unilateral DVT, those with an ipsilateral CIV lumen of 4 mm or less have an 83% lower risk of developing symptomatic PE compared with patients with a CIV lumen greater than 4 mm. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Early rectal stenosis following stapled rectal mucosectomy for hemorrhoids

PubMed Central

Petersen, Sven; Hellmich, Gunter; Schumann, Dietrich; Schuster, Anja; Ludwig, Klaus

2004-01-01

Background Within the last years, stapled rectal mucosectomy (SRM) has become a widely accepted procedure for second and third degree hemorrhoids. One of the delayed complications is a stenosis of the lower rectum. In order to evaluate the specific problem of rectal stenosis following SRM we reviewed our data with special respect to potential predictive factors or stenotic events. Methods A retrospective analysis of 419 consecutive patients, which underwent SRM from December 1998 to August 2003 was performed. Only patients with at least one follow-up check were evaluated, thus the analysis includes 289 patients with a mean follow-up of 281 days (±18 days). For statistic analysis the groups with and without stenosis were evaluated using the Chi-Square Test, using the Kaplan-Meier statistic the actuarial incidence for rectal stenosis was plotted. Results Rectal stenosis was observed in 9 patients (3.1%), eight of these stenoses were detected within the first 100 days after surgery; the median time to stenosis was 95 days. Only one patient had a rectal stenosis after more than one year. 8 of the 9 patients had no obstructive symptoms, however the remaining patients complained of obstructive defecation and underwent surgery for transanal strictureplasty with electrocautery. A statistical analysis revealed that patients with stenosis had significantly more often prior treatment for hemorrhoids (p < 0.01). According to the SRM only severe postoperative pain was significantly associated with stenoses (p < 0.01). Other factors, such as gender (p = 0.11), surgical technique (p = 0.25), revision (p = 0.79) or histological evidence of squamous skin (p = 0.69) showed no significance. Conclusion Rectal stenosis is an uncommon event after SRM. Early stenosis will occur within the first three months after surgery. The majority of the stenoses are without clinical relevance. Only one of nine patients had to undergo surgery for a relevant stenosis. The predictive factor for stenosis in the patient-characteristics is previous interventions for hemorrhoids, severe postoperative pain might also predict rectal stenosis. PMID:15153248

The influence of side branch stenosis on fractional flow reserve assessment of the main branch in a swine model.

PubMed

Oh, Jun-Hyok; Song, Seunghwan; Kim, Changhoon; Kim, Jeongsu; Sup Park, Jin; Won Lee, Hye; Hyun Choi, Jung; Cheol Lee, Han; Soo Cha, Kwang; Jong Hong, Taek

2017-02-01

The aim of this study was to explore the effect of one stenosis in a daughter artery on the fractional flow reserve (FFR) of another stenosis parallels in side branch. The impact of one stenosis on the FFR of another parallel stenosis has not been evaluated. The proximal segments of the left anterior descending (LAD) and left circumflex (LCX) arteries were exposed and encircled with a Teflon pledget complex in seven swine (55-70 kg). Five degrees of stenosis (to approximate angiographic diameter stenoses of 0%, 25%, 50%, 75%, and 100%) were made by tightening the pledgets. FFR was evaluated simultaneously in the LAD and the LCX with two pressure wires in each coronary artery. A mixed-effects linear model was used to evaluate the association between the FFR values. A total of 115 paired FFR values were obtained. The FFR of the LAD and LCX were not significantly associated with each other (F = 0.237 and P = 0.627 for the LCX FFR to predict the LAD FFR; F = 0.541 and P = 0.463 for the LAD FFR to predict the LCX FFR). The individual FFR values of each parallel stenosis in the LAD and the LCX were not significantly influenced by each other. This relationship was independent of the mean aortic pressure and heart rate. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Management of carotid stenosis in women

PubMed Central

Brown, Martin M.; Didier, Leys; Howard, Virginia J.; Moore, Wesley S.; Paciaroni, Maurizio; Ringleb, Peter; Rockman, Caron; Caso, Valeria

2013-01-01

Objective: Specific guidelines for management of cerebrovascular risk in women are currently lacking. This study aims to provide a consensus expert opinion to help make clinical decisions in women with carotid stenosis. Methods: Proposals for the use of carotid endarterectomy (CEA), carotid stenting (CAS), and medical therapy for stroke prevention in women with carotid stenosis were provided by a group of 9 international experts with consensus method. Results: Symptomatic women with severe carotid stenosis can be managed by CEA provided that the perioperative risk of the operators is low (<4%). Periprocedural stroke risks may be increased in symptomatic women if revascularization is performed by CAS; however, the choice of CAS vs CEA can be tailored in subgroups best fit for each procedure (e.g., women with restenosis or severe coronary disease, best suited for CAS; women with tortuous vessels or old age, best suited for CEA). There is currently limited evidence to consider medical therapy alone as the best choice for women with neurologically severe asymptomatic carotid stenosis, who should be best managed within randomized trials including a medical arm. Medical management and cardiovascular risk factor control must be implemented in all women with carotid stenosis in periprocedural period and lifelong regardless of whether or not intervention is planned. Conclusions: The suggestions provided in this article may constitute a decision-making basis for planning treatment of carotid stenosis in women. Most recommendations are of limited strength; however, it is unlikely that new robust data will emerge soon to induce relevant changes. PMID:23751919

Assessment of lake sturgeon (Acipenser fulvescens) spawning efforts in the lower St. Clair River, Michigan

USGS Publications Warehouse

Nichols, S. Jerrine; Kennedy, Gregory; Crawford, Eric; Allen, Jeffrey; French, John; Black, Glen; Blouin, Marc; Hickey, James P.; Chernyak, Sergei; Haas, Robert; Thomas, Michael

2003-01-01

One of the most threatened remaining populations of lake sturgeon in the Great Lakes is found in the connecting channels between Lake Huron and Lake Erie. Only two spawning grounds are presently known to be active in this region, and both are in the St. Clair River. The spawning reef in the St. Clair River delta has been recently colonized by round gobies (Neogobius melanostomus) in densities up to 25/m2, raising concerns regarding predation on the benthic-oriented eggs and larvae of the sturgeon. Investigations in 1998–1999 showed that while round goby predation does occur, a number of other factors may be equally affecting sturgeon spawning success, including few spawning adults (< 60), suspected poaching pressure, low retention rate of eggs on the reef, low hatch rate (~0.5%), the presence of organic contaminants, and predation from native and exotic invertebrates and fish. Overall, we estimate that less than 1% of the eggs deposited during a spawning run survive to hatch. We were able to increase the egg hatch rate to 16% by placing eggs in predator-exclusion chambers on the reef. The fate of the larvae is uncertain. Two weeks after hatching, no larvae were found on the reef. We were unable to find them anywhere else in the river, nor was predation on larvae noted in either year. There were factors other than predation affecting larval survival in 1999. There was a higher silt load on the reef than in 1998 and large numbers of dead larvae were found. Recruitment success from this site could be improved by utilizing techniques to increase the number of eggs on the reef, such as reducing the illegal take of adult fish and by placing eggs in predator-exclusion chambers to increase hatch rate.

Walleye in Lake Erie and Lake St. Clair

USGS Publications Warehouse

Nepszy, S.J.; Davies, D.H.; Einhouse, D.; Hatch, R.W.; Isbell, G.; MacLennan, D.; Muth, K.M.

1991-01-01

The history and current status of walleye (Stizostedion vitreum vitreum) stocks in Lake Erie and Lake St. Clair are reviewed in relation to their exploitation by commercial and recreational fishermen, environmental factors, rehabilitation efforts, and community dynamics. Management initiatives and stock recovery under these processes are outlined. After the collapse of the fishery in 1957, the highly productive walleye stock of western Lake Erie remained depressed through the 1960s, while the eastern basin stock remained stable. Closure of the fishery for walleye from 1970-73 because of mercury contamination provided an opportunity for the development of an international interagency management plan. With quota management, the walleye stock in western Lake Erie responded well to limited exploitation, steadily increased, and expanded its range. As population expanded, growth began to decline and was more apparent in the young-of-the-year (YOY) in the 1970s, and in older walleye in the late 1970s and 1980s. At the turn of the century, commercial harvest of walleye in Lake St. Clair ranged from 12-127 tonnes annually. A relatively stable period from 1910-59 was followed by significantly increased harvests (100-150 t) in 1959-65. This increase was a result of increased commercial exploitation as well as an increased abundance of walleye. After the mercury contamination problem of 1970, angling effort and harvest was reduced but then gradually increased in Ontario waters from 37 t in 1973 to 62 t in 1988. The increased mean age of the stock during the early 1970s was due to a few strong year-classes (1970, 1972, and 1974) as well as a period of stable or reduced catch per unit effort. With the current mean age not reduced significantly, the stocks of walleye should continue to provide good yields.

Expansion of tubenose gobies Proterorhinus semilunaris into western Lake Erie and potential effects on native species

USGS Publications Warehouse

Kocovsky, P.M.; Tallman, J.A.; Jude, D.J.; Murphy, D.M.; Brown, J.E.; Stepien, C.A.

2011-01-01

The Eurasian freshwater tubenose goby Proterorhinus semilunaris (formerly Proterorhinus marmoratus) invaded the Laurentian Great Lakes in the 1990s, presumably via ballast water from transoceanic cargo ships. Tubenose gobies spread throughout Lake St. Clair, its tributaries, and the Detroit River system, and also are present in the Duluth-Superior harbor of Lake Superior. Using seines and bottom trawls, we collected 113 tubenose gobies between July 2007 and August 2009 at several locations in western Lake Erie. The number and range of sizes of specimens collected suggest that that tubenose gobies have become established and self-sustaining in the western basin of Lake Erie. Tubenose gobies reached maximum densities in sheltered areas with abundant macrophyte growth, which also is their common habitat in native northern Black Sea populations. The diet of tubenose gobies was almost exclusively invertebrates, suggesting dietary overlap with other benthic fishes, such as darters (Etheostoma spp. and Percina sp.), madtoms (Noturus spp.), and sculpins (Cottus spp.). A single mitochondrial DNA haplotype was identified, which is the most common haplotype found in the original colonization area in the Lake St. Clair region, suggesting a founder effect. Tubenose gobies, like round gobies Neogobius melanostomus, have early life stages that drift owing to vertical migration, which probably allowed them to spread from areas of colonization. The Lake St. Clair-Lake Erie corridor appears to have served as an avenue for them to spread to the western basin of Lake Erie, and abundance of shallow macrophyte-rich habitats may be a key factor facilitating their further expansion within Lake Erie and the remainder of the Laurentian Great Lakes.

Origin and heterogeneity of pore sizes in the Mount Simon Sandstone and Eau Claire Formation: Implications for multiphase fluid flow

DOE PAGES

Mozley, Peter S.; Heath, Jason E.; Dewers, Thomas A.; ...

2016-01-01

The Mount Simon Sandstone and Eau Claire Formation represent a principal reservoir - caprock system for wastewater disposal, geologic CO 2 storage, and compressed air energy storage (CAES) in the Midwestern United States. Of primary concern to site performance is heterogeneity in flow properties that could lead to non-ideal injectivity and distribution of injected fluids (e.g., poor sweep efficiency). Using core samples from the Dallas Center Structure, Iowa, we investigate pore structure that governs flow properties of major lithofacies of these formations. Methods include gas porosimetry and permeametry, mercury intrusion porosimetry, thin section petrography, and X-ray diffraction. The lithofacies exhibitmore » highly variable intra- and inter-informational distributions of pore throat and body sizes. Based on pore-throat size, samples fall into four distinct groups. Micropore-throat dominated samples are from the Eau Claire Formation, whereas the macropore-, mesopore-, and uniform-dominated samples are from the Mount Simon Sandstone. Complex paragenesis governs the high degree of pore and pore-throat size heterogeneity, due to an interplay of precipitation, non-uniform compaction, and later dissolution of cements. Furthermore, the cement dissolution event probably accounts for much of the current porosity in the unit. The unusually heterogeneous nature of the pore networks in the Mount Simon Sandstone indicates that there is a greater-than-normal opportunity for reservoir capillary trapping of non-wetting fluids — as quantified by CO 2 and air column heights — which should be taken into account when assessing the potential of the reservoir-caprock system for CO 2 storage and CAES.« less

[Calcified aortic stenosis due to healed experimental bacterial endocarditis].

PubMed

Contreras Rodríguez, R; Rodríguez Velasco, A; Flores Miranda, J R; Ramos Amaro, J

1993-01-01

We studied the role of bacterial endocarditis in the development of aortic valve stenosis. A femoral arterio venous shunt was performed in nine dogs with the method previously proposed by Lillehei. We induced bacteremic infection with the administration of streptococcus mitis (1 x 10(10)) 10 ml once a day for 15 days these bacterium were sensible to penicillin. All dogs were treated with 1,000,000 U of benzatinic penicillin and sacrificed between 28-102 days after the bacterial inoculation ended. In one dog we observed bacterial endocarditis in the mitral and aortic valves and in other three dogs there was an aortic valve stenosis with calcium deposits in the body and in the free edges of the aortic valve with evident irregular stenosis as seen in man.

Birth defects in relation to Bendectin use in pregnancy. II. Pyloric stenosis.

PubMed

Mitchell, A A; Schwingl, P J; Rosenberg, L; Louik, C; Shapiro, S

1983-12-01

To test the hypothesis that the use of Bendectin in pregnancy increases the risk of pyloric stenosis, we determined rates of antenatal Bendectin exposure among 325 infants with pyloric stenosis and among two control groups comprising infants with other defects; one consisted of 3,153 infants with other conditions, and the other, a subset of that group, consisted of 724 infants with defects that may have had their origins at any time in pregnancy. Comparisons between the cases and the two control series yielded estimated relative risks of 0.9 (95% confidence interval, 0.6 to 1.2) and 1.0 (0.7 to 1.4), respectively. The findings from this large case-control study suggest that Bendectin does not increase the risk of pyloric stenosis.

Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn's disease.

PubMed

Seastedt, Kenneth P; Trencheva, Koiana; Michelassi, Fabrizio; Alsaleh, Doaa; Milsom, Jeffrey W; Sonoda, Toyooki; Lee, Sang W; Nandakumar, Govind

2014-12-01

CT enterography and magnetic resonance enterography have emerged as first-line imaging technologies for the evaluation of the gastrointestinal tract in Crohn's disease. The purpose of this work was to evaluate the accuracy of these imaging modalities to identify Crohn's disease lesions preoperatively. This was a retrospective chart review. The study was conducted at a single institution. Seventy-six patients with Crohn's disease with preoperative CT enterography and/or magnetic resonance enterography were included in the study. The number of stenoses, fistulas, and abscesses on CT enterography and/or magnetic resonance enterography before surgery were compared with operative findings. Forty patients (53%) were women, 46 (60%) underwent surgery for recurrent Crohn's disease, and 46 (57%) had previous abdominal surgery. Thirty-six (47%) had a preoperative CT enterography and 43 (57%) had a preoperative magnetic resonance enterography. CT enterography sensitivity was 75% for stenosis and 50% for fistula. MRE sensitivity was 68% for stenosis and 60% for fistula. The negative predictive values of CT enterography and magnetic resonance enterography for stenosis were very low (54% and 65%) and were 85% and 81% for fistula. CT enterography had 76% accuracy for stenosis and 79% for fistula; magnetic resonance enterography had 78% accuracy for stenosis and 85% for fistula. Both were accurate for abscess. False-negative rates for CT enterography were 50% for fistula and 25% for stenosis. False-negative rates for magnetic resonance enterography were 40% for fistula and 32% for stenosis. Unexpected intraoperative findings led to modification of the planned surgical procedure in 20 patients (26%). This study was limited by its small sample size, its retrospective nature, and that some studies were performed at outside institutions. CT enterography and magnetic resonance enterography in patients with Crohn's disease were accurate for the identification of abscesses but not for fistulas or stenoses. Surgeons should search for additional lesions intraoperatively. Patients should be appropriately counseled regarding the need for unexpected interventions (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A162).

Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis.

PubMed

Choi, Won Jae; Park, Jong-Jae; Park, Jain; Lim, Eun-Hye; Joo, Moon Kyung; Yun, Jae-Won; Noh, Hyejin; Kim, Sung Ho; Choi, Woo Seok; Lee, Beom Jae; Kim, Ji Hoon; Yeon, Jong Eun; Kim, Jae Seon; Byun, Kwan Soo; Bak, Young-Tae

2013-07-01

The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration.

Effects of the Temporary Placement of a Self-Expandable Metallic Stent in Benign Pyloric Stenosis

PubMed Central

Choi, Won Jae; Park, Jain; Lim, Eun-Hye; Joo, Moon Kyung; Yun, Jae-Won; Noh, Hyejin; Kim, Sung Ho; Choi, Woo Seok; Lee, Beom Jae; Kim, Ji Hoon; Yeon, Jong Eun; Kim, Jae Seon; Byun, Kwan Soo; Bak, Young-Tae

2013-01-01

Background/Aims The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. Methods Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. Results No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. Conclusions Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration. PMID:23898381

Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy.

PubMed

Koëter, Marijn; van der Sangen, Maurice J C; Hurkmans, Coen W; Luyer, Misha D P; Rutten, Harm J T; Nieuwenhuijzen, Grard A P

2015-03-06

Neoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. The aim of this study was to determine the influence of radiation dose on the incidence of leakage and stenosis. Fifty-three patients with esophageal cancer received neoadjuvant chemoradiation (23 × 1.8 Gy) (combined with Paclitaxel and Carboplatin) followed by a transhiatal esophagectomy between 2009 and 2011. On planning CT, the future anastomotic region was determined and the mean radiation dose, V20, V25, V30, V35 and V40 were calculated. Logistic regression analysis was conducted to examine determinants of anastomotic leakage and stenosis. Anastomotic leaks occurred in 13 of 53 patients (25.5%) and anastomotic stenosis occurred in 24 of 53 patients (45.3%). Median follow-up was 20 months. Logistic regression analysis showed that mean dose, V20-V40, age, co-morbidity, method of anastomosis, operating time and interval between last radiotherapy treatment and surgery were not predictors of anastomotic leakage and stenosis. A radiation dose of 23 × 1.8 Gy on the future anastomotic region has no influence on the occurrence of anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by transhiatal esophagectomy.

The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

PubMed

Radnic, Bojana; Radojevic, Nemanja; Vucinic, Jelena; Duborija-Kovacevic, Natasa

2017-07-01

Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

[Traumatic Lacrimal Duct Stenosis: Demographics and Success Rate of Surgical Procedures for Secondary Treatment].

PubMed

Alnawaiseh, M; Böhm, M R R; Rosentreter, A; Wieneke, A C; Wirths, G; Merté, R L; Eter, N; Zumhagen, L

2016-06-01

Traumatic lacrimal duct stenosis can be the result of sharp trauma of the eyelid, indirect trauma or surgery in the nasoorbital region, as well as burns, chemotherapy and radiation of the facial region. The aim of the study is to present the demographics, patient satisfaction, and course of different surgical procedures for secondary treatment of traumatic lacrimal duct stenosis. We retrospectively reviewed the medical records of 50 patients who required surgery for traumatic lacrimal duct stenosis from 2009 to 2011 at the University Eye Hospital in Muenster. The evaluation included the following criteria: age, sex, duration of symptoms, complication rate and the rate of recurrence. We systematically evaluated the medical data and asked the patients about the recent symptoms via telephone questionnaire. 60 eyes of 50 patients were included (18 women; 32 men; age: 51.8 ± 17.1 years); 34 eyes (56.7 %) had already had operations of the lacrimal system. The success rate was 58.1 %. The mean postoperative follow-up was 52.3 ± 10.7 months. In 11 cases (18.3 %), a dakryocystorhinostomy (DCR) was necessary. Traumatic lacrimal stenosis is more common in men, and has a poorer prognosis than lacrimal duct stenosis from other causes. Georg Thieme Verlag KG Stuttgart · New York.

Balloon dilation of congenital supravalvular pulmonic stenosis in a dog.

PubMed

Treseder, Julia R; Jung, SeungWoo

2017-03-30

Percutaneous balloon valvuloplasty is considered the standard of care for treatment of valvular pulmonic stenosis, a common congenital defect in dogs. Supravalvular pulmonic stenosis is a rare form of pulmonic stenosis in dogs and standard treatment has not been established. Although, there have been reports of successful treatment of supravalvular pulmonic stenosis with surgical and stenting techniques, there have been no reports of balloon dilation to treat dogs with this condition. Here, a case of supravalvular pulmonic stenosis diagnosed echocardiographically and angiographically in which a significant reduction in pressure gradient was achieved with balloon dilation alone is presented.

Carotid Consensus Panel duplex criteria can replace modified University of Washington criteria without affecting accuracy.

PubMed

Kim, Ann H; Augustin, Gener; Shevitz, Andrew; Kim, Hannah; Trivonovich, Michael R; Powell, Alexis R; Kumins, Norman; Tarr, Robert; Kashyap, Vikram S

2018-04-01

The decision to intervene for internal carotid stenosis often depends on the degree of stenosis seen on duplex ultrasound (US). The aim of this study is to compare the diagnostic accuracy of two criteria: modified University of Washington (UW) and 2003 Carotid Consensus Panel (CCP). All patients undergoing US in an accredited (IAC) vascular laboratory from January 2010 to June 2015 were reviewed ( n=18,772 US exams). Patients receiving a neck computed tomography angiography (CTA) within 6 months of the US were included in the study ( n=254). The degree of stenosis was determined by UW/CCP criteria and confirmed on CTA images using North American Symptomatic Carotid Endarterectomy Trial (NASCET)/European Carotid Surgery Trial (ECST) schema. Kappa analysis with 95% confidence intervals (CIs) were utilized to determine duplex-CTA agreement. A total of 417 carotid arteries from 221 patients were assessed in this study. The modified UW criteria accurately classified 266 (63.9%, kappa = 0.321, 95% CI 0.255 to 0.386) cases according to NASCET-derived measurements. The sensitivity, specificity, and accuracy at ≥ 60% stenosis were 65.7%, 81.3%, and 81.9%. The CCP criteria resulted in 296 (70.9%) accurate diagnoses (kappa = 0.359, 95% CI 0.280 to 0.437). At ≥ 70% stenosis, the sensitivity, specificity and accuracy were 38.8%, 91.6%, and 87.1% for NASCET. Comparison of the duplex results to ECST-derived CTA measurements revealed a similar trend (UW 53.1%, κ = 0.301 vs CCP 62.1%, κ = 0.315). The CCP criteria demonstrate a higher concordance rate with measurements taken from CTAs. The CCP criteria may be more sensitive in classifying clinically significant degrees of stenosis without a loss in diagnostic accuracy.

Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis.

PubMed

Al Sabah, Salman; Al Haddad, Eliana; Siddique, Iqbal

2017-09-01

Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric surgery, accounting for more than 50% of these procedures performed in the USA. Given this popularity, more is being understood about the complications associated with LSG, which, though uncommon, include the formation of strictures and stenosis. The purpose of this study is to establish a safe and effective protocol for the treatment of stenosis post-LSG using endoscopic balloon dilatation. This is a prospective review of 26 patients who had undergone LSG in Kuwait, followed by sleeve gastrectomy stenosis (SGS) and were then referred to Amiri Hospital for endoscopic balloon dilatation from October 2008 up to June 2016. A total of 26 patients (four males; 22 females) presented with symptoms of stenosis post-LSG during the study period. The mean age of the patients was 34.6 ± 10.8 years. The mean body mass index at the time of surgery was 43 ± 1.6 kg/m 2 . The median interval from the initial LSG surgery was 95 days. Nine patients had an early presentation (≤3 months from surgery), while 17 presented late (>3 months). The patients were followed for a mean duration of 156 ± 20 days from the last endoscopic balloon dilatation. A total of 23 (88.5%) patients had complete resolution of their symptoms. Adverse events were observed in one patients, who was removed from the study. Gastric stenosis is a rare but potentially serious complication of LSG. Serial dilatation of SGS employing endoscopic balloons is a safe method of treatment, with high efficacy rates. This new method may offer a less invasive alternative to surgical revision. However, if endoscopic treatment fails, surgery is necessary.

Prevalence and Risk Factors of Central Venous Stenosis among Prevalent Hemodialysis Patients, a Single Center Experience.

PubMed

Osman, Osama O; El-Magzoub, Abdul-Rahman A; Elamin, Sarra

2014-01-01

Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. In this study we evaluated the prevalence and risk factors of CVS among hemodialysis (HD) patients in a single center in Sudan, using Doppler ultrasound as a screening tool. The study included 106 prevalent HD patients. For every patient, we performed Duplex Doppler for the right and left jugular, subclavian and femoral veins. A patient was considered to have hemodynamically significant stenosis if the pre-stenosis to the post-stenosis velocities ratio was ≥ 2.5 or they had complete vein occlusion. Overall, 28.3% of patients had Doppler detected CVS, including 25.5% with hemodynamically significant stenosis and 2.8% with compromised flow. The prevalence of CVS was 68.4% among symptomatic patients compared to 19.5% in asymptomatic patients. The prevalence of CVS among patients with history of 0-1, 2-3 and ≥ 4 central venous catheters was 3.4%, 29.4% and 53.8% respectively (p=0.00). CVS was not more common in patients with history of previous/current jugular or femoral vein catheterization compared to no catheter placement in these veins (28.3% vs 28.6% and 35% vs 26.7% respectively; p >0.1). However, CVS was significantly more common in patients with previous/ current subclavian vein catheterization compared to no catheter placement in this vein (47.8% vs 22.9%, p = 0.02). CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS.

Progression of external and internal carotid artery stenosis is associated with a higher risk of ischemic neurologic events in patients with asymptomatic carotid artery stenosis.

PubMed

Masoomi, Reza; Shah, Zubair; Dawn, Buddhadeb; Vamanan, Karthik; Nanjundappa, Aravinda; Gupta, Kamal

2017-10-01

A small percentage of patients with asymptomatic carotid artery stenosis (ACAS) who are on optimal medical management do go on to develop ischemic stroke or transient ischemic attacks (IS/TIA). Several diagnostic tools have been studied to identify those patients who are at increased risk. However, most of these diagnostic tools are not available for routine clinical use or are resource intensive. We performed a retrospective study to assess the incremental value of external carotid artery stenosis progression (ECASP) along with internal carotid artery stenosis progression (ICASP) in predicting risk of ipsilateral IS/TIA in a cohort of patients with ACAS. We conducted a retrospective analysis of patients with ACAS who had at least two serial duplex ultrasounds (DUS) at our center. A total of 356 patients (712 carotid arteries) were included in the study (mean age 74.7±9 years, 49.2% male) with a mean follow-up of 60.7±32.7 months. In univariate analysis, concurrent progression of ICA and ECA stenosis on the same side arteries was associated with a very significant increased risk of ipsilateral IS/TIA (14.7% vs 4.6%, p<0.001). Also, multivariable regression analysis showed that concurrent ECA/ICA progression was an independent predictor of IS/TIA (OR=3.6, 95% CI 1.64-7.8; p=0.001). ECASP along with ICASP is significantly associated with increased risk of ipsilateral IS/TIA and provides incremental risk stratification over that provided by ICASP alone. The ECA is routinely evaluated in clinical practice, and it could serve as an additional marker for identifying higher risk patients with ACAS.

75 FR 82427 - Departmental Offices; Privacy Act of 1974, as Amended

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-30

... source categories: Information in this system is obtained from individuals. Exemptions claimed for the... Library, Room 1428, Main Treasury Building, 1500 Pennsylvania Avenue, NW., Washington, DC 20220, on... information that you wish to make available publicly. FOR FURTHER INFORMATION CONTACT: Claire Stapleton...

Complaint, Master Settlement Agreement et al. for John Hubenka and LeClair Irrigation District

EPA Pesticide Factsheets

In 2000, Mr. Hubenka discharged dredged and/or fill material into the Wind River by constructing a series of dikes in the river without first obtaining a CWA Section 404 permit from the Army Corps of Engineers (“Corps”).

Defense Satellite Communications: DOD Needs Additional Information to Improve Procurements

DTIC Science & Technology

2015-07-01

Acquisition of Services, GAO-02- 230 (Washington, D.C: Jan. 18, 2002); Strategic Sourcing: Improved and Expanded Use Could Save Billions in Annual...Gallegos, Assistant Director; William Allbritton; Claire Buck; James Haynes ; John Krump; Katherine Lenane; Jay Tallon; and Gwyneth Woolwine made key

16. Photographic copy of sepia of original construction drawing dated ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. Photographic copy of sepia of original construction drawing dated September 15, 1938 (original sepia in plan room of Base Civil Engineer, Scott AFB) Interior details - Scott Air Force Base, General Officer Quarters, 229 Birchard Street, O'Fallon, St. Clair County, IL

17. Photographic copy of original remodeling drawings dated July 8, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. Photographic copy of original remodeling drawings dated July 8, 1988 (original sepia in plan room of Base Civil Engineer, Scott AFB) First and second floor plans - Scott Air Force Base, General Officer Quarters, 229 Birchard Street, O'Fallon, St. Clair County, IL

Atherosclerotic renal artery stenosis: epidemiology, cardiovascular outcomes, and clinical prediction rules.

PubMed

Zoccali, Carmine; Mallamaci, Francesca; Finocchiaro, Pietro

2002-11-01

Atherosclerotic renal artery stenosis is the most common primary disease of the renal arteries, and it is associated with two major clinical syndromes, ischemic renal disease and hypertension. The prevalence of this disease in the population is undefined because there is no simple and reliable test that can be applied on a large scale. Renal artery involvement in patients with coronary heart disease and/or heart failure is frequent, and it may influence cardiovascular outcomes and survival in these patients. Suspecting renal arterial stenosis in patients with recurrent episodes of pulmonary edema is justified by observations showing that about one third of elderly patients with heart failure display atherosclerotic renal disease. Whether interventions aimed at restoring arterial patency may reduce the high mortality in patients with heart failure is still unclear because, to date, no prospective study has been carried out in these patients. Increased awareness of the need for cost containment has renewed the interest in clinical cues for suspecting renovascular hypertension. In this regard, the DRASTIC study constitutes an important attempt at validating clinical prediction rules. In this study, a clinical rule was derived that predicted renal artery stenosis as efficiently as renal scintigraphy (sensitivity: clinical rule, 65% versus scintigraphy, 72%; specificity: 87% versus 92%). When tested in a systematic and quantitative manner, clinical findings can perform as accurately as more complex tests in the detection of renal artery stenosis.

Clinical implications of differentiating between types of post-tracheostomy tracheal stenosis

PubMed Central

Shin, Beomsu; Kim, Kang; Eom, Jung Seop; Song, Won Jun; Kim, Hojoong

2017-01-01

Background Post-tracheostomy tracheal stenosis (PTTS) can be divided into four types according to stenosis mechanism and site: subglottic, stoma, cuff, and tip granuloma. However, there is little information available regarding clinical differences among types of PTTS; therefore, we evaluated the clinical differences between these types. Methods We retrospectively evaluated 99 PTTS patients who underwent interventional bronchoscopy between 2004 and 2014. Patients were divided into two groups according to pathophysiological similarities as follows: subglottic or stoma type (n=59) and cuff or tip type (n=40). Results There were no differences in baseline characteristics between groups. However, silicone stents were more frequently needed in patients with subglottic or stoma type stenosis (76%) than those with cuff or tip type stenosis (55%, P=0.031) to maintain airway patency. On the contrary, permanent tracheostomy was more frequently performed in patients with cuff or tip type stenosis (50%) than those with subglottic or stoma type stenosis (19%, P=0.002). Finally, successful removal of the tracheostomy tube without surgery and procedure- or disease-related mortality were more frequently achieved in patients with subglottic or stoma type stenosis (71%) than those with cuff or tip type stenosis (45%, P=0.012). Conclusions Although there were no significant differences in baseline characteristics between PTTS types, patients with subglottic or stoma type stenosis had more favorable outcomes than those with cuff or tip type stenosis. Therefore, it could be important to distinguish between types of PTTS when assessing prognosis. PMID:29268510

Regulation Of The Tumor Suppressor Activity Of p53 In Human Breast Cancer

DTIC Science & Technology

1998-09-01

Cell. Biol. 11, (51). As with the studies reported here (Fig. 2 and Table I), the 34. Diller, L., Kassel, J., Nelson, C. E., Gryka , M . A., Litwak, G...this research: 1. Resnick-Silverman, L., S. St Clair, M . Maurer, K. Zhao, and J. J. Manfredi. 1998. Identification of a novel class of genomic DNA...Zhao, J. F. Pizzolato, M . Fonarev, J. C. Langer, and J. J. Manfredi. 1998. Constitutive expression of the cyclin-dependent kinase inhibitor p21 is

Carotid DSA based CFD simulation in assessing the patient with asymptomatic carotid stenosis: a preliminary study.

PubMed

Zhang, Dong; Xu, Pengcheng; Qiao, Hongyu; Liu, Xin; Luo, Liangping; Huang, Wenhua; Zhang, Heye; Shi, Changzheng

2018-03-12

Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references. The cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including trans-stenotic pressure-wired measurement were implemented on a 65-year-old man with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified boundary condition was performed in DSA data to calculate the CAFA index. The cerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired. CFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic overestimation (mean difference - 0.007, standard deviation 0.017) compared with pressure-wired measurement. No significant difference was observed between them (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%, the simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant stenosis which was also verified by a compensatory final CBF (fronto-temporal/fronto-parietal region: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s) in the involved territories, together with a normal left-right percentage difference (2.1-8.85%). The DSA based CFD simulation showed good consistence with invasive approach and could be used as a cost-saving and efficient way to study the relationship between hemodynamic disorder caused by ICA stenosis and subsequent perfusion variations in brain. Further research should focus on the role of noninvasive pressure-based CAFA in screening asymptomatic ischemia-causing carotid stenosis.

Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China.

PubMed

Zhang, Haibo; Mu, Lin; Hu, Shuang; Nallamothu, Brahmajee K; Lansky, Alexandra J; Xu, Bo; Bouras, Georgios; Cohen, David J; Spertus, John A; Masoudi, Frederick A; Curtis, Jeptha P; Gao, Runlin; Ge, Junbo; Yang, Yuejin; Li, Jing; Li, Xi; Zheng, Xin; Li, Yetong; Krumholz, Harlan M; Jiang, Lixin

2018-02-01

Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acute myocardial infarction (AMI). In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0% (11.5%) greater than that by QCA in patients without AMI and 10.2% (12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70% or more stenosis by PVA, 427 (50.6%) were less than 70% by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6% (95% CI, 0.4%-14.7%) to 21.3% (95% CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95% CI, -1.4%-15.3%) to 26.4% (95% CI, 21.5%-31.4%). For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories.

The effect of anatomic variations of circle of Willis on cerebral blood distribution during posture change from supination to standing: a model study.

PubMed

Zhang, Chi; Li, Shuyu; Pu, Fang; Fan, Yubo; Li, Deyu

2014-01-01

The anatomic variation of Circle of Willis (CoW) has great impact on its compensatory capacity during stroke and cerebral ischemia. In the present study, a series of lumped parameter models were developed and used to simulate the effect of postural changes on the cerebral blood flow in ICA stenosis patients with different anatomic variants of the CoW. The results showed that the asymmetric distribution of cerebral blood flow caused by stenosis was attenuated in standing position in complete and half-complete CoW. However, in incomplete CoW, the decrease in blood flow in the ipsilateral cerebral arteries caused by unilateral ICA stenosis was dramatic in both supine and standing positions, a likely result of inadequate collateral circulation within the CoW. In conclusion, the anatomic variation of CoW plays a significant role in maintaining the balance of cerebral blood supply in patients with ICA stenosis, especially during postural change.

Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study.

PubMed

Poyraz, Esra; Öz, Tuğba Kemaloğlu; Zeren, Gönül; Güvenç, Tolga Sinan; Dönmez, Cevdet; Can, Fatma; Güvenç, Rengin Çetin; Dayı, Şennur Ünal

2017-09-01

In a fraction of patients with mild mitral stenosis, left ventricular systolic function deteriorates despite the lack of hemodynamic load imposed by the dysfunctioning valve. Neither the predisposing factors nor the earlier changes in left ventricular contractility were understood adequately. In the present study we aimed to evaluate left ventricular mechanics using three-dimensional (3D) speckle tracking echocardiography. A total of 31 patients with mild rheumatic mitral stenosis and 27 healthy controls were enrolled to the study. All subjects included to the study underwent echocardiographic examination to collect data for two- and three-dimensional speckle-tracking based stain, twist angle and torsion measurements. Data was analyzed offline with a echocardiographic data analysis software. Patients with rheumatic mild MS had lower global longitudinal (p < 0.001) circumferential (p = 0.02) and radial (p < 0.01) strain compared to controls, despite ejection fraction was similar for both groups [(p = 0.45) for three dimensional and (p = 0.37) for two dimensional measurement]. While the twist angle was not significantly different between groups (p = 0.11), left ventricular torsion was significantly higher in mitral stenosis group (p = 0.03). All strain values had a weak but significant positive correlation with mitral valve area measured with planimetry. Subclinical left ventricular systolic dysfunction develops at an early stage in rheumatic mitral stenosis. Further work is needed to elucidate patients at risk for developing overt systolic dysfunction.

Dynamic Computed Tomography Angiography: Role in the Evaluation of Popliteal Artery Entrapment Syndrome

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

Anil, Gopinathan, E-mail: ivyanil10@gmail.com; Tay, Kiang-Hiong; Howe, Tse-Chiang

2011-04-15

This study reviews our experience with dynamic computed tomographic angiography (CTA) as an imaging modality in the evaluation of popliteal artery entrapment syndrome (PAES). Eight patients with surgically proven PAES were included in this study. Dynamic CTA studies performed with the feet in neutral and plantar flexed positions were reviewed for the detailed anatomy of the region and to define the location and extent of the stenosis, occlusions and collateral circulation. These findings were compared with intraoperative observations. CTA provided adequate angiographic and anatomic information required to arrive at the diagnosis and make a surgical decision. Thirteen limbs were affectedmore » in eight patients. There was popliteal artery occlusion in four limbs, stenosis at rest that was accentuated on stress imaging in two limbs, and patent popliteal artery with marked stenosis on stress imaging in seven limbs. Long-segment stenosis was seen in functional entrapment compared to short-segment stenosis in anatomic PAES. Anteroposterior compression of the popliteal artery in anatomic PAES unlike the side-to-side compression in functional PAES was a unique observation in this study. The CTA and surgical characterisation and classification of PAES matched in all the patients, except for misinterpretation of compressing fibrous bands as accessory slips of muscles in three limbs. In conclusion, dynamic CTA is a robust diagnostic tool that provides clinically relevant information and serves as a rapidly performed and easily available 'one-stop-shop' imaging modality in the management of PAES.« less

Spastic quadriplegia in Down syndrome with congenital duodenal stenosis/atresia.

PubMed

Kurosawa, Kenji; Enomoto, Keisuke; Tominaga, Makiko; Furuya, Noritaka; Sameshima, Kiyoko; Iai, Mizue; Take, Hiroshi; Shinkai, Masato; Ishikawa, Hiroshi; Yamanaka, Michiko; Matsui, Kiyoshi; Masuno, Mitsuo

2012-06-01

Down syndrome is an autosomal chromosome disorder, characterized by intellectual disability and muscle hypotonia. Muscle hypotonia is observed from neonates to adulthood in Down syndrome patients, but muscle hypertonicity is extremely unusual in this syndrome. During a study period of nine years, we found three patients with severe spastic quadriplegia among 20 cases with Down syndrome and congenital duodenal stenosis/atresia (3/20). However, we could find no patient with spastic quadriplegia among 644 cases with Down syndrome without congenital duodenal stenosis/atresia during the same period (0/644, P < 0.05). Further, we did not find any cases with spastic quadriplegia among 17 patients with congenital duodenal stenosis/atresia without Down syndrome admitted during the same period to use as a control group (0/17, P < 0.05). Our results suggest that congenital duodenal stenosis/atresia is a potential risk factor for spastic quadriplegia in patients with Down syndrome. Long-term survival is improving, and the large majority of people with Down syndrome are expected to live well into adult life. Management and further study for the various problems, representing a low prevalence but serious and specific to patients with Down syndrome, are required to improve their quality of life. © 2012 The Authors. Congenital Anomalies © 2012 Japanese Teratology Society.

Influence of Lumbar Lordosis on the Outcome of Decompression Surgery for Lumbar Canal Stenosis.

PubMed

Chang, Han Soo

2018-01-01

Although sagittal spinal balance plays an important role in spinal deformity surgery, its role in decompression surgery for lumbar canal stenosis is not well understood. To investigate the hypothesis that sagittal spinal balance also plays a role in decompression surgery for lumbar canal stenosis, a prospective cohort study analyzing the correlation between preoperative lumbar lordosis and outcome was performed. A cohort of 85 consecutive patients who underwent decompression for lumbar canal stenosis during the period 2007-2011 was analyzed. Standing lumbar x-rays and 36-item short form health survey questionnaires were obtained before and up to 2 years after surgery. Correlations between lumbar lordosis and 2 parameters of the 36-item short form health survey (average physical score and bodily pain score) were statistically analyzed using linear mixed effects models. There was a significant correlation between preoperative lumbar lordosis and the 2 outcome parameters at postoperative, 6-month, 1-year, and 2-year time points. A 10° increase of lumbar lordosis was associated with a 5-point improvement in average physical scores. This correlation was not present in preoperative scores. This study showed that preoperative lumbar lordosis significantly influences the outcome of decompression surgery on lumbar canal stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Modeling and analysis of biomagnetic blood Carreau fluid flow through a stenosis artery with magnetic heat transfer: A transient study.

PubMed

Abdollahzadeh Jamalabadi, Mohammad Yaghoub; Daqiqshirazi, Mohammadreza; Nasiri, Hossein; Safaei, Mohammad Reza; Nguyen, Truong Khang

2018-01-01

We present a numerical investigation of tapered arteries that addresses the transient simulation of non-Newtonian bio-magnetic fluid dynamics (BFD) of blood through a stenosis artery in the presence of a transverse magnetic field. The current model is consistent with ferro-hydrodynamic (FHD) and magneto-hydrodynamic (MHD) principles. In the present work, blood in small arteries is analyzed using the Carreau-Yasuda model. The arterial wall is assumed to be fixed with cosine geometry for the stenosis. A parametric study was conducted to reveal the effects of the stenosis intensity and the Hartman number on a wide range of flow parameters, such as the flow velocity, temperature, and wall shear stress. Current findings are in a good agreement with recent findings in previous research studies. The results show that wall temperature control can keep the blood in its ideal blood temperature range (below 40°C) and that a severe pressure drop occurs for blockages of more than 60 percent. Additionally, with an increase in the Ha number, a velocity drop in the blood vessel is experienced.

[Three cases of the malignant esophageal stenosis successfully treated with the Niti-S™ esophageal stent].

PubMed

Isohata, Noriyuki; Naritaka, Yoshihiko; Asaka, Shinichi; Shimakawa, Takeshi; Miyaki, Akira; Yamaguchi, Kentaro; Murayama, Minoru; Katsube, Takao; Ogawa, Kenji

2011-11-01

We herein report three cases of the malignant esophageal stenosis successfully treated with the Niti-S™ esophageal stent. CASE 1: The hilar lung cancer and its mediastinal lymph node metastasis pressed the esophagus extramurally and caused the marked stenosis. CASE 2: A metastatic lymph node along the left laryngeal nerve caused the stenosis of the trachea. A primary esophageal lesion located at the middle thoracic esophagus also caused the marked stenosis. At first, tracheal stent was placed because of dyspnea, and two weeks later, we placed an esophageal stent. Case 3: Esophageal cancer at lower thoracic esophagus after definitive radiation therapy caused the marked stenosis. Because of the stenosis of esophago-gastric junction( EGJ), we used an esophageal stent with a long cover in order to prevent a reflux into the esophagus. This new Niti-STM esophageal stent was easy to place at the stenosis without difficulty using a conventional device. The symptom was improved immediately for each case. We hope this new device will be used widely.

Subglottic stenosis in granulomatosis with polyangiitis (Wegener's granulomatosis): Report of 4 cases.

PubMed

Horta-Baas, Gabriel; Hernández-Cabrera, María Fernanda; Catana, Rocío; Pérez-Cristóbal, Mario; Barile-Fabris, Leonor Adriana

2016-01-01

Subglottic stenosis (SGS) in granulomatosis with polyangiitis (GPA) may result from active disease or from chronic recurrent inflammation. The objective of the study was to describe the clinical features and treatment of patients with subglottic stenosis. We retrospectively reviewed the medical records of all patients with SGS due to GPA diagnosed at Rheumatology deparment between January 2000 and June 2015. We present 4 cases of SGS at our department during a period of 15 years. The interval between the presentation of the GPA and SGS varied between 2 and 144 months. The leading symptoms of SGS were dyspnoea on exertion and stridor. Three patients presented SGS without evidence of systemic activity. Two patients presented SGS grade i and received tracheal dilatation; two recurred and three needed a tracheostomy due to severe airway-limiting stenosis. SGS presents high morbidity. Even though subglottic dilatation provides symptomatic relief, recurrences may present. Severe airway-limiting stenosis often requires tracheostomy. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

An Auscultaiting Diagnosis Support System for Assessing Hemodialysis Shunt Stenosis by Using Self-organizing Map

NASA Astrophysics Data System (ADS)

Suzuki, Yutaka; Fukasawa, Mizuya; Sakata, Osamu; Kato, Hatsuhiro; Hattori, Asobu; Kato, Takaya

Vascular access for hemodialysis is a lifeline for over 280,000 chronic renal failure patients in Japan. Early detection of stenosis may facilitate long-term use of hemodialysis shunts. Stethoscope auscultation of vascular murmurs has some utility in the assessment of access patency; however, the sensitivity of this diagnostic approach is skill dependent. This study proposes a novel diagnosis support system to detect stenosis by using vascular murmurs. The system is based on a self-organizing map (SOM) and short-time maximum entropy method (STMEM) for data analysis. SOM is an artificial neural network, which is trained using unsupervised learning to produce a feature map that is useful for visualizing the analogous relationship between input data. The author recorded vascular murmurs before and after percutaneous transluminal angioplasty (PTA). The SOM-based classification was consistent with to the classification based on MEM spectral and spectrogram characteristics. The ratio of pre-PTA murmurs in the stenosis category was much higher than the post-PTA murmurs. The results suggest that the proposed method may be an effective tool in the determination of shunt stenosis.

Percutaneous transvenous mitral commissurotomy in patients with mitral stenosis and coexistent hyperthyroidism.

PubMed

Wang, P W; Hung, J S; Fu, M; Yeh, K H; Wu, J J

1996-01-01

Percutaneous transvenous mitral commissurotomy (PTMC) was performed successfully without complications in 3 patients with severe mitral stenosis and hyperthyroidism. All 3 patients had pliable, noncalcified mitral valves. One patient who had been treated with methimazole for 6 months was still in a hyperthyroid state when she presented with intractable congestive heart failure and was found to have severe mitral stenosis. The heart failure improved immediately after PTMC, but the patient remained in New York Heart Association functional class 2 until a euthyroid state was achieved with I131 therapy. In the other 2 patients, hyperthyroidism was unsuspected at the time of PTMC. Unexpectedly suboptimal symptom improvement led to the diagnosis of hyperthyroidism 1 month after the intervention. In all 3 patients, PTMC resulted in an immediate hemodynamic and clinical improvement. However, complete clinical improvement occurred only when euthyroid state was achieved after antithyroid treatment. The present study suggests that PTMC is a safe and effective intervention modality in patients with coexisting hyperthyroidism and severe mitral stenosis. The procedure may be considered a therapeutic option in patients with hyperthyroidism and severe mitral stenosis.

Environmental factors and flow paths related to Escherichia coli concentrations at two beaches on Lake St. Clair, Michigan, 2002–2005

USGS Publications Warehouse

Holtschlag, David J.; Shively, Dawn; Whitman, Richard L.; Haack, Sheridan K.; Fogarty, Lisa R.

2008-01-01

Regression analyses and hydrodynamic modeling were used to identify environmental factors and flow paths associated with Escherichia coli (E. coli) concentrations at Memorial and Metropolitan Beaches on Lake St. Clair in Macomb County, Mich. Lake St. Clair is part of the binational waterway between the United States and Canada that connects Lake Huron with Lake Erie in the Great Lakes Basin. Linear regression, regression-tree, and logistic regression models were developed from E. coli concentration and ancillary environmental data. Linear regression models on log10 E. coli concentrations indicated that rainfall prior to sampling, water temperature, and turbidity were positively associated with bacteria concentrations at both beaches. Flow from Clinton River, changes in water levels, wind conditions, and log10 E. coli concentrations 2 days before or after the target bacteria concentrations were statistically significant at one or both beaches. In addition, various interaction terms were significant at Memorial Beach. Linear regression models for both beaches explained only about 30 percent of the variability in log10 E. coli concentrations. Regression-tree models were developed from data from both Memorial and Metropolitan Beaches but were found to have limited predictive capability in this study. The results indicate that too few observations were available to develop reliable regression-tree models. Linear logistic models were developed to estimate the probability of E. coli concentrations exceeding 300 most probable number (MPN) per 100 milliliters (mL). Rainfall amounts before bacteria sampling were positively associated with exceedance probabilities at both beaches. Flow of Clinton River, turbidity, and log10 E. coli concentrations measured before or after the target E. coli measurements were related to exceedances at one or both beaches. The linear logistic models were effective in estimating bacteria exceedances at both beaches. A receiver operating characteristic (ROC) analysis was used to determine cut points for maximizing the true positive rate prediction while minimizing the false positive rate. A two-dimensional hydrodynamic model was developed to simulate horizontal current patterns on Lake St. Clair in response to wind, flow, and water-level conditions at model boundaries. Simulated velocity fields were used to track hypothetical massless particles backward in time from the beaches along flow paths toward source areas. Reverse particle tracking for idealized steady-state conditions shows changes in expected flow paths and traveltimes with wind speeds and directions from 24 sectors. The results indicate that three to four sets of contiguous wind sectors have similar effects on flow paths in the vicinity of the beaches. In addition, reverse particle tracking was used for transient conditions to identify expected flow paths for 10 E. coli sampling events in 2004. These results demonstrate the ability to track hypothetical particles from the beaches, backward in time, to likely source areas. This ability, coupled with a greater frequency of bacteria sampling, may provide insight into changes in bacteria concentrations between source and sink areas.

Simultaneous extraction of centerlines, stenosis, and thrombus detection in renal CT angiography

NASA Astrophysics Data System (ADS)

Subramanyan, Krishna; Durgan, Jacob; Hodgkiss, Thomas D.; Chandra, Shalabh

2004-05-01

The Renal Artery Stenosis (RAS) is the major cause of renovascular hypertension and CT angiography has shown tremendous promise as a noninvasive method for reliably detecting renal artery stenosis. The purpose of this study was to validate the semi-automated methods to assist in extraction of renal branches and characterizing the associated renal artery stenosis. Automatically computed diagnostic images such as straight MIP, curved MPR, cross-sections, and diameters from multi-slice CT are presented and evaluated for its acceptance. We used vessel-tracking image processing methods to extract the aortic-renal vessel tree in a CT data in axial slice images. Next, from the topology and anatomy of the aortic vessel tree, the stenosis, and thrombus section and branching of the renal arteries are extracted. The results are presented in curved MPR and continuously variable MIP images. In this study, 15 patients were scanned with contrast on Mx8000 CT scanner (Philips Medical Systems), with 1.0 mm thickness, 0.5mm slice spacing, and 120kVp and a stack of 512x512x150 volume sets were reconstructed. The automated image processing took less than 50 seconds to compute the centerline and borders of the aortic/renal vessel tree. The overall assessment of manual and automatically generated stenosis yielded a weighted kappa statistic of 0.97 at right renal arteries, 0.94 at the left renal branches. The thrombus region contoured manually and semi-automatically agreed upon at 0.93. The manual time to process each case is approximately 25 to 30 minutes.

The Effects of Hemodynamic Alterations on Lung Volumes in Fetuses with Tetralogy of Fallot: An MRI Study.

PubMed

Berger-Kulemann, Vanessa; Berger, Rudolf; Mlczoch, Elisabeth; Sternal, Daniel; Mailath-Pokorny, Mariella; Hachemian, Nilouparak; Prayer, Daniela; Weber, Michael; Salzer-Muhar, Ulrike

2015-08-01

This study assessed whether the presence of tetralogy of Fallot (TOF) affects fetal lung development and whether these fetuses are at risk of pulmonary hypoplasia (PH). Furthermore, we investigated whether the degree of the concomitant pulmonary valve (PV) stenosis or a stenosis in the branch pulmonary arteries correlates with the fetal lung volume. Lung volumetry was performed in 16 fetuses with TOF who underwent MRI between gestational weeks 21 and 35 and in 22 controls. Fetal biometric data and the diameters of the PVs were evaluated by ultrasound. PV and branch pulmonary artery diameters were standardized (z-scores), and fetal lung volume/fetal body weight (FLV/FBW) ratios (ml/g) were calculated. The mean FLV/FBW ratio (0.031 ± 0.009 ml/g) in the TOF group was statistically significantly lower than in the control group (0.041 ± 0.009 ml/g; P = 0.003). None of the fetuses with TOF met the criterion for PH. FLV did not correlate with the degree of PV stenosis, but rather with the presence of a significant stenosis in at least one branch pulmonary artery. The presence of TOF moderately affects fetal lung growth, which is apparently not dependent on the degree of the PV stenosis. However, only an additional stenosis in at least one branch pulmonary artery was associated with a small FLV, but not with PH. Thus, reduced pulmonary blood flow may be offset by additional factors, such as the ability to establish a sufficient collateral system and to alter structural vascular size and, thus, pulmonary vascular resistance.

64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis.

PubMed

Barbero, Umberto; Iannaccone, Mario; d'Ascenzo, Fabrizio; Barbero, Cristina; Mohamed, Abdirashid; Annone, Umberto; Benedetto, Sara; Celentani, Dario; Gagliardi, Marco; Moretti, Claudio; Gaita, Fiorenzo

2016-08-01

A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Analysis of the Sensitivity and Specificity of Noninvasive Imaging Tests for the Diagnosis of Renal Artery Stenosis

PubMed Central

Borelli, Flavio Antonio de Oliveira; Pinto, Ibraim M. F.; Amodeo, Celso; Smanio, Paola E. P.; Kambara, Antonio M.; Petisco, Ana Claudia G.; Moreira, Samuel M.; Paiva, Ricardo Calil; Lopes, Hugo Belotti; Sousa, Amanda G. M. R.

2013-01-01

Background Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. Objective To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. Methods In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). Results The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m2. Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. Conclusion Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction. PMID:24061685

Indwelling esophageal balloon catheter for benign esophageal stenosis in infants and children.

PubMed

van der Zee, David; Hulsker, Caroline

2014-04-01

Balloon dilatation of benign esophageal strictures is an established mode of therapy in adults and children. There remains a group of patients with refractory stenosis despite dilatation at regular intervals. An indwelling balloon catheter may offer an alternative. This is a retrospective study of 19 children who underwent esophagoscopy between 2004 and 2012 with placement of an indwelling balloon catheter for refractory esophageal stenosis. Total number of endoscopies, number of endoscopies with indwelling balloon catheter, as well as complications, reoperations, and mortality due to use of the balloon catheter were studied. Patient age ranged from 4 weeks to 15 years. The indwelling balloon catheter was used to treat refractory stenosis after corrective surgery of long gap esophageal atresia (n = 5), esophageal atresia with distal fistula (n = 2), refractory esophageal stenosis due to caustic esophageal burns (n = 7), reflux (n = 2), and stenosis of unknown cause (n = 3). With the indwelling balloon catheter in place, the mean number of endoscopies equalled four. Complications were restenosis after a symptom-free period for which a new indwelling balloon catheter was necessary (n = 3). Two others needed two to five additional dilations: balloon leakage requiring replacement (n = 7 in 5 patients), sputum retention (n = 1), and dislodgement (n = 5 in 4 patients). More importantly, there was no mortality or the need for any patient to undergo a surgical resection. The indwelling balloon catheter is safe to use and can be used by parents at home. More importantly it obviates the need for rethoracotomy/-scopy or esophageal replacement.

Screening for Carotid Artery Stenosis

MedlinePlus

... build up and harden the arteries, limiting the flow of blood to the brain. Facts About Carotid Artery Stenosis Carotid artery stenosis is one of many risk factors for stroke, a leading cause of death and disability in the United States. However, carotid artery stenosis is uncommon—about ½ ...

The Kenny syndrome, a rare type of growth deficiency with tubular stenosis, transient hypoparathyroidism and anomalies of refraction.

PubMed

Majewski, F; Rosendahl, W; Ranke, M; Nolte, K

1981-03-01

One family (3 cases) with the Kenny syndrome and a second family (3 cases) with features of Kenny syndrome but lacking medullary stenosis are reported. The main symptoms in both families are proportionate dwarfism, cortical thickening of tubular bones, variable anomalies of the calvaria, anemia, transient hypoparathyroidism and variable ocular anomalies. The latter include microphthalmia, and moderate-to-severe myopia or hyperopia. In the first family there was medullary stenosis of most tubular bones. In the second family two cases exhibited mild-to-moderate cortical thickening of tubular bones, but absent or mild medullary stenosis. Possible variability of the Kenny syndrome is discussed. Endocrine studies failed to demonstrate any permanent disturbance of parathormone or calcitonin metabolism, or GH deficiency. Pathogenesis remains unclear. Autosomal dominant inheritance seems to be likely.

The role of jet eccentricity in generating disproportionately elevated transaortic pressure gradients in patients with aortic stenosis.

PubMed

Abbas, Amr E; Franey, Laura M; Lester, Steven; Raff, Gilbert; Gallagher, Michael J; Hanzel, George; Safian, Robert D; Pibarot, Philippe

2015-02-01

In patients with aortic stenosis (AS) and eccentric transaortic flow, greater pressure loss occurs as the jet collides with the aortic wall together with delayed and diminished pressure recovery. This leads to the elevated transaortic valve pressure gradients noted on both Doppler and cardiac catheterization. Such situations may present a diagnostic dilemma where traditional measures of stenosis severity indicate severe AS, while imaging modalities of the aortic valve geometric aortic valve area (GOA) suggest less than severe stenosis. In this study, we present a series of cases exemplifying this clinical dilemma and demonstrate how color M-mode, 2D and 3D transthoracic (TTE) and transesophageal (TEE) echocardiography, cardiac computed tomography angiography (CTA), and magnetic resonance imaging (MRI), may be used to resolve such discrepancies. © 2014, Wiley Periodicals, Inc.

Runge-Kutta method for wall shear stress of blood flow in stenosed artery

NASA Astrophysics Data System (ADS)

Awaludin, Izyan Syazana; Ahmad, Rokiah@Rozita

2014-06-01

A mathematical model of blood flow through stenotic artery is considered. A stenosis is defined as the partial occlusion of the blood vessels due to the accumulation of cholesterols, fats and the abnormal growth of tissue on the artery walls. The development of stenosis in the artery is one of the factors that cause problem in blood circulation system. This study was conducted to determine the wall shear stress of blood flow in stenosed artery. Modified mathematical model is used to analyze the relationship of the wall shear stress versus the length and height of stenosis. The existing models that have been created by previous researchers are solved using fourth order Runge-Kutta method. Numerical results show that the wall shear stress is proportionate to the length and height of stenosis.

[Virtual clinical diagnosis support system of degenerative stenosis of the lumbar spinal canal].

PubMed

Shevelev, I N; Konovalov, N A; Cherkashov, A M; Molodchenkov, A A; Sharamko, T G; Asiutin, D S; Nazarenko, A G

2013-01-01

The aim of the study was to develop a virtual clinical diagnostic support system of degenerative lumbar spinal stenosis on database of spine registry. Choice of criteria's for diagnostic system was made on symptom analysis of 298 patients with lumbar spinal stenosis. Also was analysed a group of patient with disc herniation's for sensitivity and specify assessment of developed diagnostic support system. Represented clinical diagnostic support system allows identifying patients with degenerative lumbar spinal stenosis on stage of patient's primary visit. System sensitivity and specify are 90 and 71% respectively. "Online" mode of diagnostic system in structure of spine registry provides maximal availability for specialists, regardless of their locations. Development of tools "medicine 2.0" is the actual direction for carrying out further researches with which carrying out the centralized baea collection by means of specialized registers helps.

Valvar stenosis in truncus arteriosus.

PubMed Central

Gerlis, L M; Wilson, N; Dickinson, D F; Scott, O

1984-01-01

Twenty three morphological specimens of truncus arteriosus were examined for evidence of stenosis of the semilunar valve. One third showed good evidence of stenosis as judged by careful measurement of the valve orifice, the valve ring, and the maximum diameter of the truncus. Correlation with measured pressure gradients was poor, but angiography and cross sectional echocardiography were better predictors of stenosis. Stenosis was invariably associated with cusp dysplasia and was more common in valves with two or four cusps. Images PMID:6477783

Labs that Mean Business.

ERIC Educational Resources Information Center

Benedict, Richard; Rochon, Angela

1987-01-01

The authors describe vocational experiential learning programs, called "Enterprise Programs," at St. Clair County Skill Center in Michigan. These programs feature small groups of vocational students engaged in profit-making businesses that allow them to apply what they have learned and earn some money. The authors claim the program helps with…

The Period of 2167 Erin

NASA Astrophysics Data System (ADS)

Montigiana, N.; Benedetti, W.; Mannucci, M.; Riccetti, S.

2008-09-01

Analysis of data taken in March and April 2007 by groups from Osservatorio Astronomico Margherita Hack and the University of Wisconsin-Eau Claire indicates a likely period of 5.7186 ± 0.0001 h for 2167 Erin. The amplitude of the lightcurve was 0.53 ± 0.02 mag.

For Your Bookshelf.

ERIC Educational Resources Information Center

Jones, Rebecca

2002-01-01

Reviews notable education books of 2001: "Not in Front of the Children" (Marjorie Heins); "The other Boston Busing Story" (Susan E. Eaton); "Another Planet" (Elinor Burkett); "Parents Under Siege" (James Garbarino and Claire Bedard); "Radical Equations" (Robert P. Moses and Charles E. Cobb, Jr.); "School" (Sheila Curran Bernard and Sarah Mondale);…

150-211 E. Illinois St and 450-51 N St. Clair Streets, February 2018, Lindsay Light Radiological Survey

EPA Pesticide Factsheets

The field gamma measurements within the excavation during the excavation process did not exceed the instrument threshold previously stated and ranged from a minimum of 1,100 cpm to a maximum of 2,100cpm shielded.

Joy Development Properties, LLC, Pleasant Valley, Iowa and Summit Concrete, Inc., LeClaire, Iowa - Clean Water Act Public Notice

EPA Pesticide Factsheets

The EPA is providing notice of a proposed Administrative Penalty Assessment against Joy Development Properties, LLC and Summit Concrete, Inc., for alleged violations at the companies’ residential construction site known as the Schutter Farms Addition loca

14. Photographic copy of sepia of original construction drawing dated ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. Photographic copy of sepia of original construction drawing dated September 15, 1938 (Original sepia in plan room of Base Civil Engineer, Scott AFB) First and second floor plans - Scott Air Force Base, General Officer Quarters, 229 Birchard Street, O'Fallon, St. Clair County, IL

Stenosis differentially affects subendocardial and subepicardial arterioles in vivo.

PubMed

Merkus, D; Vergroesen, I; Hiramatsu, O; Tachibana, H; Nakamoto, H; Toyota, E; Goto, M; Ogasawara, Y; Spaan, J A; Kajiya, F

2001-04-01

The presence of a coronary stenosis results primarily in subendocardial ischemia. Apart from the decrease in coronary perfusion pressure, a stenosis also decreases coronary flow pulsations. Applying a coronary perfusion system, we compared the autoregulatory response of subendocardial (n = 10) and subepicardial (n = 12) arterioles (<120 microm) after stepwise decreases in coronary arterial pressure from 100 to 70, 50, and 30 mmHg in vivo in dogs (n = 9). Pressure steps were performed with and without stenosis on the perfusion line. Maximal arteriolar diameter during the cardiac cycle was determined and normalized to its value at 100 mmHg. The initial decrease in diameter during reductions in pressure was significantly larger at the subendocardium. Diameters of subendocardial and subepicardial arterioles were similar 10--15 s after the decrease in pressure without stenosis. However, stenosis decreased the dilatory response of the subendocardial arterioles significantly. This decreased dilatory response was also evidenced by a lower coronary inflow at similar average pressure in the presence of a stenosis. Inhibition of nitric oxide production with N(G)-monomethyl-L-arginine abrogated the effect of the stenosis on flow. We conclude that the decrease in pressure caused by a stenosis in vivo results in a larger decrease in diameter of the subendocardial arterioles than in the subepicardial arterioles, and furthermore stenosis selectively decreases the dilatory response of subendocardial arterioles. These two findings expand our understanding of subendocardial vulnerability to ischemia.

Percutaneous transhepatic stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms.

PubMed

Kim, Kyung Rae; Ko, Gi-Young; Sung, Kyu-Bo; Yoon, Hyun-Ki

2011-04-01

The purpose of this study was to evaluate the efficacy and safety of stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. From September 1995 to April 2007, percutaneous transhepatic portal venous stent placement was attempted in 19 patients with postoperative portal venous stenosis. Portal venous stenosis was a complication of surgery in 11 patients and caused by tumor recurrence in eight patients. The clinical manifestations were ascites, hematochezia, melena, esophageal varices, and abnormal liver function. Stents were placed in the stenotic or occluded lesions after percutaneous transhepatic portography. Technical and clinical success, stent patency, and complications were evaluated. Stent placement was successful in 18 patients (technical success rate, 95%). Clinical manifestations improved in 16 patients (clinical success rate, 84%). The mean patency period among the 18 patients with technical success was 21.3 ± 23.2 months. The mean patency period of the benign stenosis group (30.1 ± 25.6 months) was longer than that of the tumor recurrence group (7.3 ± 7.7 months), and the difference was statistically significant (p = 0.038). There were two cases of a minor complication (transient fever) and three cases of major complications (septicemia, liver abscess, and acute portal venous thrombosis). Percutaneous transhepatic stent placement can be safe and effective in relieving portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. Patients with benign stenosis had more favorable results than did those with tumor recurrence.

The variation in frequency locations in Doppler ultrasound spectra for maximum blood flow velocities in narrowed vessels.

PubMed

Zhang, Yingyun; Zhang, Yufeng; Gao, Lian; Deng, Li; Hu, Xiao; Zhang, Kexin; Li, Haiyan

2017-11-01

This study assessed the variation in the frequency locations in the Doppler ultrasound spectra for the maximum blood flow velocities of in vessels with different degrees of bilaterally axisymmetric stenosis. This was done by comparing the relationship between the velocity distributions and corresponding Doppler power spectra. First, a geometric vessel model with axisymmetric stenosis was established. This made it possible to obtain the blood flow velocity distributions for different degrees of stenosis from the solutions of the Navier-Stokes equations. Then, the Doppler spectra were calculated for the entire segment of the vessel that was covered by the sound field. Finally, the maximum frequency locations for the spectra were determined based on the intersections of the maximum values chosen from the calculated blood flow velocity distributions and their corresponding spectra. The computational analysis showed that the maximum frequencies, which corresponded to the maximum blood flow velocities for different degrees of stenosis, were located at different positions along the spectral falling edges. The location for a normal (stenosis free) vessel was in the middle of the falling edge. For vessels with increasing degrees of stenosis, this location shifted approximately linearly downward along the falling edge. For 40% stenosis, the location reached a position at the falling edge of 0.32. Results obtained using the Field II simulation tool demonstrated the validity of the theoretical analysis and calculations, and may help to improve the maximum velocity estimation accuracy for Doppler blood flow spectra in stenosed vessels. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Efficacy of treatment of edge stenosis of endografts inserted for superficial femoral artery stenotic disease.

PubMed

Golchehr, Bahar; Holewijn, Suzanne; Kruse, Rombout R; van Walraven, Laurens A; Zeebregts, Clark J; Reijnen, Michel M P J

2015-09-01

The role of endografts in the treatment of extensive superficial femoral artery (SFA) occlusive disease is enlarging. Results are limited by the occurrence of edge stenosis. The aim of the study was to retrospectively evaluate the efficacy of treatment of edge stenosis of endografts inserted for SFA occlusive disease. All patients, treated between November 2001 and December 2011, with a self-expandable polytetrafluoroethylene-endograft were gathered in a prospective database in three hospitals. The incidence of primary edge stenosis and the incidence of re-edge stenosis after treatment were retrospectively noted and a comparison was made between the results of percutaneous transluminal angioplasty (PTA) and extension of the endograft. A total of 88 patients presented with 115 edge stenoses, of which the majority presented within 1 year after insertion of the endograft (mean time to edge stenosis 10.7 ± 8.2 months). Seventy-three stenoses (63%) manifested at the proximal and 42 at the distal edge (37%). The 1-year incidence of restenosis and/or occlusion was 45% after PTA and 43% after endograft extension, with 1-year patency rates of 81% and 92%, respectively. The incidence of restenosis/occlusion after treatment with PTA was 12% higher at two years compared to extension of the endograft (55% vs. 43%, respectively). Edge stenosis may well be treated with either PTA or extension of the endograft. The incidence of restenosis and/or occlusion after both PTA and extension is high, but patency rates are acceptable. Aggressive surveillance is needed during the first year after insertion. © 2015 Wiley Periodicals, Inc.

Duplex ultrasonography for the detection of vertebral artery stenosis: A comparison with CT angiography.

PubMed

Rozeman, Anouk D; Hund, Hajo; Westein, Michel; Wermer, Marieke J H; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Schimsheimer, Robert-Jan; Algra, Ale

2017-08-01

Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and compared it with CT angiography (CTA). We gathered data on 337 consecutive patients who had DUS because of posterior circulation stroke or TIA. Matching CTA studies were retrieved and used as reference. Stenosis on CTA was considered "significant" if >50%, at DUS if Peak Systolic Velocity (PSV) > 140 cm/s for the V1 segment and PSV > 125 cm/s for the V2 segment. We determined the area under the ROC curve (AUROC). In addition, we calculated which PSV cut-off value resulted in highest sensitivity with acceptable specificity. DUS was able to make an adequate measurement in 378 of 674 V1 segments and 673 of 674 V2 segments. DUS detected a significant stenosis in 52 of 378 V1 segments; 12 were confirmed by CTA (AUROC 0.73, 95% Confidence Interval 0.63-0.83). The optimal DUS PSV cut-off value for this segment was 90 cm/s. For the V2 segment there were too few stenoses to allow reliable assessment of diagnostic characteristics of DUS. Although DUS has a fair AUROC for detecting significant stenosis, adequate assessment of the V1 segment is often not possible due to anatomic difficulties. Assessment of the V2 segment is feasible but yielded few stenoses. Hence, we consider usefulness of DUS for screening of extracranial vertebral artery stenosis limited.

Clinical and echocardiographic features of primary infundibular stenosis with intact ventricular septum in dogs.

PubMed

Minors, Sandra L; O'Grady, Michael R; Williams, Regan M; O'Sullivan, M Lynne

2006-01-01

Primary infundibular stenosis is a rare congenital defect in which the right ventricle is divided into a proximal "high-pressure" chamber and a distal "low-pressure" chamber. The condition can be misdiagnosed as ventricular septal defect or valvular pulmonic stenosis and the disease severity underestimated. The purpose of this study was to provide a detailed clinical and echocardiographic description of this anomaly in a series of dogs. Several anatomic forms of infundibular stenosis exist. High resolution two-dimensional echocardiography could differentiate 3 gross anatomic substrates. Knowledge of the anatomy of the obstructing lesion could influence options for corrective interventions. Thirteen dogs examined at the Ontario Veterinary College teaching hospital from 1994 to 2005 with an ultrasound diagnosis of subpulmonic stenasis. A retrospective review was made of case records from 1994 to 2005. Thirteen dogs were identified as having primary infundibular stenosis, with apparent increased prevalence in Golden Retrievers (8/13, 62%) and Siberian Huskies (3/13, 23%). Three types of infundibular lesions were identified by ultrasound in 11/13 dogs: a fibrous diaphragm (6), fibromuscular (4), and muscular obstruction (1). Two dogs with a fibrous diaphragm underwent direct surgical dilation without the use of cardiopulmonary bypass or inflow occlusion, resulting in substantial reduction of the severity of stenosis. Accurate determination of the severity of the stenosis and the anatomy of the obstructing lesion are important in devising a treatment strategy. Recognition of the fibrous diaphragm by echocardiography identifies a subset of dogs potentially amenable to surgical dilation without the need for cardiopulmonary bypass.

An LBM based model for initial stenosis development in the carotid artery

NASA Astrophysics Data System (ADS)

Stamou, A. C.; Buick, J. M.

2016-05-01

A numerical scheme is proposed to simulate the early stages of stenosis development based on the properties of blood flow in the carotid artery, computed using the lattice Boltzmann method. The model is developed on the premise, supported by evidence from the literature, that the stenosis develops in regions of low velocity and low wall shear stress. The model is based on two spatial parameters which relate to the extent to which the stenosis can grow in each development phase. Simulations of stenosis development are presented for a range of the spacial parameters to determine suitable ranges for their application. Flow fields are also presented which indicate that the stenosis is developing in a realistic manner, providing evidence that stenosis development is indeed influenced by the low shear stress, rather than occurring in such areas coincidentally.

Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve Replacement: Systematic Review and Meta-Analysis.

PubMed

Chaikriangkrai, Kongkiat; Jhun, Hye Yeon; Shantha, Ghanshyam Palamaner Subash; Abdulhak, Aref Bin; Tandon, Rudhir; Alqasrawi, Musab; Klappa, Anthony; Pancholy, Samir; Deshmukh, Abhishek; Bhama, Jay; Sigurdsson, Gardar

2018-07-01

In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard. We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft. Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR. Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.

External carotid artery stenosis after internal and common carotid stenting.

PubMed

Siracuse, Jeffrey J; Epelboym, Irene; Li, Boyangzi; Hoque, Rahima; Catz, Diana; Morrissey, Nicholas J

2015-04-01

The external carotid artery (ECA) can be an important collateral for cerebral perfusion in the presence of severe internal carotid artery (ICA) disease. ICA stenting that covers the ECA origin may put the ECA at increased risk of stenosis. Our objective was to determine the rate of ECA stenosis secondary to ICA stenting, determine predictive factors, and describe any subsequent associated symptoms. We retrospectively reviewed clinical data on all ICA stents crossing the origin of the ECA placed by vascular surgeons at our institution. We analyzed patient demographics, comorbidities, stent type and sizes, as well as medication profile to determine predictors of ECA stenosis. Between 2005 and 2013, there were 72 (out of 119 total ICA stenting) patients (mean age 71, 68% male) who underwent placement of ICA stents that also crossed the origin of the ECA. Six patients (8.3%) had a significantly increased ECA stenosis postprocedure. There were no occlusions. All patients with ECA stenosis maintained patency of their ICA stent and were asymptomatic. Age, gender, comorbidities, stent type and size, and medication profile were not associated with ECA stenosis after stenting. ECA stenosis after ICA stenting covering the ECA origin is uncommon and not clinically significant in patients with patent ICA stents. The clinical significance of concurrent ECA and ICA stenosis after stenting is unclear as it is not captured here. The potential for ECA stenosis should not deter stenting across the ECA origin if necessary. Patient and stent factors are not predictive of ECA stenosis. Copyright © 2015 Elsevier Inc. All rights reserved.

Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischaemia Stenting Trial.

PubMed

Markus, Hugh S; Larsson, Susanna C; Kuker, Wilhelm; Schulz, Ursula G; Ford, Ian; Rothwell, Peter M; Clifton, Andrew

2017-09-19

To compare in the Vertebral Artery Ischaemia Stenting Trial (VIST) the risks and benefits of vertebral angioplasty and stenting with best medical treatment (BMT) alone for symptomatic vertebral artery stenosis. VIST was a prospective, randomized, open-blinded endpoint clinical trial performed in 14 hospitals in the United Kingdom. Participants with symptomatic vertebral stenosis ≥50% were randomly assigned (1:1) to vertebral angioplasty/stenting plus BMT or to BMT alone with randomization stratified by site of stenosis (extracranial vs intracranial). Because of slow recruitment and cessation of funding, recruitment was stopped after 182 participants. Follow-up was a minimum of ≥1 year for each participant. Three patients did not contribute any follow-up data and were excluded, leaving 91 patients in the stent group and 88 in the medical group. Mean follow-up was 3.5 (interquartile range 2.1-4.7) years. Of 61 patients who were stented, stenosis was extracranial in 48 (78.7%) and intracranial in 13 (21.3%). No periprocedural complications occurred with extracranial stenting; 2 strokes occurred during intracranial stenting. The primary endpoint of fatal or nonfatal stroke occurred in 5 patients in the stent group vs 12 in the medical group (hazard ratio 0.40, 95% confidence interval 0.14-1.13, p = 0.08), with an absolute risk reduction of 25 strokes per 1,000 person-years. The hazard ratio for stroke or TIA was 0.50 ( p = 0.05). Stenting in extracranial stenosis appears safe with low complication rates. Large phase 3 trials are required to determine whether stenting reduces stroke risk. ISRCTN95212240. This study provides Class I evidence that for patients with symptomatic vertebral stenosis, angioplasty with stenting does not reduce the risk of stroke. However, the study lacked the precision to exclude a benefit from stenting. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

An Investigation of Tenascin-C Levels in Rheumatic Mitral Stenosis and Their Response to Percutaneous Mitral Balloon Valvuloplasty

PubMed Central

Celik, Ahmet; Gunebakmaz, Ozgur; Baran, Oguzhan; Dogdu, Orhan; Elcik, Deniz; Kobat, Mehmet Ali; Balin, Mehmet; Erdem, Kenan; Aydin, Suleyman; Ozdogru, Ibrahim; Topsakal, Ramazan

2012-01-01

Objective The purpose of this study was to evaluate the tenascin-C levels in severe rheumatic mitral stenosis before and after percutaneous mitral balloon valvuloplasty (PMBV). Subjects and Methods Forty patients with severe mitral stenosis requiring PMBV and 20 age-matched healthy subjects were included in the study. The mitral valve areas, mitral gradients and systolic pulmonary artery pressure (sPAP) were measured by echocardiography. The sPAP values and mitral gradients were also measured by catheterization before and after PMBV. The blood tenascin-C levels were measured before PMBV and 1 month after the procedure. Results The echocardiographic mean mitral gradients had a significant decrease after PMBV (11.7 ± 2.8 vs. 5.6 ± 1.7 mm Hg; p < 0.001) and also those of catheterization (13.9 ± 4.4 vs. 4.0 ± 2.4 mm Hg; p < 0.001). Mitral valve areas increased significantly after PMBV (from 1.1 ± 0.1 to 1.8 ± 0.2 cm2, p < 0.001). Tenascin-C levels decreased significantly in patients after PMBV (from 15.0 ± 3.8 to 10.9 ± 3.1 ng/ml; p < 0.001). Tenascin-C levels were higher in patients with mitral stenosis before PMBV than in healthy subjects (15.0 ± 3.8 and 9.4 ± 2.9 ng/ml; p < 0.001, respectively). There were no significant differences between patients with mitral stenosis after PMBV and healthy subjects (10.9 ± 3.1 and 9.4 ± 2.9 ng/ml; p = 0.09, respectively). There was a significant positive correlation between tenascin-C levels and sPAP (r = 0.508, p < 0.001). In multivariant analysis, tenascin-C predicted mitral stenosis (p = 0.004, OR: 2.31). Conclusions Tenascin-C was an independent predictor for rheumatic mitral stenosis. PMID:22889719

Preoperative retrolisthesis as a predictive risk factor of reoperation due to delayed-onset symptomatic foraminal stenosis after central decompression for lumbar canal stenosis without fusion.

PubMed

Ikegami, Daisuke; Hosono, Noboru; Mukai, Yoshihiro; Tateishi, Kosuke; Fuji, Takeshi

2017-08-01

For patients diagnosed with lumbar central canal stenosis with asymptomatic foraminal stenosis (FS), surgeons occasionally only decompress central stenosis and preserve asymptomatic FS. These surgeries have the potential risk of converting preoperative asymptomatic FS into symptomatic FS postoperatively by accelerating spinal degeneration, which requires reoperation. However, little is known about delayed-onset symptomatic FS postoperatively. This study aimed to evaluate the rate of reoperation for delayed-onset symptomatic FS after lumbar central canal decompression in patients with preoperative asymptomatic FS, and determine the predictive risk factors of those reoperations. This study is a retrospective cohort study. Two hundred eight consecutive patients undergoing posterior central decompression for lumbar canal stenosis between January 2009 and June 2014 were included in this study. The number of patients who had preoperative FS and the reoperation rate for delayed-onset symptomatic FS at the index levels were the outcome measures. Patients were divided into two groups with and without preoperative asymptomatic FS at the decompressed levels. The baseline characteristics and revision rates for delayed-onset symptomatic FS were compared between the two groups. Predictive risk factors for such reoperations were determined using multivariate logistic regression and receiver operating characteristics analyses. Preoperatively, 118 patients (56.7%) had asymptomatic FS. Of those, 18 patients (15.3%) underwent reoperation for delayed-onset symptomatic FS at a mean of 1.9 years after the initial surgery. Posterior slip in neutral position and posterior extension-neutral translation were significant risk factors for reoperation due to FS. The optimal cutoff values of posterior slip in neutral position and posterior extension-neutral translation for predicting the occurrence of such reoperations were both 1 mm; 66.7% of patients who met both of these cutoff values had undergone reoperation. This study demonstrated that 15.3% of patients with preoperative asymptomatic FS underwent reoperation for delayed-onset symptomatic FS at the index levels at a mean of 1.9 years after central decompression, and preoperative retrolisthesis was a predictive risk factor for such a reoperation. These findings are valuable for establishing standards of appropriate treatment strategies in patients with lumbar central canal stenosis with asymptomatic FS. Copyright © 2017 Elsevier Inc. All rights reserved.

Bronchoscopic management of benign bronchial stenosis by electrocautery and balloon dilatation.

PubMed

Garg, M; Gogia, Pratibha; Manoria, P; Goyal, R

2012-01-01

Benign bronchial stenosis is managed by surgical or bronchoscopic methods. Although surgical approach is definitive, it is technically demanding and is costlier than bronchoscopic treatment. Here, we report the case of a 27-year-old female patient with symptomatic benign bronchial stenosis of the left main bronchus. The stenosis was dilated successfully through a fibreoptic bronchoscope by electrocautery followed by balloon bronchoplasty and application of mitomycin-C. On follow up, there was no evidence of re-stenosis.

Computational fluid dynamics simulation of transcatheter aortic valve degeneration.

PubMed

Dwyer, Harry A; Matthews, Peter B; Azadani, Ali; Jaussaud, Nicolas; Ge, Liang; Guy, T Sloane; Tseng, Elaine E

2009-08-01

Studied under clinical trials, transcatheter aortic valves (TAV) have demonstrated good short-term feasibility and results in high-risk surgical patients with severe aortic stenosis. However, their long-term safety and durability are unknown. The objective of this study is to evaluate hemodynamic changes within TAV created by bioprosthetic leaflet degeneration. Computational fluid dynamics (CFD) simulations were performed to evaluate the hemodynamics through TAV sclerosis (35% orifice reduction) and stenosis (78% orifice reduction). A three-dimensional surface mesh of the TAV within the aortic root was generated for each simulation. Leaflets were contained within an open, cylindrical body without attachment to the sinus commissures representing the stent. A continuous surface between the annulus and TAV excluded the geometry of the native calcified leaflets and prevented paravalvular leak. Unsteady control volume analysis throughout systole was used to calculate leaflet shear stress and total force on the TAV. Sclerosis increased total force on the TAV by 63% (0.602-0.98 N). Advancement of degeneration from sclerosis to stenosis was accompanied by an 86% increase in total force (1.82 N) but only a 32% increase in peak wall shear stress on the leaflets. Of the total force exerted on the TAV, 99% was in the direction of axial flow. Shear stresses on the TAV were greatest during peak systolic flow with stress concentrations on the tips of the leaflets. In the normal TAV, the aortic root geometry and physiologic flow dominate location and magnitude of shear stress. Following leaflet degeneration, the specific geometry of the stenosis dictates the profile of axial velocity leaving the TAV and shear stress on the leaflets. A dramatic increase in peak leaflet shear stress was observed (115 Pa stenosis vs. 87 Pa sclerosis and 29 Pa normal). CFD simulations in this study provide the first of its kind data quantifying hemodynamics within stenosed TAV. Stenosis leads to significant forces of TAV during systole; however, diastolic forces predominate even with significant stenosis. Substantial changes in peak shear stress occur with TAV degeneration. As the first implanted TAV begin to stenose, the authors recommend watchful examination for device failure.

Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis.

PubMed

Ringle, Anne; Levy, Franck; Ennezat, Pierre-Vladimir; Le Goffic, Caroline; Castel, Anne-Laure; Delelis, François; Menet, Aymeric; Malaquin, Dorothée; Graux, Pierre; Vincentelli, André; Tribouilloy, Christophe; Maréchaux, Sylvestre

We hypothesized that large exercise-induced increases in aortic mean pressure gradient can predict haemodynamic progression during follow-up in asymptomatic patients with aortic stenosis. We retrospectively identified patients with asymptomatic moderate or severe aortic stenosis (aortic valve area<1.5cm 2 or<1cm 2 ) and normal ejection fraction, who underwent an exercise stress echocardiography at baseline with a normal exercise test and a resting echocardiography during follow-up. The relationship between exercise-induced increase in aortic mean pressure gradient and annualised changes in resting mean pressure gradient during follow-up was investigated. Fifty-five patients (mean age 66±15 years; 45% severe aortic stenosis) were included. Aortic mean pressure gradient significantly increased from rest to peak exercise (P<0.001). During a median follow-up of 1.6 [1.1-3.2] years, resting mean pressure gradient increased from 35±13mmHg to 48±16mmHg, P<0.0001. Median annualised change in resting mean pressure gradient during follow-up was 5 [2-11] mmHg. Exercise-induced increase in aortic mean pressure gradient did correlate with annualised changes in mean pressure gradient during follow-up (r=0.35, P=0.01). Hemodynamic progression of aortic stenosis was faster in patients with large exercise-induced increase in aortic mean pressure gradient (≥20mmHg) as compared to those with exercise-induced increase in aortic mean pressure gradient<20mmHg (median annualised increase in mean pressure gradient 19 [6-28] vs. 4 [2-10] mmHg/y respectively, P=0.002). Similar results were found in the subgroup of 30 patients with moderate aortic stenosis. Large exercise-induced increases in aortic mean pressure gradient correlate with haemodynamic progression of stenosis during follow-up in patients with asymptomatic aortic stenosis. Further studies are needed to fully establish the role of ESE in the decision-making process in comparison to other prognostic markers in asymptomatic patients with aortic stenosis. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting.

PubMed

Tulip, Hans H; Rosero, Eric B; Higuera, Adriana J; Ilarraza, Adriana; Valentine, R James; Timaran, Carlos H

2012-12-01

Previous studies have investigated the development of new ischemic brain lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) after carotid artery stenting (CAS). The rate of ischemic brain injury after CAS for asymptomatic stenosis has not been extensively studied but is presumed to be less likely than in symptomatic patients. This study assessed the occurrence of cerebral embolization after CAS for asymptomatic vs symptomatic carotid stenosis. During an 18-month period, 40 patients undergoing CAS under filter embolic protection were prospectively evaluated. Transcranial Doppler (TCD) during CAS and preprocedural and 24-hour postprocedural DW-MRI were used to assess cerebral embolization. Univariate and nonparametric analyses were used to compare differences in cerebral embolization after CAS in asymptomatic and symptomatic patients. CAS was performed for 23 asymptomatic (58%) and 17 symptomatic (42%) carotid stenoses. The median microembolic counts detected by TCD were 285 (interquartile range [IQR], 182-376) for asymptomatic and 313 (IQR, 170-426) for symptomatic carotid stenosis (P=.6). DW-MRI was available for assessment in 20 asymptomatic and 14 symptomatic patients. New acute cerebral emboli detected with DW-MRI occurred in 10 asymptomatic (50%) and 7 symptomatic patients (50%) undergoing CAS (P=.9). The ipsilateral and total median number of DW-MRI lesions between groups were not statistically significantly different at, respectively, 1 (IQR, 0-2.5) and 1.5 (IQR, 0-3) for asymptomatic vs 0.5 (IQR, 0-2) and 0.5 (IQR, 0-3) for symptomatic carotid stenosis (P>.5). One asymptomatic patient sustained a minor stroke after CAS. No new neurologic events occurred in symptomatic patients. The 30-day stroke-death rate was 2.5% in this series. Cerebral embolization, as detected by TCD and DW-MRI, occurs with a similar frequency after CAS for asymptomatic and symptomatic carotid stenosis. Because postprocedural ischemic brain injury occurs in approximately half of asymptomatic patients, the safety of CAS under filter embolic protection for asymptomatic carotid stenosis is uncertain and warrants further study. Published by Mosby, Inc.

Transjugular Portal Venous Stenting in Inflammatory Extrahepatic Portal Vein Stenosis

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

Schaible, Rolf; Textor, Jochen; Decker, Pan

2002-12-15

We report the case of a 37-year-old man with necrotizing pancreatitis associated with inflammatory extrahepatic portal vein stenosis and progressive ascites. Four months after the acute onset, when no signs of infection were present, portal decompression was performed to treat refractory ascites. Transjugulartranshepatic venoplasty failed to dilate the stenosis in the extrahepatic portion of the portal vein sufficiently. Therefore a Wallstent was implanted, resulting in almost normal diameter of the vessel. In follow-up imaging studies the stent and the portal vein were still patent 12 months after the intervention and total resolution of the ascites was observed.

Severe mitral stenosis with atypical presentation: hemorrhagic pleural effusion--a case report and literature review.

PubMed

Albalbissi, Kais A; Burress, Jonathan W; Garcia, Israel D; Iskandar, Said B

2009-02-01

Mitral stenosis is a well-described valvular heart disease. We report a 68-year-old patient with an unusual presentation of mitral stenosis. He presented with recurrent episodes of hemorrhagic pleural effusion. Afterwards, an extensive atrial thrombosis complicated his course of illness. We will discuss how the clinical presentation of mitral stenosis is mainly dictated by the underlying pathophysiology of the disease. Also, the need for anticoagulation in the setting of mitral stenosis is often linked to the presence of atrial fibrillation. We will discuss the independent risk factors for thromboembolism in the setting of mitral stenosis. Finally, a review of the current recommendation for anticoagulation is conferred.

Predictive Value of Dynamic Cerebral Autoregulation Assessment in Surgical Management of Patients with High-Grade Carotid Artery Stenosis

PubMed Central

Semenyutin, Vladimir B.; Asaturyan, Gregory A.; Nikiforova, Anna A.; Aliev, Vugar A.; Panuntsev, Grigory K.; Iblyaminov, Vadim B.; Savello, Alexander V.; Patzak, Andreas

2017-01-01

Dynamic cerebral autoregulation (DCA) capacity along with the degree of internal carotid artery (ICA) stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA) by calculating phase shift (PS) between Mayer waves of blood flow velocity (BFV) and blood pressure (BP) before and after operation. In 18 cases, regardless of clinical type, preoperative PS on ipsilateral side was within the normal range and did not change considerably after surgery. In other 17 cases preoperative PS was reliably lower both in patients with symptomatic and asymptomatic stenosis. Surgical reconstruction led to restoration of impaired DCA evidenced by significant increase of PS in postoperative period. Our data suggest that regardless clinical type of disease various state of DCA may be present in patients with severe ICA stenosis. This finding can contribute to establishing the optimal treatment strategy, and first of all for asymptomatic patients. Patients with compromised DCA should be considered as ones with higher risk of stroke and first candidates for reconstructive surgery. PMID:29163214

Resolution of massive left atrial appendage thrombi with rivaroxaban before balloon mitral commissurotomy in severe mitral stenosis: A case report and literature review.

PubMed

Li, Yuechun; Lin, Jiafeng; Peng, Chen

2016-12-01

Data on nonvitamin K antagonist oral anticoagulant being used for the treatment of LAA thrombi are limited only in nonvalvular atrial fibrillation. There are no data on the antithrombotic efficacy and safety of nonvitamin K antagonist oral anticoagulant in the resolution of left atrial appendage (LAA) thrombi in patients with rheumatic mitral stenosis. A 49-year-old woman with known rheumatic mitral stenosis and atrial fibrillation was referred for percutaneous transvenous mitral commissurotomy because of progressive dyspnea on exertion over a period of 3 months. Transesophageal echocardiography (TEE) demonstrated a large LAA thrombus protruding into left atria cavity before the procedure. Direct factor Xa (FXa) inhibitor rivaroxaban (20 mg/d) was started for the patient. After 3 weeks of rivaroxaban treatment TEE showed a relevantly decreased thrombus size, and a complete thrombus resolution was achieved after 5 weeks of anticoagulant therapy with the FXa inhibitor. To the best of our knowledge, this is the first documented case of large LAA thrombus resolution with nonvitamin K antagonist oral anticoagulant in severe mitral stenosis, and in which percutaneous transvenous mitral commissurotomy was performed subsequently. The report indicated that rivaroxaban could be a therapeutic option for mitral stenosis patients with LAA thrombus. Further study is required before the routine use of rivaroxaban in patients with rheumatic mitral stenosis and atrial fibrillation.

Estimating the irreversible pressure drop across a stenosis by quantifying turbulence production using 4D Flow MRI

PubMed Central

Ha, Hojin; Lantz, Jonas; Ziegler, Magnus; Casas, Belen; Karlsson, Matts; Dyverfeldt, Petter; Ebbers, Tino

2017-01-01

The pressure drop across a stenotic vessel is an important parameter in medicine, providing a commonly used and intuitive metric for evaluating the severity of the stenosis. However, non-invasive estimation of the pressure drop under pathological conditions has remained difficult. This study demonstrates a novel method to quantify the irreversible pressure drop across a stenosis using 4D Flow MRI by calculating the total turbulence production of the flow. Simulation MRI acquisitions showed that the energy lost to turbulence production can be accurately quantified with 4D Flow MRI within a range of practical spatial resolutions (1–3 mm; regression slope = 0.91, R2 = 0.96). The quantification of the turbulence production was not substantially influenced by the signal-to-noise ratio (SNR), resulting in less than 2% mean bias at SNR > 10. Pressure drop estimation based on turbulence production robustly predicted the irreversible pressure drop, regardless of the stenosis severity and post-stenosis dilatation (regression slope = 0.956, R2 = 0.96). In vitro validation of the technique in a 75% stenosis channel confirmed that pressure drop prediction based on the turbulence production agreed with the measured pressure drop (regression slope = 1.15, R2 = 0.999, Bland-Altman agreement = 0.75 ± 3.93 mmHg). PMID:28425452

Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis.

PubMed

Tellegen, Anna R; Willems, Nicole; Tryfonidou, Marianna A; Meij, Björn P

2015-12-07

Degenerative lumbosacral stenosis is a common problem in large breed dogs. For severe degenerative lumbosacral stenosis, conservative treatment is often not effective and surgical intervention remains as the last treatment option. The objective of this retrospective study was to assess the middle to long term outcome of treatment of severe degenerative lumbosacral stenosis with pedicle screw-rod fixation with or without evidence of radiological discospondylitis. Twelve client-owned dogs with severe degenerative lumbosacral stenosis underwent pedicle screw-rod fixation of the lumbosacral junction. During long term follow-up, dogs were monitored by clinical evaluation, diagnostic imaging, force plate analysis, and by using questionnaires to owners. Clinical evaluation, force plate data, and responses to questionnaires completed by the owners showed resolution (n = 8) or improvement (n = 4) of clinical signs after pedicle screw-rod fixation in 12 dogs. There were no implant failures, however, no interbody vertebral bone fusion of the lumbosacral junction was observed in the follow-up period. Four dogs developed mild recurrent low back pain that could easily be controlled by pain medication and an altered exercise regime. Pedicle screw-rod fixation offers a surgical treatment option for large breed dogs with severe degenerative lumbosacral stenosis with or without evidence of radiological discospondylitis in which no other treatment is available. Pedicle screw-rod fixation alone does not result in interbody vertebral bone fusion between L7 and S1.

Risk factors for esophageal stenosis after entire circumferential endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma.

PubMed

Miwata, Tomohiro; Oka, Shiro; Tanaka, Shinji; Kagemoto, Kenichi; Sanomura, Yoji; Urabe, Yuji; Hiyama, Toru; Chayama, Kazuaki

2016-09-01

Endoscopic submucosal dissection (ESD) is used to perform en block resection for esophageal squamous cell carcinoma, but it is strongly associated with postoperative stenosis, especially during entire circumferential resection. This study aimed to clarify the risk factors for refractory postoperative stenosis after entire circumferential esophageal ESD. Nineteen patients who underwent entire circumferential esophageal ESD from February 2006 to December 2013 at Hiroshima University Hospital were divided into two groups: refractory postoperative stenosis [≥6 endoscopic balloon dilation (EBD) procedures, 12 lesions in 12 patients] and non-refractory postoperative stenosis (≤5 EBD procedures, 7 lesions in 7 patients). We retrospectively examined the patient factors (age, sex, alcohol consumption, smoking index, and chemoradiation therapy history), tumor factors (location, macroscopic type, fibrosis, and depth), and treatment factors (mean procedure time, entire circumferential resection diameter, muscle layer damage, and steroid administration method) between the two groups. Muscle layer damage (p = 0.019) and ≥5 cm of longitudinal mucosal defect length after entire circumferential esophageal ESD (p = 0.010) were significant factors associated with the refractory group. Regarding the patient and tumor factors, there were no significant differences between the two groups. Our data suggest that refractory post-ESD stenosis occurs after entire circumferential esophageal ESD with muscle layer damage and ≥5 cm of longitudinal mucosal defect length.

Diffuse supravalvular aortic stenosis with multiple stenoses of the branches of arcus aorta in a child.

PubMed

Uçar, Tayfun; Tutar, Ercan; Atalay, Semra

2008-01-01

We give details of a sporadic case with congenital supravalvular aortic stenosis associated with critical stenosis of the left carotid artery, and severe stenosis of the innominate artery at their origins as well as excessive dilatations of both the right and the left coronary arteries.

Technical Writing in Hydrogeology.

ERIC Educational Resources Information Center

Tinker, John R., Jr.

1986-01-01

A project for Writing Across the Curriculum at the University of Wisconsin-Eau Claire is described as a method to relate the process of writing to the process of learning hydrology. The project focuses on an actual groundwater contamination case and is designed to improve the technical writing skills of students. (JN)

Reading Professionals: The Vital Link.

ERIC Educational Resources Information Center

Gabler, Carol L.

The Family Literacy Program in Eau Claire, Wisconsin is an example of a strong linkage between professional educators, volunteers, and parents. The program uses the strengths of reading professionals working with preschool students and adult learners in order to break the intergenerational cycle of illiteracy. Cooperation and hard work are the…

Center for Adaptive Optics | Center

Science.gov Websites

Center for Adaptive Optics A University of California Science and Technology Center home Contact Us Director: Claire Max Office: Room 205, Center for Adaptive Optics Phone: (831) 459-2049 Fax: (831 ) 459-5717 Email: max@ucolick.org Associate Director: Donald Gavel Office: Room 209, Center for Adaptive

78 FR 61591 - Decision and Order: Clair L. Pettinger, M.D.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

... DEA requirements and the applicable standard of care.'' Id. Respondent thus concludes by arguing that... requirements and the applicable community standard of care.'' Id. Here again, Respondent is confused, but not... requirements and the applicable . . . standard of care.'' Resp. Exceptions, at 5. Next, Respondent argues that...

29 CFR 1420.5 - Optional input of parties to Board of Inquiry selection.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Connecticut, Rhode Island, Massachusetts, New York, Puerto Rico, the Virgin Islands, Pennsylvania, Delaware..., Boon, Cooper, Pettis, Johnson, Cass, Bates, Henry, St. Clair, Benton, and Morgan); American Somoa; and Wake Island. [44 FR 42683, July 20, 1979, as amended at 47 FR 10530, Mar. 11, 1982] ...

29 CFR 1420.5 - Optional input of parties to Board of Inquiry selection.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Connecticut, Rhode Island, Massachusetts, New York, Puerto Rico, the Virgin Islands, Pennsylvania, Delaware..., Boon, Cooper, Pettis, Johnson, Cass, Bates, Henry, St. Clair, Benton, and Morgan); American Somoa; and Wake Island. [44 FR 42683, July 20, 1979, as amended at 47 FR 10530, Mar. 11, 1982] ...

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Code of Federal Regulations, 2012 CFR

2012-07-01

..., Connecticut, Rhode Island, Massachusetts, New York, Puerto Rico, the Virgin Islands, Pennsylvania, Delaware..., Boon, Cooper, Pettis, Johnson, Cass, Bates, Henry, St. Clair, Benton, and Morgan); American Somoa; and Wake Island. [44 FR 42683, July 20, 1979, as amended at 47 FR 10530, Mar. 11, 1982] ...

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Code of Federal Regulations, 2011 CFR

2011-07-01

..., Connecticut, Rhode Island, Massachusetts, New York, Puerto Rico, the Virgin Islands, Pennsylvania, Delaware..., Boon, Cooper, Pettis, Johnson, Cass, Bates, Henry, St. Clair, Benton, and Morgan); American Somoa; and Wake Island. [44 FR 42683, July 20, 1979, as amended at 47 FR 10530, Mar. 11, 1982] ...

29 CFR 1420.5 - Optional input of parties to Board of Inquiry selection.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Connecticut, Rhode Island, Massachusetts, New York, Puerto Rico, the Virgin Islands, Pennsylvania, Delaware..., Boon, Cooper, Pettis, Johnson, Cass, Bates, Henry, St. Clair, Benton, and Morgan); American Somoa; and Wake Island. [44 FR 42683, July 20, 1979, as amended at 47 FR 10530, Mar. 11, 1982] ...

78 FR 36566 - Notice of Availability of the Assessment Plan for the Sauget Industrial Corridor Sites, St. Clair...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... natural resource trustees (USFWS, State of Illinois, and State of Missouri) for conducting the assessment... Assessment Plan to: Annette Trowbridge, U.S. Fish and Wildlife Service, Regional Environmental Contaminants..., Contaminant Assessment Section, Illinois Department of Natural Resources, One Natural Resources Way...

Forum: Knowledge, Action, Involvement

ERIC Educational Resources Information Center

Weinberger, JoAnn

2015-01-01

St. Clair (EJ1072357) provides a summary and lays out some of the important issues inherent in the broad strategies articulated in "Making Skills Everyone's Business: A Call to Transform Adult Learning in the United States" (MSEB) (United States Department of Education [USDoE], 2015) (see ED558793). In this commentary, JoAnn Weinberger…

78 FR 12802 - Sunshine Act Meetings

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2013-02-25

... PRIVACY AND CIVIL LIBERTIES OVERSIGHT BOARD [Notice-PCLOB-2013-02; Docket No. 2013-0004; Sequence... public. The rest of the meeting will be closed to the public. MATTERS TO BE CONSIDERED: The Privacy and... 21, 2013. Claire McKenna, Legal Counsel, Privacy and Civil Liberties Oversight Board. [FR Doc. 2013...

77 FR 40276 - Implementation of the Commercial Advertisement Loudness Mitigation (CALM) Act

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2012-07-09

... crafting effective rules ``due to the subjective nature of many of the factors that contribute to loudness... stages of distribution (i.e., production, post-production and real time production).\\25\\ It specifically... Reply''); Ex Parte Comments of Sens. Sheldon Whitehouse, Sherrod Brown, Tim Johnson, Claire McCaskill...

76 FR 49697 - Television Broadcasting Services; Eau Claire, WI

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..., viewers have reported difficulties receiving the station's digital signal on channel 13 since the end of the digital transition. Substituting channel 38 for channel 13 will allow Gray to leverage the... Report and Order in a report to be sent to Congress and the Government Accountability Office pursuant to...

Incompetence and Intrusion: On the Metaphysical Use of Illiteracy in U.S. Political Discourse

ERIC Educational Resources Information Center

St. Clair, Ralf; Sandlin, Jennifer A.

2004-01-01

"Illiteracy" is still a powerful concept in adult literacy education. St. Clair and Sandlin examine the use of the term and the policies and programs it currently justifies. The authors argue that the concept of illiteracy should be avoided due to its inherent deficit focus.

18. Photographic copy of original remodeling drawings dated July 8, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. Photographic copy of original remodeling drawings dated July 8, 1988 (original sepia in plan room of Base Civil Engineer, Scott AFB) First and second floor demolition and framing plan - Scott Air Force Base, General Officer Quarters, 229 Birchard Street, O'Fallon, St. Clair County, IL

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

Tapping, C. R.; Ahmed, M.; Scott, P. M.

The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included pairedmore » Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.« less

[Doppler ultrasonography of the renal artery: Guidelines and predictive factors for the presence of a tight stenosis. Retrospective analysis of 450 consecutive examinations].

PubMed

Dejerome, C; Grange, C; De Laforcade, L; Bonin, O; Laville, M; Lermusiaux, P; Long, A

2018-05-01

Duplex ultrasonography screening for renal artery stenosis has been the object of guidelines published by four societies designed to optimize the cost-effectiveness of the examination. To determine how well guideline indications for ultrasonography matched with requests and results in our university hospital; to determine whether compliance with guidelines was predictive of renal artery stenosis; to identify guidelines predictive of presence of stenosis; and to determine whether other predictive factors can be recognized. Requests and results of 450 Duplex ultrasonography examinations of the renal arteries performed from January 1st 2014 to December 31st 2015 were compared with published guidelines. At least one guideline indication was identified for 212 of the 450 examinations performed (47.1%). Among these examinations, renal artery stenosis≥70% was identified in 18 patients (8.0%). No case of stenosis was identified during examinations performed outside guideline indications. Factors predictive of stenosis were: compliance with guidelines (OR=21.86 [2.88; 165.8]). Predictive guidelines were: resistant hypertension in spite of appropriate treatment (OR=3.85, [1.44; 10.33], P=0.011), accelerated hypertension (OR=7.30, [1.40; 37.99], P=0.049), sudden unexplained pulmonary edema (OR=7.30, [1.40; 37.99], P=0.049), unexplained renal insufficiency (OR=3.58, [1.37; 9.37], P=0.011), unexplained renal hypotrophy (OR=16.69, [4.38; 63.69], P<0.001), renal asymmetry (OR=4.32, [1.45; 12.85], P<0.016). No other factor was predictive of renal stenosis. These examinations had therapeutic consequences in only 50% of patients. This study confirms the relevance of published guidelines. The diagnostic-effectiveness of Duplex ultrasonography examinations to search for renal artery stenosis depends upon compliance with these guidelines. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

PubMed

Chaturvedi, S; Bruno, A; Feasby, T; Holloway, R; Benavente, O; Cohen, S N; Cote, R; Hess, D; Saver, J; Spence, J D; Stern, B; Wilterdink, J

2005-09-27

To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symptomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy. Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A). Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with <50% stenosis (Level A). For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made. Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (<3%) (Level A). Low dose aspirin (81 to 325 mg) is preferred for patients before and after carotid endarterectomy to reduce the rate of stroke, myocardial infarction, and death (Level A).

New dedicated bifurcated silicone stent placement for stenosis around the primary right carina.

PubMed

Oki, Masahide; Saka, Hideo

2013-08-01

Silicone stenting has been widely used to palliate respiratory symptoms in patients suffering from airway stenosis. Although many types and shapes of stents have been developed, there is no ideal stent for stenosis around the carina between the bronchus to the right upper lobe and the bronchus intermedius (primary right carina). The purpose of this study was to evaluate the feasibility, efficacy, and safety of a new silicone stent designed for treating airway stenosis around the primary right carina. We recruited 16 patients with suspected stenosis around the primary right carina. Ten of the patients met the inclusion criteria for inserting the study stent. All stenting procedures were performed with a rigid and flexible bronchoscope under general anesthesia. The study stent could be mounted successfully on the primary right carina in all 10 patients. Five patients underwent stenting using only the new stent, and the other five underwent stenting with it on the primary right carina and a silicone Y stent on the main carina. The dyspnea index improved in eight of the 10 patients, including one who was mechanically ventilated. Early complications developed in three patients (temporary pneumonia in two and retention of secretions in one), and late complications occurred in two patients (granuloma formation in one and hemoptysis in one). Stent placement with the new silicone stent designed to fit on the primary right carina is feasible, effective, and acceptably safe. UMIN-Clinical Trials Registry; No.: UMIN000001776; URL: www.umin.ac.jp/ctr.

[Endoscopic dilatation of benign colon and rectum stenosis].

PubMed

Rivera Vega, Juan; Frisancho Velarde, Oscar; Cervera, Zenón; Ruiz, Edwin; Yoza, Max; Larrea, Pedro

2002-01-01

To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.

Systemic rapamycin to prevent in-stent stenosis in peripheral pulmonary arterial disease: early clinical experience.

PubMed

Hallbergson, Anna; Esch, Jesse J; Tran, Trang X; Lock, James E; Marshall, Audrey C

2016-10-01

We have taken a novel approach using oral rapamycin - sirolimus - as a medical adjunct to percutaneous therapy in patients with in-stent stenosis and high risk of right ventricular failure. Peripheral pulmonary artery stenosis can result in right ventricular hypertension, dysfunction, and death. Percutaneous pulmonary artery angioplasty and stent placement acutely relieve obstructions, but patients frequently require re-interventions due to re-stenosis. In patients with tetralogy of Fallot or arteriopathy, the problem of in-stent stenosis contributes to the rapidly recurrent disease. Rapamycin was administered to 10 patients (1.5-18 years) with peripheral pulmonary stenosis and in-stent stenosis and either right ventricular hypertension, pulmonary blood flow maldistribution, or segmental pulmonary hypertension. Treatment was initiated around the time of catheterisation and continued for 1-3 months. Potential side-effects were monitored by clinical review and blood tests. Target serum rapamycin level (6-10 ng/ml) was accomplished in all patients; eight of the nine patients who returned for clinically indicated catheterisations demonstrated reduction in in-stent stenosis, and eight of the 10 patients experienced no significant side-effects. Among all, one patient developed diarrhoea requiring drug discontinuation, and one patient experienced gastrointestinal bleeding while on therapy that was likely due to an indwelling feeding tube and this patient tolerated rapamycin well following tube removal. Our initial clinical experience supports that patients with peripheral pulmonary artery stenosis can be safely treated with rapamycin. Systemic rapamycin may provide a novel medical approach to reduce in-stent stenosis.

Characteristics of intracranial aneurysms associated with extracranial carotid artery disease in South Korea.

PubMed

Cho, Young Dae; Jung, Keun-Hwa; Roh, Jae-Kyu; Kang, Hyun-Seung; Han, Moon Hee; Lim, Jeong Wook

2013-09-01

Although it is hypothesized that inflammatory signals and/or hemodynamic stress resulting from carotid disease increase the risk of aneurysm formation and growth, a relationship between intracranial aneurysms and extracranial carotid artery disease (ECAD) has not been explored. Here, we examined the characteristics of intracranial aneurysms associated with ECAD. A total of 606 consecutive patients with stenosis of 50% or more of the proximal internal carotid artery (pICA) were enrolled. Stenosis was identified by conventional angiography between January 2003 and December 2009. We determined the prevalence of intracranial aneurysms in this population. The characteristics of the aneurysms were analyzed according to the degree and laterality of stenosis. The changes in the aneurysms were tracked for the evaluation of stability. In 86 patients (14.2%), 120 aneurysms were detected in association with pICA stenosis. In this group, 97 were associated with unilateral pICA stenosis. The distribution of aneurysms was independent of the laterality of stenosis, but aneurysms were more prevalent in the contralateral side as the stenosis grade increased (P<0.001). All aneurysms with an imaging follow-up (28.9 ± 14.3 months) were stable, and the course was not affected by treatment of the carotid stenosis. In 23 aneurysms associated with bilateral pICA stenosis, there was only one case that increased in size during a 41-month period. Intracranial aneurysms were most likely associated with ECAD, but were evenly distributed irrespective of the laterality of the stenosis. The distribution was related to the severity of the contralateral pICA stenosis. The low incidence of aneurysm growth or rupture in patients with significant ECAD indicates that these aneurysms do not require immediate intervention more than other conditions. Copyright © 2013 Elsevier B.V. All rights reserved.

Ultrasound for the evaluation of stenosis after flow diversion.

PubMed

McDougall, Cameron M; Khan, Khurshid; Saqqur, Maher; Jack, Andrew; Rempel, Jeremy; Derksen, Carol; Xi, Yin; Chow, Michael

2018-03-01

Flow diversion is a relatively new strategy used to treat complex cerebral aneurysms. The optimal method for radiographic follow-up of patients treated with flow diverters has not been established. The rate and clinical implications of in-stent stenosis for these devices is unclear. We evaluate the use of transcranial Doppler ultrasound (TCD) for follow-up of in-stent stenosis. We analyzed 28 patients treated with the Pipeline embolization device (PED) over the course of 42 months from January 2009 to June 2012. Standard conventional cerebral angiograms were performed in all patients. TCD studies were available in 23 patients. Angiographic and TCD results were compared and found to correlate well. TCD is a potentially useful adjunct for evaluating in-stent stenosis after flow diversion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Treatment of symptomatic carotid stenosis: carotid stent placement versus endarterectomy.

PubMed

Alqadri, Syeda L; Qureshi, Adnan I

2013-08-01

The mainstay of treatment options for symptomatic carotid stenosis is focused around medical management, carotid endarterectomy, and carotid angioplasty and stent placement. The International Carotid Stenting Study (ICSS), also called Carotid and Vertebral Artery Transluminal Angioplasty Study 2 (CAVATAS 2), the Stent-Supported Percutaneous Angioplasty of the Carotid Artery Versus Endarterectomy (SPACE) trial, the Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, and the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) were five major trials which compared carotid endarterectomy and carotid angioplasty and stent placement. We review the results of the trials and incorporation of the results into clinical decision making.

High Spatial Inhomogeneity in the Intima-Media Thickness of the Common Carotid Artery is Associated with a Larger Degree of Stenosis in the Internal Carotid Artery: The PARISK Study.

PubMed

Steinbuch, Jeire; van Dijk, Anouk C; Schreuder, Floris H B M; Truijman, Martine T B; de Rotte, Alexandra A J; Nederkoorn, Paul J; van der Lugt, Aad; Hermeling, Evelien; Hoeks, Arnold P G; Mess, Werner H

2017-10-01

Purpose  Inhomogeneity of arterial wall thickness may be indicative of distal plaques. This study investigates the intra-subject association between relative spatial intima-media thickness (IMT) inhomogeneity of the common carotid artery (CCA) and the degree of stenosis of plaques in the internal carotid artery (ICA). Materials and Methods  We included 240 patients with a recent ischemic stroke or transient ischemic attack and mild-to-moderate stenosis in the ipsilateral ICA. IMT inhomogeneity was extracted from B-mode ultrasound recordings. The degree of ICA stenosis was assessed on CT angiography according to the European Carotid Surgery Trial method. Patients were divided into groups with a low (≤ 2 %) and a high (> 2 %) IMT inhomogeneity scaled with respect to the local end-diastolic diameter. Results  182 patients had suitable CT and ultrasound measurements. Relative CCA-IMT inhomogeneity was similar for the symptomatic and asymptomatic side (difference: 0.02 %, p = 0.85). High relative IMT inhomogeneity was associated with a larger IMT (difference: 235 µm, p < 0.001) and larger degree of ICA stenosis (difference: 5 %, p = 0.023) which remained significant (p = 0.016) after adjustment for common risk factors. Conclusion  Regardless of common risk factors, high relative CCA-IMT inhomogeneity is associated with a greater degree of ICA stenosis and is therefore indicative of atherosclerotic disease. The predictive value of CCA-IMT inhomogeneity for plaque progression and recurrence of cerebrovascular symptoms will be determined in the follow-up phase of PARISK. © Georg Thieme Verlag KG Stuttgart · New York.

The role of stenosis ratio as a predictor of surgical satisfaction in patients with lumbar spinal canal stenosis: a receiver-operator characteristic (ROC) curve analysis.

PubMed

Mohammadi, Hassanreza R; Azimi, Parisa; Benzel, Edward C; Shahzadi, Sohrab; Azhari, Shirzad

2016-09-01

The aim of this study was to elucidate independent factors that predict surgical satisfaction in lumbar spinal canal stenosis (LSCS) patients. Patients who underwent surgery were grouped based on the age, gender, duration of symptoms, walking distance, Neurogenic Claudication Outcome Score (NCOS) and the stenosis ratio (SR) described by Lurencin. We recorded on 2-year patient satisfaction using standardized measure. The optimal cut-off points in SR, NCOS and walking distance for predicting surgical satisfaction were estimated from sensitivity and specificity calculations and receiver operator characteristic (ROC) curves. One hundred fifty consecutive patients (51 male, 99 female, mean age 62.4±10.9 years) were followed up for 34±13 months (range 24-49). One, two, three and four level stenosis was observed in 10.7%, 39.3%, 36.0 % and 14.0% of patients, respectively. Post-surgical satisfaction was 78.5% at the 2 years follow up. In ROC curve analysis, the asymptotic significance is less than 0.05 in SR and the optimal cut-off value of SR to predict worsening surgical satisfaction was measured as more than 0.52, with 85.4% sensitivity and 77.4% specificity (AUC 0.798, 95% CI 0.73-0.90; P<0.01). The present study suggests that the SR, with a cut-off set a 0.52 cross-sectional area, may be superior to walking distance and NCOS in patients with degenerative lumbar stenosis considered for surgical treatment. Using a ROC curve analysis, a radiological feature, the SR, demonstrated superiority in predicting patient satisfaction, compared to functional and clinical characteristics such as walking distance and NCOS.

Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity.

PubMed

Markar, Sheraz R; Penna, Marta; Venkat-Ramen, Vishal; Karthikesalingam, Alan; Hashemi, Majid

2012-01-01

The aim of the present study was to provide a pooled analysis of individual small trials comparing 21-mm and 25-mm circular stapled laparoscopic gastrojejunal (GJ) anastomosis in morbid obesity surgery. A systematic literature search of MEDLINE, Embase, and Cochrane library databases was performed to identify all relevant studies comparing 21-mm and 25-mm circular stapled laparoscopic GJ anastomosis in morbid obesity surgery. The primary outcomes were GJ stenosis and the interval to GJ stenosis. The secondary outcomes were the estimated weight loss, GJ diameter, and the number of endoscopic dilations. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. Five trials were included, comprising 1217 patients (393 with 21-mm and 824 with 25-mm circular GJ anastomoses). The primary outcome analysis revealed a significantly increased incidence of intraluminal stenosis associated with the 21-mm circular stapler (pooled odds ratio 3.54; P < .0001). The secondary outcome analysis revealed a significantly reduced GJ anastomotic diameter on endoscopy with the 21-mm circular stapler group (weighted mean difference -1.67; P = .002). Statistical analysis revealed no significant difference between the groups for the interval to stenosis, number of endoscopic dilations, and estimated weight loss. The results of the present pooled analysis have demonstrated a significantly increased incidence of symptomatic stenosis associated with the 21-mm circular stapler compared with the 25-mm stapler. This serves as evidence to validate the preferential selection of the 25-mm circular stapler for laparoscopic GJ bypass. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Vertebral artery origin stent placement with distal protection: technical and clinical results.

PubMed

Qureshi, A I; Kirmani, J F; Harris-Lane, P; Divani, A A; Ahmed, S; Ebrihimi, A; Al Kawi, A; Janjua, N

2006-05-01

To report the feasibility, safety, and 1-month results of performing stent placement for vertebral origin stenosis with the use of a distal protection device. Distal protection devices have been shown to reduce the number of cerebral emboli and subsequent ischemic events when used as adjuncts to percutaneous carotid intervention; however, one case of the use of a distal protection device for vertebral artery has been reported in the literature. We retrospectively determined rates of technical success and 1-month stroke or death associated with stent placement by using distal protection (Filter EX; Boston Scientific, Natick, Mass) in patients with symptomatic vertebral artery origin stenosis. Technical success was defined as successful deployment of distal protection device and stent at target lesion followed by successful retrieval of the device and a final residual stenosis of less than 30%. Other outcomes ascertained included any stroke, death, and semiquantitative assessment of particulate material retained by the filter device. The mean age of the 12 treated patients was 68 years (range, 52-88 years) and the group included 9 men and 3 women. The mean percentage of vertebral artery origin stenosis was 71 +/- 6%. Femoral and radial approaches were used in 9 and 3 cases, respectively. Technical success was achieved in 11 of the 12 patients in whom distal protection device placement was attempted. Postprocedure residual stenosis was 5 +/- 4%. Eight devices held macroscopically visible embolic debris (large and small amounts in 3 and 5 devices, respectively). No stroke or death was observed in the 1-month follow-up. The present study demonstrates the feasibility of performing stent placement for vertebral artery origin stenosis by using a distal protection device. Further studies are required to determine the effectiveness of this approach for vertebral artery origin atherosclerosis.

The impact of the metabolic syndrome on the outcome after aortic valve replacement.

PubMed

Tadic, Marijana; Vukadinovic, Davor; Cvijanovic, Dane; Celic, Vera; Kocica, Mladen; Putnik, Svetozar; Ivanovic, Branislava

2014-10-01

The aim of this study was to examine the influence of the metabolic syndrome on the left ventricular geometry as well as on the early and mid-time outcome in patients with aortic stenosis who underwent aortic valve replacement. The study included 182 patients who underwent aortic valve replacement due to aortic stenosis. The metabolic syndrome was defined by the presence of at least three AHA-NHLB (American Heart Association/National Heart, Lung and Blood Institute) criteria. All the patients were followed for at least 2 years after the surgery. The metabolic syndrome did not influence the severity of aortic stenosis (mean gradient and aortic valve area). However, the metabolic syndrome was associated with the reduced prevalence of the normal left ventricular geometry and the increased risk of concentric left ventricular hypertrophy in patients with aortic stenosis. Among the metabolic syndrome criteria, only increased blood pressure was simultaneously associated with the short-term and mid-term outcome, independently of other risk factors. Increased fasting glucose level was an independent predictor of the only 30-day outcome after the valve replacement. The metabolic syndrome and left ventricular hypertrophy were, independently of hypertension and diabetes, associated with the 30-day outcome, as well as incidence of major cerebrovascular and cardiovascular events in the 2-year postoperative period. The metabolic syndrome does not change severity of the aortic stenosis, but significantly impacts the left ventricular remodeling in these patients. The metabolic syndrome and left ventricular hypertrophy, irrespective of hypertension and diabetes, are predictors of the short-term and mid-term outcome of patients with aortic stenosis who underwent aortic valve replacement.

Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer.

PubMed

Martins, Jumara; Vaz, Ana Francisca; Grion, Regina Celia; Esteves, Sérgio Carlos Barros; Costa-Paiva, Lúcia; Baccaro, Luiz Francisco

2017-12-01

This study reports the incidence and factors associated with vaginal stenosis and changes in vaginal dimensions after pelvic radiotherapy for cervical cancer. A descriptive longitudinal study with 139 women with cervical cancer was conducted from January 2013 to November 2015. The outcome variables were vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE v3.0) and changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using χ 2 , Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Most women (50.4%) had stage IIIB tumors. According to CTCAE v3.0 scale, 30.2% had no stenosis, 69.1% had grade 1 and 0.7% had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures, the mean variation in diameter was - 0.6 (± 1.7) mm and the mean variation in length was - 0.6 (± 1.3) cm. In the final statistical model, having tumoral invasion of the vaginal walls (coefficient + 0.73, p < 0.01) and diabetes (coefficient + 1.16; p < 0.01) were associated with lower vaginal stenosis and lower reduction of vaginal dimensions. Advanced clinical stage (coefficient + 1.44; p = 0.02) and receiving brachytherapy/teletherapy (coefficient - 1.17, p < 0.01) were associated with higher reduction of vaginal dimensions. Most women had mild vaginal stenosis with slight reductions in both diameter and length of the vaginal canal. Women with tumoral invasion of the vagina have an increase in vaginal length soon after radiotherapy due to a reduction in tumoral volume.

C-reactive protein in degenerative aortic valve stenosis

PubMed Central

Sanchez, Pedro L; Mazzone, AnnaMaria

2006-01-01

Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar to atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum C-reactive protein, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression. PMID:16774687

When the gold standard is not always golden: The value of invasive hemodynamic assessment to overcome the pitfalls of echocardiography in challenging cases of mitral stenosis.

PubMed

Harper, Yenal; Salem, Salem A; Alsafwah, Shadwan; Koshy, Santhosh; Garg, Nadish

2018-01-01

Mitral stenosis is a uncommon valvular lesion in the developed countries. Noninvasive evaluation is the first-line modality for assessment of mitral stenosis, however the noninvasive methods may have limitations in certain cases. Invasive hemodynamics can be used as adjunct tool for assessment of mitral stenosis in such difficult cases. Mitral valve using three-dimensional planimetry is a promising technique for assessment of mitral stenosis. © 2018 Wiley Periodicals, Inc.

Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion.

PubMed

Horie, Nobutaka; Tateishi, Yohei; Morikawa, Minoru; Morofuji, Yoichi; Hayashi, Kentaro; Izumo, Tsuyoshi; Tsujino, Akira; Nagata, Izumi; Matsuo, Takayuki

2016-10-01

Acute ischemic stroke with major intracranial vessel occlusion is commonly due to cardioembolic or atherosclerosis-related in situ stenosis/occlusion, and immediate identification of these subtypes is important to establish the optimal treatment strategy. The aim of this study was to clarify the differences in clinical presentation, radiological findings, neurological temporal courses, and outcomes between these etiologies, which have not been fully evaluated. Consecutive emergency patients with acute ischemic stroke were retrospectively reviewed. Among them, patients with stroke with major intracranial vessel occlusion were analyzed with a focus on clinical and radiological findings, and a comparison was performed for those with cardioembolic or atherosclerosis-related in situ stenosis/occlusion. Of 1053 patients, 80 had stroke with acute major intracranial vessel occlusion (45 with cardioembolic and 35 with atherosclerosis-related in situ stenosis/occlusion). Interestingly, the susceptibility vessel sign (SVS) on T2-weighted MR angiography was more frequently detected in cardioembolic stroke (80.0%) than in atherosclerosis (in situ stenosis: 5.9%, chronic occlusion: 14.3%). Moreover, the proximal intra-arterial signal (IAS) on arterial spin labeling MRI and the distal IAS on fluid attenuated inversion recovery MRI was less frequently detected in chronic occlusion (27.3% and 50.0%, respectively) than in acute occlusion due to cardioembolic or in situ stenosis. Multivariate regression analysis showed that the SVS was significantly related to cardioembolism (adjusted odds ratio (OR): 21.68, P=0.004). Clinical characteristics of acute stroke with major intracranial vessel occlusion differ depending on the etiology. The SVS and proximal/distal IAS on MRI are useful to distinguish between cardioembolic and atherosclerotic-related in situ stenosis/occlusion. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de; Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de

PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft wasmore » the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.« less

Application of Electrocautery Needle Knife Combined with Balloon Dilatation versus Balloon Dilatation in the Treatment of Tracheal Fibrotic Scar Stenosis.

PubMed

Bo, Liyan; Li, Congcong; Chen, Min; Mu, Deguang; Jin, Faguang

Electrocautery needle knives can largely reduce scar and granulation tissue hyperplasia and play an important role in treating patients with benign stricture. The aim of this retrospective study was to evaluate the efficacy and safety of electrocautery needle knife combined with balloon dilatation versus balloon dilatation alone in the treatment of tracheal stenosis caused by tracheal intubation or tracheotomy. We retrospectively analysed the clinical data of 43 patients with tracheal stenosis caused by tracheotomy or tracheal intubation in our department from January 2013 to January 2016. Among these 43 patients, 23 had simple web-like stenosis and 20 had complex steno sis. All patients were treated under general anaesthesia, and the treatment methods were (1) balloon dilatation alone, (2) needle knife excision of fibrotic tissue combined with balloon dilatation, and (3) needle knife radial incision of fibrotic tissue combined with balloon dilatation. After treatment the symptoms, such as shortness of breath, were markedly improved immediately in all cases. The stenosis degree of patients who were treated with the elec-trocautery needle knife combined with balloon dilatation had better improvement compared with that of those treated with balloon dilatation treatment alone after 3 months (0.45 ± 0.04 vs. 0.67 ± 0.05, p < 0.01), and the proportion of restenosis occurrence that required further treatment was decreased at 6 months (46.9 vs. 81.8%), especially for the web-like stenosis patients, as most of their stenoses dilated with no obvious restenosis and achieved clinical cure. Electrocautery needle knife combined with balloon dilatation is an effective and safe treatment for tracheal fibrotic stenosis compared with balloon dilatation alone. © 2017 S. Karger AG, Basel.

Relationship between Plaque Echo, Thickness and Neovascularization Assessed by Quantitative and Semi-quantitative Contrast-Enhanced Ultrasonography in Different Stenosis Groups.

PubMed

Song, Yan; Feng, Jun; Dang, Ying; Zhao, Chao; Zheng, Jie; Ruan, Litao

2017-12-01

The aim of this study was to determine the relationship between plaque echo, thickness and neovascularization in different stenosis groups using quantitative and semi-quantitative contrast-enhanced ultrasound (CEUS) in patients with carotid atherosclerosis plaque. A total of 224 plaques were divided into mild stenosis (<50%; 135 plaques, 60.27%), moderate stenosis (50%-69%; 39 plaques, 17.41%) and severe stenosis (70%-99%; 50 plaques, 22.32%) groups. Quantitative and semi-quantitative methods were used to assess plaque neovascularization and determine the relationship between plaque echo, thickness and neovascularization. Correlation analysis revealed no relationship of neovascularization with plaque echo in the groups using either quantitative or semi-quantitative methods. Furthermore, there was no correlation of neovascularization with plaque thickness using the semi-quantitative method. The ratio of areas under the curve (RAUC) was negatively correlated with plaque thickness (r = -0.317, p = 0.001) in the mild stenosis group. With the quartile method, plaque thickness of the mild stenosis group was divided into four groups, with significant differences between the 1.5-2.2 mm and ≥3.5 mm groups (p = 0.002), 2.3-2.8 mm and ≥3.5 mm groups (p <0.001) and 2.9-3.4 mm and ≥3.5 mm groups (p <0.001). Both semi-quantitative and quantitative CEUS methods characterizing neovascularization of plaque are equivalent with respect to assessing relationships between neovascularization, echogenicity and thickness. However, the quantitative method could fail for plaque <3.5 mm because of motion artifacts. Copyright © 2017 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Polychlorinated naphthalenes and polychlorinated biphenyls in benthic organisms of a Great Lakes food chain.

PubMed

Hanari, N; Kannan, K; Horii, Y; Taniyasu, S; Yamashita, N; Jude, D J; Berg, M B

2004-07-01

Invasion of zebra mussels, Dreissena polymorpha, and round gobies, Neogobius melanostomus, into the Great Lakes has altered the food web structure and thereby the pathways of toxic contaminants such as polychlorinated biphenyls (PCBs) and polychlorinated naphthalenes (PCNs). In this study, concentrations of PCNs and PCBs were measured in organisms of a Great Lakes benthic food chain encompassing zebra mussels. PCNs were found in all of the benthic organisms, including phytoplankton, algae, amphipods, zebra mussels, round goby, and smallmouth bass, Micropterus dolomieui. Concentrations of PCNs were greater in samples collected from the Raisin River than in samples from the St. Clair River. Biomagnification factors (BMF) for tetra- through octa-CN congeners in going from algae to zebra mussels from the St. Clair River ranged from 3 to 10. No major biomagnification of PCNs was found in round gobies, when concentrations were related to those in their prey species, zebra mussels. The biomagnification potential of PCNs appears to be similar to that of PCBs in the benthic food chain investigated in this study, despite the fact that PCNs may be metabolized by organisms higher in the food chain. Among several congeners, the BMFs of PCN congeners 35, 42, 43/45, 52/60, 58, and 66/67 were highest in round gobies. PCNs accounted for 1-22% of the total TEQs (toxic equivalents) of PCBs and PCNs in benthic organisms analyzed in this study. PCB congener 126 was the major contributor to TEQs, accounting for 72-99% of the PCB-TEQs in the food chain organisms analyzed.

Modeling and analysis of biomagnetic blood Carreau fluid flow through a stenosis artery with magnetic heat transfer: A transient study

PubMed Central

Abdollahzadeh Jamalabadi, Mohammad Yaghoub; Daqiqshirazi, Mohammadreza; Nasiri, Hossein; Nguyen, Truong Khang

2018-01-01

We present a numerical investigation of tapered arteries that addresses the transient simulation of non-Newtonian bio-magnetic fluid dynamics (BFD) of blood through a stenosis artery in the presence of a transverse magnetic field. The current model is consistent with ferro-hydrodynamic (FHD) and magneto-hydrodynamic (MHD) principles. In the present work, blood in small arteries is analyzed using the Carreau-Yasuda model. The arterial wall is assumed to be fixed with cosine geometry for the stenosis. A parametric study was conducted to reveal the effects of the stenosis intensity and the Hartman number on a wide range of flow parameters, such as the flow velocity, temperature, and wall shear stress. Current findings are in a good agreement with recent findings in previous research studies. The results show that wall temperature control can keep the blood in its ideal blood temperature range (below 40°C) and that a severe pressure drop occurs for blockages of more than 60 percent. Additionally, with an increase in the Ha number, a velocity drop in the blood vessel is experienced. PMID:29489852

Cryoplasty for Canine Iliac Artery Stenosis and its Impact on Expression of TIMP-2 and MMP-2.

PubMed

Wu, Zhengzhong; Zang, Shengbing; Liu, Wenwen; Jiang, Na; Yang, Weizhu

2015-01-01

This study was performed to observe the effects of cryoplasty on canine iliac artery stenosis and the expression of tissue inhibition of matrix metalloproteinase 2 (TIMP-2) and matrix metalloproteinase 2 (MMP-2). We produced a reliable canine model to mimic the atherosclerotic stenosis in the iliac artery by suturing the artery followed by vessel ligation to create an injury to intimal and medial walls. Sixteen mongrel dogs with iliac artery stenosis were randomized to conventional balloon angioplasty (n = 8) or cryoplasty (n = 8). Four weeks posttreatment, the cryoplasty group with less collagen fibers and smooth muscle demonstrated significantly larger luminal diameter of iliac artery compared to the balloon angioplasty group (P < .001). Expression of TIMP-2 significantly increased and expression of MMP-2 significantly reduced in iliac artery of the cryoplasty group compared to conventional balloon angioplasty. Our study suggests cryoplasty might increase the expression of TIMP-2 and decrease the expression of MMP-2, thereby inhibiting vascular hyperplasia and collagen fibers synthesis of the stenotic vessels. © The Author(s) 2015.

Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one?

PubMed

Smith, Marshall E; Elstad, Mark

2009-02-01

Endoscopic treatment of laryngotracheal stenosis by airway dilation, despite short-term improvement, is often associated with long-term relapse. Mitomycin-C (MMC) inhibits fibroblast proliferation and synthesis of extracellular matrix proteins, and thereby modulates wound healing and scarring. MMC application at the time of endoscopic dilation and laser surgery has been suggested to improve outcomes, but this has not been studied in a rigorous manner. This study examines the hypothesis that two topical applications of MMC given 3-6 weeks apart will result in decreased scarring/restenosis of the airway, when compared to a single topical application. A randomized, prospective, double-blind, placebo-controlled clinical trial. Twenty-six patients with laryngotracheal stenosis due to idiopathic subglottic stenosis, postintubation stenosis, or Wegener's granulomatosis entered a protocol to receive three endoscopic CO(2) laser and dilation procedures over a 3-month interval. At the first procedure, after radial CO(2) laser incision and airway dilation, all patients received topical application of MMC (0.5 mg/mL) to the airway lesion. One month later, a second endoscopic incision and dilation was performed and the patients were randomized to either a second application of mitomycin-C or to application of saline placebo. A third dilation procedure was performed 2 months later, without MMC application. Patients were followed for up to 5 years for relapse of airway stenosis with clinical symptoms sufficient to require a subsequent procedure. The relapse rates at 1, 3, and 5 years were 7%, 36%, and 69% for patients treated with two applications of MMC compared to 33%, 58%, and 70% for patients treated with one application of MMC. The median interval to relapse was 3.8 years in the two-application group, compared with 2.4 years in the one-application group. This prospective randomized double-blind placebo-controlled trial suggests that, in the endoscopic management of laryngotracheal stenosis, two applications of MMC given 3-4 weeks apart after airway radial incision and dilation reduces the restenosis rate for 2 to 3 years after treatment when compared to a single application. However, restenosis and delayed symptom recurrence continues so that at 5 years the relapse rates are the same. Thus, MMC may postpone, but does not prevent, the recurrence of symptomatic stenosis in the majority of patients.

Effect of balloon mitral valvotomy on left ventricular function in rheumatic mitral stenosis.

PubMed

Rajesh, Gopalan Nair; Sreekumar, Pradeep; Haridasan, Vellani; Sajeev, C G; Bastian, Cicy; Vinayakumar, D; Kadermuneer, P; Mathew, Dolly; George, Biju; Krishnan, M N

Mitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS. In this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E'), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure. MASV, MAPSE, E', and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E' improved significantly. MASV and E' showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up. There were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special conditions: Hospital-based study.

PubMed

Rajbhandari, Rajib; Malla, Rabi; Maskey, Arun; Bhatta, Yadav; Limbu, Yubraj; Sharma, Ranjit; Singh, Satish; Adhikari, Chandramani; Mishra, Sundeep

The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure. The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions. All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5cm 2 with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital. Mean mitral valve area increased from 0.90cm 2 (SD±0.14) to 1.5cm 2 (SD±0.21) (p=0.02). Left atrial mean pressure decreased from mean of 20 to 10mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery. The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands. Copyright © 2016. Published by Elsevier B.V.

Flow of Red Blood Cells in Stenosed Microvessels.

PubMed

Vahidkhah, Koohyar; Balogh, Peter; Bagchi, Prosenjit

2016-06-20

A computational study is presented on the flow of deformable red blood cells in stenosed microvessels. It is observed that the Fahraeus-Lindqvist effect is significantly enhanced due to the presence of a stenosis. The apparent viscosity of blood is observed to increase by several folds when compared to non-stenosed vessels. An asymmetric distribution of the red blood cells, caused by geometric focusing in stenosed vessels, is observed to play a major role in the enhancement. The asymmetry in cell distribution also results in an asymmetry in average velocity and wall shear stress along the length of the stenosis. The discrete motion of the cells causes large time-dependent fluctuations in flow properties. The root-mean-square of flow rate fluctuations could be an order of magnitude higher than that in non-stenosed vessels. Several folds increase in Eulerian velocity fluctuation is also observed in the vicinity of the stenosis. Surprisingly, a transient flow reversal is observed upstream a stenosis but not downstream. The asymmetry and fluctuations in flow quantities and the flow reversal would not occur in absence of the cells. It is concluded that the flow physics and its physiological consequences are significantly different in micro- versus macrovascular stenosis.

Flow of Red Blood Cells in Stenosed Microvessels

NASA Astrophysics Data System (ADS)

Vahidkhah, Koohyar; Balogh, Peter; Bagchi, Prosenjit

2016-06-01

A computational study is presented on the flow of deformable red blood cells in stenosed microvessels. It is observed that the Fahraeus-Lindqvist effect is significantly enhanced due to the presence of a stenosis. The apparent viscosity of blood is observed to increase by several folds when compared to non-stenosed vessels. An asymmetric distribution of the red blood cells, caused by geometric focusing in stenosed vessels, is observed to play a major role in the enhancement. The asymmetry in cell distribution also results in an asymmetry in average velocity and wall shear stress along the length of the stenosis. The discrete motion of the cells causes large time-dependent fluctuations in flow properties. The root-mean-square of flow rate fluctuations could be an order of magnitude higher than that in non-stenosed vessels. Several folds increase in Eulerian velocity fluctuation is also observed in the vicinity of the stenosis. Surprisingly, a transient flow reversal is observed upstream a stenosis but not downstream. The asymmetry and fluctuations in flow quantities and the flow reversal would not occur in absence of the cells. It is concluded that the flow physics and its physiological consequences are significantly different in micro- versus macrovascular stenosis.

[Acquired caustic vagina stenosis: Surgical outcomes of 21 cases].

PubMed

Séni, K; Horo, A G; Koffi, A; Aka, K E; Fomba, M; Koné, M

2016-03-01

To document epidemiology, causes, anatomical varieties and surgical management outcomes of caustic acquired vagina stenosis. Retrospective study of 21 patients involved from 1996 to 2012 at the department of obstetrics and gynecology of Yopougon's teaching hospital in Abidjan, Côte d'Ivoire. Vaginal stenosis due to genital malformation, vaginal irradiation of pelvic tumours, repair of bladder and vaginal fistulae or intersexual disorders were excluded. The prevalence was 0.14/1000 admissions, mean age was 32.1 years, mean gravidity was 1.76 and mean parity was 1.1. Vaginal stenosis seat and extent were variable and 100 % had a caustic origin by use of traditional medicine vaginal pessaire. Of the patients, 95.2 % underwent surgical treatment followed by several dilations sessions with glass dilators. Successful surgical outcome allowing coitus was achieved in 47.6 % of cases with 52.4 % failure. Acquired caustic vagina stenosis are frequently occurring and are a public health problem related to ignorance. Health education and establishment of expert centers with exchange of experiences in West Africa should be able to improve surgical outcomes. Copyright © 2016. Published by Elsevier SAS.

Tracheal stenosis: our experience at a tertiary care centre in India with special regard to cause and management.

PubMed

Nair, Satish; Mohan, Sharad; Mandal, Ghanashyam; Nilakantan, Ajith

2014-01-01

Tracheal stenosis (TS), a challenging problem, is a known complication of prolonged intubation and tracheostomy. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience with severe TS with regards to patient characteristics, cause and management. A retrospective analysis of 20 patients of severe TS treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with severe TS who required surgical intervention. Exclusion criteria were patients with associated laryngeal stenosis and TS due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Descriptive analysis of data were performed SPSS 18. Results of the 20 patients, 17 patients (85 %) developed TS post tracheostomy, or post intubation and subsequent tracheostomy. 13 Patients (65 %) had true stenosis of which 7 patients (35 %) had simple web or circumferential fibrosis and 6 patients (30 %) had complex stenosis. Seven patients (35 %) had granulations causing severe TS which were mostly suprastomal (5 patients), stomal (5 patients) and combined stomal and suprastomal (3 patients). The average length of stenosis was 3.57 cm (0.5-8 cm). Montgomery t tube insertion was a common procedure in 18 patients (90 %) pre or post intervention. Each patient underwent an average of 3.4 procedures during their course of treatment which included rigid bronchoscopy and mechanical debulking, Nd YAG laser, KTP laser, balloon dilatation and use of stents. Among the 7 patients with granulations 100 % successful decanulation was noted with endoscopic management whereas in 13 patients with true stenosis, 10 patients (76.9 %) required open surgical management (8 tracheal resection and anastomosis and 2 tracheoplasty) with 80 % successful decanulation, 2 patients (15.4 %) were treated with endoscopy with 100 % successful decanulation and 1 patient (7.7 %) was a non surgical candidate on stent. Of the total 20 patients with severe TS in this series, 17 (85 %) of patients who were decanulated, asymptomatic on routine daily activities with normal FFB were considered cured. TS is a challenging condition requiring a highly skilled multidisciplinary team for adequate management. Prolonged intubation and tracheostomy are the common causes leading to tracheal stenosis. Simple tracheal stenosis is easier to manage than a complex stenosis which usually requires an open surgical procedure for successful management. Presence of conditions like tracheoesophageal fistula and long segment tracheomalacia are poor factors for successful management. In our cases successful decanulation was possible in 85 % of the patients following a systematic multidisciplinary approach.

Proximal pulmonary vein stenosis detection in pediatric patients: value of multiplanar and 3-D VR imaging evaluation.

PubMed

Lee, Edward Y; Jenkins, Kathy J; Muneeb, Muhammad; Marshall, Audrey C; Tracy, Donald A; Zurakowski, David; Boiselle, Phillip M

2013-08-01

One of the important benefits of using multidetector computed tomography (MDCT) is its capability to generate high-quality two-dimensional (2-D) multiplanar (MPR) and three-dimensional (3-D) images from volumetric and isotropic axial CT data. However, to the best of our knowledge, no results have been published on the potential diagnostic role of multiplanar and 3-D volume-rendered (VR) images in detecting pulmonary vein stenosis, a condition in which MDCT has recently assumed a role as the initial noninvasive imaging modality of choice. The purpose of this study was to compare diagnostic accuracy and interpretation time of axial, multiplanar and 3-D VR images for detection of proximal pulmonary vein stenosis in children, and to assess the potential added diagnostic value of multiplanar and 3-D VR images. We used our hospital information system to identify all consecutive children (< 18 years of age) with proximal pulmonary vein stenosis who had both a thoracic MDCT angiography study and a catheter-based conventional angiography within 2 months from June 2005 to February 2012. Two experienced pediatric radiologists independently reviewed each MDCT study for the presence of proximal pulmonary vein stenosis defined as ≥ 50% of luminal narrowing on axial, multiplanar and 3-D VR images. Final diagnosis was confirmed by angiographic findings. Diagnostic accuracy was compared using the z-test. Confidence level of diagnosis (scale 1-5, 5 = highest), perceived added diagnostic value (scale 1-5, 5 = highest), and interpretation time of multiplanar or 3-D VR images were compared using paired t-tests. Interobserver agreement was measured using the chance-corrected kappa coefficient. The final study population consisted of 28 children (15 boys and 13 girls; mean age: 5.2 months). Diagnostic accuracy based on 116 individual pulmonary veins for detection of proximal pulmonary vein stenosis was 72.4% (84 of 116) for axial MDCT images, 77.5% (90 of 116 cases) for multiplanar MDCT images, and 93% (108 of 116 cases) for 3-D VR images with significantly higher accuracy with 3-D VR compared to axial (z = 4.17, P < 0.001) and multiplanar (z = 3.34, P < 0.001) images. Confidence levels for detection of proximal pulmonary vein stenosis were significantly higher with 3-D VR images (mean level: 4.6) compared to axial MDCT images (mean level: 1.7) and multiplanar MDCT images (mean level: 2.0) (paired t-tests, P < 0.001). Thus, 3-D VR images (mean added diagnostic value: 4.7) were found to provide added diagnostic value for detecting proximal pulmonary vein stenosis (paired t-test, P < 0.001); however, multiplanar MDCT images did not provide added value (paired t-test, P = 0.89). Interpretation time was significantly longer and interobserver agreement was higher when using 3-D VR images than using axial MDCT images or MPR MDCT images for diagnosing proximal pulmonary vein stenosis (paired t-tests, P < 0.001). Use of 3-D VR images in the diagnosis of proximal pulmonary vein stenosis in children significantly increases accuracy, confidence level, added diagnostic value and interobserver agreement. Thus, the routine use of this technique should be encouraged despite its increased interpretation time.

Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature.

PubMed

Frericks, H; Kievit, J; van Baalen, J M; van Bockel, J H

1998-01-01

The main goal of follow-up after carotid endarterectomy is to prevent new strokes caused by recurrent stenosis. To determine the most cost-effective follow-up schedule, it is necessary to know the incidence of recurrent stenosis and the risk of stroke it carries. A systematic review of the literature was performed using standard meta-analytical techniques. Incidence of recurrent stenosis: The data were very heterogeneous. The risk of recurrent stenosis was 10% in the first year, 3% in the second, and 2% in the third. Long-term risk of recurrent stenosis is about 1% per year. Risk of stroke: The reported relative risks of stroke in patients with recurrent stenosis compared with patients without recurrent stenosis showed extreme heterogeneity and ranged from 10 to 0.10. The random effects summary estimator of relative risk was 1.88. The data were very heterogeneous, and much better data are needed to arrive at truly reliable estimates of these important parameters of follow-up. It is clear, though, that the risk of recurrent stenosis is highest in the first few years after carotid endarterectomy and very low in later years. By use of general decision-analytic arguments, it can be argued that, given the test characteristics of carotid ultrasound, a small number of tests can be done in the first few years and that testing for restenosis should not be done after 4 years.

Congenital mitral stenosis, subvalvular aortic stenosis, and congestive heart failure in a duck.

PubMed

Mitchell, Elizabeth B; Hawkins, Michelle G; Orvalho, Joao S; Thomas, William P

2008-06-01

A 2.6-year-old duck was evaluated for respiratory difficulty. On the basis of physical, radiographic and echocardiographic findings, a diagnosis of congestive heart failure secondary to congenital mitral stenosis and subvalvular aortic stenosis was made. The duck did not respond well to medical therapy and was euthanized. The diagnosis was confirmed at necropsy.

Drag reducing polymers improve coronary flow reserve through modulation of capillary resistance.

PubMed

Pacella, John J; Kameneva, Marina V; Villanueva, Flordeliza S

2009-01-01

We have shown that drag-reducing polymers (DRP) reduce microvascular resistance and improve myocardial perfusion during coronary stenosis. We used myocardial contrast echocardiography (MCE) and mathematical modeling to define the DRP microvascular effects. A non-flow-limiting left anterior descending (LAD) stenosis was created in 8 dogs. Intramyocardial blood volume, RBC velocity and flow in the LAD and circumflex (CX) beds were obtained from MCE at baseline, and in hyperemia, stenosis, hyperemia + stenosis, and hyperemia + stenosis + DRP. Microvascular resistances were calculated from a lumped-parameter model. During stenosis + hyperemia, LAD bed microvascular resistance increased (p<0.015), and capillary volume (p<0.002) and red cell velocity (p<0.0004) decreased relative to baseline. With DRP, during stenosis and hyperemia, LAD bed microvascular resistance decreased (p<0.04); there was an increase in capillary volume (p<0.007), RBC velocity (p<0.006), and flow (p<0.05). Decreased model-computed capillary resistance accounted for the reduction in LAD bed resistance after DRP. We conclude that DRP improve flow reserve during coronary stenosis by modulating capillary resistance. Primary modification of the rheological properties of blood to affect capillary resistance is a novel approach for the treatment of acute coronary syndromes.

Hemodynamic effects of innominate artery occlusive disease on anterior cerebral artery.

PubMed

Tan, Teng-Yeow; Lien, Li-Ming; Schminke, Ulf; Tesh, Paul; Reynolds, Patrick S; Tegeler, Charles H

2002-01-01

Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.

Spinal Stenosis

MedlinePlus

... Overview Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on ... stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Types of ...

Double stenting with silicone and metallic stents for malignant airway stenosis.

PubMed

Matsumoto, Keitaro; Yamasaki, Naoya; Tsuchiya, Tomoshi; Miyazaki, Takuro; Kamohara, Ryotaro; Hatachi, Go; Nagayasu, Takeshi

2017-08-01

For severe malignant airway stenosis, there are several types of commercially available airway stents, and each has its own advantages and disadvantages. We herein describe the safety and efficacy of combination stenting with silicone and metallic stents for patients with extended malignant airway stenosis. Seven patients with malignant airway stenosis were treated via combination stenting with a silicone stent and a metallic stent for extended airway stenosis from the central to peripheral airways. Five patients were diagnosed with advanced esophageal cancer, two of whom had tracheoesophageal fistulas. One patient had adenoid cystic carcinoma, and another had mediastinal tumor. There were no specific complications related to the double stenting. Combination stenting with silicone and metallic stents proved to be a safe option for patients with severe, extended, and complicated malignant airway stenosis.

External auditory canal stenosis due to the use of powdered boric acid.

PubMed

Dündar, Riza; Soy, Fatih Kemal; Kulduk, Erkan; Muluk, Nuray Bayar; Cingi, Cemal

2014-09-01

Acquired stenosis of the external auditory canal (EAC) may occur because of chronic external otitis, recurrent chronic catarrhal otitis media associated with tympanic membrane perforation, chronic dermatitis, tumors, and trauma. Stenosis occurs generally at the one-third bone part of the external auditory canal. In this article, we present 3 cases of acquired EAC stenosis due to the previous powdered boric acid application. Besides the presentation of surgical intervetions in these cases, we want to notify the physicians not to use or carefully use powdered boric acid because of the complication of EAC stenosis.

Technical refinements to improve outcomes following distal hypospadias repair.

PubMed

Lacy, John M; Hendrix, Lauren N; Bole, Raevti; Habib, Enmar; Wootton, Cole W; Ziada, Ali M

2016-02-01

Hypospadias complications, most notably meatal stenosis, are commonly reported to occur after tubularized incised plate (TIP) hypospadias repair. We focus on a point of technique in TIP repair and its effect on outcome of this possible complication, as well as other commonly reported complications. Meatal stenosis after TIP can be avoided if the urethra and overlying glans are dissected and sutured separately with no attempt at cross suturing whether the urethra ends below, behind, or above the glans sutures. This hypothesis was evaluated by a prospective data collection before and after implementation to evaluate the effect of a technical refinement on rates of meatal stenosis in TIP hypospadias repair. All cases of coronal to midpenile hypospadias repair during two periods were included in our study. Group 1 included 140 consecutive patients over a 30 month period. Group 2 included 122 consecutive patients over a 36 month period during which the above mentioned technical changes were implemented by all participating pediatric urologists. Rates of complications between the two groups were compared with special emphasis on meatal stenosis. Median follow up for both groups was > 1 year. Overall complication rate in Group 1 was 31.5% compared to 9.8% in Group 2. Meatal stenosis was significantly reduced from 13 patients (9.3%) in Group 1 to 2 patients (1.6%) in Group 2, p = 0.008. The technical refinements described resulted in reduction of complication rates and a decrease in incidence of meatal stenosis.

Idiopathic tracheal stenosis: a clinicopathologic study of 63 cases and comparison of the pathology with chondromalacia.

PubMed

Mark, Eugene J; Meng, Fanqing; Kradin, Richard L; Mathisen, Douglas J; Matsubara, Osamu

2008-08-01

Tracheal stenosis in adults usually is the result of mechanical injuries either from direct trauma or intubation. Rarely do cases develop in patients without such a precedent history, and there are few reports of the pathology of idiopathic tracheal stenosis (ITS). We reviewed clinicopathologically, 63 tracheal resections for tracheal stenosis in patients who had no antecedent explanation for their stenosis. We contrasted these 63 cases with 34 cases of tracheal stenosis owing to chondromalacia (CM) after mechanical injury. All 63 cases occurred in females, with a mean age of 49 years. The most common symptom was dyspnea on exertion. The average duration of symptoms was greater than 2 years. One-third of the patients gave a history of gastroesophageal reflux. All but one of the cases occurred in the subglottic region and/or upper one-third of the trachea. Pathologically, most cases showed extensive keloidal fibrosis and dilation of mucus glands, a finding that was not obvious in most cases of CM. ITS has relatively normal cartilage with smooth inner and outer perichondrium, whereas CM has extensive degeneration of cartilage with irregular border of inner perichondrium observable at shirt sleeve magnification. Immunohistochemical staining for estrogen receptor and progesterone receptor was positive in fibroblasts cells in most cases. ITS is a rare disease and restricted to females. It may represent some form of fibromatosis. ITS can be distinguished histologically from CM in tracheal resection specimens in most cases.

Irradiation inhibits vascular anastomotic stenosis in a canine model.

PubMed

Saito, Takeshi; Iguchi, Atsushi; Tabayashi, Koichi

2009-08-01

The graft patency rate after coronary artery bypass grafting (CABG) correlates with anastomotic stenosis. Intracoronary radiation therapy is effective for preventing restenosis after percutaneous coronary intervention (PCI). We postulated that intracoronary radiation therapy could prevent anastomotic stenosis and tested this hypothesis in an animal model. Femoral arteries and veins of beagle dogs were harvested, and composite arterioarterial and arteriovenous grafts were prepared. After external irradiation of the anastomotic sites, these composite grafts were transplanted into femoral arteries. Histomorphometric and immunohistological analyses of the anastomotic sites were performed. The study groups consisted of controls and animals exposed to 10 Gy, 20 Gy, and 30 Gy (n = 5, in each group). In the artery graft model, the ratio of negative remodeling was significantly increased in all groups exposed to >or=10 Gy. The ratio of neointimal hyperplasia was significantly decreased in all groups exposed to >or=10 Gy. Cell density of anti-alpha-actin antibody-positive cells and anti-proliferating cell nuclear antigen (PCNA) antibody-positive cells was highest in the adventitial layer, and the density decreased as the dosage increased. Experimental results were almost the same in the vein graft models as in the artery graft models. With double immunohistostaining, the anti-PCNA antibody-positive cells expressed alpha-actin. Irradiation can inhibit anastomotic stenosis in a canine model. Adventitia is a factor in the creation of stenosis, and irradiation appears to target the adventitia. We speculate that there might be a possible role for intracoronary irradiation in the future to prevent anastomotic stenosis.

Effectiveness and safety of endoscopic radial incision and cutting for severe benign anastomotic stenosis after surgery for colorectal carcinoma: a three-case series.

PubMed

Asayama, Naoki; Nagata, Shinji; Shigita, Kenjiro; Aoyama, Taiki; Fukumoto, Akira; Mukai, Shinichi

2018-03-01

Benign colonic anastomotic stenosis sometimes occurs after surgical resection and usually requires surgical or endoscopic dilation. Limited data are available on the effectiveness and safety of the endoscopic radial incision and cutting (RIC) method at sites other than the esophagus. The aim of this retrospective study was to investigate the effectiveness and safety of RIC dilation for severe benign anastomotic colonic stenosis. Subjects were 3 men (median age 72 years, range 65 - 76 years) who developed severe benign anastomotic stenosis after surgical resection for colorectal carcinoma and were subsequently treated by RIC dilation at Hiroshima City Asa Citizens Hospital between May 2014 and December 2016. Severe anastomotic stenosis was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. The median interval from surgery to RIC was 21 months (range 9 - 29 months). RIC was successful in all 3 patients and reduced the severity of dyschezia postoperatively; 2 patients experienced improvement after a single RIC session and the other after 6 RIC sessions. No treatment-related adverse events or re-stenosis requiring repeat dilation was noted during a median follow-up of 27 months (range 8 - 37 months). Our findings indicate that the RIC technique can be applied safely and effectively to various sites in the colon, avoiding the need for reoperation.

The management of patients with esophageal cancer and coronary artery stenosis undergoing radiotherapy or concurrent chemoradiotherapy: a single-center experience.

PubMed

Luo, Hui; Chen, Xiaojian; Zhang, Qiugui; Wang, Lanhua; Qiao, Lili; Liang, Ning; Xie, Jian; Yu, Xinshuang; Song, Meijuan; Liu, Zhen; Lv, Yajuan; Liu, Fengjun; Tian, Yuan; Cheng, Jian; Deng, Guodong; Zhang, Jingxin; Li, X Allen; Zhang, Jiandong

2016-01-01

The incidence of esophageal cancer (EC) patients with coronary artery stenosis presents particular challenges. The aim of this retrospective study was to evaluate the efficiency of management on patients with both diseases treated by radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Fifty-three patients with both EC and coronary artery stenosis from June 2009 to August 2012 were retrospectively analyzed. The patients received RT or CCRT with coronary artery stenosis management. Cardiac treatments often prescribed included aspirin, β-blockers, statins etc. The adverse effects, overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) were analyzed. Most of the patients were 40-70 years old. There were 25 patients in the CCRT group and 28 patients in the RT group. The complete response (CR) rate was higher in the patients in the CCRT group than in those in the RT group (48.0 vs 21.4%; p=0.041). The median PFS was 15.9 months in the CCRT group and 11.6 months in the RT group (p=0.025). OS was 22.4 months in the CCRT group and 15.8 months in the RT group (p=0.013). Though adverse effects were less in the RT group, no significance differences in grade 3-4 toxicity were observed. With the appropriate of coronary artery stenosis management, RT and CCRT were both tolerable and effective in EC patients with coronary artery stenosis.