WorldWideScience

Sample records for anastomosis so-called persistent

  1. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Il; Kim, Dong Ik; Jun, Pyoung; Yoon, Pyeong Ho; Hwang, Geum Ju; Cheon, Young Jik; Lim, Joon Seok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-11-01

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20.

  2. On the Persistance of Dualism in our so-called Unified Neurosciences: The case of the autonomic nervous system

    Directory of Open Access Journals (Sweden)

    Nathalie Pattyn

    2009-06-01

    Full Text Available In the present paper, the historical overview of descriptions of the autonomic nervous system (ANS is applied as a case study to serve the demonstration of the persistence of dualisms in our current framework of neurosciences. First, the four main views on the ANS are briefly summarised, with an emphasis on the latest one, being the neurovisceral integration perspectives, striving for an integrative view on cognition, emotion regulation and physiological adaptation. Second, an explanation is offered on why we are so reluctant to give up the explanatory framework of dualisms, based on both developmental psychology accounts and postmodernism philosophy. To conclude, an attitude based on positivism and epistemological anarchism is suggested for scientists.

  3. The So-Called 'Face on Mars'

    Science.gov (United States)

    2002-01-01

    (Released 13 April 2002) The Science The so called 'Face on Mars' can be seen slightly above center and to the right in this THEMIS visible image. This 3-km long knob, located near 10o N, 40o W (320o E), was first imaged by the Viking spacecraft in the 1970's and was seen by some to resemble a face carved into the rocks of Mars. Since that time the Mars Orbiter Camera on the Mars Global Surveyor spacecraft has provided detailed views of this hill that clearly show that it is a normal geologic feature with slopes and ridges carved by eons of wind and downslope motion due to gravity. A similar-size hill in Phoenix, Arizona resembles a camel lying on the ground, and Phoenicians whimsically refer to it as Camelback Mountain. Like the hills and knobs of Mars, however, Camelback Mountain was carved into its unusual shape by thousands of years of erosion. The THEMIS image provides a broad perspective of the landscape in this region, showing numerous knobs and hills that have been eroded into a remarkable array of different shapes. Many of these knobs, including the 'Face', have several flat ledges partway up the hill slopes. These ledges are made of more resistant layers of rock and are the last remnants of layers that once were continuous across this entire region. Erosion has completely removed these layers in most places, leaving behind only the small isolated hills and knobs seen today. Many of the hills and ridges in this area also show unusual deposits of material that occur preferentially on the cold, north-facing slopes. It has been suggested that these deposits were 'pasted' on the slopes, with the distinct, rounded boundary on their upslope edges being the highest remaining point of this pasted-on layer. In several locations, such as in the large knob directly south of the 'Face', these deposits occur at several different heights on the hill. This observation suggests the layer once draped the entire knob and has since been removed from all but the north

  4. Vascular malformation (so-called hemangioma) of Scarpa's ganglion

    NARCIS (Netherlands)

    Bernardeschi, D; Dunnebier, EA; Sauvaget, E; Herman, P; Wassef, M; Huy, PTB

    2004-01-01

    Vascular malformations of the cerebello-pontine angle (CPA) arising from the capillary plexus surrounding Scarpa's ganglion are rare tumors. We report a case of so-called "hemangioma" of the CPA which was operated on via a trans-labyrinthine approach based on a preoperative diagnosis of vestibular s

  5. Vascular malformation (so-called hemangioma) of Scarpa's ganglion

    NARCIS (Netherlands)

    Bernardeschi, D; Dunnebier, EA; Sauvaget, E; Herman, P; Wassef, M; Huy, PTB

    2004-01-01

    Vascular malformations of the cerebello-pontine angle (CPA) arising from the capillary plexus surrounding Scarpa's ganglion are rare tumors. We report a case of so-called "hemangioma" of the CPA which was operated on via a trans-labyrinthine approach based on a preoperative diagnosis of vestibular

  6. A Histopathological Study of the so-called Buruli ulcer

    OpenAIRE

    山下, 裕人; 千馬, 正敬; 板倉, 英世

    1980-01-01

    A histopathological study of the so-called "Buruli ulcer" was reported. The patient was a 10-year-old African boy in Kenya suffering from ulcer formation. The ulcer was 10cm in diameter and located over the left hip. It was undermined and covered by overhanged epithelia at the ulcer edge. There was edema or lytic change in the dermis which formed gaps between the epidermis and dermis in adjacent regions. Microscopically, inflammatory cells infiltration, granulation tissue, fibrosis, and sever...

  7. [Once again the so-called Testament of Hippocrates].

    Science.gov (United States)

    Sideras, Alexander

    2006-01-01

    This study is dealing with the so-called Testament of Hippocrates, a short ethic about the doctor's background, knowledge, character, appearance and behaviour towards the patient. Along with the three well-known Greek manuscripts the author is looking at two other by now unknown codices, so that the two Greek versions are accompanied by a third and larger version. After a careful consideration of the relations between the different versions he is discussing all readings of the codices explaining the terms within the background of the history of medicine. At the end he is presenting a reconstruction of the Greek original together with a German translation.

  8. Thoughts on the so-called radius-capitellum axis

    Energy Technology Data Exchange (ETDEWEB)

    Schild, H.; Mueller, H.A.; Wagner, H.; Baetz, W.

    1982-02-01

    We have studied 438 patients radiologically in order to observe the so-called 'radius-capitellum axis'. In about a quarter of people with normal elbows the axis passes lateral to the middle portion of the capitellum, so that even when there is marked deviation, there is no certainty that the humero-radial joint is abnormal. Deviation of the axis can be caused by changes in the shape of the capitellum or of the radius, or by distension of the capsule of the elbow joint, or by various changes in muscular pull.

  9. Investigation of CT picture in so-called loose shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Kuroda, Shigehito; Sakamaki, Hiroshi; Matsuoka, Akira; Moriishi, Takeji; Takada, Keiichi

    1985-03-01

    CT picture of the shoulder joint was analyzed in 124 shoulders (114 patients). A line perpendicular to a given line between the precornu of acetabular tegmen (A) and the postcornu of acetabular tegmen (B) was drawn and the intersection where the line and the caput humeri meet (C) was obtained. The angle of CAB was defined as the backward angular aperture of the acetabular tegmen. The angular aperture was 26.2 +- 1.9 in 16 so-called loose shoulders, 17.3 +- 1.0 in 28 loose shoulders restricted to the inward rotation, and 12.2 +- 0.4 in 80 normal shoulders, showing a distinct correlation between the angular aperture and the degree of loose shoulder. An increased backward angular aperture of the acetabular tegmen was considered greatly attributable to the forward glenohumeral movement resulting from malformation of the acetabular tegmen and flaccidity of the joint. Glenoid osteotomy was thus performed in 9 patients, 6 of whom underwent CT scanning before and after osteotomy. Coronal and transverse CT images of the shoulder joint disclosed a noticeable improvement of the glenohumeral alignment. The angular aperture shown on CT seems to be of major importance not only in the diagnosis of so-called loose shoulder but also in surgical choice. (Namekawa, K.).

  10. Emotional distance to so-called difficult patients

    DEFF Research Database (Denmark)

    Michaelsen, Jette Joost

    2012-01-01

    patient, the avoidance strategy did not necessarily represent the terminal stage, since a nurse could revert to the compromise strategy. Some of the nurses experienced painful emotions regarding these interactions. Conclusions: The avoidance strategy (emotional distance) resulted in important social......Scand J Caring Sci; 2011 Emotional distance to so-called difficult patients Purpose: To explore nurses' relationships with patients they regard as being difficult. How do nurses feel about such patients and relate to them, and what are the consequences for nurse and patient? Design and methods....... Patients' case records were studied and four meetings with the staff were arranged to discuss the findings. Data collection lasted 18 months in all. Findings: Three strategies were identified: persuasion, avoidance (emotional distance), and compromise. Interestingly, in the relationship with a particular...

  11. Insight into the so-called spatial reciprocity

    Science.gov (United States)

    Wang, Zhen; Kokubo, Satoshi; Tanimoto, Jun; Fukuda, Eriko; Shigaki, Keizo

    2013-10-01

    Up to now, there have been a great number of studies that demonstrate the effect of spatial topology on the promotion of cooperation dynamics (namely, the so-called “spatial reciprocity”). However, most researchers probably attribute it to the positive assortment of strategies supported by spatial arrangement. In this paper, we analyze the time course of cooperation evolution under different evolution rules. Interestingly, a typical evolution process can be divided into two evident periods: the enduring (END) period and the expanding (EXP) period where the former features that cooperators try to endure defectors’ invasion and the latter shows that perfect C clusters fast expand their area. We find that the final cooperation level relies on two key factors: the formation of the perfect C cluster at the end of the END period and the expanding fashion of the perfect C cluster during the EXP period. For deterministic rule, the smooth expansion of C cluster boundaries enables cooperators to reach a dominant state, whereas, the rough boundaries for stochastic rule cannot provide a sufficient beneficial environment for the evolution of cooperation. Moreover, we show that expansion of the perfect C cluster is closely related to the cluster coefficient of interaction topology. To some extent, we present a viable method for understanding the spatial reciprocity mechanism in nature and hope that it will inspire further studies to resolve social dilemmas.

  12. BIOCHEMICAL STUDIES ON SO-CALLED SYPHILIS ANTIGEN.

    Science.gov (United States)

    Noguchi, H; Bronfenbrenner, J

    1911-01-01

    of tissue is very variable. (c) Substances Soluble in Ether, Alcohol, and Aceton.-In this group are found varying amounts of fatty acids, both saturated and unsaturated, some neutral fats, cholesterin and many unidentified lipoidal bodies. This group causes either hemolysis or inhibition, of hemolysis. In other words, it is anticomplementary as well as hemolytic in the majority of preparations. At the same time, in some preparations it is, to a certain extent, antigenic. This great variation in the amounts of these substances in given extracts renders their presence in the antigen preparation undesirable. It is not denied, however, that, when added in adequate quantities, some of these substances may improve the activity of the antigenic lipoids. (d) Substances Insoluble in Aceton.-This group of substances consists of phosphatids. The best known among them is, of course, lecithin. Besides lecithin, however, there must be various other phosphatids present in this fraction. It will be noticed that the precipitate formed by mixing the ethereal solution with aceton contains a certain amount of lipoids insoluble in ether as well as in alcohol. Before the fractionation in aceton, all lipoids were soluble in ether or ethyl alcohol. Further analytical work on the nature of the phosphatids contained in this fraction is necessary. This fraction, in general, is more constant in amount in the various liver extracts. Biologically considered, it is the most important. It is usually non-hemolytic, frequently anticomplementary, but much more strongly antigenic than the other fractions. The antigenic strength varies with different preparations, being almost absent in the extracts derived from fatty livers. An aceton insoluble fraction may be strongly antigenic without any other auxiliary effects, or may be accompanied by an anticomplementary property. This fraction does not cause the so-called non-specific reaction with an active human serum. For these reasons it is recommended (as

  13. Esophageal anastomosis.

    Science.gov (United States)

    Yuan, Y; Wang, K-N; Chen, L-Q

    2015-01-01

    This review gives an overview of the esophageal anastomosis. The history, various techniques and substitution organs, their advantages and disadvantages, healing mechanism, complications, and actual trend of this essential part of esophageal surgery are described. The history of the esophageal anastomosis extending from the first anastomosis in 1901 to today has undergone more than one century. In the early days, the success rate of the anastomosis was extremely low. As the technology progressed, the anastomosis got significant achievement. Various anastomotic techniques are currently being used. However, controversies exist on the choice of anastomotic method concerning the success rate, postoperative complication and quality of life. How to choose the method, no one can give the best answer. We searched the manuscripts about the esophageal anastomoses in recent years and studied the controversy questions about the anastomosis. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Every anastomosis technique has its own merit, but the outcomes were different if it was performed by different surgeons, and we also found that the complication rate of the anastomosis was mainly associated with the surgeons. So the surgeons should learn from their previous experience and others to avoid technical errors.

  14. Improving Teaching of Reading, Writing, and Spelling Words with the So-Called Long Vowel Sounds

    Science.gov (United States)

    Taschow, H. G.

    1976-01-01

    Investigating 1,908 words which contain the five so-called long vowel sounds, this study analyzes, describes, and summarizes their phoneme-grapheme correspondences together with their implicate and variant spelling patterns for purposes of assisting in the development of a more scientific teaching methodology. (JC)

  15. ARE THE SO-CALLED POISONOUS FOOD-COMBINATIONS REALLY POISONOUS?

    Institute of Scientific and Technical Information of China (English)

    Libin T CHENG

    2009-01-01

    @@ The idea that to eat certain two foods simultaneously is to get poisoned has been entertained by柄Chinese people for many years. There are about 184 pairs of the so-called poisonous food-combinations, and 180 of them are mentioned in Chinese Ancient Materia Medica, Ben-Tsao-Gung-Mu (本草纲目) or other books. (1a,2a) This belief was based upon some personal sketch, old-fashioned doctors' notes, stories and other false facts. Although these statements were originated without any experimental ground, yet many of the Chinese, even at present time, still believe them firmly. Whenever any poisoning outbreak occurs accidentally after having taken the so-called poisonous food-combination, they always attribute the cause of the poisoning to the two foods served simultaneously.

  16. Constructivism, the so-called semantic learning theories, and situated cognition versus the psychological learning theories.

    Science.gov (United States)

    Aparicio, Juan José; Rodríguez Moneo, María

    2005-11-01

    In this paper, the perspective of situated cognition, which gave rise both to the pragmatic theories and the so-called semantic theories of learning and has probably become the most representative standpoint of constructivism, is examined. We consider the claim of situated cognition to provide alternative explanations of the learning phenomenon to those of psychology and, especially, to those of the symbolic perspective, currently predominant in cognitive psychology. The level of analysis of situated cognition (i.e., global interactive systems) is considered an inappropriate approach to the problem of learning. From our analysis, it is concluded that the pragmatic theories and the so-called semantic theories of learning which originated in situated cognition can hardly be considered alternatives to the psychological learning theories, and they are unlikely to add anything of interest to the learning theory or to contribute to the improvement of our knowledge about the learning phenomenon.

  17. The History of the So-Called Lense-Thirring Effect

    Science.gov (United States)

    Pfister, H.

    2008-09-01

    Some historical documents, especially the Einstein-Besso manuscript from 1913, an extensive notebook by Thirring from 1917, and a correspondence between Thirring and Einstein from 1917 reveal that most of the credit for the so-called Lense-Thirring effect belongs to Einstein. I also comment on the later history of the problem of a correct centrifugal force inside a rotating mass shell which was resolved only relatively recently.

  18. On the history of the so-called Lense-Thirring effect

    Science.gov (United States)

    Pfister, Herbert

    2007-11-01

    Some historical documents, especially the Einstein Besso manuscript from 1913, an extensive notebook by H. Thirring from 1917, and the correspondence between Thirring and Einstein in the year 1917 reveal that most of the merit for the so-called Lense-Thirring effect of general relativity belongs to Einstein. Besides telling this “central story” of the effect, we give a short “prehistory”, with contributions by E. Mach, B. and I. Friedlaender, and A. Föppl, followed by the later history of the problem of a correct centrifugal force inside a rotating mass shell, which was resolved only relatively recently.

  19. So-called embryonal hyperplasia of Bowman's capsular epithelium: an immunohistochemical and ultrastructural study.

    Science.gov (United States)

    Ogata, K; Hajikano, H; Sakaguchi, H

    1991-01-01

    The so-called embryonal hyperplasia of Bowman's capsular epithelium (EHBCE) is a rather specific lesion occurring in kidneys of patients maintained on chronic dialysis. It consists of poorly differentiated cells proliferating around sclerosed or obsolescent glomeruli. In this study, immunohistochemical and ultrastructural characterization of EHBCE was performed. The poorly differentiated cells in the lesion exhibited a positive reaction for vimentin and a negative one for cytokeratin (PKK 1) and epithelial membrane antigen. On ultrastructural examination, specialized junctions between adjoining cells, microvilli-like structures on their surfaces, and immature basal folds were observed. These observations suggest that the cells of EHBCE may be associated with the anlage of glomerular epithelium. The background in which neoplasms like renal cell carcinoma or atypical epithelium of cyst wall develop in end-stage kidneys of adult patients on long-term dialysis may cause such a proliferation of poorly differentiated cells in young or paediatric age group patients.

  20. So-called "papillary and cystic neoplasm of the pancreas." An immunohistochemical and ultrastructural study.

    Science.gov (United States)

    Kamisawa, T; Fukayama, M; Koike, M; Tabata, I; Okamoto, A

    1987-05-01

    A case of so-called "papillary and cystic neoplasm of the pancreas" (PCNP) was reported and investigated immunohistochemically and ultrastructurally. A tumor of the pancreatic head in a 21-year-old female was curatively resected. The tumor was cystic and histologically consisted of uniform cells in papillary and solid structure. Although there was no immunoreactivity for pancreaticogut hormones or secretory products of the pancreas in the tumor cells, most of the tumor cells were diffusely immunoreactive for neuron-specific enolase (NSE). Some neurosecretory granules were detected in the tumor cells ultrastructurally. Both facts suggested endocrine cell character of the tumor. Certain cases of PCNP might show a differentiation to endocrine cells.

  1. Nursing so-called monsters: on the importance of abjection and fear in forensic psychiatric nursing.

    Science.gov (United States)

    Jacob, Jean Daniel; Gagnon, Marilou; Holmes, Dave

    2009-01-01

    Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear. The main objective of this theoretical paper is to engage the readers in a theoretical reflection regarding the concepts of abjection and fear since they both apply to the experiences of caring for mentally ill individuals in forensic psychiatric settings. Our contention is with the potential impact of feelings such as disgust, repulsion, and fear on the therapeutic relationship and, more particularly, with the boundaries imposed on this relationship when these feelings are unrecognized by nurses. Acknowledging that patients may evoke feelings of disgust, repulsion, and fear is essential if nurses wish to understand the implications of these emotions in the therapeutic process. In forensic psychiatric settings, caring for so-called "monsters" in the face of abjection and fear is not an easy task to achieve given the lack of theoretical understanding regarding both concepts. Given the actual state of knowledge in forensic nursing, we argue that theoretical (conceptual) analyses, as well as ethical and political discussions, are paramount if we wish to understand the specificities of this complex field of nursing practice.

  2. Compression anastomosis Clip for gastrointestinal anastomosis

    Institute of Scientific and Technical Information of China (English)

    Pi-Chu Liu; Zhi-Wei Jiang; Xiao-Lin Zhu; Zhi-Ming Wang; Yan-Qing Diao; Ning Li; Jie-Shou Li

    2008-01-01

    AIM:To investigate the feasibility of compression anastomosis clip(CAC)for gastrointestinal anastomosis proximal to the ileocecal junction.METHODS:Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method,CAC or stapler.RESULTS:The postoperative recovery of patients in CAC and stapled anastomosis groups was similar.No postoperative complication related to the anastomotic method was found in either group.Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis.CONCLUSION:CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis.Our result strongly suggests that CAC anastomosis is safe in various complication circumstances.However,it should be further confirmed with a larger patient sample.

  3. [Differential indications for so-called "lateral release" in treatment of chondropathia patellae].

    Science.gov (United States)

    Schultz, W; Buhmann, H W; Leib, S

    1996-03-01

    The success rate of the operation of lateral release for pain caused by the patella is reported as being between 14% and 99%. The choice between arthroscopic or open procedures does not seem to affect the results. The wide ranges of results probably reflects differences in patients selection or the method and investigations of follow up. The early term outcome usually show better results than long term follow up. This study evaluates the indications for the operation of lateral releases and discusses the result of 36 out of a total of 42 patients who were follow up for 3 years later surgery. We found that an insufficiency of dysplasia of the vastus medialis, the laxity of the capsule and soft ligaments, and a strong lateral retinaculum were important factors in the indication for this procedure. The quadriceps angle was also of prime importance, but the minor forms of patellar dysplasia played only a minor role. In the so-called hyperpression syndrome, where the patella has a strong tendency to move laterally, the simple lateral release is the single most successful operation. The indication for procedures additionally to the lateral release is examined. We found that in a case with an insufficiently guided patella, a weak capsule and ligaments, an additional capsule roughing should be performed. The presence of early degenerative changes in the joint predisposes to poor results in operations such as abrasion and pride drilling. The results in our study were assessed using the Lysholm score. Our results show that the most successful technique was the combination of an arthroscopy and an extraarticular open operation controlled by arthroscopic means. This technique was not associated with major complications such as haemarthrosis and consecutive prolonged postoperative rehabilitation. Overall we achieved a rate of 83% of good or satisfactory results at more than 3 years using the indications and techniques described above.

  4. Techniques for colorectal anastomosis

    Institute of Scientific and Technical Information of China (English)

    Yik-Hong; Ho; Mohamed; Ahmed; Tawfi; k; Ashour

    2010-01-01

    Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety aspects of anastom...

  5. Awareness survey of so-called Dappou drugs or Kiken drugs (New Psychoactive Substances) among University Students in Japan

    OpenAIRE

    Fuse-Nagase, Yasuko; SAITO, Fukumi; HIROHARA, Toshie; MIYAKAWA, Happei

    2015-01-01

    Background Spread of new psychoactive substances (NPS) is a worldwide problem. In Japan, NPSs with psychoactive ingredients are called as “dappou drugs” or “kiken drugs.” Their potential effect on the Japanese society cannot be ignored. Findings We conducted an awareness survey of So-called Dappou Drugs or Kiken Drugs among the students of Ibaraki University, a national university in Japan, in April 2014. 3976 students (2425 men, 1406 women and 145 unspecified) participated in this study. 281...

  6. Astronomical references in the planning of ancient roads I. The case of the so-called Great Hopewell Road

    CERN Document Server

    Magli, Giulio

    2007-01-01

    Possible astronomical references in the planning of the so-called Great Hopewell Road, a 90 Kilometres straight road composed by two parallel earth embankments which connected the Hopewell ceremonial centres of Newark and Chillicothe, Ohio, are investigated. It turns out that a very peculiar, although simple, astronomical combination took place in alignment with the road during its construction (II BC-I AD), namely the rising of the bright star Capella and the setting of the bright star Fomalhaut. The possibility of a non-fortuitous connection with the direction of the road is proposed and analysed.

  7. Glycoproteomics using so-called ‘fluid-biopsy’ specimens in the discovery of lung cancer biomarkers. Promise and challenge

    Science.gov (United States)

    Li, Qing Kay; Gabrielson, Ed; Askin, Frederic; Chan, Daniel W; Zhang, Hui

    2016-01-01

    Lung cancer is the number one cancer in the US and worldwide. In spite of the rapid progression in personalized treatments, the overall survival rate of lung cancer patients is still suboptimal. Over the past decade, tremendous efforts have been focused on the discovery of protein biomarkers to facilitate the early detection and monitoring lung cancer progression during treatment. In addition to tumor tissues and cancer cell lines, a variety of biological material has been studied. Particularly in recent years, studies using fluid-based specimen or so-called “fluid-biopsy” specimen have progressed rapidly. Fluid specimens are relatively easier to collect than tumor tissue, and they can be repeatedly sampled during the disease progression. Glycoproteins have long been recognized to play fundamental roles in many physiological and pathological processes. In this review, we focus the discussion on recent advances of glycoproteomics, particularly in the identification of potential protein biomarkers using so-called fluid-based specimens in lung cancer. The purpose of this review is to summarize current strategies, achievements and perspectives in the field. This insight will highlight the discovery of tumor-associated glycoprotein biomarkers in lung cancer and their potential clinical applications. PMID:23112109

  8. Acute kidney injury and critical limb ischaemia associated with the use of the so called "legal high" 3-fluorophenmetrazine.

    Science.gov (United States)

    Fawzy, Michael; Wong-Morrow, Wei San; Beaumont, Anthony; Farmer, Chris K T

    2017-07-15

    Until the law in the United Kingdom (UK) changed in May 2016 so called "legal highs" or "new psychoactive substances" were freely available in high street shops across the UK. Following prohibition these drugs are still easily purchased illegally via the internet. We report a case of a patient who self-administered 3-fluorophenmetrazine intravenously with catastrophic consequences. Adverse effects were almost immediate with symptoms of malaise and tachycardia. Two days post administration he was transferred to the intensive therapy unit with acute kidney injury and irreversible four limb ischaemia. He required a period of renal replacement therapy and bilateral lower limb amputation. This case highlights the fact that new psychoactive substances have many unintended adverse effect which have not been previously described. Multiple routes of administration are used by people taking these agents including intravenously. Medical practitioners should always consider ingestion of new psychoactive substances in the differential diagnosis of acutely ill patients.

  9. The so-called "Spanish model" - tobacco industry strategies and its impact in Europe and Latin America.

    Science.gov (United States)

    Schneider, Nick K; Sebrié, Ernesto M; Fernández, Esteve

    2011-12-07

    To demonstrate the tobacco industry rationale behind the "Spanish model" on non-smokers' protection in hospitality venues and the impact it had on some European and Latin American countries between 2006 and 2011. Tobacco industry documents research triangulated against news and media reports. As an alternative to the successful implementation of 100% smoke-free policies, several European and Latin American countries introduced partial smoking bans based on the so-called "Spanish model", a legal framework widely advocated by parts of the hospitality industry with striking similarities to "accommodation programmes" promoted by the tobacco industry in the late 1990s. These developments started with the implementation of the Spanish tobacco control law (Ley 28/2005) in 2006 and have increased since then. The Spanish experience demonstrates that partial smoking bans often resemble tobacco industry strategies and are used to spread a failed approach on international level. Researchers, advocates and policy makers should be aware of this ineffective policy.

  10. The so-called "Spanish model" - Tobacco industry strategies and its impact in Europe and Latin America

    Science.gov (United States)

    2011-01-01

    Background To demonstrate the tobacco industry rationale behind the "Spanish model" on non-smokers' protection in hospitality venues and the impact it had on some European and Latin American countries between 2006 and 2011. Methods Tobacco industry documents research triangulated against news and media reports. Results As an alternative to the successful implementation of 100% smoke-free policies, several European and Latin American countries introduced partial smoking bans based on the so-called "Spanish model", a legal framework widely advocated by parts of the hospitality industry with striking similarities to "accommodation programmes" promoted by the tobacco industry in the late 1990s. These developments started with the implementation of the Spanish tobacco control law (Ley 28/2005) in 2006 and have increased since then. Conclusion The Spanish experience demonstrates that partial smoking bans often resemble tobacco industry strategies and are used to spread a failed approach on international level. Researchers, advocates and policy makers should be aware of this ineffective policy. PMID:22151884

  11. Functional class (so called “part of speech” assignment as a kind of meaning-bound word syntactic information

    Directory of Open Access Journals (Sweden)

    Jadwiga Wajszczuk

    2015-11-01

    Full Text Available Functional class (so called “part of speech” assignment as a kind of meaning-bound word syntactic information The traditional division of the lexicon into parts of speech which seems to satisfy the requirements of a syntactic description, on the one hand, and a word formation description, on the other hand, cannot be looked upon as a result of a strict classification covering the totality of the lexicon and being based on a coherent set of criteria. Making the criteria more precise or correcting them is an issue of extreme importance and urgency in the work on the theory of language. Such achievements can help solve many other problems, in particular, syntactic ones. The article presents a scheme of several preliminary steps of an amelioration program (a scheme which has been improved compared to the author’s earlier attempts going in the same direction. The program is based on combinability characteristics of words, i.e. on those properties that are responsible for the tasks to be accomplished by a given class of expressions in making up a higher order unit, i.e. a syntagm (the author emphasizes this point: it is syntagm rather than sentence which is the category the recommended approach is focusing on, and that, importantly, determine the limits of syntactic rules, i.e. the ins and outs of the rules (the limits concerning the overall stock of words.

  12. The so-called "Spanish model" - Tobacco industry strategies and its impact in Europe and Latin America

    Directory of Open Access Journals (Sweden)

    Schneider Nick K

    2011-12-01

    Full Text Available Abstract Background To demonstrate the tobacco industry rationale behind the "Spanish model" on non-smokers' protection in hospitality venues and the impact it had on some European and Latin American countries between 2006 and 2011. Methods Tobacco industry documents research triangulated against news and media reports. Results As an alternative to the successful implementation of 100% smoke-free policies, several European and Latin American countries introduced partial smoking bans based on the so-called "Spanish model", a legal framework widely advocated by parts of the hospitality industry with striking similarities to "accommodation programmes" promoted by the tobacco industry in the late 1990s. These developments started with the implementation of the Spanish tobacco control law (Ley 28/2005 in 2006 and have increased since then. Conclusion The Spanish experience demonstrates that partial smoking bans often resemble tobacco industry strategies and are used to spread a failed approach on international level. Researchers, advocates and policy makers should be aware of this ineffective policy.

  13. The so-called "Pre-Levantine" phase and the chronology of the Levantine Rock Painting. A critical review

    Directory of Open Access Journals (Sweden)

    Mateo Saura, Miguel Ángel

    2002-06-01

    Full Text Available The rejection of the principles on which the so-called "prelevantine phase" is based and the discussion about the neolithic material culture parallels for levantine art allow its attribution to Epipaleolithic groups of hunters and gatherers. In the same way, the data on the process of transition between the Epipaleolithic and the Neolithic, and the relationship between the levantine style and the schematic rock painting seem to support a pre-neolithic chronology of the levantine art, related to non-producing ways of living.

    El rechazo de las bases en las que se sustenta la llamada "fase pre-levantina" y la discusión de los paralelos mobiliares neolíticos propuestos para el arte levantino dejan expedito el camino para su adscripción a los grupos de cazadores y recolectores epipaleolíticos. Asimismo, los datos con que contamos sobre el proceso de transición Epipaleolítico/Neolítico, y la relación entre el estilo levantino y la pintura rupestre esquemática parecen abogar también por una cronología pre-neolítica de lo levantino, asociado a unos modos de vida no productores.

  14. Letter to Editor. Is it possible to support cognitive behavioral therapy, led remotely, by determining so-called therapeutic tasks?

    Directory of Open Access Journals (Sweden)

    Andrzej Brodziak

    2015-12-01

    Full Text Available In this letter to the Editor, the authors comment recent publications about the attempts to remote realizations of Cognitive Behavioral Therapy (CBT in the treatment of anxiety disorders in elderly. The distinguished clinical situation is a part of a wider problem that can be named as “global crisis of aging populations”. The use of CBT in many geriatric clinical situations is very effective, however, such therapy is very time-consuming, what hamper its widespread utilizations in practice. The authors therefore propose to support this form of treatment by determining so-called ‘therapeutic tasks’. They derive the rationale for the proposed method from the analysis of the acting elements of various, new forms of CBT in combination with the analysis of sources of psychological resistance (resilience of those older people who are doing well. The essence of the method proposed by the authors is assigning tasks which facilitate to patients’ remembering of their ‘trajectory of life’. The patients are then much more aware of unresolved psychological conflicts. The next tasks aid the patients to search for solutions to such mental problems and create a balanced imagery of their lives.

  15. Do liquid films rupture due to the so-called hydrophobic force or migration of dissolved gases?

    Science.gov (United States)

    Karakashev, Stoyan I; Nguyen, Anh V

    2009-04-09

    Liquid films between hydrophobic (water-repellent) interfaces are not stable. The film rupture has been attributed to the so-called hydrophobic attraction. In this paper microinterferometry experiments show that gases inherently dissolved in water have a significant effect on the film rupture. Specifically, films of ultrapure deionized water in contact with degassed oil (squalene) were stable for as long as 35 min, while the water films in contact with nondegassed oil had a lifetime of seconds. These films ruptured at film thicknesses of approximately 150 nm. The degassed oil was also purposely left in contact with air. The oil-in-water emulsion films formed between degassed oil left in contact with air for a long period of time did not last longer than a few seconds and ruptured at significantly high thicknesses (about 800 nm). The degassing effect did not change the interfacial potential (about -65 mV) and the electrical double-layer repulsion between the squalene-water interfaces. Migration of dissolved gases between oil and water caused the rupture phenomena observed.

  16. Origin of the color of Cv. rhapsody in blue rose and some other so-called "blue" roses.

    Science.gov (United States)

    Gonnet, Jean-François

    2003-08-13

    Flowers of the rose cultivar Rhapsody in Blue display unusual colors, changing as they age, from a vivid red-purple to a lighter and duller purple, which are based on tonalities corresponding to hue angles between 340 and 320 degrees in the CIELAB scale. Unexpectedly, the chemical basis of these colors is among the simplest, featuring cyanin (cyanidin 3,5-di-O-glucoside), the most frequent anthocyanin in flowers, as the sole pigment and quercetin kaempferol glycosides as copigments at a relatively low copigment/pigment ratio (about 3/1), which usually produces magenta or red shades in roses. This color shift to bluer shades is coupled with the progressive accumulation of cyanin into vacuolar anthocyanic inclusions (AVIs), the occurrence of which increases as the petals grow older. In addition to the normal lambda(max) of cyanin at approximately 545 nm, the transmission spectra of live petals and of epidermal cells exhibit a second lambda(max) in the 620-625 nm range, the relative importance increasing with the presence of AVIs. In petals of fully opened flowers, the only pigmented structures in the vacuoles of epidermal cells are AVIs; their intense and massive absorption in the 520-640 nm area produces a much darker and bluer color than measured for the vacuolar solution present at the very first opening stage. Cyanin is probably "trapped" into AVIs at higher concentrations than would be possible in a vacuolar solution and in quinonoidal form, appearing purple-blue because of additional absorption in the 580-630 nm area. Quite similar pigmentation features were found in very ancient rose cultivars (cv. L'Evêque or Bleu Magenta), also displaying this type of so-called "blue" color.

  17. Usefulness of K-Point Injection for the Nonspecific Neck Pain in So-Called K-Point Syndrome.

    Science.gov (United States)

    Moon, Jeong Jae; Ahn, Myun Whan; Ahn, Hyo Sae; Lee, Sung Jun; Lee, Dong Yeol

    2016-12-01

    Shoichi Kokubun introduced his successful experience with local anesthetic injection at the occipital insertion of the sternocleidomastoid muscle in K-point syndrome. The purpose of this study was to evaluate the short-term and long-term effectiveness of K-point injection and investigate factors affecting treatment results. K-point injection was performed in 58 patients with K-point syndrome at Yeungnam University Medical Center. The syndrome was associated with cervical whiplash injury in 10 patients and was of nonspecific origin in the rest. One milliliter of 2% lidocaine mixed with 1 milliliter of dexamethasone was injected in 50 patients and 2 milliliters of 1% lidocaine alone in the rest. Initially, the severity of local tenderness at the K-point and other tender points was examined and the degree of immediate pain relief effect was assessed within 1 hour after injection. Early effect within 1 month after the injection and current effect were evaluated in 27 patients using a modified Kim's questionnaire with regard to the duration of improvement, degree of improvement in pain and daily living activities, and satisfaction. Of the total 58 patients, 44 (75.8%) apparently had immediate pain relief after K-point injection. The only factor associated with successful immediate pain relief was the whiplash injury associated with traffic accident (TA). The early pain control effect was associated with the immediate effect. The current effect was associated with the early effect alone. Satisfaction with the K-point injection was related to early successful pain relief. K-point injection would be useful for early pain relief in nonspecific neck pain syndrome so called K-point syndrome, but not for current pain relief. Especially, it was very effective for early pain control in the whiplash injury associated with TA.

  18. Usefulness of K-Point Injection for the Nonspecific Neck Pain in So-Called K-Point Syndrome

    Science.gov (United States)

    Moon, Jeong Jae; Ahn, Hyo Sae; Lee, Sung Jun; Lee, Dong Yeol

    2016-01-01

    Background Shoichi Kokubun introduced his successful experience with local anesthetic injection at the occipital insertion of the sternocleidomastoid muscle in K-point syndrome. The purpose of this study was to evaluate the short-term and long-term effectiveness of K-point injection and investigate factors affecting treatment results. Methods K-point injection was performed in 58 patients with K-point syndrome at Yeungnam University Medical Center. The syndrome was associated with cervical whiplash injury in 10 patients and was of nonspecific origin in the rest. One milliliter of 2% lidocaine mixed with 1 milliliter of dexamethasone was injected in 50 patients and 2 milliliters of 1% lidocaine alone in the rest. Initially, the severity of local tenderness at the K-point and other tender points was examined and the degree of immediate pain relief effect was assessed within 1 hour after injection. Early effect within 1 month after the injection and current effect were evaluated in 27 patients using a modified Kim's questionnaire with regard to the duration of improvement, degree of improvement in pain and daily living activities, and satisfaction. Results Of the total 58 patients, 44 (75.8%) apparently had immediate pain relief after K-point injection. The only factor associated with successful immediate pain relief was the whiplash injury associated with traffic accident (TA). The early pain control effect was associated with the immediate effect. The current effect was associated with the early effect alone. Satisfaction with the K-point injection was related to early successful pain relief. Conclusions K-point injection would be useful for early pain relief in nonspecific neck pain syndrome so called K-point syndrome, but not for current pain relief. Especially, it was very effective for early pain control in the whiplash injury associated with TA. PMID:27904721

  19. Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called "normal pressure hydrocephalus" syndrome.

    Science.gov (United States)

    Sahuquillo, J; Rubio, E; Codina, A; Molins, A; Guitart, J M; Poca, M A; Chasampi, A

    1991-01-01

    Fifty-four shunt-responsive patients were selected from a prospective protocol directed to study patients with suspected normal pressure hydrocephalus (NPH). Patients with gait disturbances, dementia, non-responsive L-Dopa Parkinsonism, urinary or faecal incontinence and an Evans ratio greater or equal to 0.30 on the CT scan were included in the study. As a part of their work-up all patients underwent intracranial pressure monitoring and hydrodynamic studies using Marmarou's bolus test. According to mean intracranial pressure (ICP) and the percentage of high amplitude B-waves, patients were subdivided in the following categories: 1) Active hydrocephalus (mean ICP above 15 mmHg), which is in fact no tone normal pressure hydrocephalus; 2) Compensated unstable hydrocephalus, when mean ICP was below 15 mmHg and B-waves were present in more than 25% of the total recording time and 3) Compensated stable hydrocephalus when ICP was lower or equal to 15 mmHg and beta waves were present in less than 25% of the total recording time. The majority of the patients in this study (70%) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group). Mean resistance to outflow of CSF (Rout) was 38.8 mm Hg/ml/min in active hydrocephalus and 23.5 mm Hg/ml/min in the compensated group (Students t-test, p less than 0.05). Higher resistance to outflow was found in patients with obliterated cortical sulci and obliterated Sylvian cisterns in the CT scan. No statistically significant correlation was found when plotting the percentage of beta waves against pressure volume index (PVI), compliance or Rout. An exponential correlation was found when plotting beta waves against the sum of conductance to outflow and compliance calculated by PVI method (r = 0.79). Patients with the so-called normal pressure hydrocephalus syndrome have different ICP and CSF dynamic profiles. Additional studies taking into consideration these differences are necessary

  20. A conceptual framework for an ecosystem services-based assessment of the so-called "emergency stabilization" measures following wildfire

    Science.gov (United States)

    Valente, Sandra; Prats, Sergio; Ribeiro, Cristina; Verheijen, Frank; Fleskens, Luuk; Keizer, Jacob

    2015-04-01

    Wildfires have become a major environmental concern in many Southern European countries over the past few decades. This includes Portugal, where, on average, some 100 000 ha of rural lands are affected by wildfire every year. While policies, laws, plans and public expenditure in Portugal continue to be largely directed towards fire combat and, arguably, to a lesser extent fire prevention, there has only recently been increasing attention for post-fire land management. For example following frequent and several large wildfires during the summer of 2010, so-called emergency stabilization measures were implemented in 16 different burnt areas in northern and central Portugal, using funds of the EU Rural Development Plan in Portugal (PRODER). The measures that were implemented included mulching (i.e. application of a protective layer of organic material), seeding and the construction of log barriers. However, the effectiveness of the implemented measures has not been monitored or otherwise assessed in a systematic manner. In fact, until very recently none of the post-fire emergency stabilization measures contemplated under PRODER seem to have been studied in an exhaustive manner in Portugal, whether under laboratory or field conditions. Prats et al. (2012, 2013, 2014) tested two of these measures by field trials, i.e. hydro-mulching and forest residue mulching. The authors found both measures to be highly effective in terms of reducing overland flow and especially erosion. It remains a challenge, however, to assess the effectiveness of these and other measures in a broader context, not only beyond overland flow and sediment losses but also beyond the spatio-temporal scale that are typical for such field trials (plots and the first two years after fire). This challenge will be addressed in the Portuguese case study of the RECARE project. Nonetheless, the present study wants to be a first attempt at an ecosystem services-based assessment of mulching as a post

  1. Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes

    Directory of Open Access Journals (Sweden)

    Bendix Tom

    2008-01-01

    Full Text Available Abstract Background Recently, the MRI finding of "Modic changes" has been identified as pathologic spinal condition that probably reflects a vertebral inflammatory process (VIP, which coincides with spinal pain in most. We hypothesized that heavy smoking in combination with macro- or repeated microtrauma could lead to VIP. The objectives were to investigate if combinations of self-reported heavy smoking, hard physical work, and overweight would be more strongly linked with VIP than with other spinal conditions, such as degenerated discs and non-specific low back pain (LBP. Methods Secondary analysis was made of a data base pertaining to a population-based cross-sectional study. A population-generated cohort of 412 40-yr old Danes provided questionnaire information on smoking, weight, height, type of work, and LBP. MRI was used to determine the presence/absence of disc degeneration and of VIP. Associations were tested between three explanatory variables (type of work, smoking, and body mass index and four outcome variables (LBP in the past year, more persistent LBP in the past year, disc degeneration, and VIP. Associations with these four outcome variables were studied for each single explanatory variable and for combinations of two at a time, and, finally, in a multivariable analysis including all three explanatory variables. Results There were no significant associations between the single explanatory variables and the two pain variables or with disc degeneration. However, VIP was found in 15% of non-smokers vs. 26% of heavy smokers. Similarly, VIP was noted in 11% of those in sedentary jobs vs. 31% of those with hard physical work. Further, the prevalence of VIP in those, who neither smoked heavily nor had a hard physical job was 13%, 25% in those who either smoked heavily or had a hard physical job, and 41% in those who both smoked heavily and worked hard. The odds ratio was 4.9 (1.6–13.0 for those who were both heavy smokers and had a hard

  2. Management of low colorectal anastomotic leak: Preserving the anastomosis.

    Science.gov (United States)

    Blumetti, Jennifer; Abcarian, Herand

    2015-12-27

    Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy (Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.

  3. Persistence

    Science.gov (United States)

    Moore, John W.

    1998-11-01

    Eudora Welty, the famous writer, was once asked what should be done by society or government to encourage young writers. Her response, which surprised the questioner, and me when I heard it, was "Nothing". Welty contended that a person who was really a writer would be persistent enough to overcome whatever obstacles were in the way, needing no interference or support from others.

  4. Dissimilation, assimilation and vowel reduction. Constraint interaction in East Slavic dialects with so-called dissimilative akan'e and jakan'e.

    OpenAIRE

    2002-01-01

    This paper presents an Optimality Theory-based analysis of  the unstressed vocalism in Russian. It is argued that an account of the so-called dissimilative akan’e and jakan’e patterns in terms of dissimilation alone is simplistic and that the vowel patterns in question arise as a result of complex interaction of three factors, viz. dissimilation, assimilation and vowel reduction.

  5. Dissimilation, Assimilation and Vowel Reduction: Constraint Interaction in East Slavic Dialects with so-called Dissimilative Akan’e and Jakan’e

    Directory of Open Access Journals (Sweden)

    Tore Nesset

    2002-02-01

    Full Text Available This paper presents an Optimality Theory-based analysis of  the unstressed vocalism in Russian. It is argued that an account of the so-called dissimilative akan’e and jakan’e patterns in terms of dissimilation alone is simplistic and that the vowel patterns in question arise as a result of complex interaction of three factors, viz. dissimilation, assimilation and vowel reduction.

  6. A Case of Hyalinizing Clear Cell Carcinoma, So-Called Clear Cell Carcinoma, Not Otherwise Specified, of the Minor Salivary Glands of the Buccal Mucosa

    Directory of Open Access Journals (Sweden)

    Takahiro Yamanishi

    2015-01-01

    Full Text Available Hyalinizing clear cell carcinoma (HCCC, so-called clear cell carcinoma, not otherwise specified (CCC (NOS, of the salivary glands is a rare and low-grade malignant tumor. We report a case of HCCC so-called CCC (NOS (referred to as HCCC of the minor salivary gland of the buccal mucosa. A 52-year-old woman had presented with a gradually growing and indolent mass in the right buccal mucosa for about two years. The first biopsy histopathologically suggested the possibility of malignancy derived from the minor salivary glands. A month later, she visited our hospital. The tumor measured approximately 1.5 cm in diameter and was elastic hard, smooth, and well movable. Image examinations demonstrated internal homogeneity of the lesion, which had a smooth margin, in the right buccal mucosa. Complete tumor resection followed by covering with a polyglycolic acid sheet and fibrin glue spray was performed without surgical flap reconstruction. Histopathological findings revealed proliferating tumor cells with clear cytoplasm surrounded by hyalinizing stroma in the submucosal minor salivary glands. Immunohistochemical stains revealed these tumor cells to be positive for epithelial cell markers but negative for myoepithelial ones. These findings confirmed the diagnosis of HCCC. Good wound healing and no evidence of local recurrence and metastasis have been shown since surgery.

  7. Einstein's physical geometry at play: inertial motion, the boostability assumption, the Lorentz transformations, and the so-called conventionality of the one-way speed of light

    CERN Document Server

    Valente, Mario Bacelar

    2013-01-01

    In this work, Einstein's view of geometry as physical geometry is taken into account in the analysis of diverse issues related to the notions of inertial motion and inertial reference frame. Einstein's physical geometry enables a non-conventional view on Euclidean geometry (as the geometry associated to inertial motion and inertial reference frames) and on the uniform time. Also, by taking into account the implications of the view of geometry as a physical geometry, it is presented a critical reassessment of the so-called boostability assumption (implicit according to Einstein in the formulation of the theory) and also of 'alternative' derivations of the Lorentz transformations that do not take into account the so-called 'light postulate'. Finally it is addressed the issue of the eventual conventionality of the one-way speed of light or, what is the same, the conventionality of distant simultaneity (within the same inertial reference frame). It turns out that it is possible to see the (possible) conventionali...

  8. Modified Continuous Loop Technique for microvascular anastomosis

    Directory of Open Access Journals (Sweden)

    Kumar Pramod

    2001-01-01

    Full Text Available A modified method of continuous loop technique for microvascular anastomosis is described. The handling of loop is easier & even last suture is placed under vision. This makes the microvascular anastomosis easier and simpler.

  9. Save from oblivion – the melancholy of the intellectual in the so-called “literature of retribution” (1946–1948

    Directory of Open Access Journals (Sweden)

    Izabela Kozłowska

    2016-06-01

    Full Text Available The article deals with the so-called “literature of retribution”, produced between 1946–1948. Postwar literary criticism accused intellectual characters of passivity, self-centeredness and reserve towards contemporary socio-political transformations. The only issue perceived by critics was the attempt to establish the role of the intelligentsia in times of historic breakthrough. My article shows that this way of interpreting the literature of retribution is insufficient. It becomes obvious that the interpretative key used by the literary critics of the 1940s was Marxist ideology, and that their conclusions narrow the scope of the issues touched upon in these novels. These literary works do not only relate the experiences of one social class – they deal with universal issues, those connected with human existence in general and the relationship between the individual, society and the world. The category I use to extract the universal issues from the literary works analysed here is melancholy. The use of the melancholic perspective enriched the traditional interpretation of the “literature of retribution” by lending it a new context and allowing the rehabilitation of the intellectuals it portrayed.

  10. Secretion of interleukin-6 and vascular endothelial growth factor by spindle cell sarcoma complicating Castleman's disease (so-called 'vascular neoplasia').

    Science.gov (United States)

    Kakiuchi, Chihiro; Ishida, Tsuyoshi; Sato, Hitoshi; Katano, Harutaka; Ishiko, Tositaka; Mukai, Hiroyuki; Kogi, Mieko; Kasuga, Naoki; Takeuchi, Kengo; Yamane, Kenichi; Fukayama, Masashi; Mori, Shigeo

    2002-06-01

    So-called 'vascular neoplasia' (VN) is a rare tumour of unknown origin that complicates hyaline vascular type Castleman's disease (CD). This paper reports a case of VN complicating CD of hyaline vascular type, in which neoplastic cells were shown to secrete interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF). In this case, VN first occurred in the retroperitoneum of a 60-year-old male. The lesion showed typical morphology, with three distinct areas: (1) a lymph node-like area with regressively transformed lymph follicles showing hyaline vascular changes and with a hypervascular interfollicular region filled with slit-like vascular channels; (2) an area composed of spindle cell sarcoma; and (3) an area showing angiolipomatous hamartoma. A proportion of the cells in the spindle cell area showed severe pleomorphism. Subcutaneous recurrence after 8 months was composed purely of pleomorphic spindle cells. A karyotypic analysis of the recurrent tumour showed 47, XXY with some instability. Supernatant from primary culture contained high levels of IL-6 and VEGF, suggesting high secretion of these cytokines from neoplastic cells. Immunohistochemically, p53 overexpression was identified only in the pleomorphic spindle cells of the primary lesion and metastatic tumour. No features suggestive of vascular origin were shown on immunohistochemical or electron microscopic analysis of the neoplastic cells. Human herpesvirus type 8 was not detected by immunohistochemistry or PCR analysis. High levels of IL-6 and/or VEGF have been reported to play a role in CD. This is the first case report that clarifies the site of such cytokine production, showing the possibility of CD as a paraneoplastic phenomenon.

  11. Limits and Perspectives of cultivation of Biomass crops in marginal areas of Campania Region: the case of the so called "Terra dei Fuochi".

    Science.gov (United States)

    Fagnano, Massimo; Fioretnino, Nunzio

    2017-04-01

    The definition of a soil contamination is a 2 step process, based on screening values and risk analysis. The variability of values of screening values across Europe casts some doubts about the ecological and toxicological meaning of such values. In the case of agricultural soils, the situation is more unclear since there is not a clear process for evaluation of the suitability of a soil for food production. Different methods have been proposed (i.e metal bioavailability by using different extracting agents), but the final response is given by plant analyses that can assess if the contaminants have been accumulated in edible organs. The study case of the so called Terra dei Fuochi (plainy area of Campania Region, Southern Italy) is presented, since in this area the LIFE-Project Ecoremed was developed with the aim to identify the contaminated soils in the perspective of their phytoremediation with biomass crops that could be used as source of renewable energy, thus avoiding competition for land between energy and food crops. At the end of assessment activities, the contaminated agricultural soils in this area resulted too few (about 30 ha) for satisfying the exigence of a bio-refinery. Therefore in Terra dei Fuochi area there aren't perspectives for biomass crops, because there is an intense production of high-value, healthy and safe vegetables and water buffalo mozzarella cheese, that are exported worldwide. Instead other marginal areas are very spread in internal hilly arable land of Southern Italy where 100,000 ha of durum wheat are not sustainable both from economic and environmental points of view. In particular, yields are very low (2-3 t/ha) and income (4-600 €/ha) doesn't cover the cultivation costs; soils are vulnerable to soil losses due to water erosion (not covered from tillage in August to germination in November) in the months in which rainfall erosivity is higher. A reasonable percentage of this area (i.e. 10%) could be used for producing biomasses

  12. Relationship between selected indoor volatile organic compounds, so-called microbial VOC, and the prevalence of mucous membrane symptoms in single family homes

    Energy Technology Data Exchange (ETDEWEB)

    Araki, Atsuko [Hokkaido University Graduate School of Medicine, Department of Public Health Sciences, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638 (Japan); Kawai, Toshio; Eitaki, Yoko; Kanazawa, Ayako [Osaka Occupational Health Service Center, Japan Industrial Safety and Health Association, 2-3-8 Tosahori, Nishi-ku, Osaka 550-0001 (Japan); Morimoto, Kanehisa; Nakayama, Kunio [Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871 (Japan); Shibata, Eiji [Aichi Medical University School of Medicine, 21 Yazakokarimata, Nagakute, Aichi 480-1195 (Japan); Tanaka, Masatoshi [Fukushima College, 1 Miyashiro Chigoike, Fukushima 960-0181 (Japan); Takigawa, Tomoko [Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558 (Japan); Yoshimura, Takesumi; Chikara, Hisao [Fukuoka Institute of Health and Environmental Sciences, 39 Mukaizano, Dazaifu 818-0135 (Japan); Saijo, Yasuaki [Asahikawa Medical College, 1-1-1 Midorigaoka Higashi 2 jo, Asahikawa 078-8510 (Japan); Kishi, Reiko, E-mail: rkishi@med.hokudai.ac.jp [Hokkaido University Graduate School of Medicine, Department of Public Health Sciences, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638 (Japan)

    2010-04-15

    Microorganisms are known to produce a range of volatile organic compounds, so-called microbial VOC (MVOC). Chamber studies where humans were exposed to MVOC addressed the acute effects of objective and/or subjective signs of mucosal irritation. However, the effect of MVOC on inhabitants due to household exposure is still unclear. The purpose of this epidemiological study was to measure indoor MVOC levels in single family homes and to evaluate the relationship between exposure to them and sick building syndrome (SBS). All inhabitants of the dwellings were given a self-administered questionnaire with standardized questions to assess their symptoms. Air samples were collected and the concentrations of eight selected compounds in indoor air were analyzed by gas chromatography/mass spectrometry - selective ion monitoring mode (GC/MS-SIM). The most frequently detected MVOC was 1-pentanol at a detection rate of 78.6% and geometric mean of 0.60 {mu}g/m{sup 3}. Among 620 participants, 120 (19.4%) reported one or more mucous symptoms; irritation of the eyes, nose, airway, or coughing every week (weekly symptoms), and 30 (4.8%) reported that the symptoms were home-related (home-related symptoms). Weekly symptoms were not associated with any of MVOC, whereas significant associations between home-related mucous symptoms and 1-octen-3-ol (per log{sub 10}-unit: odds ratio (OR) 5.6, 95% confidence interval (CI): 2.1 to 14.8) and 2-pentanol (per log{sub 10}-unit: OR 2.3, 95% CI: 1.0 to 4.9) were obtained after adjustment for gender, age, and smoking. Associations between home-related symptoms and 1-octen-3-ol remained after mutual adjustment. However, concentrations of the selected compounds in indoors were lower than the estimated safety level in animal studies. Thus, the statistically significant association between 1-octen-3-ol may be due to a direct effect of the compounds or the associations may be being associated with other offending compounds. Additional studies are needed

  13. Compliance of laser-assisted microvascular anastomosis: a comparative study with manual anastomosis (preliminary results)

    Science.gov (United States)

    Demaria, Roland G.; Lhote, Francois-Marie; Dauzat, Michel; Juan, Jean-Marie; Oliva-Lauraire, Marie-Claire; Durrleman, Nicolas; Delacretaz, Guy P.; Albat, Bernard; Frapier, Jean-Marc; Chaptal, Paul-Andre; Godlewski, Guilhem

    1999-01-01

    The compliance of microvascular anastomosis is an important predictive factor for long term patency of graft or vascular reconstruction. This experimental study compare the compliance of manual suture and laser assisted end to end microvascular anastomosis. In nine New-Zealand white rabbits we performed manual end-to-end suture anastomosis on the left femoral artery and laser assisted anastomosis on the right femoral artery, with a diode laser (wavelength 988 nm, power output 500 mW). Compliance was obtained by echotracking (CBI 8000 sonomicrometry system with 20 MHz implantable microprobe from Crystal-Biotech, USA) on the anastomosis site as well as upstream, and downstream from the anastomosis. Vessel compliance was lower on the manual suture side compared to the laser assisted anastomosis side, especially downstream from the anastomosis.

  14. Autologous fibrin adhesive in experimental tubal anastomosis.

    Science.gov (United States)

    Rajaram, S; Rusia, U; Agarwal, S; Agarwal, N

    1996-01-01

    To evaluate autologous fibrin in rabbit oviduct anastomosis versus 7-0 vikryl, a conventional suture material used in tubal anastomosis. Thrombin was added to the autologous fibrinogen at the site of anastomosis to obtain a tissue adhesive. The anastomotic time, pregnancy rate, and litter size were evaluated. Three months later, a relaparotomy was done to evaluate patency and degree of adhesions, and a tubal biopsy was taken from the site of anastomosis. Analysis of results showed a statistically significant (P < .001) shortened anastomotic time and superior histopathological union in the tissue adhesive group. Patency rate, pregnancy rate, and degree of adhesions were comparable in both groups.

  15. If only Derrida missed that flight... About the assessment of the "academic achievements" of the so-called "American Anthropology" by Belgrade Structural-semiotic School of Folklore

    Directory of Open Access Journals (Sweden)

    Miloš Milenković

    2016-02-01

    Full Text Available Taking into account recent critiques of "underdevelopment", "positivism", "methodological backwardness" and other failings attributed to socalled "American Anthropology" by some of the authors from the Belgrade Structural-semiotic School of Anthropology of Folklore, I analyse the context in which colleagues and students may be tempted to explain common sense political connection between polyphone ethnography, neo-romanticism and nationalism as counter-intuitive history of the discipline. I already pointed that the important transformative differences in the attitudes towards structuralism between European anthropologists, especially Belgrade Structural-semiotic School of Anthropology of Folklore and so called "American Anthropology", are the consequence of a pure coincidence – the fact that French structuralism and French poststructuralism were launched simultaneously at the American interdisciplinary intellectual scene ("Theory" at the same conference. This ironic concurrence would not be much more than one entertaining episode for students, historians of anthropology and historians of ideas, if there were no attempts (more and more frequent and increasingly fluently articulated to compare different intellectual traditions as they were elements of the same unilineal evolution of the discipline. Belgrade Structural-semiotic School (further called only SS and especially its spiritus movens and most prominent representative Prof. Kovačević started in recent years to criticise some "American Anthropology" measuring its academic "achievement" (the author’s term in comparative perspective and taking as an analytical unit uncritically generalized traditions marked with a single term of "postmodern anthropology" on the one hand, and "anthropology" on the other. Belgrade SS School did develop globally original, although badly promoted and never fully used, battery for the synchronic analysis of the folklore phenomena, but this was done only after

  16. Non-suture methods of vascular anastomosis

    NARCIS (Netherlands)

    Zeebregts, CJ; Heijmen, RH; van den Dungen, JJ; van Schilfgaarde, R

    2003-01-01

    Background: The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several a

  17. Antemortem diagnosis with multiple random skin biopsies and transbronchial lung biopsy in a patient with intravascular large B-cell lymphoma, the so-called Asian variant lymphoma.

    Science.gov (United States)

    Nishizawa, Tomotaka; Saraya, Takeshi; Ishii, Haruyuki; Goto, Hajime

    2014-03-14

    A 59-year-old, previously healthy man presented to our hospital, with a 3-month history of high fever, nocturnal sweating and exertional dyspnoea. Aggressive diagnostic procedures such as multiple random skin biopsies and transbronchial lung biopsy (TBLB) led to an antemortem diagnosis of intravascular large B-cell lymphoma (IVLBCL), which showed abundant CD20 atypical lymphocytes aggregated in lumina of small vessels. The 29 cases diagnosed with IVLBCL during their lifetime by TBLB were reviewed. Their clinical features included respiratory symptoms (hypoxaemia, dyspnoea and dry cough) and persistent fever. IVLBCL patients show various radiological patterns (ground glass opacities, multiple centrilobular nodules, interlobular septal thickening, interstitial shadows and thickening of bronchovascular bundles), suggesting lymphatic or haematological spread. Antemortem diagnosis of IVLBCL is difficult, but a multidisciplinary approach, with aggressive multiple random skin biopsies and/or TBLB, should be considered in patients with respiratory symptoms that are refractory to antibiotics or prednisolone treatment.

  18. Intraluminal tissue welding for anastomosis

    Science.gov (United States)

    Glinsky, Michael; London, Richard; Zimmerman, George; Jacques, Steven

    1998-10-27

    A method and device are provided for performing intraluminal tissue welding for anastomosis of a hollow organ. A retractable catheter assembly is delivered through the hollow organ and consists of a catheter connected to an optical fiber, an inflatable balloon, and a biocompatible patch mounted on the balloon. The disconnected ends of the hollow organ are brought together on the catheter assembly, and upon inflation of the balloon, the free ends are held together on the balloon to form a continuous channel while the patch is deployed against the inner wall of the hollow organ. The ends are joined or "welded" using laser radiation transmitted through the optical fiber to the patch. A thin layer of a light-absorbing dye on the patch can provide a target for welding. The patch may also contain a bonding agent to strengthen the bond. The laser radiation delivered has a pulse profile to minimize tissue damage.

  19. Multispectral tissue characterization for intestinal anastomosis optimization

    Science.gov (United States)

    Cha, Jaepyeong; Shademan, Azad; Le, Hanh N. D.; Decker, Ryan; Kim, Peter C. W.; Kang, Jin U.; Krieger, Axel

    2015-10-01

    Intestinal anastomosis is a surgical procedure that restores bowel continuity after surgical resection to treat intestinal malignancy, inflammation, or obstruction. Despite the routine nature of intestinal anastomosis procedures, the rate of complications is high. Standard visual inspection cannot distinguish the tissue subsurface and small changes in spectral characteristics of the tissue, so existing tissue anastomosis techniques that rely on human vision to guide suturing could lead to problems such as bleeding and leakage from suturing sites. We present a proof-of-concept study using a portable multispectral imaging (MSI) platform for tissue characterization and preoperative surgical planning in intestinal anastomosis. The platform is composed of a fiber ring light-guided MSI system coupled with polarizers and image analysis software. The system is tested on ex vivo porcine intestine tissue, and we demonstrate the feasibility of identifying optimal regions for suture placement.

  20. Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis

    Institute of Scientific and Technical Information of China (English)

    Chao Fan; Jia Ma; Hong-ke Zhang; Rui Gao; Jian-hui Li; Liang Yu; Zheng Wu; Yi Lv

    2011-01-01

    Objective To explore the feasibility and efficiency of a novel magnetic compression anastomats (MCAs) in intestinal anastomosis.Methods A total of 36 male mongrel canines underwent intestinal anastomosis using traditional hand-sewn (n=18) or a novel MCAs (n=18). We compared the anastomosis time, postoperative complications, bursting strength of anastomoses, gross appearance, and pathology between two groups at each timepoint of follow-up.Results The mean anastomosis time with MCAs was significantly less than that with hand-sewn (8.50±1.95 vs. 31.1±4.32 minutes, P<0.001). The blood stools and intussusceptions occurred in both groups during follow-up period. Only 1 mongrel canine receiving intestinal anastomosis by MCAs experienced anastomotic leakage. The average bursting pressure of anastomoses obtained from mongrel canines undergoing intestinal anastomosis by MCAs was significantly higher than that by traditional hand-sewn at 1 week's follow-up time (P<0.05). Gross appearance of the anastomoses constructed by MCAs was relatively smoother and flatter. Pathological evalution of anastomoses revealed that general inflammation was greater in hand-sewn anastomoses than magnetic anastomosis.Conclusion The magnetic compression anastomat is a safe and effective device of sutureless intestinal anastomosis in canine models.

  1. Pathological aspects of so called "hilar cholangiocarcinoma"

    Science.gov (United States)

    Castellano-Megías, Víctor M; Ibarrola-de Andrés, Carolina; Colina-Ruizdelgado, Francisco

    2013-01-01

    Cholangiocarcinoma (CC) arising from the large intrahepatic bile ducts and extrahepatic hilar bile ducts share clinicopathological features and have been called hilar and perihilar CC as a group. However, “hilar and perihilar CC” are also used to refer exclusively to the intrahepatic hilar type CC or, more commonly, the extrahepatic hilar CC. Grossly, a major distinction can be made between papillary and non-papillary tumors. Histologically, most hilar CCs are well to moderately differentiated conventional type (biliary) carcinomas. Immunohistochemically, CK7, CK20, CEA and MUC1 are normally expressed, being MUC2 positive in less than 50% of cases. Two main premalignant lesions are known: biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the biliary tract (IPNB). IPNB includes the lesions previously named biliary papillomatosis and papillary carcinoma. A series of 29 resected hilar CC from our archives is reviewed. Most (82.8%) were conventional type adenocarcinomas, mostly well to moderately differentiated, although with a broad morphological spectrum; three cases exhibited a poorly differentiated cell component resembling signet ring cells. IPNB was observed in 5 (17.2%), four of them with an associated invasive carcinoma. A clear cell type carcinoma, an adenosquamous carcinoma and two gastric foveolar type carcinomas were observed. PMID:23919110

  2. [About the so-called "Geserick sign"].

    Science.gov (United States)

    Püschel, Klaus

    2004-01-01

    Geserick et al. were the first who reported about fractures of the medial and basal wall of the orbita, originating from blunt occipital trauma leading to consecutive contrecoup lesions of the bulbus/orbita complex. A case history with (survived) occipital craniocerebral trauma and monocle hematoma (48-year-old drunken homeless person, found unconscious in a small street of the redlight quarter) is presented. The question was whether the injuries were caused by falling or inflicted by an assailant.

  3. Stent-and-glue sutureless vascular anastomosis.

    Science.gov (United States)

    Khorgami, Zhamak; Shoar, Saeed; Aminian, Ali; Nasiri, Shirzad; Mahmoodzadeh, Habibollah

    2011-07-01

    Vascular anastomosis is commonly done by hand-sewn methods which not only are slow in pace, but also need experiences in surgeons' hands. As the old techniques are replaced by the new ones all the time, it is sensed that a new sutureless approach should be welcomed in the field of vascular anastomosis. Although lots of efforts have been done, such previous recommended techniques are associated with adverse consequences and here is where the need for new methods is still sensed. In this manuscript, we bring all the benefits from other methods together and conclude a novel one for end-to-end vascular anastomosis which uses biological glue as connecting material and also an absorbable stent to keep vessel patency while using balloon catheter and tacking suture.

  4. [Colo-anal anastomosis. Our experience].

    Science.gov (United States)

    Morlino, A; Tramutola, G; Rossi, M T; Scutari, F

    2009-03-01

    The aim of study is to report the results of our experience about ultra-low rectum carcinomas treated with anterior resection and colo-anal anastomosis. The surgery still represents the treatment of choice for the cancer of the rectum. The problems concern the conservation of the sphincter functions (anal and urethral), and sexual function and the reduction of the locoregional recurrences. From 2005 to 2007, 33 patients underwent surgery for low and ultralow rectal carcinoma (30 treated with neoadjuvant radio-chemotherapy, and 3 only with surgery). In 16 of these we have performed a colo-anal anastomosis, in 11 an ultralow colorectal anastomosis and in 7 a Miles resection. We report our updated results.

  5. Autologous nerve anastomosis versus human amniotic membrane anastomosis A rheological comparison following simulated sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    Guangyao Liu; Qiao Zhang; Yan Jin; Zhongli Gao

    2011-01-01

    The sciatic nerve is biological viscoelastic solid, with stress relaxation and creep characteristics. In this study, a comparative analysis of the stress relaxation and creep characteristics of the sciatic nerve was conducted after simulating sciatic nerve injury and anastomosing with autologous nerve or human amniotic membrane. The results demonstrate that, at the 7 200-second time point, both stress reduction and strain increase in the human amniotic membrane anastomosis group were significantly greater than in the autologous nerve anastomosis group. Our findings indicate that human amniotic membrane anastomosis for sciatic nerve injury has excellent rheological characteristics and is conducive to regeneration of the injured nerve.

  6. Angiographic results of retinal-retinal anastomosis and retinal-choroidal anastomosis after treatments in eyes with retinal angiomatous proliferation

    Directory of Open Access Journals (Sweden)

    Saito M

    2012-08-01

    Full Text Available Masaaki Saito,1 Tomohiro Iida,1,2 Mariko Kano,1 Kanako Itagaki11Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, 2Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, JapanBackground: The purpose of this study was to evaluate the angiographic results of retinal-retinal anastomosis (RRA and retinal-choroidal anastomosis (RCA for eyes with retinal angiomatous proliferation (RAP after treatment with intravitreal bevacizumab injections as monotherapy or intravitreal bevacizumab combined with photodynamic therapy.Methods: In this interventional, consecutive case series, we retrospectively reviewed five naïve eyes from four patients (mean age 80 years treated with three consecutive monthly intravitreal bevacizumab (1.25 mg/0.05 mL injections as initial treatment, and followed up for at least 3 months. In cases with over 3 months of follow-up and having recurrence of RAP or leakage by fluorescein angiography, retreatment was performed with a single intravitreal bevacizumab injection and photodynamic therapy.Results: Indocyanine green angiography showed RRA in three eyes with subretinal neovascularization and RCA in two eyes with choroidal neovascularization at baseline. At 3 months after baseline (month 3, neither the RRA nor RCA was occluded in any eye on indocyanine green angiography. Retreatment with intravitreal bevacizumab plus photodynamic therapy was performed in three eyes at months 3 (persistent leakage on fluorescein angiography, 6, and 7 (recurrence of RAP lesion, which achieved obvious occlusion of the RRA and RCA. Mean best-corrected visual acuity improved from 0.13 to 0.21 at month 3 (P = 0.066. No complications or systemic adverse events were noted.Conclusion: Although intravitreal bevacizumab for RAP was effective in improving visual acuity during short-term follow-up, intravitreal bevacizumab could not achieve complete occlusion of RRA and RCA, which could

  7. [On Atomic Nuclear Fusion Processes at Low-Temperatures. An Enhancement of the Probability of Transition through a Potential Barrier Due to the So-Called Barrier Anti-Zeno Effect].

    Science.gov (United States)

    Namiot, V A

    2016-01-01

    It is known that in quantum mechanics the act of observing the experiment can affect the experimental findings in some cases. In particular, it happens under the so-called Zeno effect. In this work it is shown that in contrast to the "standard" Zeno-effect where the act of observing a process reduces the probability of its reality, an inverse situation when a particle transmits through a potential barrier (a so-called barrier anti-Zeno effect) can be observed, the observation of the particle essentially increases the probability of its transmission through the barrier. The possibility of using the barrier anti-Zeno effect is discussed to explain paradoxical results of experiments on "cold nuclear fusion" observed in various systems including biological ones. (According to the observers who performed the observations, the energy generation, which could not be explained by any chemical processes, as well as the change in the isotope and even element composition of the studied object may occur in these systems.

  8. Epidural block and neostigmine cause anastomosis leak

    Directory of Open Access Journals (Sweden)

    Ataro G

    2016-05-01

    Full Text Available Getu Ataro Department of Anesthesia, Jimma University, Jimma, EthiopiaI read the article by Phillips entitled, “Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions”, published in the journal of Open Access Surgery with enthusiasm and found it crucial for perioperative management of patients with gastrointestinal (GI surgery, particularly anastomosis. I appreciate the author’s exhaustive search of literature and discussion with some limitation on review basics like methodology, which may affect the reliability of the review findings. The effects of risk factors for anastomosis leak, such as malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique, were well discussed.1 However, from anesthesia perspective, there are some other well-studied risk factors that can affect healing of anastomosis wound and cause anastomosis leak. Among others, the effect of neostigmine and epidural block has been reported in many studies since half a century ago. View the original paper by Phillips

  9. A training model for laparoscopic urethrovesical anastomosis.

    Science.gov (United States)

    Jiang, Chun; Lin, Tianxin; Zhang, Caixia; Guo, Zhenghui; Xu, Kewei; Dong, Wen; Han, Jinli; Huang, Hai; Yin, Xinbao; Huang, Jian

    2008-07-01

    To create and evaluate the effectiveness of an in vitro training model for laparoscopic urethrovesical anastomosis. Chicken posterior trunks and porcine colons were used to construct the training model, which was later compared with the chicken skin model. The posterior trunk of a chicken was used to simulate a human pelvis, and a 3-mm cloacal stump was used to simulate a human urethral stump. A 15-cm segment of porcine colon with a 1-cm orifice was used to simulate a human bladder or neobladder. An imitation urethrovesical anastomosis was performed with laparoscopic instruments in a laparoscopic training box. The simulated urethral stump and bladder neck were anastomosed with six interrupted stitches. Forty urologic residents were randomized into two groups. The residents in group A (n = 20) practiced using this model for 8 hours, while those in group B (n = 20) practiced using the chicken skin model for 8 hours. The residents' skills were assessed using the porcine model before and after training. All residents accomplished the training course and both assessments. There was no significant difference between the groups in anastomosis time (122.65 +/- 19.98 minutes v 120.70 +/- 17.30 minutes, P > 0.05) and quality (3.80 +/- 1.24 v 3.75 +/- 1.16, P > 0.05) before training. After the training sessions, both groups improved in anastomosis time and quality. Compared with residents in group B, residents in group A required less time (63.55 +/- 11.08 minutes v 76.55 +/- 12.46 minutes, P model more accurately resembles the structure and characteristic of the human pelvis, urethral stump, and bladder (neobladder). In addition, all the materials needed for this model are inexpensive and easily obtained. Therefore, it is an effective, convenient training model for laparoscopic urethrovesical anastomosis.

  10. Container design testing for the final repository Konrad - experiences with respect to so called ''old'' containers; Bauartpruefungen an Behaeltern fuer das Endlager KONRAD. Erfahrungen bezueglich sog. ''Alt''-Behaelter

    Energy Technology Data Exchange (ETDEWEB)

    Noack, Volker; Voelzke, Holger; Nieslony, Gregor; Kovacs, Oliver; Hagenow, Peter [BAM Bundesanstalt fuer Materialforschung und -pruefung (Germany)

    2009-07-01

    The Konrad ore mine is a final repository for low- and intermediate-level radioactive waste in Germany. The demand for final storage suitable containers is increasing. The authors describe tests of so called ''old'' containers for qualification with respect to the appropriateness for final disposal. BAM (Bundesanstalt fuer Materialpruefung) has test facilities for drop tests and fire tests. The testing requirements for all available container types are discussed, including the boundary conditions with respect to the supposed waste properties, conditioning and loading. The project of container design testing is aimed to the possibility of a continuous recording of a large amount of waste packages for the final repository Konrad that allows a short-term backtracking of the relevant data for quality assurance.

  11. Effect of sweating set rate on clothing real evaporative resistance determined on a sweating thermal manikin in a so-called isothermal condition (T manikin = T a = T r).

    Science.gov (United States)

    Lu, Yehu; Wang, Faming; Peng, Hui; Shi, Wen; Song, Guowen

    2016-04-01

    The ASTM F2370 (2010) is the only standard with regard to measurement of clothing real evaporative resistance by means of a sweating manikin. However, the sweating set-point is not recommended in the standard. In this study, the effect of sweating rate on clothing real evaporative resistance was investigated on a 34-zone "Newton" sweating thermal manikin in a so-called isothermal condition (T manikin = T a = T r). Four different sweating set rates (i.e., all segments had a sweating rate of 400, 800, 1200 ml/hr ∙ m(2), respectively, and different sweating rates were assigned to different segments) were applied to determine the clothing real evaporative resistance of five clothing ensembles and the boundary air layer. The results indicated that the sweating rate did not affect the real evaporative resistance of clothing ensembles with the absence of strong moisture absorbent layers. For the clothing ensemble with tight cotton underwear, a sweating rate of lower than 400 ml/hr ∙ m(2) is not recommended. This is mainly because the wet fabric "skin" might not be fully saturated and thus led to a lower evaporative heat loss and thereby a higher real evaporative resistance. For vapor permeable clothing, the real evaporative resistance determined in the so-called isothermal condition should be corrected before being used in thermal comfort or heat strain models. However, the reduction of wet thermal insulation due to moisture absorption in different test scenarios had a limited contribution to the effect of sweating rate on the real evaporative resistance.

  12. Predictors of patency after two-stitch invagination vaso-epididymal anastomosis for idiopathic obstructive azoospermia

    Directory of Open Access Journals (Sweden)

    G Gautam

    2005-01-01

    Full Text Available Objectives: Anastomotic patency with return of sperm in the ejaculate following microsurgical vasoepididymostomy (VEA is not universal and may be delayed. The ability to predict the result of VEA based on preoperative or intra-operative parameters would enable the surgeon to offer the best treatment to the infertile couple. We used the two-stitch invagination technique of VEA in patients of idiopathic obstructive azoospermia and prospectively analyzed factors that could predict a patent anastomosis. While such studies have previously been done for patients undergoing VEA for secondary infertility following a vasectomy, to the best of our knowledge this is the first study analyzing these parameters for patients with primary infertility and idiopathic obstruction. Methods and materials: Over a 2-year period, 29 men underwent the 2-suture invagination VEA for idiopathic obstructive azoospermia. Twenty-four patients provided at least one postoperative semen sample. Preoperative and intra-operative parameters were compared between patients with a patent anastomosis with sperm in ejaculate (n = 12 and those with no sperm in the ejaculate (n = 12 using the t-test, Fisher′s exact test or chi-square test, as appropriate and a multivariate statistical analysis to determine any significant difference. Results: The mean follow up of the 24 patients was 7.6 months (2-30 months. A significantly greater number of patients with patent anastomosis had motile epididymal sperms (P = 0.034 and higher surgeon′s technical satisfaction with the procedure (P = 0.034. However, this difference was seen only on a univariate analysis and did not persist when a multivariate analysis was used. Conclusions: The presence of motile sperms in the epididymal fluid and a high level of technical satisfaction with the anastomosis may indicate a higher likelihood of success following a vaso-epididymal anastomosis for idiopathic obstruction. However, these parameters are not

  13. Genetic control of anastomosis in Podospora anserina.

    Science.gov (United States)

    Tong, Laetitia Chan Ho; Silar, Philippe; Lalucque, Hervé

    2014-09-01

    We developed a new microscopy procedure to study anastomoses in the model ascomycete Podospora anserina and compared it with the previous method involving the formation of balanced heterokaryons. Both methods showed a good correlation. Heterokaryon formation was less quantifiable, but enabled to observe very rare events. Microscopic analysis evidenced that anastomoses were greatly influence by growth conditions and were severely impaired in the IDC mutants of the PaMpk1, PaMpk2, IDC1 and PaNox1 pathways. Yet some mutants readily formed heterokaryons, albeit with a delay when compared to the wild type. We also identified IDC(821), a new mutant presenting a phenotype similar to the other IDC mutants, including lack of anastomosis. Complete genome sequencing revealed that IDC(821) was affected in the orthologue of the Neurospora crassa So gene known to control anastomosis in several other ascomycetes.

  14. Randomized trial on the application of biofragmentable anastomosis ring in intestinal anastomosis

    Institute of Scientific and Technical Information of China (English)

    CHEN Shuang; YANG Bin; HE Jia-hui; ZHANG Yu-chao; LAI Dong-ming

    2009-01-01

    Background The biofragmentable anastomosis ring(BAR)is a simple alternative device to create intestinal anastomosis.Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis.Methods A total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group(n=82)and manual suture group(n=85)as control.They were equally allocated to the two groups regarding sex,age,site of anastomosis,emergent or elective surgery and contaminant diseases.The results of postoperative complications and recovery were recorded in each group.Results Eighty-seven intraperitoneal BAR anastomoses were completed in 82 patients.Two and one postoperative deaths were recorded in BAR and suture group,respectively,no deaths were directly related to anastomotic technique.In suture group,anastomotic leakage and early bleeding both occurred in two patients respectively,no anastomotic bleeding occurred in BAR group,one patient in BAR group developed enterocutaneous fistulae.Perioperative bleeding,operation time and length of hospitalization were similar in two groups(P>0.05).Time for return of bowel function was significantly shortened in BAR group than that in suture group(P<0.05).Conclusion The BAR appears to be a standard,easy,safe and effective altemative either in elective or emergent intraperitoneal intestinal anastomotic surgery.

  15. [Intimal hyperplasia within a vascular anastomosis].

    Science.gov (United States)

    Kur'ianov, P S; Razuvaev, A S; Vavilov, V N

    2008-01-01

    Intimal hyperplasia (IH) appears to rank high amongst plausible causes of reconstructed arteries restenosis. It always occurs in the area of a surgical intervention on a vessel in response to a mechanical lesion. IH is the cause of thrombosis in 15 to 50% of cases following vascular reconstruction during the first year after the operation (with the exception of early thromboses, which are probably caused by an improperly performed interventional technique). Of a wide variety of clinical situations leading to development of IH in the vascular wall, for the purposes of the present review, we singled out the problem concerning the onset and development of this tissue reaction in intervascular anastomoses, which is currently one of the most important issues. Analysing the publications on the problem concerned showed that amongst significantfactors influencing the development of IH in the anastomosis, the investigators single out different parameters of the anastomoses, configuration (either an end-to-end or an end-to-side anastomosis, the use of special inserts and patches within the latter), as well as the use of autologous or synthetic conduits, blanket suture or interrupted suture, peculiarities of local haemodynamics (linear blood flow rate, distribution of parietal fraction forces, zones of stagnation and flow separation), etc. To a certain degree, the published data are rather controversial. There remain many problems, which are either unaddressed as yet, or insufficiently studied, if at all. For instance, while establishing an anastomosis between a bypass graft and an artery, surgeons often resort to endarterectomy. It is not known whether or not this technique would influence the IH pattern in the anastomosis concerned. Neither is it clear whether the high velocity flow exerts a direct damaging action upon the endothelium, whether it promotes the development of IH in the area of the lesion, and if affirmative, then what the mechanisms of this effect really are

  16. A case of age-related Epstein-Barr virus (EBV)-associated B cell lymphoproliferative disorder, so-called polymorphous subtype, of the mandible, with a review of the literature.

    Science.gov (United States)

    Kikuchi, Kentaro; Fukunaga, Shuichi; Inoue, Harumi; Miyazaki, Yuji; Kojima, Masaru; Ide, Fumio; Kusama, Kaoru

    2013-06-01

    Epstein-Barr virus (EBV) is known to be associated with the development of lymphomas in immunocompromised patients. Recently, age-related immune impairment has been recognized as a predisposing factor in the development of EBV-driven lymphoproliferative disorders (LPDs) in elderly patients without any known immunodeficiency or prior lymphoma. In approximately 70% of reported cases, the affected sites have been extranodal, such as the skin, lung, tonsil and stomach. However, age-related EBV-associated B cell (EBV + B cell) LPD is extremely rare in the oral cavity. Here we report a 71-year-old Japanese man who developed an EBV + B cell LPD resembling classical Hodgkin lymphoma (CHL)--so-called polymorphous subtype-of the mandible. Histopathologically, infiltration of large atypical lymphoid cells including Hodgkin or Reed-Sternberg-like cells into granulation tissue with marked necrosis was found in the mandibular bone. Immunohistochemical analysis revealed that the large atypical Hodgkin or Reed-Sternberg-like cells were CD3-, CD15-, CD20+, CD30+ and Epstein-Barr virus (EBV)-latent infection membrane protein-1 (LMP-1)+. In situ hybridization (ISH) demonstrated EBV-encoded small RNA (EBER) + in numerous Hodgkin or Reed-Sternberg-like cells. EBNA-2 was detected by polymerase chain reaction (PCR) using an extract from the formalin-fixed, paraffin-embedded specimen. To our knowledge, this is the first reported case of the polymorphous subtype of age-related EBV + B cell LPD affecting the mandible.

  17. Methotrexate-related Epstein-Barr Virus (EBV)-associated lymphoproliferative disorder--so-called "Hodgkin-like lesion"--of the oral cavity in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Kikuchi, Kentaro; Miyazaki, Yuji; Tanaka, Akio; Shigematu, Hisao; Kojima, Masaru; Sakashita, Hideaki; Kusama, Kaoru

    2010-12-01

    Patients affected by autoimmune diseases (rheumatoid arthritis, psoriasis, dermatomyositis) who are treated with methotrexate (MTX) sometimes develop lymphoproliferative disorders (LPDs). In approximately 40% of reported cases, the affected sites have been extranodal, and have included the gastrointestinal tract, skin, lung, kidney, and soft tissues. However, MTX-associated LPD (MTX-LPD) is extremely rare in the oral cavity. Here we report a 69-year-old Japanese woman with rheumatoid arthritis (RA) who developed MTX-LPD resembling Hodgkin's disease--so-called "Hodgkin-like lesion"--in the left upper jaw. Histopathologically, large atypical lymphoid cells including Hodgkin or Reed-Sternberg-like cells were found to have infiltrated into granulation tissue in the ulcerative oral mucosa. Immunohistochemistry showed that the large atypical cells were positive for CD20, CD30 and Epstein-Barr virus (EBV)-latent infection membrane protein-1 (LMP-1) and negative for CD15. EBV was detected by in situ hybridization (ISH) with EBV-encoded small RNA (EBER), and polymerase chain reaction (PCR) for LMP-1 and EBNA-2 in material taken from the formalin-fixed, paraffin-embedded specimen. To our knowledge, this is the first reported case of MTX-related EBV-associated LPD (MTX-EBVLPD), "Hodgkin-like lesion", of the oral cavity in a patient with RA.

  18. The Public Health Impact of the So-Called "Fluad Effect" on the 2014/2015 Influenza Vaccination Campaign in Italy: Ethical Implications for Health-Care Workers and Health Communication Practitioners.

    Science.gov (United States)

    Rosselli, Roberto; Martini, Mariano; Bragazzi, Nicola Luigi; Watad, Abdulla

    2017-01-01

    Seasonal influenza, causing complications, hospitalizations and deaths, generates a serious socio-economic burden, especially among elderly and high-risk subjects, as well as among adult individuals. Despite the availability and active free-of charge offer of influenza vaccines, vaccine coverage rates remain low and far from the target established by the Ministry of Health. Notwithstanding their effectiveness, vaccines are victims of prejudices and false myths, that contribute to the increasing phenomenon of vaccine hesitancy and loss of confidence. Media and, in particular, new media and information and communication technologies (ICTs) play a major role in disseminating health-related information. They are extremely promising devices for delivering health education and promoting disease prevention, including immunization. However, they can also have a negative impact on population's health attitudes and behaviors when channeling wrong, misleading information. During the 2014/2015 influenza vaccination campaign, the report of four deaths allegedly caused by administration of an adjuvanted influenza vaccine, Fluad - the so-called "Fluad case" - received an important media coverage, which contributed to the failure of the vaccination campaign, dramatically reducing the influenza vaccine uptake. In the extant literature, there is a dearth of information concerning the effect of the "Fluad case". The current study aims at quantifying the impact of the "Fluad effect" at the level of the Local Health Unit 3 (LHU3) ASL3 Genovese, Genoa, Italy. Ethical implications for health-care workers and health communication practitioners are also envisaged.

  19. O PROJETO PARA O PAVILHÃO BRASILEIRO NA EXPO’ 92 EM SEVILHA E A CHAMADA “ARQUITETURA PAULISTA” / The project for the Brazil Pavilion in Expo’92 in Seville and the so called “Paulista architecture”

    Directory of Open Access Journals (Sweden)

    Evandro Fiorin

    2012-11-01

    , buildings with large spans, constructed in reinforced concrete. These architects were the heirs of the so called “Paulista architecture”, which was characterised by the work undertaken from the 60’s by important architects such as Vilanova Artigas and Paulo Mendes da Rocha. The modern references adopted by the winning project, from the architects Ângelo Bucci, Álvaro Puntoni and José Oswaldo Vilela, sparked controversies because of the difficulty of resuming the teachings of the old modern masters when faced with new times. These controversies were related to the end of the military dictatorship in Brazil and the process of opening markets, and by the relevance of a re-evaluation of the so-called “Paulista architecture”.

  20. [Effectiveness and difficulty of education on nosocomial infection control for pre-clinical practice in the clinic, so-called inclusive clinical practice phase I, for students in the Faculty of Dentistry, Tokyo Medical and Dental University].

    Science.gov (United States)

    Sunakawa, Mitsuhiro; Matsumoto, Hiroyuki

    2009-03-01

    It has been planned to give pre-clinical practice in the clinic, so-called inclusive clinical practice phase I, for fifth-grade students in the School of Dentistry, Faculty of Dentistry, Tokyo Medical and Dental University, to give them the clinical training needed to perform dental practice and clinical practicum for comprehensive patient care, namely inclusive clinical practice phase II. This study analyzed the educative efficiency of the class on nosocomial infection control (NIC) by comparing achievements pre- and post-test, and discussed appropriate education planning on the NIC for dental students. Sixty-two fifth-grade students in the 2007 academic year sat the pre- and post-tests; the mean score and standard deviation of these tests were 5.30 +/- 1.26 (n = 56) and 8.59 +/- 1.18 (n = 59), respectively. There was a statistically significant difference between them (paired t-test, p < 0.01). Another finding was that students with high scores in the post-test did not necessarily achieve high ratings in the pre-test. It is suggested that the introduction of pre- and post-tests and the clarification of main points in the class as a theme of NIC could be a useful tool for increasing the comprehension of students on the theme. Since students at lower grades will attend clinical practice in the university hospital, it is thought that students should be given NIC training early in the clinical course, and the current curriculum should be improved to increase the opportunity for students to study this important issue.

  1. Hypoplasia of the internal carotid artery with intercavernous anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Chen, C.J.; Wang, L.J.; Wong, Y.C. [Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Medical College, 199 Tung Hwa North Road, Taipei (Taiwan, Province of China); Chen, S.T.; Hsieh, F.Y. [Department of Neurology, Chang Gung Memorial Hospital and Medical College, Taipei (Taiwan, Province of China)

    1998-04-01

    We report a symptomatic case of unilateral hypoplasia of the internal carotid artery with an intercavernous anastomosis, a very rare developmental anomaly. The symptoms were caused by occlusion of the proximal middle cerebral artery which possibly related to the haemodynamic stress caused by the anomalous intercavernous anastomosis. (orig.) With 2 figs., 20 refs.

  2. Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain

    Science.gov (United States)

    Hara, Hisako; Zhou, Han Peng; Tange, Shuichi; Kikuchi, Kazuki

    2017-01-01

    Background: We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain. Methods: We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded. Results: A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery. Conclusion: LVA can release the pain in the affected limbs of lymphedema. PMID:28203506

  3. Clinical repercussions of Martin-Gruber anastomosis: anatomical study☆

    Science.gov (United States)

    Cavalheiro, Cristina Schmitt; Filho, Mauro Razuk; Pedro, Gabriel; Caetano, Maurício Ferreira; Vieira, Luiz Angelo; Caetano, Edie Benedito

    2016-01-01

    Objective The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. Method 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. Results Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). Conclusion Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable. PMID:27069892

  4. LEAKAGE OF COLONIC ANASTOMOSIS AFTER COLON RESECTION

    Institute of Scientific and Technical Information of China (English)

    Kanellos I; Pramateftakis MG

    2004-01-01

    Objective To present the diagnosis and management of anastomotic leakage after colon resection. Methods Early diagnosis and urgent therapeutic intervention are required in order to avert life-threatening conditions that may be caused by anastomotic leakage. Results The diagnosis of anastomotic leakage is based on clinical features, peripheral blood investigations and abdominal computed tomography (CT) scan. Major leaks are defined by symptoms of peritonitis and septicaemia due to leakage. Major leaks should be managed operatively. Minor leaks can be managed conservatively with successful outcomes. Conclusion Leakage of colonic anastomosis remains the most serious complication after colon resection. It is a major cause of postoperative morbidity and mortality. A high index of suspicion is required in order to detect early, nonspecific signs of a leakage and urgent surgical intervention is usually required to avert life-threatening events.

  5. Morbidity and Mortality after Gut Resection and Anastomosis Western Kenya

    Directory of Open Access Journals (Sweden)

    Pius MUSAU

    2013-08-01

    Full Text Available The objective of this study was to determine the morbidity and mortality after gut resection and anastomosis in a tertiary centre in Kenya. To do this a retrospective, hospital-based study, cohort study of patients who underwent resection and anastomosis in the period 2002 - 2006, both years inclusive. The general surgical wards of Moi Teaching and Referral Hospital (MTRH, a 750 teaching and referral hospital in the Western region of Kenya was used for the study. Two hundred and twenty patients of all ages underwent gut resection and anastomosis for various reasons over the period of study. The primary outcome measures were morbidity and mortality in this group of patients. Morbidity was considered in terms of postoperative complications and hospital length stay. The secondary outcome measures were the patient demography, vital signs at admission and delay in surgery. The morbidity rate was 22.7 % while the mortality rate was 15.9 %. The principal indicators of morbidity were the intra-abdominal pathology, the duration from onset of symptoms to surgery and the type of anastomosis. The patient’s age, type of anastomosis and postoperative complications were key determinants of mortality. In conclusion, pre-operative resuscitation in patients who underwent gut resection and anastomosis influenced morbidity and mortality. Delay in surgery and the type of anastomosis done were determinants of post-operative complications which in turn influenced the outcome of treatment.

  6. A double stapled technique for oesophago-enteric anastomosis

    Institute of Scientific and Technical Information of China (English)

    A Kotru; A K John; E P Dewar

    2004-01-01

    AIM: Leakage from oesophageal anastomosis is associated with substantial morbidity and morality. This study presented a novel, safe and effective double stapled technique for oesophago-enteric anastomosis.METHODS: The data were obtained prospectively from hospital held clinical database. Thirty nine patients (26males, 13 females) underwent upper-gastrointestinal resection between 1996 and 2000 for carcinoma (n = 36),gastric lymphoma (n = 1), and benign pathology (n = 2).Double stapled oesophago-enteric anastomosis was performed in all cases.RESULTS: No anastomotic leak was reported. In cases of malignancy, the resected margins were free of neoplasm.Three deaths occurred, which were not related to anastomotic complications.CONCLUSION: Even though the reported study is an uncontrolled one, the technique described is reliable, and effective for oesophago-enteric anastomosis.

  7. A novel colonic anastomosis technique involving fixed polyglycolic acid mesh

    Science.gov (United States)

    Aysan, Erhan; Bektas, Hasan; Ersoz, Feyzullah; Sari, Serkan; Kaygusuz, Arslan

    2010-01-01

    Background: Polyglycolic acid mesh (PAM) reinforcement of colonic anastomoses were evaluated. Methods: Twenty female albino rabbits were divided into two groups. Each rabbit underwent segmental colonic resection with single-layer anastomosis. In one group of rabbits, PAM of length equal to the circumference of the anastomosis was applied. Rabbits were sacrificed on postoperative day 10 and peritoneal adhesions, anastomosis burst pressure, and anastomosis histopathological characteristics were evaluated. Results: The average burst pressure for the control and PAM groups was 149±15.95 mmHgand 224±124.5 mmHg, respectively (p=0.578). All control anastomoses burst, whereas only five (50%) PAM anastomoses burst (p<0.03). There was no anastomotic leakage in the control group, whereas three PAM group anastomoses leaked (p=0.210). The collagen fiber density and amount of neovascularization were lower in the PAM than the control group (p=0.001 and p=0.002, respectively). The average peritoneal adhesion value was 1.6±0.51 in the control group and 2.9±0.31 in the PAM group (p<0.0001). Conclusion: The new fixed PAM-reinforced anastomosis technique resulted in an increased risk of anastomosis leakage and peritoneal adhesion, but also higher in non-burst anastomoses. PMID:21072268

  8. Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Zaritzky, Mario [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina); University of Chicago Medical Center, Department of Radiology, Chicago, IL (United States); Ben, Ricardo [Hospital de Ninos de La Plata, Department of Gastroenterology, Buenos Aires (Argentina); Zylberg, Gaston I.; Yampolsky, Brian [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina)

    2009-09-15

    We describe a unique technique to promote a nonsurgical esophageal anastomosis with magnets in children with esophageal atresia. To evaluate the efficacy of magnetic lengthening of atretic esophageal ends to produce an anastomosis and to communicate our results after more than 2 years of follow-up. Between September 2001 and March 2004, five children were selected for treatment. Two of the children had esophageal atresia without fistula (type A) and three had atresia with fistula converted to type A surgically; however, surgeons failed to achieve an anastomosis because of the width of the gap. Neodymium-iron-boron magnets were used. Daily chest radiographs were taken until union of the magnets was observed. They were then replaced with an orogastric tube. Anastomosis was achieved in all patients in an average of 4.8 days. One patient, with signs of early sepsis, was successfully treated with antibiotics. In four of the five patients, esophageal stenosis developed. At the time of this report, two patients were free of treatment and on an oral diet (after 26 months), two patients required periodic balloon dilatation, and one patient had recently undergone surgery due to recurrent esophageal stenosis not amenable to balloon dilatation. Magnetic esophageal anastomosis is a feasible method in selected patients with esophageal atresia. Esophageal anastomosis was achieved in all patients. The only observed complication of significance was esophageal stenosis. One patient needed surgery because of stenosis. (orig.)

  9. Management of low colorectal anastomotic leak: Preservingthe anastomosis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Anastomotic leak continues to be a dreaded complicationafter colorectal surgery, especially in the lowcolorectal or coloanal anastomosis. However, therehas been no consensus on the management of the lowcolorectal anastomotic leak. Currently operative proceduresare reserved for patients with frank purulentor feculent peritonitis and unstable vital signs, and varyfrom simple fecal diversion with drainage to resectionof the anastomosis and closure of the rectal stump withend colostomy (Hartmann's procedure). However, ifthe patient is stable, and the leak is identified days oreven weeks postoperatively, less aggressive therapeuticmeasures may result in healing of the leak and salvageof the anastomosis. Advances in diagnosis and treatmentof pelvic collections with percutaneous treatments, andnewer methods of endoscopic therapies for the acutelyleaking anastomosis, such as use of the endosponge,stents or clips, have greatly reduced the need for surgicalintervention in selected cases. Diverting ileostomy, ifnot already in place, may be considered to reduce fecalcontamination. For subclinical leaks or those that persistafter the initial surgery, endoluminal approaches suchas injection of fibrin sealant, use of endoscopic clips, ortransanal closure of the very low anastomosis may beutilized. These newer techniques have variable successrates and must be individualized to the patient, with thegoal of treatment being restoration of gastrointestinalcontinuity and healing of the anastomosis. A reviewof the treatment of low colorectal anastomotic leaks ispresented.

  10. The Effect of Infliximab on Intestinal Anastomosis Healing in Rats.

    Science.gov (United States)

    Karaköse, Oktay; Eken, Hüseyin; Ulusoy, Ali Naki; Topgül, Hüseyin Koray; Bilgin, Mehmet; Yürüker, Saim Savaş; Gülbahar, Mustafa Yavuz

    Intestinal anastomosis healing is a complex physiological process in which many local and systemic factors play a role. One of the significant cytokines in this process is TNF-α. Infliximab is a chimeric monoclonal antibody which binds to TNF-α with high affinity. Although this agent is used in ulcerative colitis and Crohn's disease, intestinal surgery may be required in these patients. In this study it was aimed to determine whether or not there was any negative effect of preoperative single dose infliximab treatment on intestinal anastomosis healing. Two groups of 10 rats were formed. One of these groups was administered with a single dose of infliximab 8 mg/kg as a 20-minute intravenous infusion from the femoral vein. Four days after the infusion, a full layer incision was made to the colon and anastomosis was applied to all the rats. At 7 days after anastomosis, the subjects were sacrificed. The anastomosis segment was removed and the bursting pressure was measured. Tissue samples were taken from this segment for hydroxyproline concentration and histopathological examination. A blood sample was taken to measure TNF-α values. No statistically significant difference was determined between the groups in terms of bursting pressure, tissue hydroxyproline concentration or histopathological scoring. A single dose of 8 mg/kg infliximab administered 4 days preoperatively was not found to have any negative effect on intestinal anastomosis healing in rats.

  11. Effect of omentum graft on esophageal anastomosis in dogs

    Directory of Open Access Journals (Sweden)

    A. K. Mahdi

    2011-01-01

    Full Text Available The aim of this study was to evaluate the complications and final function outcome of wrapping nonvascularized omentum graft around the suture line of esophageal anastomosis. Twelve adult local breed dogs were used in this study. The animals were divided into two equal groups (control and treated, all animal induced into general anesthesia by injection of atropen sulphate in a dose 0.04 mg/kg B.W, intramuscularly then after 15 minute given mixture of ketamine hydrochloride and xylazine hydrochloride in doses 15 mg/kg and 5 mg/kg B.W intramuscularly respectively. An oblique resection of about 1cm of the esophageal length and anastomosis by double layer of simple interrupted pattern by 2.0 cat gut suture (control group, same procedure was done in treated group except the wrapping the anastomosis site with patch of omentum tissue after lapratomy operation in the left flank region procedure. The clinical signs of treated animal revealed signs of dysphagia and regurgitation in treated group while this signs disappear in the control group. Radiological and histopathological examination of the anastomosis site performed at 15 and 30 days post operation. Radiological study recorded high degree of stenosis in the anastomosis site in treated group at 15 and 30 days post operation in compared with animals in control group that record mean degree of stenosis in treated group at 15 day (57.61±0.2 and at 30 day (55.78±0.2 while it recorded in control group at 15 day (39.34±1.04 and at 30 day (36.0.6 ±0.9, histopathological results recorded enhanced healing of anastomosis site in treated animals more than control animals. In conclusion we found that non vascularized omental graft prevent leak when used around the anastomosis line in esophageal and enhanced healing of anastomosis line but it increase the stenosis, fibrosis and adhesion of anastomosis site with surrounding muscle and this interferes with the swallowing as well as dysphagia and regurgitation

  12. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis: A Novel Approach Adopting the Double-Loop Reconstruction Method.

    Science.gov (United States)

    Parisi, Amilcare; Ricci, Francesco; Trastulli, Stefano; Cirocchi, Roberto; Gemini, Alessandro; Grassi, Veronica; Corsi, Alessia; Renzi, Claudio; De Santis, Francesco; Petrina, Adolfo; Pironi, Daniele; D'Andrea, Vito; Santoro, Alberto; Desiderio, Jacopo

    2015-12-01

    Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

  13. Transdiaphragnatic exposure for direct atrioatrial anastomosis in liver transplantation

    Institute of Scientific and Technical Information of China (English)

    CHEN Zhe-yu; YAN Lü-nan; ZENG Yong; WEN Tian-fu; LI Bo; ZHAO Ji-chun; WANG Wen-tao; YANG Jia-yin; XU Ming-qing

    2010-01-01

    Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients (six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis) underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.

  14. Sutureless open vascular anastomosis connector: An experimental study.

    Science.gov (United States)

    Kapischke, Matthias; Gerhard, Dietmar; Pries, Alexandra

    2017-02-01

    The objective of this study was to assess the safety of a new developed sutureless vascular adapter system in a porcine model. In five pigs, 4-cm-long polyester prosthesis (6 mm diameter) were implanted and anastomosed with the newly developed adapter proximally and suture anastomosis distally. The integration of the adapter was investigated in comparison to the suture anastomosis. These investigations were performed by light microscopy and scanning electron microscopy. Median operative time for performing the adapter anastomosis was significantly shorter compared to suture anastomosis (66 s vs. 246 s, p anastomosis implementation was 22.5 mL (range 19.0-25.0 mL) compared to 48.2 mL (range 45.4-63.5 mL, p < 0.05). In five hand-sewn anastomoses, overall eight additional stitches were necessary whereas all adapter anastomoses showed primary leak tightness. This in vivo study shows the technical feasibility of the newly developed adapter.

  15. Minimally invasive oesophagectomy: preliminary results after introduction of an intrathoracic anastomosis

    NARCIS (Netherlands)

    Workum, F. van; Wildenberg, F.J. van den; Polat, F.; Wilt, J.H.W. de; Rosman, C.

    2014-01-01

    BACKGROUND: Intrathoracic anastomosis after oesophagectomy has recently been associated with reduced functional morbidity compared to a cervical anastomosis. METHODS: From January 2011 until August 2012, all operable patients were scheduled to undergo minimally invasive oesophagectomy (MIE) with int

  16. Moyamoya disease associated with an anterior inferior cerebellar artery arising from a persistent trigeminal artery

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Takase, Y.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan); Koizumi, T. [Department of Neurosurgery, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan)

    2002-07-01

    The authors present a case of moyamoya disease associated with a persistent trigeminal artery from which the anterior inferior cerebellar artery arose. We reviewed previously reported cases of moyamoya disease associated with persistent carotid-basilar arterial anastomosis and investigated the embryology of this rare arterial variation. (orig.)

  17. [Prevention of the anastomosis dehiscence following low anterior rectal resections].

    Science.gov (United States)

    Hut'an, M; Lukác, I; Poticný, V

    2005-10-01

    Authors analyse 106 patients that were operated in their department by Dixon's method, in retrospective study. They analyse indications for operations, lesions distance in rectum, endosonographic and CT findings. Basic principles of the operation technique are adequate blood flow, sufficient colon mobilization and tightness of the anastomosis being supplemented with transanal pertubation. Out of early complications anastomosis dehiscence appeared in 6 patients (e.g. 5.6%) out of which 4 were treated conservatively and 2 were being reoperated on (by axial ileostomia and drainage). In discussion different opinions on preoperative preparation, neoadjuvant therapy, presacral drainage, transanal pertubation and other decompressive techniques are anticipated.

  18. Infliximab treatment reduces tensile strength in intestinal anastomosis

    DEFF Research Database (Denmark)

    Jensen, Jonas Sanberg; Petersen, Nacie Bello; Biagini, Matteo;

    2015-01-01

    effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. METHODS: Thirty-two rabbits were randomized (2...... as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 +/- 1.26 versus 3.31 +/- 1.65, P = 0.03). CONCLUSIONS: Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits...

  19. Biofragmentable anastomosis ring (BAR) in intestinal surgery: review of 21 cases and evaluation of postoperative morbidity.

    Science.gov (United States)

    Gallinaro, L S; Forte, A; Chiarot, M; Montesano, G; Bertagni, A; Turano, R; Illuminati, G

    1997-01-01

    The authors report their experience with the use of biofragmentable anastomosis ring in intestinal anastomosis: 21 patients underwent intestinal resection and anastomosis by BAR. There was no operative mortality. One patient developed an anastomotic leak and three patients had symptoms of intestinal obstruction. The endoscopic follow up showed no late complications. Technical factors regarding the BAR are discussed. Advantages appear to be a safe, rapid and easy alternative to hand and stapled intraperitoneal large bowel anastomosis.

  20. Flow Field Characterization Inside an Arteriovenous Graft-to-Vein Anastomosis Under Pulsatile Flow Conditions

    Science.gov (United States)

    2007-11-02

    1 FLOW FIELD CHARACTERIZATION INSIDE AN ARTERIOVENOUS GRAFT- TO-VEIN ANASTOMOSIS UNDER PULSATILE FLOW CONDITIONS Nurullah Arslan1, Francis Loth2...the relationship between the distribution of turbulence intensity and the localization of stenoses inside the venous anastomosis of arteriovenous (A...found to be greatest downstream of the anastomosis . KEYWORDS: Arteriovenous graft, dialysis, turbulence, stenosis I. INTRODUCTION

  1. The influence of the anastomosis angle on the hemodynamics in the distal anastomosis in the infrainguinal bypass: an in vitro study.

    Science.gov (United States)

    Grus, T; Grusová, G; Lambert, L; Banerjee, R; Matěcha, J; Mlček, M

    2016-11-08

    The geometric shape of the distal anastomosis in an infrainguinal bypass has an influence on its durability. In this article, we compared three different angles of the anastomosis with regard to the hemodynamics. Three experimental models of the distal infrainguinal anastomosis with angles of 25°, 45°, and 60° respectively were constructed according to the similarity theory to assess flow in the anastomoses using particle image velocimetry and computational fluid dynamics. In the toe, heel, and floor of the anastomosis that correspond to the locations worst affected by intimal hyperplasia, adverse blood flow and wall shear stress were observed in the 45° and 60° models. In the 25° model, laminar blood flow was apparent more peripherally from the anastomosis. In conclusions, decreasing the distal anastomosis angle in a femoropopliteal bypass results in more favorable hemodynamics including the flow pattern and wall shear stress in locations susceptible to intimal hyperplasia.

  2. Effect of Erythropoietin on Microvascular Anastomosis in Rat

    African Journals Online (AJOL)

    accelerated re-endothelialization in rat femoral arteries following microvascular anastomosis. Keywords: .... significance levels were two-tailed and set at p <. 0.05. ... vein endothelial cell (HUVEC) cultures in ... injection, to maintain a high EPO concentration in blood, the .... replacement for endothelial cells in the rabbit. Circ.

  3. Surgery for necrotising enterocolitis : primary anastomosis or enterostomy?

    NARCIS (Netherlands)

    Hofman, FN; Bax, NMA; van der Zee, DC

    2004-01-01

    The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel

  4. OCT-aided anastomosis platform study in the rodent model

    Science.gov (United States)

    Huang, Yong; Tong, Dedi; Zhu, Shan; Wu, Lehao; Ibrahim, Zuhaib; Lee, WP Andrew; Brandacher, Gerald; Kang, Jin U.

    2014-02-01

    Anastomosis is one of the most commonly performed procedure in the clinical environment that involves tubular structures, such as blood vessel, lymphatic vessel, seminal duct and ureter. Suture based anastomosis is still the foundation for most basic surgical training and clinical operation, although alternate techniques have been developed and under development. For those tubular-structure-anastomosis, immediate real-time post-operative evaluation of the surgical outcome is critical to the success of surgery. Previously evaluation is mostly based on surgeons' experience. Fourier-domain optical coherence tomography is high-speed, high-resolution noninvasive 3D imaging modality that has been widely used in the biomedical research and clinical study. In this study we used Fourier-domain optical coherence tomography as an evaluation tool for anastomosis of lymphatic vessels, ureter and seminal duct in rodent model. Immediate post-operative and long term surgical site data were collected and analyzed. Critical clinical parameters such as lumen patency, anastomosed site narrowing and suture error detection are provided to surgeons.

  5. Protection of low rectal anastomosis with a new tube ileostomy using a biofragmentable anastomosis ring

    Science.gov (United States)

    Liu, Liming; Huang, Qi; Wang, Jialiang; Chen, Quanning; Lin, Rui; Ge, Bujun

    2016-01-01

    Abstract A temporarily defunctioning stoma, while effective at reducing symptomatic anastomotic leakage after low anterior resection (LAR) of rectal cancer, and its subsequent closure, is associated with significant morbidity. Here, we devised a new tube ileostomy using a biofragmentable anastomosis ring (TIB) with no need for reversal. This is a retrospective cohort study. From June 2011 to March 2015, TIBs were performed on 31 consecutive patients with mid- or low-rectal cancer who underwent elective laparoscopic LARs. From January 2008 to May 2011, 25 similarly diseased patients underwent elective laparoscopic LARs and conventional loop ileostomy (LI) and were included as controls. All of the anastomotic sites were within 6 cm of the anal verge. Demographic, clinical feature, and operative data were recorded. The demographic features of both groups were similar. The TIB mean surgical duration was significantly lower than in the LI group (215 ± 28 vs 245 ± 54 min, P = 0.010). Because of readmission for stoma closure, the total hospital stay of the LI group was longer than that of the TIB group (38.1 ± 26.5 vs 19.1 ± 7.9 days, respectively, P = 0.002). Ileal content was completely diverted by TIB for 13.7 ± 2.1 (range, 10–19) days postoperatively. The drainage tube was removed on postoperative day 27.8 ± 6.9 (range, 20–44), and the mean continued duration of the discharge tract, before fistula healing, was 4.5 ± 1.9 (range, 2–10) days. Postoperative complications of the 2 modalities were not significant. In the TIB group, 1 rectovaginal fistula occurred 30 days postsurgery. In the LI group, 1 rectovaginal fistula occurred 3 months after stoma closure. Both complications were treated with transverse colostomy. No major TIB associated complications were observed in the present study. TIB is a safe, feasible, effective, but time-limited diversion technique, which may reduce symptomatic anastomosis leakage after LAR

  6. Magnetic Anastomosis for Glycemic Insulin Control (MAGIC): A Pilot Study of Minimally Invasive (Endoscopic/Laparoscopic) Side-to-Side Duodeno-Distal Ileal Anastomosis in Pigs

    Science.gov (United States)

    2013-10-08

    17 OCT 2013 2. REPORT TYPE Final 3. DATES COVERED 01 NOv 2012 - 17 Oct 2013 4. TITLE AND SUBTITLE FDG20130001A entitled Magnetic Anastomosis ...for Glycemic Insulin Control (MAGIC): A pilot study of minimally invasive (endoscopic/laparoscopic) side-to-side duodeno-distal ileal anastomosis in...Compression Anastomosis Corrects Insulin Resistance in Diabetic Pigs. PURPOSE: Bariatric surgery corrects insulin resistance independent of weight loss

  7. MARTIN–GRUBER ANASTOMOSIS AND ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk

    2015-01-01

    Full Text Available The communication between the median and ulnar nerves on the forearm, known as the Martin–Gruber anastomosis, is widespread in the general population. Despite the fact that this connection is described by anatomists in XVIII century, its importance has only recently been appreciated because of the widespread of the electrophysiological techniques in clinical practies. However, in the Russian literature aspects of its practical value described so far is not enough. This article deals with the prevalence of the anastomosis, its anatomical and electrophysiological classification, options innervation of muscles of the hand, is carried out through him, described electrophysiological methods and criteria for its diagnosis, including the collision technique, in healthy subjects and patients with lesions of the median and ulnar nerves, given its practical value. Such a course of nerve fibers through this anastomosis can have a significant impact on the clinical manifestations in patients with lesions of the median and ulnar nerves, as well as the results of an electrophysiological study. Martin–Gruber anastomosis provides variability innervation muscles of the hand, which can make it difficult topic diagnostic damage to the median and ulnar nerves, in addition, because of the connection between the nerves of the clinical presentation may not reflect the extent of their defeat: the hand muscles function can be preserved with full nerve damage or, conversely, significantly disrupted with minimal nerve lesions. Moreover, different electrophysiological findings on patients with pathology of the median or ulnar nerves in the conditions of functioning anastomosis may also complicate the interpretation of the clinical data. Thus, knowledge of the anatomy and physiology of the Martin–Gruber communication as necessary for the electrophysiologist for correct interpretation of the finding and the clinician to accurately diagnose the pathology of the median

  8. Laparoscopic duodenoduodenostomy with parallel anastomosis for duodenal atresia.

    Science.gov (United States)

    Oh, Chaeyoun; Lee, Sanghoon; Lee, Suk-Koo; Seo, Jeong-Meen

    2017-06-01

    Currently, a diamond-shaped anastomosis is preferred for the surgical repair of duodenal atresia (DA) in both open and laparoscopic surgery. We report the results of laparoscopic duodenoduodenostomy with parallel anastomosis (LDPA) in DA. We retrospectively reviewed 22 patients who underwent laparoscopic duodenoduodenostomy from February 2005 to May 2015 in Samsung Medical Center. All patients underwent operation within the first month after birth. Patients who were transversely anastomosed after duodenotomy and patients who underwent simultaneous operation on combined anomalies were excluded. Parallel anastomosis was used in all surgeries. Four trocars were used in laparoscopic repair. After mobilization of both proximal and distal ends, the proximal end was incised transversely and the distal end was incised longitudinally. Duodenoduodenostomy with parallel anastomosis using a 5-0 glyconate monofilament was performed with interrupted sutures. Eleven patients (50 %) were male. Median gestational age was 36 + 6 weeks (32 + 7-40 + 6). Median age at the time of operation and median body weight were 3 days (1-12) and 2.53 kg (1.63-3.18), respectively. All patients were diagnosed prenatally and 16 patients (72.7 %) had associated anomalies. Median operation time was 142 min (96-290) and median postoperative day to start oral feeding was 5 days (3-9) and median postoperative day of reaching full feeding was 11 days (6-19). Median postoperative day was 13 days (10-60). There was no anastomotic leakage or stenosis. Median follow up was 3.5 months (1-21). Currently, there is no late complication. LDPA can be performed easily to patients who have DA in neonatal period. It is anatomically natural and the risk of leakage or stenosis does not seem significant. Therefore, parallel anastomosis should be considered as a safe procedural option for laparoscopic duodenoduodenostomy in DA.

  9. On so called “paradoxical monocular stereoscopy”

    NARCIS (Netherlands)

    Koenderink, J.J.; Doorn, A.J. van; Kappers, A.M.L.

    1994-01-01

    Human observers are apparently well able to judge properties of 'three-dimensional objects' on the basis of flat pictures such as photographs of physical objects. They obtain this 'pictorial relief' without much conscious effort and with little interference from the (flat) picture surface. Methods

  10. [So-called "spontaneous" lesions of the popliteal artery].

    Science.gov (United States)

    Miani, S; De Monti, M; Boneschi, M; Giordanengo, F

    1997-11-01

    The term "spontaneous", when attributed to a stenotic or obliterative arterial lesion, could seem ambiguous and doesn't completely explain the anatomical substrate that is the basis of this morbid condition. However, it is true that injuries can occur without the patient being aware of any traumatic event, and can cause a symptomatology arising suddenly and, apparently, "spontaneously". In this study, three cases of patients observed for acute or chronic lower limb ischemia are presented. All patients were male, young and underwent an angiographic examination that demonstrated, in an otherwise normal arterial tree, filling defects or obstruction involving the popliteal artery. Two patients underwent a reconstructive surgical procedure. The third was medically treated. CAT or MNR examinations were performed in order to exclude developmental defect such as an anomalous course of popliteal artery determined by a displacement due to medial head of the gastrocnemius muscle. Actually in these three cases, a definite etiology of the arterial damage was not demonstrated and therefore it is suggested that a physical effort could have injured an already weakened arterial structure.

  11. Philosophy in the so-called big science

    Directory of Open Access Journals (Sweden)

    Jacek Poznański

    2017-07-01

    Full Text Available Both our understanding of the term “science”, and that which it is employed to refer to, have undergone significant changes over the centuries. The 20th century, in particular, has seen important transformations within science and, in consequence, heated debate. One important transformation, rarely noticed by philosophers of science, has been the emergence of large-scale research projects of the sort often referred to as “big science”. Such projects require science to be organized, and function, in quite new ways. Their influence upon science, construed as an activity and an institution, has been very great indeed - as has been their impact on our understanding of what it is that such activities ultimately produce (theories, hypotheses. The aim of this article is to identify and spell out the philosophical aspects of this scenario as it pertains to science. I begin with an outline of the historical development of big science. Then, with reference to other scholars, I try to establish a definition of it. I briefly point to some developments in 20th century philosophy of science, and argue for the need to construct a distinctive philosophy of big science itself. The latter, I claim, should construe the philosophy of science in terms broad enough to be adequate for the analysis of a number of issues emerging in the context of the most developed branches of the natural sciences. I review a selection of these issues in the last part of my article.

  12. On the so called rogue waves in nonlinear Schrodinger equations

    Directory of Open Access Journals (Sweden)

    Y. Charles Li

    2016-04-01

    Full Text Available The mechanism of a rogue water wave is still unknown. One popular conjecture is that the Peregrine wave solution of the nonlinear Schrodinger equation (NLS provides a mechanism. A Peregrine wave solution can be obtained by taking the infinite spatial period limit to the homoclinic solutions. In this article, from the perspective of the phase space structure of these homoclinic orbits in the infinite dimensional phase space where the NLS defines a dynamical system, we examine the observability of these homoclinic orbits (and their approximations. Our conclusion is that these approximate homoclinic orbits are the most observable solutions, and they should correspond to the most common deep ocean waves rather than the rare rogue waves. We also discuss other possibilities for the mechanism of a rogue wave: rough dependence on initial data or finite time blow up.

  13. On the so-called Boy or Girl Paradox

    CERN Document Server

    D'Agostini, G

    2010-01-01

    A quite old problem has been recently revitalized by Leonard Mlodinow's book The Drunkard's Walk, where it is presented in a way that has definitely confused several people, that wonder why the prevalence of the name of one daughter among the population should change the probability that the other child is a girl too. I try here to discuss the problem from scratch, showing that the rarity of the name plays no role, unless the strange assumption of two identical names in the same family is taken into account. But also the name itself does not matter. What is really important is `identification', meant in an acceptation broader than usual, in the sense that a child is characterized by a set of attributes that make him/her uniquely identifiable (`that one') inside a family. The important point of how the information is acquired is also commented, suggesting an explanation of why several people tend to consider the informations "at least one boy" and "a well defined boy" (elder/youngest or of a given name) equiva...

  14. Pubic inguinal pain syndrome: the so-called sports hernia.

    Science.gov (United States)

    Cavalli, Marta; Bombini, Grazia; Campanelli, Giampiero

    2014-03-01

    The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia. We proposed the new name "pubic inguinal pain syndrome." In the period between January 2006 and November 2013 all patients afferent in our ambulatory clinic for chronic groin pain without a clinically evident hernia were assessed with medical history, physical examination, dynamic ultrasound, and pelvic and lumbar MRI. All patients were proposed for a conservative treatment and then, if it was not effective, for a surgical treatment. Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases.

  15. Solitary Fibrous Tumors and So-Called Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    Nicolas Penel

    2012-01-01

    Full Text Available We have reviewed the literature data regarding the spectrum of tumors including solitary fibrous tumor and hemangiopericytoma with special focus on definition of the disease, discussion of the criteria for malignancy, and the key elements of standard treatment of localized disease. We have discussed the emerging concepts on the tumor biology and the different systemic treatments (chemotherapy and molecular-targeted therapies.

  16. [The controversy about so-called "active euthanasia"].

    Science.gov (United States)

    Karbowski, K

    1996-09-17

    In the past few years, the discussion about the right to kill severely ill patients for humanitarian reasons--once called euthanasia and after World War II in the German speaking countries as euphemism called 'aktive Sterbehilfe' (active help to die)--has become more intensive. Actually, only the Netherlands do officially practice euthanasia. But the variant that consists in putting a pharmaceutical at the patient's disposal in order to kill himself is very well known in other countries, e.g. in Switzerland, where the pressure on the legislator to also legalize euthanasia grows. Taking into account medico-ethical reasons, historical experiences, alarming euthanasia ideas in bioethics and social philosophy, the danger due to the impossibility to control the development in this field, and the insidious extension of euthanasia indications, the author rejects firmly the idea of legalized euthanasia. These problems are related to those that occur in fixing the moment of death of potential organ donors. A lack of organs in transplantation medicine should not lead physicians to explant organs from donors in a dying condition. For physicians who take care of potential organ donors and who have to look after their interests towards transplantation teams, it is often too difficult to cope with this task. Local ethical commissions should support them.

  17. Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery

    Directory of Open Access Journals (Sweden)

    Rajsrinivas Parthasarathy

    2016-01-01

    Full Text Available Embryonic carotid – basilar anastomosis when persistent in adult life can present with a variety of neurological symptoms. We present a patient with isolated intermittent vertigo attributable to the embryonic anastomosis and describe the different types of persistent trigeminal artery. A 76-year-old Caucasian man presented with isolated intermittent vertigo and symptoms suggestive of anterior and posterior circulation strokes. Impaired vasomotor reactivity was demonstrated on insonation of the anterior and posterior cerebral arteries in this patient with a persistent left trigeminal artery and 75% stenosis of the left internal carotid artery (ICA. The symptom of intermittent vertigo resolved with carotid endarterectomy. Decreased flow across the stenotic segment of the ICA which subserved the posterior circulation resulted in basilar insufficiency. Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is a likely cause for the intermittent vertigo.

  18. Blind loop perforation after side-to-side ileocolonic anastomosis

    Institute of Scientific and Technical Information of China (English)

    Raffaele; Dalla; Valle; Roberto; Zinicola; Maurizio; Iaria

    2014-01-01

    Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  19. Blind loop perforation after side-to-side ileocolonic anastomosis.

    Science.gov (United States)

    Valle, Raffaele Dalla; Zinicola, Roberto; Iaria, Maurizio

    2014-08-27

    Blind loop syndrome after side-to-side ileocolonic anastomosis is a well-recognized entity even though its incidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perforation. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  20. Probing the Nature of Deficits in the "Approximate Number System" in Children with Persistent Developmental Dyscalculia

    Science.gov (United States)

    Bugden, Stephanie; Ansari, Daniel

    2016-01-01

    In the present study we examined whether children with Developmental Dyscalculia (DD) exhibit a deficit in the so-called "Approximate Number System" (ANS). To do so, we examined a group of elementary school children who demonstrated persistent low math achievement over 4 years and compared them to typically developing (TD), aged-matched…

  1. Evaluation healing of jejunal anastomosis in preoperative dexamethasone treated dogs

    Directory of Open Access Journals (Sweden)

    A.S. Al-Qadhi

    2015-06-01

    Full Text Available The objective of this study is to evaluate the healing process of jejunal anastomosis by the aid of histopathology and measurement of bursting pressure of anastomosis site in thirty two adult preoperatively with dexamethasone. The animals were randomly divided into 2 equal groups: Group 1: consists of 16 dogs underwent apposition end-to-end jejunal anastomosis using simple interrupted suture technique which in turn divided into 2 subgroups: subgroup A: consists of 8 dogs treated preoperatively for 15 days with dexamethasone at a dose of (0.2mg/kg given I/M. Subgroup B: control group consists of 8 dogs not treated with dexamethasone. Group 2: consists of 16 dogs underwent inverted end-to-end jejunal anastomosis using continuous Lembert suture pattern that also divided into 2 subgroups: subgroup A: consists of 8 dogs treated preoperatively for 15 days with dexamethasone at a dose of (0.2mg/kg given I/M. subgroup B: control group consists of 8 dogs not treated with dexamethasone. The result of bursting pressure measurement showed higher tensile strength in the control groups (445±9.6 in comparison with the steroidal groups (255±25.3 for both techniques. The histopathological study showed that the healing was good in all groups but the rupture that occur due to shedding the pressure lead to non discrimination between which is better in terms of healing. Massonʼs trichrome showed that collagen content of subgroups taking dexamethasone was lower than that of subgroups not treated with dexamethasone.

  2. Zigzag Persistence

    CERN Document Server

    Carlsson, Gunnar

    2008-01-01

    We describe a new methodology for studying persistence of topological features across a family of spaces or point-cloud data sets, called zigzag persistence. Building on classical results about quiver representations, zigzag persistence generalises the highly successful theory of persistent homology and addresses several situations which are not covered by that theory. In this paper we develop theoretical and algorithmic foundations with a view towards applications in topological statistics.

  3. Straight ileo-anal anastomosis with myectomy as an alternative to ileal pouch-anal anastomosis in restorative proctocolectomy.

    Science.gov (United States)

    Landi, E; Landa, L; Fianchini, A; Marmorale, C; Piloni, V

    1994-04-01

    Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.

  4. [Linear form compression device for formation of colon anastomosis in experiment].

    Science.gov (United States)

    Zaĭtsev, E Iu

    2009-01-01

    The possibility of compressive intestine anastomosis formation with the help of linear form nikelid-titan implant was carried out in experiment (12 dogs). It is stat that linear form nikelid-titan implant migrates from a zone of anastomosis and leaves an organism of an experimental animal in the natural way in 5th - 6th day. Average pressure of break developed anastomosis using pneumatic pressure makes 193 +/- 8,6 mm mercury.

  5. Side-to-side anastomosis using 4 interrupted sutures in small coronary arteries.

    Science.gov (United States)

    Kawahito, Koji; Muraoka, Arata; Misawa, Yoshio

    2014-01-01

    Side-to-side anastomosis in sequential bypass grafting of coronary arteries 1.0 mm in diameter or smaller, requires delicate surgical techniques with a high degree of technical difficulty. However, using only 4 interrupted sutures, we have performed side-to-side anastomosis in sequential grafting without difficulty in a short operative duration. We applied this technique in 58 distal anastomosis procedures, achieving an early angiographic graft patency rate of 100%.

  6. Longer coronary anastomosis provides lower energy loss in coronary artery bypass grafting.

    Science.gov (United States)

    Tsukui, Hiroyuki; Shinke, Manabu; Park, Young Kwang; Yamazaki, Kenji

    2017-01-01

    Distal anastomosis technique affects graft patency and long-term outcomes in coronary artery bypass grafting, however, there is no standard for the appropriate length of distal anastomosis. The purpose of this study is to evaluate whether longer distal anastomosis provides higher quality of distal anastomosis and better hemodynamic patterns. Off pump CABG training simulator, YOUCAN (EBM Corporation, Japan), was used for distal anastomosis model. Two lengths of distal anastomosis model (10 versus 4 mm) were prepared by end-to-side anastomosis technique. After CT scan constructed three-dimensional inner shape of distal anastomosis, computational flow dynamics (CFD) was used to analyze hemodynamic patterns. The working flow was defined as Newtonian fluid with density of 1050 kg/m(3) and viscosity of 4 mPa s. The boundary condition was set to 100 mmHg at inlet, 50 ml/min at outlet, and 100 % stenosis of proximal coronary artery. Three-dimensional CT imaging showed quality of distal anastomosis in 10 mm model was more uniform without vessel wall inversion or kinking compared to 4 mm model. Anastomotic flow area was significantly larger in 10 mm model than that in 4 mm model (28.67 ± 4.91 versus 8.89 ± 3.18 mm(2), p anastomosis provided higher quality of distal anastomosis, larger anastomotic flow area, smaller anastomotic angle, and smoother graft curvatures. These factors yielded lower energy loss at distal anastomosis.

  7. Zum Problem der terminologisch-konzeptuellen Äquivalenz zwischen zwei Sprach- und Kulturgemeinschaften: die sogenannten „differenzen“ zwischen den Sachen. On the problem of the terminological-conceptual equivalence between two language and culture communities: the so called "differences in the matter"

    Directory of Open Access Journals (Sweden)

    Hans-Harry Drößiger

    2007-01-01

    Full Text Available The article discusses issues concerning terminological-conceptual equivalence between so called “systems of concepts” of two language and culture communities in the context of the work of a translator or the translatability of terminologies. Based on several studies (mostly concerning legal terminology carried out in the last few years in MA papers of students of the study program Interpreting/Translation of Vilnius University some of the general questions of terminology work can be pointed out that are connected to the problem of the so called terminological “gap” and need to be reassessed. On the basis of the studies concerning the language combination German-Lithuanian not only “pure” linguistic differences between those two languages but also “differences in the matter” (i.e. differences between the language and culture communities always were identifiable. The examples presented in this article should demonstrate how those gaps in “systems of concepts” can be dealt with so that it can be useful in the work of an interpreter or a translator who stands between those two languages and cultures.

  8. Reanastomosis with Stapler in Duodenojejunal Junction Anastomosis Leakage: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmet Seker

    2013-04-01

    Full Text Available After anastomosis leakages, treatment of patient gets more difficult and mortality rates increase. At lower level gastrointestinal anastomosis leakages, because of always there is an ostomy alternative, digestion problems are seen lesser. But at upper level gastrointestinal system anastomosis leakages, when it is taken account of nutrient condition of patient, requirement of making anastomos increases. So moratlity rates increase. At this article we aimed to present a different technique that we administered on management of a patient who had duodenojejunal junction anastomosis leakage.

  9. Comparative study of three methods of esophageal anastomosis in dogs

    Directory of Open Access Journals (Sweden)

    Z. T. Abd Al-Maseeh

    2009-01-01

    Full Text Available This study was performed to compare three methods of esophageal anastomosis. Twenty four healthy adult dogs were used in this study. The animals were divided into three groups; each one consisted of 8 animals. In group 1; two layers were used to perform the esophageal anastomosis. The first layer represented simple interrupted suture to close the mucosa with knot inside the lumen, and the second layer represented horizontal mattress interrupted suture to close the other layers of esophagus. While in group 2; one layer of cross interrupted mattress suture was used to close all layers of esophageal wall, and in group 3; one layer of Schmieden's suture was used to close all layers of esophageal wall. The results of clinical, radiological and histopathological studies after 15 and 30 days of surgical operation revealed that most of the animals showed different degrees of difficulty concerning the moderate dysphagia and regurgitation. The radiological study showed significant difference of stenosis. The best results were recorded in the second group where the mean degree of stenosis was 7.69%, however the mean degree of stenosis was 42.80% in the first group, while the mean degree of stenosis in the third groups was 37.81%, through 30 days. The histopathological study of group 2 showed rapid healing of the site of anastomosis, lack of granulation tissue and consequently the less degree of stricture and other complications as compared with groups 1 and 3. The Schmieden's suture was characterized by its standard short time as compared with group 1 and 2, although accompanied by some complications. In conclusion this study revealed that the cross mattress suture used in the second group characterized by faster healing and minimal amount of fibrous tissue formation manifested by decrease in moderate degree of stenosis as compared with the two other suture patterns used in the first and third groups.

  10. Gastrojejunal anastomosis stricture after laparoscopic gastric bypass: Our experience with 62 patients Estenosis de la anastomosis gastroyeyunal en el bypass gástrico laparoscópico: Nuestra experiencia con 62 pacientes

    Directory of Open Access Journals (Sweden)

    A. Campillo-Soto

    2010-03-01

    Full Text Available Objective: gastrojejunal stricture (GYS, not only is a common complication after laparoscopic gastric bypass (LGBP, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 62 LGBP. Patients and method: from January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass (Wittgrove's technique. The gastrojejunal anastomosis is performed with auto suture material type CEAA No 21 termino-lateral (ILS, Ethicon. In 4 cases (6.45% was converted to laparotomy, perform the anastomosis in the same way. Monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm. Results: five cases (8.1% developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. Two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points. All cases were resolved by endoscopic dilatation. At follow-up has not been detected re-stricture. Conclusion: Clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. The situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. In cases of suspected barium transit offers us a high diagnostic yield. Endoscopic dilatation resolved, so far, all cases.Objetivo: la estenosis de la anastomosis gastroyeyunal representa una

  11. Polarization-sensitive multispectral tissue characterization for optimizing intestinal anastomosis

    Science.gov (United States)

    Cha, Jaepyeong; Triana, Brian; Shademan, Azad; Krieger, Axel; Kim, Peter C. W.; Kang, Jin U.

    2014-03-01

    A novel imaging system that recommends potential suture placement for anastomosis to surgeons is developed. This is achieved by a multispectral imaging system coupled with polarizers and image analysis software. We performed preliminary imaging of ex vivo porcine intestine to evaluate the system. Vulnerable tissue regions including blood vessels were successfully identified and segmented. Thickness of different tissue areas is visualized. Strategies towards optimal points for suture placements have been discussed. Preliminary data suggest our imaging platform and analysis algorithm may be useful in avoiding blood vessels, identifying optimal regions for suture placements to perform safer operations in possibly reduced time.

  12. Persister Awakening.

    Science.gov (United States)

    Lewis, Kim; Shan, Yue

    2016-07-07

    In this issue of Molecular Cell, Cheverton et al. (2016) report that Samonella toxin TacT contributes to persister formation by acetylating tRNA, a novel mechanism of toxin action. Hydrolyzing corrupted tRNA resuscitates persisters.

  13. Arbuscular mycorrhizal fungi reveal distinct patterns of anastomosis formation and hyphal healing mechanisms between different phylogenic groups

    NARCIS (Netherlands)

    De Souza, F.A.; Fernández, F.; Delmas, N.S.; Declerck, S.

    2005-01-01

    The significance of anastomosis formation and the hyphal healing mechanism (HHM) for functionality and integrity of the arbuscular mycorrhizal (AM) fungal mycelial network remains poorly documented. Four Glomeraceae and three Gigasporaceae were cultured monoxenically. Anastomosis formation was asses

  14. successful endoscopic dilatation of a stenosis in relation to an ileorectal anastomosis by acute ileus

    DEFF Research Database (Denmark)

    Kjærgaard, Jane Christensen; Hendel, Jakob; Gügenur, Ismail

    2014-01-01

    Endoscopic dilatation is a treatment option for patients with Crohns disease suffering from stenosis in relation to an ileorectal anastomosis. We present a case of a patient with Crohns disease who was admitted with acute obstructive symptoms due to a stensosis of the ileorectal anastomosis...

  15. Mucosectomy and stapled pouch-anal anastomosis in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, S

    2012-01-01

    In familial adenomatous polyposis, a restorative proctocolectomy with an ileo-anal pouch may be performed either with a mucosectomy and a hand-sewn anastomosis or as a stapled anastomosis without a mucosectomy. The disadvantage of the former is suboptimal bowel function and the disadvantage...

  16. Microvascular anastomosis using fibrin glue and venous cuff in rat carotid artery.

    Science.gov (United States)

    Sacak, Bulent; Tosun, Ugur; Egemen, Onur; Sakiz, Damlanur; Ugurlu, Kemal

    2015-04-01

    Conventional anastomosis with interrupted sutures can be time-consuming, can cause vessel narrowing, and can lead to thrombosis at the site of repair. The amount of suture material inside the lumen can impair the endothelium of the vessel, triggering thrombosis. In microsurgery, fibrin sealants have the potential beneficial effects of reducing anastomosis time and promoting accurate haemostasis at the anastomotic site. However, there has been a general reluctance to use fibrin glue for microvascular anastomoses because the fibrin polymer is highly thrombogenic and may not provide adequate strength. To overcome these problems, a novel technique was defined for microvascular anastomosis with fibrin glue and a venous cuff. Sixty-four rats in two groups are included in the study. In the experimental group (n = 32), end-to-end arterial anastomosis was performed with two stay sutures, fibrin glue, and a venous cuff. In the control group (n = 32), conventional end-to-end arterial anastomosis was performed. Fibrin glue assisted anastomosis with a venous cuff took less time, caused less bleeding at the anastomotic site, and achieved a patency rate comparable to that provided by the conventional technique. Fibrin sealant assisted microvascular anastomosis with venous cuff is a rapid, easy, and reliable technique compared to the end-to-end arterial anastomosis.

  17. Magnetic compression anastomosis for treatment of benign biliary stricture.

    Science.gov (United States)

    Jang, Sung Ill; Choi, Jungran; Lee, Dong Ki

    2015-01-01

    Endoscopic and percutaneous procedures have shown high success rates when used to treat benign biliary stricture. However, cases in which a guidewire cannot be passed through a refractory stricture or a complete obstruction are difficult to treat using conventional methods. Magnetic compression anastomosis (MCA) has emerged as a non-surgical alternative avoiding operational mortality and morbidity. The feasibility and safety of MCA have been experimentally and clinically verified in cases of biliobiliary and bilioenteric anastomosis. However, no pre-MCA assessment modality capable of predicting outcomes is as yet available, and no universally effective magnet delivery method has as yet been established, rendering it difficult to identify patients for whom MCA is appropriate. Various experimental studies seeking to overcome these limitations are underway. Such work will improve our in-depth understanding of MCA, which has been trialed in various fields. Upon further development, MCA may become a ground-breaking option for treatment of benign strictures that are difficult to resolve using conventional methods, and MCA may be expected to be minimally traumatic and highly effective. The aim of the present study was to discuss the current status of MCA and the direction of MCA development by reviewing clinical and experimental MCA data.

  18. Compatibility and incompatibility in hyphal anastomosis of arbuscular mycorrhizal fungi

    Directory of Open Access Journals (Sweden)

    Candido Barreto de Novais

    Full Text Available ABSTRACT: Arbuscular mycorrhizal fungi (AMF, which live in symbiosis with 80 % of plants, are not able to grow when separated from their hosts. Spore germination is not host-regulated and germling growth is shortly arrested in the absence of host roots. Germling survival chances may be increased by hyphal fusions (anastomoses, which allow access to nutrients flowing in the extraradical mycelium (ERM. Perfect anastomoses, occurring with high frequency among germlings and the ERM of the same isolate, show protoplasm continuity and disappearance of hyphal walls. A low frequency of perfect fusions has been detected among co-specific genetically different isolates, although fungal nuclei have been consistently detected in all perfect fusions, suggesting active nuclear migration. When plants of different taxa establish symbioses with the same AMF species, anastomoses between ERM spreading from single root systems establish a common mycelium, which is an essential element to plant nutrition and communication. The interaction among mycelia produced by different isolates may also lead to pre-fusion incompatibility which hinders anastomosis formation, or to incompatibility after fusion, which separates the hyphal compartments. Results reported here, obtained by analyses of hyphal compatibility/incompatibility in AMF, suggest that anastomosis formation and establishment of protoplasm flow, fundamental to the maintenance of mycelial physiological and genetic continuity, may affect the fitness of these ecologically important biotrophic fungi.

  19. Caudal shif ting of hepatic vein anastomosis inright liver living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Sheung Tat Fan

    2008-01-01

    BACKGROUND: In right liver living donor liver trans-plantation, hepatic venous anastomosis is performed using the recipient's right hepatic vein oriifce. There may be situations that the portal vein is short or the right liver graft is small, leading to dififculty in portal vein, hepatic artery or duct-to-duct anastomosis. METHODS: The recipient's right hepatic vein oriifce is closed partially for 2 cm at the cranial end or totally, and a new venotomy is made caudal to the right hepatic vein oriifce. Hepatic vein anastomosis is performed with the new venotomy. RESULTS: The distance between the liver graft hilum and hepatoduodenal ligament is reduced. Portal vein, hepatic artery and biliary anastomosis could be performed without tension or conduit. CONCLUSION: Caudal shifting of hepatic vein anasto-mosis facilitates implantation of a right liver living donor graft.

  20. Application of Parachute Anastomosis in Cholangio-Intestinal Anastomosis%降落伞式缝合在肠道吻合术中的应用

    Institute of Scientific and Technical Information of China (English)

    韩家发; 郭鹏; 卢芳; 马炼平; 黄亚梅

    2011-01-01

    目的:通过胆肠吻合缝合技术的改进,减少并发症的发生.方法:对52例肠道吻合手术采用降落伞式缝合.结果:降落伞式胆肠吻合时间平均20 min,明显缩短了手术时间,全部病例均未出现胆肠吻合漏,无死亡病例.结论:降落伞式胆肠吻合米具有操作简便、省时、并发症少等特点.%Objective: To improve the cholangio-intestinal anastomosis technique,so as to decrease complications. Methods: Fifty-two cholangio-intestinal anastomosis cases were performed by parachute anastomosis continue suture. Results: The average time of the parachute cholangio-intestinal anastomosis was 20 minutes, the operational time was shortened obviously, and there was no bile leakage in all eases, no death happened. Conclusions: The parachute cholangio-intestinal anastomosis has the advantages of easy to operate, saving time and less complications, thus it is an effective improvement of cholangio-intestinal anastomosis.

  1. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Licia Pacheco; Nepomuceno, Lara A.M.; Coimbra, Pablo Picasso; Oliveira Neto, Sabino Rodrigues de [Hospital Geral de Fortaleza (HGF), CE (Brazil). Radiology Dept.], e-mail: licia_p@hotmail.com; Natal, Marcelo Ricardo C. [Hospital de Base do Distrito Federal, Brasilia, DF (Brazil)

    2009-09-15

    The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms. (author)

  2. [Persistent diarrhea

    Science.gov (United States)

    Andrade, J A; Moreira, C; Fagundes Neto, U

    2000-07-01

    INTRODUCTION: Persistent diarrhea has high impact on infantile morbidity and mortality rates in developing countries. Several studies have shown that 3 to 20% of acute diarrheal episodes in children under 5 years of age become persistent. DEFINITION: Persistent diarrhea is defined as an episode that lasts more than 14 days. ETIOLOGY: The most important agents isolated in persistent diarrhea are: Enteropathogenic E. coli (EPEC), Salmonella, Enteroaggregative E. coli (EAEC), Klebisiella and Cryptosporidium. CLINICAL ASPECTS: In general, the clinical characteristics of patients with persistent diarrhea do not change with the pathogenic agent. Persistent diarrhea seems to represent the final result of a several insults a infant suffers that predisposes to a more severe episode of diarrhea due to a combination of host factors and high rates of enviromental contamination. Therefore, efforts should be made to promptly treat all episodes of diarrhea with apropriate follow-up. THERAPY: The aim of the treatment is to restore hydroelectrolytic deficits and to replace losses until the diarrheal ceases. It is possible in the majority of the cases, using oral rehydration therapy and erly an appropriate type of diet. PREVENTION: It is imperative that management strategies also focus on preventive aspects. The most effective diarrheal prevention strategy in young infants worldwide is promotion of exclusive breast feeding.

  3. The Complete Genome of a New Betabaculovirus from Clostera anastomosis.

    Science.gov (United States)

    Yin, Feifei; Zhu, Zheng; Liu, Xiaoping; Hou, Dianhai; Wang, Jun; Zhang, Lei; Wang, Manli; Kou, Zheng; Wang, Hualin; Deng, Fei; Hu, Zhihong

    2015-01-01

    Clostera anastomosis (Lepidoptera: Notodontidae) is a defoliating forest insect pest. Clostera anastomosis granulovirus-B (ClasGV-B) belonging to the genus Betabaculovirus of family Baculoviridae has been used for biological control of the pest. Here we reported the full genome sequence of ClasGV-B and compared it to other previously sequenced baculoviruses. The circular double-stranded DNA genome is 107,439 bp in length, with a G+C content of 37.8% and contains 123 open reading frames (ORFs) representing 93% of the genome. ClasGV-B contains 37 baculovirus core genes, 25 lepidopteran baculovirus specific genes, 19 betabaculovirus specific genes, 39 other genes with homologues to baculoviruses and 3 ORFs unique to ClasGV-B. Hrs appear to be absent from the ClasGV-B genome, however, two non-hr repeats were found. Phylogenetic tree based on 37 core genes from 73 baculovirus genomes placed ClasGV-B in the clade b of betabaculoviruses and was most closely related to Erinnyis ello GV (ErelGV). The gene arrangement of ClasGV-B also shared the strongest collinearity with ErelGV but differed from Clostera anachoreta GV (ClanGV), Clostera anastomosis GV-A (ClasGV-A, previously also called CaLGV) and Epinotia aporema GV (EpapGV) with a 20 kb inversion. ClasGV-B genome contains three copies of polyhedron envelope protein gene (pep) and phylogenetic tree divides the PEPs of betabaculoviruses into three major clades: PEP-1, PEP-2 and PEP/P10. ClasGV-B also contains three homologues of P10 which all harbor an N-terminal coiled-coil domain and a C-terminal basic sequence. ClasGV-B encodes three fibroblast growth factor (FGF) homologues which are conserved in all sequenced betabaculoviruses. Phylogenetic analysis placed these three FGFs into different groups and suggested that the FGFs were evolved at the early stage of the betabaculovirus expansion. ClasGV-B is different from previously reported ClasGV-A and ClanGV isolated from Notodontidae in sequence and gene arrangement

  4. The Complete Genome of a New Betabaculovirus from Clostera anastomosis.

    Directory of Open Access Journals (Sweden)

    Feifei Yin

    Full Text Available Clostera anastomosis (Lepidoptera: Notodontidae is a defoliating forest insect pest. Clostera anastomosis granulovirus-B (ClasGV-B belonging to the genus Betabaculovirus of family Baculoviridae has been used for biological control of the pest. Here we reported the full genome sequence of ClasGV-B and compared it to other previously sequenced baculoviruses. The circular double-stranded DNA genome is 107,439 bp in length, with a G+C content of 37.8% and contains 123 open reading frames (ORFs representing 93% of the genome. ClasGV-B contains 37 baculovirus core genes, 25 lepidopteran baculovirus specific genes, 19 betabaculovirus specific genes, 39 other genes with homologues to baculoviruses and 3 ORFs unique to ClasGV-B. Hrs appear to be absent from the ClasGV-B genome, however, two non-hr repeats were found. Phylogenetic tree based on 37 core genes from 73 baculovirus genomes placed ClasGV-B in the clade b of betabaculoviruses and was most closely related to Erinnyis ello GV (ErelGV. The gene arrangement of ClasGV-B also shared the strongest collinearity with ErelGV but differed from Clostera anachoreta GV (ClanGV, Clostera anastomosis GV-A (ClasGV-A, previously also called CaLGV and Epinotia aporema GV (EpapGV with a 20 kb inversion. ClasGV-B genome contains three copies of polyhedron envelope protein gene (pep and phylogenetic tree divides the PEPs of betabaculoviruses into three major clades: PEP-1, PEP-2 and PEP/P10. ClasGV-B also contains three homologues of P10 which all harbor an N-terminal coiled-coil domain and a C-terminal basic sequence. ClasGV-B encodes three fibroblast growth factor (FGF homologues which are conserved in all sequenced betabaculoviruses. Phylogenetic analysis placed these three FGFs into different groups and suggested that the FGFs were evolved at the early stage of the betabaculovirus expansion. ClasGV-B is different from previously reported ClasGV-A and ClanGV isolated from Notodontidae in sequence and gene

  5. [Results of using composite bypass grafts with infragenicular distal anastomosis].

    Science.gov (United States)

    Pokrovskiĭ, A V; Iakhontov, D I

    2014-01-01

    The authors share herein their experience with composite bypass grafts and PTFE synthetic prostheses used for treatment of obliterating diseases of the infrainguinal-segment arteries. The data of the study were based on the outcomes obtained in 92 patients. The authors assessed the condition of the outflow pathways and their effect on patency of composite bypass grafts in the immediate and remote postoperative periods, followed by comparative analysis of the short- and long-term therapeutic outcomes after using composite bypass grafts and PTFE synthetic prostheses in the infragenicular position for femoropopliteal and femorotibial reconstructions, also assessing the effect of the localization of the distal anastomosis on the immediate and remote therapeutic outcomes. Based on the obtained findings it was determined that the immediate results of patency depended upon the state of the outflow pathways and localization of the distal anastomosis. Thus, by the 1st, 3rd and 5th year of follow up patency of transplants in patients with the runoff score less than 7.0 amounted to 78.3, 21.7 and 4.3%, respectively. Analogous indices of patency in patients with the runoff score equalling or greater than 7.0 amounted to 60.7 and 3.6% for the 1st and 3rd year, respectively. The remote results of patency turned out to depend on the type of a vascular transplant and the state of the outflow pathways and did not depend on the localization of the distal anastomosis. Thus, the remote results of patency for the composite bypass graft for the 1st, 3rd and 5th year of follow up amounted to 74.5, 19.6 and 5.9%, respectively, versus 60.8 and 8.6% by the first and third year for the PTFE prosthesis. The limb salvage rate at the same terms for the composite bypass graft amounted to 94.1, 84.3 and 78.4% versus 73.9, 56.5 and 52.2% for the PTFE prosthesis.

  6. Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent.

    Science.gov (United States)

    Saegusa, Noriko; Sarukawa, Shunji; Ohta, Kunihiro; Takamatsu, Kensuke; Watanabe, Mitsuhiro; Sugino, Takashi; Nakagawa, Masahiro; Akiyama, Yasuto; Kusuhara, Masatoshi; Kishi, Kazuo; Inoue, Keita

    2017-01-01

    Vascular anastomosis is the highlight of cardiovascular, transplant, and reconstructive surgery, which has long been performed by hand using a needle and suture. However, anastomotic thrombosis occurs in approximately 0.5-10% of cases, which can cause serious complications. To improve the surgical outcomes, attempts to develop devices for vascular anastomosis have been made, but they have had limitations in handling, cost, patency rate, and strength at the anastomotic site. Recently, indwelling metal stents have been greatly improved with precise laser metalwork through programming technology. In the present study, we designed a bare metal stent, Microstent, that was constructed by laser machining of a shape-memory alloy, NiTi. An end-to-end microvascular anastomosis was performed in SD rats by placing the Microstent at the anastomotic site and gluing the junction. The operation time for the anastomosis was significantly shortened using Microstent. Thrombus formation, patency rate, and blood vessel strength in the Microstent anastomosis were superior or comparable to hand-sewn anastomosis. The results demonstrated the safety and effectiveness, as well as the operability, of the new method, suggesting its great benefit for surgeons by simplifying the technique for microvascular anastomosis.

  7. Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography.

    Science.gov (United States)

    Funaki, Takeshi; Takahashi, Jun C; Yoshida, Kazumichi; Takagi, Yasushi; Fushimi, Yasutaka; Kikuchi, Takayuki; Mineharu, Yohei; Okada, Tomohisa; Morimoto, Takaaki; Miyamoto, Susumu

    2016-06-01

    OBJECT The authors' aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage. METHODS This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses. RESULTS Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κw = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p anastomosis score (p anastomosis detected with MR angiography can be scored with good intra- and interrater reliability and is associated with hemorrhagic presentation at onset in moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.

  8. FE Analysis of Nitinol Leaf Springs Used in a Compression Anastomosis Device

    Science.gov (United States)

    Weizman, Amir; Monassevitch, Leonid; Greenberg, Kobby; Millis, Shahar; Harari, Boaz; Dar, Idan

    2011-07-01

    Reconstruction of the digestive system lumen patency (anastomosis creation) after its partial surgical removal is a common and crucial procedure. The conventional anastomosis methods use devices for mechanical suturing which are associated with high failure risk and can lead to major complications. The compression anastomosis as a sutureless method seems to be a promising alternative. However, attempts during the last two centuries have not been completely successful due to the complex character of the tissue-healing process. The specific mechanical behavior of Nitinol alloys was applied to the force element of the compression devices. These devices are becoming more widely adopted in surgery practice. The compression anastomosis device enables the anastomosis of colonic and intestinal tissue based on compression forces exerted by Nitinol leaf springs. By means of changing the strain distribution in the stressed leaves with varying moments of inertia, one can gain full control of the different stages in the force-deflection profile (i.e., linear elastic stage and the force plateau stage). The target of this study is the comparison of different Nitinol leaf geometries and evaluation of the finite elements analysis as a tool for preliminary design of such geometries. The results of this analysis allow us to establish regulation of the spring's mechanical behavior, thus controlling the anastomosis creation in the compression anastomosis device.

  9. Total mechanical stapled oesophagogastric anastomosis on the neck in oesophageal cancer - prevention of postoperative mediastinal complications.

    Science.gov (United States)

    Zieliński, Jacek; Jaworski, Radosław; Irga-Jaworska, Ninela; Haponiuk, Ireneusz; Jaśkiewicz, Janusz

    2015-12-01

    Oesophagogastric anastomosis after oesophagus resection is commonly performed on the neck. Even though a few different techniques of oesophagogastric anastomosis have been previously detailed, both manual and mechanical procedures have been burdened with leakages and strictures. Our simple technique of oesophagogastric anastomosis is a modification of mechanical anastomosis with the use of a circular stapler in order to prevent postoperative leak and concomitant mediastinal complications. Since 2008, we have performed nine oesophagogastric anastomoses following oesophagus resection. The mean age of the operated patients was 54 years. There was no mortality among the operated patients in the early post-operative period. The mean follow-up period for the patients operated on in our department was 17 months until the time of the analysis. None of the patients showed any leakage or stricture, and no mediastinal complications were reported in the group. Following our own experience, mechanical anastomosis with the use of a circular stapler seems to decrease the time of the operation as well as significantly reducing the incidence of leakages from the anastomosis. This type of anastomosis may decrease the number of postoperative strictures and the most dangerous mediastinal infections.

  10. Comprehensive Analysis of Chicken Vessels as Microvascular Anastomosis Training Model

    Science.gov (United States)

    Kang, Bo Young; Jeon, Byung-Joon; Lee, Kyeong-Tae

    2017-01-01

    Background Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. Methods Eight vessels—the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery—were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. Results The EDs of the vessels varied. The ischiatic vein had the largest ED of 2.69±0.33 mm, followed by the basilic vein (1.88±0.36 mm), ischiatic artery (1.68±0.24 mm), common dorsal metatarsal artery (1.23±0.23 mm), cranial tibial artery (1.18±0.19 mm), brachial artery (1.08±0.15 mm), ulnar artery (0.82±0.13 mm), and radial artery (0.56±0.12 mm), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from 74.09±19.91 µm to 158.66±40.25 µm (adventitia) and from 31.2±7.13 µm to 154.15±46.48 µm (media), respectively. Mean dissection time was <3 minutes for all vessels. Conclusions Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness. PMID:28194342

  11. Myofibroblasts and colonic anastomosis healing in Wistar rats

    Directory of Open Access Journals (Sweden)

    Vasiliadou Kalliopi

    2011-03-01

    Full Text Available Abstract Background The myofibroblasts play a central role in wound healing throughout the body. The process of wound healing in the colon was evaluated with emphasis on the role of myofibroblasts. Methods One hundred male Wistar rats weighing 274 ± 9.1 g (mean age: 3.5 months were used. A left colonic segment was transected and the colon was re-anastomosed. Animals were randomly divided into two groups. The first group experimental animals (n = 50 were sacrificed on postoperative day 3, while the second group rats (n = 50 were sacrificed on postoperative day 7. Healing of colonic anastomosis was studied in terms of anastomotic bursting pressure, as well as myofibroblastic reaction and expression of α-smooth muscle actin (α-SMA, adhesion formation, inflammatory reaction and neovascularization. Results The mean anastomotic bursting pressure increased from 20.6 ± 3.5 mmHg on the 3rd postoperative day to 148.8 ± 9.6 Hg on the 7th postoperative day. Adhesion formation was increased on the 7th day, as compared to the 3rd day. In addition, the myofibroblastic reaction was more profound on the 7th postoperative day in comparison with the 3rd postoperative day. The staining intensity for α-SMA was progressive from the 3rd to the 7th postoperative day. On the 7th day the α-SMA staining in the myofibroblats reached the level of muscular layer cells. Conclusions Our study emphasizes the pivotal role of myofibroblasts in the process of colonic anastomosis healing. The findings provide an explanation for the reduction in the incidence of wound dehiscence after the 7th postoperative day.

  12. Usefulness of continuous suture using short-thread double-armed micro-suture for cerebral vascular anastomosis

    Directory of Open Access Journals (Sweden)

    Sei Haga

    2014-01-01

    Full Text Available Background: When microvascular anastomosis is performed in a deep, narrow operating field, securing space to throw knots is difficult. To simplify the procedure and avoid obstruction of the anastomosis, we use a continuous suturing with short-thread double-armed micro-suture. Methods: Sixty-four patients (38 cerebral revasculazation, 16 moyamoya disease, and 10 aneurysm surgery undergoing microvaucular anastomosis were included. During anastomosis, a continuous suture was placed with short-thread double-armed micro-suture. Results: During 64 microanastomosis procedures, 64 consecutive continuous sutures were performed with 1-year follow up. All patients showed patency of anastomosis with long-term follow up. Conclusions: This technique is especially useful for anastomosis in a deep, narrow surgical field, such as in superior cerebellar artery anastomosis.

  13. Rescue revision techniques for end-to-side anastomosis: Technical note.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Tsutsumi, Keiji; Hasegawa, Takatoshi; Hongo, Kazuhiro

    2014-01-01

    Extracranial-intracranial bypass operation is an essential procedure for cerebrovascular surgeons. Proper procedure of the bypass requires special skills, selected instruments, and training in the microsurgical laboratory. In spite of the high success rate for extracranial-intracranial bypass, a potential pitfall while performing an end-to-side anastomosis is poor blood flow or occlusion at the anastomotic site during surgery. If this happens, revision procedure is necessary. We introduce our salvage techniques for anastomosis revision with or without recipient artery occlusion. With this method, ischemic complication related to revision procedure minimizes ischemic complications. The present technique is a simple method for anastomosis revision.

  14. Effects of sodium hypochlorite and ozone on healing of intestinal anastomosis in simulated strangulation colorectal obstruction.

    Science.gov (United States)

    Lelyanov, A D; Sergienko, V I; Ivliev, N V; Emel'yanov, V V; Guseva, E D

    2004-01-01

    Strangulation colorectal obstruction was modeled in 60 Wistar rats. Necrotic segment of the intestine was resected under conditions of peritonitis and end-to-end intestinal anastomosis was performed on a PCV catheter conducted through the anus. Sodium hypochlorite and ozone solution were used for sanitation of the abdominal cavity and intestinal lavage, and the intestinal anastomosis was coated with Ozonide (ozonized oil). The use of physicochemical methods notably reduced the incidence of postoperative pyoinflammatory complications, incompetence of intestinal anastomosis sutures, and animal mortality.

  15. Persistent Modelling

    DEFF Research Database (Denmark)

    2012-01-01

    The relationship between representation and the represented is examined here through the notion of persistent modelling. This notion is not novel to the activity of architectural design if it is considered as describing a continued active and iterative engagement with design concerns – an evident...... characteristic of architectural practice. But the persistence in persistent modelling can also be understood to apply in other ways, reflecting and anticipating extended roles for representation. This book identifies three principle areas in which these extensions are becoming apparent within contemporary....... It also provides critical insight into the use of contemporary modelling tools and methods, together with an examination of the implications their use has within the territories of architectural design, realisation and experience....

  16. The German law ''KonTraG'' is not sufficient for the energy trading. The importance of the so-called soft factors in successful risk management; Das KonTraG genuegt nicht im Energiehandel. Die Bedeutung der weichen Faktoren im erfolgreichen Risikomanagement

    Energy Technology Data Exchange (ETDEWEB)

    Jaden, E.

    2000-03-20

    The following article deals with the wholescale trading of energy. The energy market in Central Europe is under development with respect to liquidity, transparency, variety of products and standardisation of contracts. It is true that especially the big energy providers have prepared the organisations by way of significant input of own and consulting capacities to match the new German legal requirements for a sufficient risk management, but the long term success of trading in volatile markets will mainly depend on the so-called soft factors such as strategy, attitude in leadership and communication, personnel policy and most important of all the way how to manage price risk positions day by day. These soft factors can very hardly be implemented and controlled by any law, consulting or auditing. (orig.) [German] Der Verfasser eroertert den Engergie-Grosshandel. Hier ist der Markt zur Zeit in Mitteleuropa in Bezug auf Liquiditaet, Transparenz, Produktvielfalt und Standardisierung in der Entwicklungsphase. Zwar haben sich insbesondere die grossen Energiegesellschaften mit viel Eigen- und Beratungsaufwand auf die Erfuellung der neuen gesetzlichen Risikomanagement-Anforderungen vorbereitet, aber beim Handel in volatilen Maerkten sind besonders die durch Gesetz, Beratung und Wirtschaftspruefung schwer in den Griff zu bekommenden so genannten weichen Faktoren wie Strategie, Fuehrungs- und Kommunikationsverhalten, Personalpolitik und als wichtigstes das Preisrisiko-Steuerungsverhalten fuer den langfristigen Erfolg massgebend. (orig.)

  17. Habit persistence

    DEFF Research Database (Denmark)

    Vinther Møller, Stig

    2009-01-01

    This paper uses an iterated GMM approach to estimate and test the consumption based habit persistence model of Campbell and Cochrane (1999) on the US stock market. The empirical evidence shows that the model is able to explain the size premium, but fails to explain the value premium. Further...

  18. Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent

    National Research Council Canada - National Science Library

    Noriko Saegusa; Shunji Sarukawa; Kunihiro Ohta; Kensuke Takamatsu; Mitsuhiro Watanabe; Takashi Sugino; Masahiro Nakagawa; Yasuto Akiyama; Masatoshi Kusuhara; Kazuo Kishi; Keita Inoue

    2017-01-01

    .... To improve the surgical outcomes, attempts to develop devices for vascular anastomosis have been made, but they have had limitations in handling, cost, patency rate, and strength at the anastomotic site...

  19. Endoscopic microwave coagulation therapy of postoperative hemorrhage from a stapled anastomosis.

    Science.gov (United States)

    Umano, Yasukazu; Horiuchi, Tetsuya; Inoue, Masaya; Shono, Yoshiharu; Oku, Yoshimasa; Tanishima, Hiroyuki; Tsuji, Takeshi; Tabuse, Katsuyoshi

    2005-01-01

    We experienced three cases of postoperative hemorrhage from a stapled gastrointestinal anastomosis, and established endoscopic microwave coagulation therapy (EMCT) with a cylinder-type electrode. We were able to treat postoperative hemorrhage over the entire circumference of stapled anastomosis successfully. Two patients had undergone a lower third thoracic esophagogastrectomy through a left thoraco-abdominal approach for gastric cancer in the cardia, while the other case had undergone Billroth I gastrectomy. They each had fresh bleeding from the stapled anastomosis after the operation. Emergency endoscopic examination was immediately performed. Endoscopy revealed bleeding on the suture line. We performed hemostasis endoscopically with microwave coagulation therapy safely. They were discharged from the hospital without complications such as leakage and stenosis. Since EMCT with the cylinder-type electrode can coagulate shallowly and widely, it is very effective for hemorrhage from a stapled anastomosis.

  20. [Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer].

    Science.gov (United States)

    Celis, J; Ruiz, E; Berrospi, F; Payet, E

    2001-01-01

    To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures. We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplásicas (Lima-Peru) from 1986 to 1999. In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis. There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.

  1. Healing of Stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

    Institute of Scientific and Technical Information of China (English)

    Jian-hui Li; Long Guo; Wei-jie Yao; Zhi-yong Zhang; Shan-pei Wang; Shi-qi Liu; Zhi-min Geng; Xiao-ping Song; Yi Lv

    2014-01-01

    Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs (n=32). Magnetic anastomosis (group A, n=16) and traditional suture anastomosis (group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30th postoperative day, and the other half on the 90th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate (50%versus 0%on the 30th postoperative day, 37.5%versus 12.5%on the 90th postoperative day, both P Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

  2. CROSSING ANASTOMOSIS OF NERVE BUNDLES NEAR INNERVATED ORGANS TO TREAT IRREPARABLE NERVE INJURIES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To study the therapeutical effects of crossing anastomosis of nerve on the peripheral and central nerve injuries.Methods Twelve kinds of central and peripheral nerve disorders and their complications were treated with 11 kinds of crossing anastomosis of nerve bundles near the innervated organs. After nerve injury and repair, somatosensory evoked potentials (SEPs) and horseradish peroxidase (HRP) retrograde tracing studies were used to investigate the rabbit's nerve function and morphology.Results The ulcers of all patients healed. Sensation, voluntary movement, and joint function recovered. Four weeks after the anastomosis of distal stump of radialis superficialis nerve and median nerve, pain sensation regained and SEPs appeared. HRP retrograde tracing studies demonstrated sensory nerve ending of medial nerve formed new connection with the body of neuron.Conclusion Crossing anastomosis of nerve is an effective method to treat peripheral and central nerve injuries.

  3. [Central arteriovenous anastomosis: the solution for patients with treatment-resistant hypertension?

    NARCIS (Netherlands)

    Spiering, W.; de Leeuw, P. W.

    2015-01-01

    New non-pharmacological therapies for the treatment of resistant hypertension, such as baroreflex stimulation, renal denervation and barostenting, have recently been introduced. The latest development is lowering blood pressure by creating an arteriovenous anastomosis between the common iliac vein

  4. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis

    NARCIS (Netherlands)

    Ali, Usama Ahmed; Keus, Frederik; Heikens, Joost T.; Bemelman, Willem A.; Berdah, Stephane V.; Gooszen, H. G.; van Laarhoven, Cees J. H. M.

    2009-01-01

    Background Restorative proctocolectomy with ileo pouch anal anastomosis (IPAA) is the main surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). With the advancements of minimal-invasive surgery this demanding operation is increasingly being performed

  5. Surgery for aortic aneurysms: how to reduce tension on the anastomosis.

    Science.gov (United States)

    Spinelli, Francesco; Benedetto, Filippo; Spinelli, Domenico; Stilo, Francesco; Lentini, Salvatore

    2012-12-01

    We describe a simple technique we use in our institution during surgery for aortic aneurysms to reduce tension on the anastomosis when there is a discrepancy between the remnant portion of the native aorta and the vascular prosthesis.

  6. J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis

    DEFF Research Database (Denmark)

    Wewer, Vibeke; Hesselfeldt, Peter; Qvist, Niels;

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents

  7. Colectomy and ileorectal anastomosis is still an option for selected patients with familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Bulow, C.; Vasen, H.;

    2008-01-01

    PURPOSE: The risk of rectal cancer after colectomy and ileorectal anastomosis may be reduced in the last decades, as patients with severe polyposis now have an ileoanal pouch. We have reevaluated the risk of rectal cancer and proctectomy for all causes according to the year of operation. METHODS......: On the basis of the year of operation in 776 patients with ileorectal anastomosis and 471 pouch patients in Denmark, Finland, Holland, and Sweden, the "pouch period" was defined to start in 1990. Ileorectal anastomosis follow-up data was captured by May 31, 2006. The cumulative risk of rectal cancer.......17) changed. However, in females the cumulative risk of rectal cancer (p = 0.04) and of proctectomy (p = 0.03) were lower in the pouch period. CONCLUSIONS: Since the introduction of the ileoanal pouch rectal cancer has decreased after ileorectal anastomosis, but only statistically significant in females...

  8. Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis

    OpenAIRE

    2010-01-01

    Aims :A prospective clinical audit of all patients undergoing laparoscopic surgery with the intention of primary colonic left-sided intracorporeal stapled anastomosis to identify the rate of anastomotic leaks on an intention to treat basis with or without defunctioning stoma. Materials and Methods : All patients undergoing laparoscopic colorectal surgery resulting in left-sided stapled anastomosis were included with no selection criteria applied. All operations were conducted by the same sur...

  9. Bovine Pericardium Patch Wrapping Intestinal Anastomosis Improves Healing Process and Prevents Leakage in a Pig Model

    Science.gov (United States)

    Testini, Mario; Gurrado, Angela; Portincasa, Piero; Scacco, Salvatore; Marzullo, Andrea; Piccinni, Giuseppe; Lissidini, Germana; Greco, Luigi; De Salvia, Maria Antonietta; Bonfrate, Leonilde; Debellis, Lucantonio; Sardaro, Nicola; Staffieri, Francesco; Carratù, Maria Rosaria; Crovace, Antonio

    2014-01-01

    Failure of intestinal anastomosis is a major complication following abdominal surgery. Biological materials have been introduced as reinforcement of abdominal wall hernia in contaminated setting. An innovative application of biological patch is its use as reinforcement of gastrointestinal anastomosis. The aim of study was to verify whether the bovine pericardium patch improves the healing of anastomosis, when in vivo wrapping the suture line of pig intestinal anastomosis, avoiding leakage in the event of deliberately incomplete suture. Forty-three pigs were randomly divided: Group 1 (control, n = 14): hand-sewn ileo-ileal and colo-colic anastomosis; Group 2 (n = 14): standard anastomosis wrapped by pericardium bovine patch; Group 3 (n = 1) and 4 (n = 14): one suture was deliberately incomplete and also wrapped by patch in the last one. Intraoperative evaluation, histological, biochemical, tensiometric and electrophysiological studies of intestinal specimens were performed at 48 h, 7 and 90 days after. In groups 2 and 4, no leak, stenosis, abscess, peritonitis, mesh displacement or shrinkage were found and adhesion rate decreased compared to control. Biochemical studies showed mitochondrial function improvement in colic wrapped anastomosis. Tensiometric evaluations suggested that the patch preserves the colic contractility similar to the controls. Electrophysiological results demonstrated that the patch also improves the mucosal function restoring almost normal transport properties. Use of pericardium bovine patch as reinforcement of intestinal anastomosis is safe and effective, significantly improving the healing process. Data of prevention of acute peritonitis and leakage in cases of iatrogenic perforation of anastomoses, covered with patch, is unpublished. PMID:24489752

  10. Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation

    Institute of Scientific and Technical Information of China (English)

    Gabriele; Curcio; Marco; Spada; Fabrizio; di; Francesco; Ilaria; Tarantino; Luca; Barresi; Gaetano; Burgio; Mario; Traina

    2010-01-01

    Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife...

  11. Early experience of the compression anastomosis ring (CARTM 27) in left-sided colon resection

    Institute of Scientific and Technical Information of China (English)

    Jung-Yeon Lee; Jin-Hee Woo; Hong-Jo Choi; Ki-Jae Park; Young-Hoon Roh; Ki-Han Kim; Hak-Yoon Lee

    2011-01-01

    AIM: To evaluate clinical validity of the compression anastomosis ring (CAR(tm) 27) anastomosis in left-sided colonic resection. METHODS: A non-randomized prospective data col-lection was performed for patients undergoing an elective left-sided colon resection, followed by an anastomosis using the CAR(tm) 27 between November 2009 and January 2011. Eligibility criteria of the use of the CAR(tm) 27 were anastomoses between the colon and at or above the intraperitoneal rectum. The pri-mary short-term clinical endpoint, rate of anastomotic leakage, and other clinical outcomes, including intra- and postoperative complications, length of operation time and hospital stay, and the ring elimination time were evaluated.RESULTS: A total of 79 patients (male, 43; median age, 64 years) underwent an elective left-sided co-lon resection, followed by an anastomosis using the CAR(tm) 27. Colectomy was performed laparoscopically in 70 patients, in whom two patients converted to open procedure (2.9%). There was no surgical mortality. As an intraoperative complication, total disruption of the anastomosis occurred by premature enforced tension on the proximal segment of the anastomosis in one pa-tient. The ring was removed and another new CAR(tm) 27 anastomosis was constructed. One patient with sigmoid colon cancer showed postoperative anastomotic leak-age after 6 d postoperatively and temporary diverting il-eostomy was performed. Exact date of expulsion of the ring could not be recorded because most patients were not aware that the ring had been expelled. No patients manifested clinical symptoms of anastomotic stricture.CONCLUSION: Short-term evaluation of the CAR(tm) 27 anastomosis in elective left colectomy suggested it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.

  12. Middle infrared (wavelength range: 8 μm-14 μm) 2-dimensional spectroscopy (total weight with electrical controller: 1.7 kg, total cost: less than 10,000 USD) so-called hyperspectral camera for unmanned air vehicles like drones

    Science.gov (United States)

    Yamamoto, Naoyuki; Saito, Tsubasa; Ogawa, Satoru; Ishimaru, Ichiro

    2016-05-01

    We developed the palm size (optical unit: 73[mm]×102[mm]×66[mm]) and light weight (total weight with electrical controller: 1.7[kg]) middle infrared (wavelength range: 8[μm]-14[μm]) 2-dimensional spectroscopy for UAV (Unmanned Air Vehicle) like drone. And we successfully demonstrated the flights with the developed hyperspectral camera mounted on the multi-copter so-called drone in 15/Sep./2015 at Kagawa prefecture in Japan. We had proposed 2 dimensional imaging type Fourier spectroscopy that was the near-common path temporal phase-shift interferometer. We install the variable phase shifter onto optical Fourier transform plane of infinity corrected imaging optical systems. The variable phase shifter was configured with a movable mirror and a fixed mirror. The movable mirror was actuated by the impact drive piezo-electric device (stroke: 4.5[mm], resolution: 0.01[μm], maker: Technohands Co.,Ltd., type:XDT50-45, price: around 1,000USD). We realized the wavefront division type and near common path interferometry that has strong robustness against mechanical vibrations. Without anti-mechanical vibration systems, the palm-size Fourier spectroscopy was realized. And we were able to utilize the small and low-cost middle infrared camera that was the micro borometer array (un-cooled VOxMicroborometer, pixel array: 336×256, pixel pitch: 17[μm], frame rate 60[Hz], maker: FLIR, type: Quark 336, price: around 5,000USD). And this apparatus was able to be operated by single board computer (Raspberry Pi.). Thus, total cost was less than 10,000 USD. We joined with KAMOME-PJ (Kanagawa Advanced MOdule for Material Evaluation Project) with DRONE FACTORY Corp., KUUSATSU Corp., Fuji Imvac Inc. And we successfully obtained the middle infrared spectroscopic imaging with multi-copter drone.

  13. Portal flow into the liver through veins at the site of biliary-enteric anastomosis.

    Science.gov (United States)

    Hashimoto, M; Heianna, J; Yasuda, K; Tate, E; Watarai, J; Shibata, S; Sato, T; Yamamoto, Y

    2005-07-01

    The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.

  14. Congenital absence of the azygos vein with persistent left superior vena cava: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Young Hee; Yi, Jeong Geun; Song, In Young; Park, Jeong Hee [Dept. of Radiology, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2014-03-15

    Absence of the azygos vein is a very rare variant of venous tributary arrangement which has been reported only in few cases so far. We hereby introduce the chest radiographic and computed tomographic findings of the congenital absence of the azygos vein with bilateral superior vena cava, incidentally detected during a follow-up for rectal cancer. The hemiazygos vein is drained into persistent left superior vena cava via left superior intercostal vein, so called the 'aortic nipple'.

  15. Acute Cholangitis After Bilioenteric Anastomosis for Bile Duct Injuries.

    Science.gov (United States)

    Ortiz-Brizuela, Edgar; Sifuentes-Osornio, José; Manzur-Sandoval, Daniel; Terán-Ellis, Santiago Mier Y; Ponce-de-León, Sergio; Torres-González, Pedro; Mercado, Miguel Ángel

    2017-07-25

    The study aims to describe the clinical features, microbiology, and associated factors of acute cholangitis (AC) after bilioenteric anastomosis (BEA) for biliary duct injury (BDI). Additionally, we assessed the performance of the Tokyo Guidelines 2013 (TG13) recommendations in these patients. We conducted a case-control study of 524 adults with a history of BEA for BDI from January 2000 to January 2014. A propensity score adjustment was performed for the analysis of the independent role of the main factors identified during the univariate logistic regression procedure. We identified 117 episodes of AC in 70 patients; 51.3% were definitive AC according to the TG13 diagnostic criteria, and 39.3% did not fulfill the imaging criteria of AC. A history of post-operative biliary complications (OR 2.55, 95% CI 1.38-4.70) and the bile duct confluence preservation (OR 0.46, 95% CI 0.24-0.87) were associated with AC. Eighty-nine percent of the microorganisms were Enterobacteriaceae; of them, 28% were extended spectrum β-lactamase (ESBL) producers. AC is a common complication after BEA and must be suspected even in the absence of imaging findings, particulary in patients with a history of post-operative biliary complications, and/or without bile duct confluence preserved. An empirical treatment for ESBL-producing Enterobacteriaceae may be appropriate in patients living in countries with a high rate of bacterial drug resistance.

  16. Microsurgical anastomosis of sperm duct by laser tissue soldering

    Science.gov (United States)

    Wehner, Martin M.; Teutu-Kengne, Alain-Fleury; Brkovic, Drasko; Henning, Thomas; Klee, Doris; Poprawe, Reinhart; Jakse, Gerhard

    2005-04-01

    Connection of small vessels is usually done by suturing which is very cumbersome. Laser tissue soldering can circumvent that obstacle if a handy procedure can be defined. Our principle approach consists of a bioresorbable hollow stent with an expected degradation time of 3 weeks in combination with laser soldering. The stent is to be fed into the vessel to stabilize both ends and should allow percolation immediately after joining. The stents are made of Poly(D,L-lactid-co-glycolid) and solder is prepared from bovine serum albumin (BSA) doped with Indocyanine green (ICG) as chromophore to increase the absorption of laser light. After insertion, solder is applied onto the outer surface of the vessel and coagulated by laser radiation. The wavelength of 810 nm of a diode laser fits favorably to absorption properties of tissue and solder such that heating up of tissue is limited to prevent from necrosis and wound healing complications. In our study the preparation of stents, the consistency and doping of solder, a beam delivery instrument and the irradiation conditions are worked out. In-vitro tests are carried out on sperm ducts of Sprague-Dowlae (SD) rats. Different irradiation conditions are investigated and a micro-optical system consisting of a lens and a reflecting prism to ensure simultaneous irradiation of front and back side of the vessels tested. Under these conditions, the short-term rupture strength of laser anastomosis revealed as high as those achieved by suturing.

  17. The effects of ghrelin on colonic anastomosis healing in rats

    Directory of Open Access Journals (Sweden)

    Canan Ceran

    2013-01-01

    Full Text Available OBJECTIVES: In addition to its roles in the stimulation of growth hormone secretion and the regulation of appetite and metabolism, ghrelin exerts immunomodulatory, anti-inflammatory and antioxidant actions in several organ systems. In this study, we investigated the effects of ghrelin on the healing of experimental colonic anastomoses. METHODS: Wistar rats were randomly divided into two groups (n = 10 in each. A segment of colon was excised, and an end-to-end anastomosis was performed in the distal colon. The Ghrelin Group received 10 ng/kg/day IP ghrelin for seven days postoperatively, whereas the Control Group received an identical volume of saline. On the seventh postoperative day, the anastomotic bursting pressures and hydroxyproline levels were measured, and adhesion formation around the anastomoses was examined. Histopathological analyses were performed to evaluate inflammatory cell infiltration, fibroblast infiltration, collagen density and neovascularization. RESULTS: In the Ghrelin Group, the bursting pressure and hydroxyproline levels were significantly higher than in the Control Group. The adhesion formation scores were lower in the Ghrelin Group than in the Control Group. Although the inflammatory cell infiltration was diminished in the Ghrelin Group, the degrees of fibroblast infiltration, collagen density and neovascularization were not significantly different between the groups. CONCLUSION: Our results indicate that ghrelin improves the healing of colonic anastomoses in rats.

  18. Endovascular Treatment of Right Coronary-to-Bronchial Anastomosis with Bronchopulmonary Shunt Presenting as Coronary Steal Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Il Joong; Kim, Dong Hyun; Koh, Young Youp [Chosun University, College of Medicine, Gwangju (Korea, Republic of)

    2010-02-15

    The occurrence of an anastomosis between the coronary artery to the systemic artery is rare. However, the probability of hemodynamic changes sufficient to cause clinical symptoms is extremely low. Anastomosis of the coronary to bronchial artery can cause myocardial ischemia due to the decreased flow to the coronary arteries. The authors report a case of coronary to bronchial artery anastomosis presenting as coronary steal syndrome that was treated with transarterial microcoil embolization instead of surgical ligation.

  19. Validation of numerical simulation with PIV measurements for two anastomosis models.

    Science.gov (United States)

    Zhang, Jun-Mei; Chua, Leok Poh; Ghista, Dhanjoo N; Zhou, Tong-Ming; Tan, Yong Seng

    2008-03-01

    Hemodynamics is widely believed to influence coronary artery bypass graft (CABG) stenosis. Although distal anastomosis has been extensively investigated, further studies on proximal anastomosis are still necessary, as the extent and initiation of the stenosis process may be influenced by the flow of the proximal anastomosis per se. Therefore, in this study, two models (i.e. 90 degrees and 135 degrees anastomotic models) were designed and constructed to simulate a proximal anastomosis of CABG for the left and right coronary arteries, respectively. Flow characteristics for these models were studied experimentally in order to validate the simulation results found earlier. PIV measurements were carried out on two Pyrex glass models, so that the disturbed flow (stagnation point, flow separation and vortex) found in both proximal anastomosis models using numerical simulation, could be verified. Consequently, a fair agreement between numerical and experimental data was observed in terms of flow characteristics, velocity profiles and wall shear stress (WSS) distributions under both steady and pulsatile flow conditions. The discrepancy was postulated to be due to the difference in detailed geometry of the physical and computational models, due to manufacturing limitations. It was not possible to reproduce the exact shape of the computational model when making the Pyrex glass model. The analysis of the hemodynamic parameters based on the numerical simulation study also suggested that the 135 degrees proximal anastomosis model would alleviate the potential of intimal thickening and/or atherosclerosis, more than that of a 90 degrees proximal anastomosis model, as it had a lower variation range of time-averaged WSS and the lower segmental average of WSSG.

  20. The relationship between suture number and the healing process of end-to-end arterial anastomosis

    Directory of Open Access Journals (Sweden)

    Winston B Yoshida

    1997-06-01

    Full Text Available In spite of the grate experience accumulated in vascular repairing, the ideal number of sutures for vascular anastomosis remains controversial. It is generally thought that the more stitches applied in a vascular anastomosis, the lesser resistant the anastomosis will be. The purpose of this study was to test this hypothesis in 20 rabbits, in which both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 8 interrupted sutures in one side (G1 and 16 in the other side (G2. After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (7 animals and for histologic analysis of the anastomosis (3 animals. Conventional staining procedures (hematoxylin-eosin and Masson methods and the picrosirius red polarization (PSP technique for collagen type determination were used. From 3 to 15 days, the tensile strength increased in both groups, from 265.0±-44.4g to 391.2±-49.0g in G1 and from 310.0±-71.5g to 348.7±-84.0g in G2 (p<0.005, with no statistical difference between the groups in each period of study. The hydroxyproline content, expressed as hydroxyproline/protein ratio, varied from 0.04±-0.01 to 0.05±-0.02 in G1 and from 0.05±-0.01 to 0.05±-0.02 in G2, with no significant difference between periods and groups. The histology showed similar inflammatory and reparative aspects in both groups. In both groups and periods the PSP technique demonstrated predominantly type I collagen in relation to type III collagen in the anastomosis. We concluded that even doubling the number of stitches, the healing process and strength did not change in the arterial anastomosis.

  1. Intimal Surface Suture Line (End-Product) Assessment of End-to-Side Microvascular Anastomosis.

    Science.gov (United States)

    Pafitanis, Georgios; Veljanoski, Damjan; Ghanem, Ali M; Myers, Simon

    2017-07-01

    Microsurgery simulation courses increasingly use assessment methodologies to evaluate the quality of microvascular anastomosis and to provide constructive feedback in competency-based training. Assessment tools evaluating the "journey" of skill acquisition in anastomosis have evolved, including global rating scores, hand motion analysis, and evaluation of the final outcome, that is, "end-product" assessment. Anastomotic patency is the gold standard end-product in clinical microvascular surgery, and in vivo end-to-side anastomosis, which can be confirmed using the Acland-test. Microsurgery simulation training is moving to include nonliving models, where possible, according to the principles of the replacement, reduction, and refinement of the use of animals in research. While a standardized end-product assessment tool for nonliving end-to-end anastomosis exists, there is no similar tool for end-to-side anastomosis. Intimal surface suture line assessment is an error list-based tool, which involves exposing the intimal surface of a vessel and analysis of the quality of suture placement. Errors in end-to side anastomosis were classified according to the potential clinical significance (high, medium, or low) perceived by the senior authors. Intimal surface suture line assessment provides constructive feedback during microsurgery training, helping to minimize technical errors, which are likely to impact on the final outcome in a clinical environment. Intimal surface suture line assessment lends itself to nonliving simulation training courses as an end-product self-assessment tool, especially during the early learning curve, to demonstrate progression. It has intraoperative relevance by assessment of the intimal surface suture line as the final sutures are placed in an end-to-side anastomosis to provide objective feedback to trainees in relation to likely physiological anastomotic outcome.

  2. Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting.

    Science.gov (United States)

    Koyama, Sachi; Kitamura, Tadashi; Itatani, Keiichi; Yamamoto, Tadashi; Miyazaki, Shohei; Oka, Norihiko; Nakashima, Kouki; Horai, Tetsuya; Ono, Minoru; Miyaji, Kagami

    2016-05-01

    For coronary artery bypass grafting (CABG), free grafts such as a saphenous vein or radial artery are often used for grafts to the lateral and posterior walls. However, the relationship between top-end anastomosis design and long-term patency remains unknown. Because coronary artery blood flow is dominant during diastole, top-end anastomosis may work better if the graft is directed towards the apex, whereas the shortest graft pathway appears to be most efficient. Using computational fluid dynamic models, we evaluated the hemodynamic variables that were affected by the angle of the top-end anastomosis. We created three-dimensional geometries of the aortic root with coronary arteries that involved 75 % stenosis in the obtuse marginal and postero-lateral branches. Two bypass models under vasodilator administration were created: in a"Model A", the top-end anastomosis is parallel to the long axis of the ascending aorta and the graft passed over the conus directed towards the apex; in a "Model B", the top-end anastomosis is directed toward the shortest pathway, and form near the right angles to the long axis of the ascending aorta. Wall shear stress (WSS) and its fluctuation, an oscillatory shear index (OSI) were evaluated to predict fibrosis progression at the anastomosis site and graft flow. Graft flow was 197.3 ml/min and 207.3 ml/min in the "Model A" and "Model B", respectively. The minimal WSS value inside the graft with the "Model A" and "Model B" was 0.53 Pa and 4.09 Pa, respectively, and the OSI value was 0.46 and 0.04, respectively. The top-end anastomosis of a free graft should be directed vertically towards the aorta to achieve the shortest graft pathway to maintain a high graft flow rate and to avoid the risks of endothelial fibrosis and plaque progression over the long-term after CABG.

  3. OUTCOME OF EARLY ORAL FEEDING AFTER ELECTIVE COLONIC ANASTOMOSIS

    Directory of Open Access Journals (Sweden)

    Sushant

    2015-08-01

    Full Text Available OBJECTIVE: Outcome of early oral feeding after elective colonic anastomosis . STUDY DESI G N: Descriptive case series . PLACE & DURATION OF STUDY : Department of Surgery Mata Gujari Medical C ollege, Kishanganj, Bihar, India. From June 2012 - March 2014. METHODOLOGY: De tailed preoperative ev aluation of the selected patients was done. Patients with malignancies, heart disease, poor general conditions, distal loop obstructions were excluded from the series. In selected patient’s proper history, physical examination and base line investigations were done. Limited bowel preparation was done in all the patients. Postope ratively 15 - 50 ml of sips was allowed 2 hourly after recovery form anesthesia . Free oral fluid intake was allowed on postoperative day - 1 , semisolids on day - 2 and day - 3 as tolerated and full oral diet allowed on day - 4. In case of two episodes of vomiting and absence of bowel sounds , patients were kept nil by mouth and nasogastric tube was inserted . RESULTS : Total 68 pat ients were selected, out of which 46(67.64% were males and 22(32.36% females (M.F2.09 : 1 . The age range was from 28 year to 76 year wi th mean age of 47.5 +2.4 year . Passage of first flatus was observed between 2 to 6 days (mean 2.8 days , and the time of first passage of stool was 3 - 8 days (mean 4.6 days. Twelve (17.64% patients did not tolerate feeding . Intolerance to feed results into vomiting and abdominal distension. Postoperative complications included wound infection (10.29% , electrolyte imbalance (4.41%, respiratory tract infections (2.94%, anastigmatic leaks (1.47% and wound dehiscence (1.47% . The hospital stay was 3 - 8 day ( M ean 5.4 day . CONCLUSION : Early oral feeding after elective colonic surgery was safe and well tolerated by majority of the patients.

  4. MRI evaluation of leptomeningeal anastomosis in middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Katsumata, Yasushi [Yokohama City Univ. (Japan). School of Medicine

    2001-05-01

    In steno-occlusive disease of the middle cerebral artery (MCA), there may be some discrepancy between the MRA and MRI findings, because the collateral flow via leptomeningeal anastomosis (LMA) from the anterior cerebral artery (ACA) to the MCA cannot be demonstrated in MRA. There is no simple method to evaluate the LMA non-invasively. We hypothesized that LMA could be identified as signal loss by flow void, so that the more LMA develops, the more the signal loss increases. We studied 18 patients with occlusive or markedly stenotic disease of the MCA, diagnosed by MRA. Although no collateral flow was demonstrated in MRA, several low signal spots suggesting flow void were noted in various degrees on the surface of the middle frontal gyrus, the border zone between the ACA and the MCA. These low signal spots were suspected to be LMA, and this was confirmed by angiography in 3 cases. Compared with the contralateral hemisphere, the spots were graded as ''-1'' (fewer), ''0'' (equal), ''+1'' (more), ''+2'' (markedly more). The number of Grades -1, 0, +1 and +2 was 0, 6, 5 and 7, respectively. MRI revealed infarct in the perforator territory in 16/18 cases. Cortical infarct was seen in 5/6 cases of Grade 0, 1/5 cases of Grade +1, and 0/7 cases of Grade +2. In Grade +1 and +2 cases, the cortex was spared by collateral flow via LMA, presumably. This result suggests that the flow void in the vicinity of the middle frontal gyrus may predict the development of LMA and the size of the infarct. (author)

  5. Application of single-layer mucosa-tomucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Bing-Yang; Hu; Jian-Jun; Leng; Tao; Wan; Wen-Zhi; Zhang

    2015-01-01

    AIM: To investigate the simplicity, reliability, andsafety of the application of single-layer mucosa-tomucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy. METHODS: A retrospective analysis was performed on the data of patients who received pancreaticoduodenectomy completed by the same surgical group between January 2011 and April 2014 in the General Hospital of the People’s Liberation Army. In total, 51 cases received single-layer mucosa-to-mucosa pancreaticojejunal anastomosis and 51 cases received double-layer pancreaticojejunal anastomosis. The diagnoses of pancreatic fistula and clinically relevant pancreatic fistula after pancreaticoduodenectomy were judged strictly by the International Study Group on pancreatic fistula definition. The preoperative and intraoperative data of these two groups were compared. χ2 test and Fisher’s exact test were used to analyze the incidences of pancreatic fistula, peritoneal catheterization, abdominal infection and overall complications between the single-layer anastomosis group and double-layer anastomosis group. Rank sum test were used to analyze the difference in operation time, pancreaticojejunal anastomosis time, postoperative hospitalization time, total hospitalization time and hospitalization expenses between the single-layer anastomosis group and double-layer anastomosis group.RESULTS: Patients with grade A pancreatic fistula accounted for 15.69%(8/51) vs 15.69%(8/51)(P = 1.0000), and patients with grades B and C pancreatic fistula accounted for 9.80%(5/51) vs 52.94%(27/51)(P = 0.0000) in the single-layer and double-layer anastomosis groups. Although there was no significant difference in the percentage of patients with grade A pancreatic fistula, there was a significant difference in the percentage of patients with grades B and C pancreatic fistula between the two groups. Theoperation time(220.059 ± 60.602 min vs 379.412 ± 90.761 min, P = 0.000), pancreaticojejunal anastomosis time(17.922 ± 5

  6. The side-to-side fashion for individual distal coronary anastomosis using venous conduit.

    Science.gov (United States)

    Kato, Takayoshi; Tsunekawa, Tomohiro; Motoji, Yusuke; Hirakawa, Akihiro; Okawa, Yasuhide; Tomita, Shinji

    2017-04-01

    Regarding to coronary artery bypass grafting (CABG), the end-to-side anastomosis (ESA) has been performed as a gold standard. Recently, the effectiveness of the distal side-to-side anastomosis (SSA) in CABG using internal mammary artery has been reported. The benefit of SSA comparing to ESA also has been disclosed by computing simulation. However, use of SSA by venous conduit for individual CABG has not been reported. In this study, we investigated feasibility of SSA. From January 2013 to October 2014, we conducted 114 CABGs. There were 92 venous distal anastomoses without sequential anastomotic site (61 SSA and 31 ESA). The anastomosis was evaluated before discharge and at 1 year after the procedure by angiography or multi-detector row computed tomographic coronary angiography. The median values for time to anastomosis were 13 min in the two group (p = 0.89). There was no revision of anastomosis in both groups. Additional stitches for hemostasis were required significantly less in SSA than ESA (18.0 vs 45.2 %, respectively, p fashion is easy to perform and maybe beneficial in blood flow pattern.

  7. Vascular Coupling System for End-to-End Anastomosis: An In Vivo Pilot Case Report.

    Science.gov (United States)

    Li, Huizhong; Gale, Bruce; Shea, Jill; Sant, Himanshu; Terry, Christi M; Agarwal, Jay

    2017-03-01

    This paper presents the latest in vivo findings of a novel vascular coupling system. Vascular anastomosis is a common procedure in reconstructive surgeries and traditional hand suturing is very time consuming. The vascular coupling system described herein was designed to be used on arteries for a rapid and error-free anastomosis. The system consists of an engaging ring made from high density polyethylene using computer numerical control machining and a back ring made from polymethylmethacrylate using laser cutting. The vascular coupling system and its corresponding installation tools were tested in a pilot animal study to evaluate their efficacy in completing arterial anastomosis. A segment of expanded polytetrafluoroethylene (ePTFE) tubing was interposed into a transected carotid artery by anastomosis using two couplers in a pig. Two end-to-end anastomoses were accomplished. Ultrasound images were obtained to evaluate the blood flow at the anastomotic site immediately after the surgery. MRI was also performed 2 weeks after the surgery to evaluate vessel and ePTFE graft patency. This anastomotic system demonstrated high efficacy and easy usability, which should facilitate vascular anastomosis procedures in trauma and reconstructive surgeries.

  8. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  9. Effect of anastomosis angle on hemodynamic of side-to-end radiocephalic arteriovenous fistula (RCAVF)

    Science.gov (United States)

    Hassan, Wan Anuar Wan; Osman, Kahar; Kadir, Mohammed Rafiq Abdul; Abdullah, Wan Ahmad Kamil Wan; Haron, Juhara; Ngali, Mohd Zamani

    2012-06-01

    Radiocephalic arteriovenous fistula (RCAVF) at wrist is the chosen access for hemodialysis. Most studies describe access complications without considering the effect of the anastomosis angle. In the present investigation, eighteen three-dimensional, simplified models of RCAVF were used to analyze the hemodynamic effect of anastomosis angle under fixed flow rate of 900 ml/min, corresponding to Reynolds number 950. EFD. Lab software was used in the flow simulation with steady flow conditions. The results show that high pressure drop was observed for RCAVF with smaller anastomosis angle. However, for cases with anastomosis angle larger than 45°, pressure drop became relatively constant. The results also show that large vortices appeared in cases with angle smaller than 30°. For cases with angle larger than 60°, low flow zone appeared at the inner wall that may lead to promotion of intimal thickening and formation of stenosis. Overall, for average flowrate, it is recommended that anastomosis angle should be maintained between 45° and 60° to minimize adverse effects.

  10. A RARE CASE OF PERSISTENT TRIGEMINAL ARTERY IN AN ADULT FEMALE WITH PARA POSTERIOR COMMUNICATING ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Banavathu Daya Bharath Singh

    2015-05-01

    Full Text Available Anastomosis found in the adulthood between the carotid and vertebro - basilar systems, apart from the posterior communicating artery, are extremely infrequent and are due to the persistence of vessels that joined both systems during the fetal period. This carotid - vertebrobasilar anastomosis are the trigeminal, otic, and hypoglossal and proatlantal arteries. P ersistent trigeminal artery is the commonest of the above mentioned four arteries. The reported incidence is about 0.2%. Patients may be asymptomatic or present symptoms due to low flow of posterior circulation or carotid microembolization from posterior circulation. PTA can cause trigemina l neuralgia. We report in this paper a case of a persistant trigeminal artery found in an adult female with a para p com aneurysm who had persistent trigeminal artery which was seen in C T angiogram .

  11. Modified Bean Model and FEM Method Combined for Persistent Current Calculation in Superconducting Coils

    CERN Document Server

    Völlinger, Christine; Russenschuck, Stephan

    2001-01-01

    Field variations in the LHC superconducting magnets, e. g. during the ramping of the magnets, induce magnetization currents in the superconducting material, the so-called persistent currents that do not decay but persist due to the lack of resistivity. This paper describes a semi-analytical hysteresis model for hard superconductors, which has been developed for the computation of the total field errors arising from persistent currents. Since the superconducting coil is surrounded by a ferromagnetic yoke structure, the persistent current model is combined with the finite element method (FEM), as the non-linear yoke can only be calculated numerically. The used finite element method is based on a reduced vector potential formulation that avoids the meshing of the coil while calculating the part of the field arising from the source currents by means of the Biot-Savart Law. The combination allows to determine persistent current induced field errors as function of the excitation and for arbitrarily shaped iron yoke...

  12. A modified technique of renal artery anastomosis in rat kidney transplantation.

    Science.gov (United States)

    Zhang, G; Zhao, H; Sun, Z-Y

    2010-01-01

    To reduce warm ischemic time and avoid irreversible damage to the graft in rat kidney transplantation. After left nephrectomy, recipients were transplanted with syngeneic kidney grafts using microsurgical techniques. In control rats (n = 20), the renal artery anastomoses were performed with 8-9 interrupted sutures by the conventional technique. In experimental animals (n = 20), a modified anastomosis was performed using fewer (5-6) sutures and fibrin glue devoid of thrombin. The number of sutures in the control group was 8.09 + or - 0.35 while that in the experimental group was 5.65 + or - 0.48 (p experimental group (p experimental and control groups were 90 and 85%, respectively. Our modified technique for renal artery anastomosis significantly reduced the warm ischemic time in rat kidney transplantation. This technique would be a safe and reliable method for rat renal artery anastomosis as well as for other microarterial anastomoses, particularly for novice surgeons. Copyright 2009 S. Karger AG, Basel.

  13. [The impact of endovascular intervention on visual functions in patients with traumatic carotid-cavernous anastomosis].

    Science.gov (United States)

    Ryzhova, I P

    1997-01-01

    In 217 patients with traumatic carotid-cavernous anastomosis (TCCA) the visual functions investigation before and after endovascular intervention conduction for the anastomosis exclusion was done. Cessation of the noise in the head synchronous with a pulse, decrease of disappearance of an exophthalmus of an eye or superior optical vein pulsation, of congestional appearance in the orbit, were the signs of the complete anastomosis exclusion. Rehabilitation or increase of visual acuity, improvement of an eye fundus ophthalmological picture, vascular index normalization were noted during deep ophthalmological investigation. Decrease of the blind spot parameters was an objective index of the visual functions rehabilitation, witnessing the disappearance of optical nerve disc (OND) oedema, contrast frequential characteristics normalization, critical frequency of light flashings radiance (CFLFR) rise, decrease of a papillary cycle time (PCT). Studying of the parameters mentioned have special significance for the estimation of postoperative conservative therapy efficiency.

  14. Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery

    DEFF Research Database (Denmark)

    Kjaer, M D; Kjeldsen, J; Qvist, N

    2016-01-01

    BACKGROUND AND AIMS: Development of a pouch-related fistula tract is an uncommon but highly morbid complication to restorative proctocolectomy with ileal pouch-anal anastomosis. Pouch failure with permanent ileostomy is reported in 21%-30% of patients, yet the factors contributing to pouch excision...... with diagnosed pouch-related fistulas were registered with information related to fistula classification, treatments, and outcome. RESULTS AND CONCLUSION: The final analysis included 48 (10.7%) of the 447 total ileal pouch-anal anastomosis patients with complicated pouch-related fistulas. Pouch-vaginal fistulas......, pouch-perianal fistulas, and other pouch-related fistulas were observed in 19 (63%), 29 (60%), and 10 (21%) patients, respectively, corresponding to an accumulated risk of 8%, 6%, and 2%, respectively. Time from ileal pouch-anal anastomosis surgery to fistula presentation was 24 (0.2-212) months...

  15. The Significance of Anti Reflux Effect of Esophago -gastric Anastomosis with Mucosal Valve

    Institute of Scientific and Technical Information of China (English)

    邱社祥; 杨殿才; 蔡辉华

    2001-01-01

    Objective To evaluate the preventive effect of reflux following esophago-gastric anastomosis with mucosal valve. Methods Retrospective analysis of 554 cases of esophageal or cardiac cancer treated in recent 10 years. Of them 207 cases of anastomosis 186 cases of tubular stepler and 161 cases of 1 layer anastomosis were fashioned with this method. The clinical results of these groups were compared. Results There were 51 reflux esophagitis cases found in 548 patients(9.3%). In group A 2 patients had this complication(0.48%). None had anastomotic leakage ,but only 1 patient had anastomotic stricture. The difference of the complications among the 3 groups were significant (P<0.01). Conclusions The results of the first group were better than those of the other two groups. It had less complications, and marked anti reflux effect. The life quality was also better. The technique is simple and easy to perform.

  16. Action of matrix metalloproteinases at restricted sites in colon anastomosis repair

    DEFF Research Database (Denmark)

    Ågran, Magnus S.; Levin Andersen, Thomas; Mirastschijski, Ursula;

    2006-01-01

    BACKGROUND: Dehiscence of colon anastomosis is a common, serious and potentially life-threatening complication after colorectal operation. In experimental models, impaired biomechanic strength of colon anastomoses is preventable by general inhibitors of matrix metalloproteinases (MMPs) and associ......BACKGROUND: Dehiscence of colon anastomosis is a common, serious and potentially life-threatening complication after colorectal operation. In experimental models, impaired biomechanic strength of colon anastomoses is preventable by general inhibitors of matrix metalloproteinases (MMPs....... CONCLUSIONS: The unique finding of this study was that the specific tissue holding the sutures of a colon anastomosis lost the most collagen presumably through induction and activation of multiple MMPs that may explain the beneficial effects of treatment with non-selective MMP antagonists....

  17. The learning rate in three dimensional high definition video assisted microvascular anastomosis in a rat model.

    Science.gov (United States)

    Kotsougiani, Dimitra; Hundepool, Caroline A; Bulstra, Liselotte F; Shin, Delaney M; Shin, Alexander Y; Bishop, Allen T

    2016-11-01

    Three-dimensional (3D) high definition (HD) video systems are changing microsurgical practice by providing stereoscopic imaging not only for the surgeon and first assistant using the binocular microscope, but also for others involved in the surgery. The purpose of this study was to evaluate the potential to replace the binocular microscope for microarterial anastomoses and assess the rate of learning based on surgeons' experience. Two experienced and two novice microsurgeons performed a total of 88 rat femoral arterial anastomoses: 44 using a 3D HD video device ('Trenion', Carl Zeiss Meditech) and 44, a binocular microscope. We evaluated anastomosis time and modified OSATS scores as well as the subjects' preference for comfort, image adequacy and technical ease. Experienced microsurgeons showed a steep learning curve for anastomosis times with equivalent OSATS scores for both systems. However, prolonged anastomosis times were required when using the novel 3D-HD system rather than direct binocular vision. Comparable learning rates for anastomosis time were demonstrated for novice microsurgeons and modified OSATS scores did not differ between the different viewing technologies. All microsurgeons reported improved comfort for the 3D HD video system but found the image quality of the conventional microscope superior, facilitating technical ease. The present study demonstrates the potential of 3D HD video systems to replace current binocular microscopes, offering qualitatively-equivalent microvascular anastomosis with improved comfort for experienced microsurgeons. However, image quality was rated inferior with the 3D HD system resulting in prolonged anastomosis times. Microsurgical skill acquisition in novice microsurgeons was not influenced by the viewing system used.

  18. A simple and effective way of maintaining the microvascular field clean and dry during anastomosis

    Directory of Open Access Journals (Sweden)

    G I Nambi

    2013-01-01

    Full Text Available During microvascular anastomosis, it is important to maintain the microsurgical field irrigated yet dry so as to achieve a good view of the vessels for approximation. In this method, an infant feeding tube (size 4, with its tip sandwiched between layers of dry gauze and a surgical glove component placed in the anastomotic field and the other end connected to a suction apparatus, is used to maintain the microsurgical field free from flooding. It also has the additional advantage of providing a stable platform for microvascular anastomosis.

  19. Experimental research of stent anastomosis of gastrojejunostomy in a porcine model

    Institute of Scientific and Technical Information of China (English)

    CAI Xiu-jun; YU Yi-chen; CAI Hua-jie; WANG Yi-fan

    2011-01-01

    Background Gastrojejunostomy is one of the most frequently used procedures for general surgeons. The creation of anastomosis between various parts of the gastrointestinal tract is a basic technical component and major task in the daily practice of almost all gastrointestinal procedures. This research evaluated a new procedure of making gastrointestinal anastomosis with stent.Methods Twenty experimental mini-pigs were randomized into two groups. In stent anastomosis group (SA), the anastomoses were constructed with a poly-levolactic acid stent. In hand-sewn group (HA), the anastomoses were performed with a single-layer continuous suture. Abdominal X-ray with intraluminal contrast was performed on the 10th postoperative day. Five pigs of each group were sacrificed on the postoperative days 3 and 14 to determine anastomotic bursting pressure in situ, hydroxyproline concentration, and histopathological evaluation of the anastomotic sites.Results There was no intraoperative morbidity or mortality. The median time needed for the sutured anastomosis was (21.7±2.3) minutes and for the stent anastomosis was (11.9±1.9) minutes (P <0.001). Abdominal X-ray with intraluminal contrast demonstrated normal gas distribution and showed no evidence of leakage or obstruction. Macroscopic appearance at the longitudinal opening of anastomosis was always good in both groups. The median anastomotic bursting pressure was (18.2±1.6) kPa in SA group on postoperative day 3, compared with (11.7±3.2) kPa in HA group (P=0.003). The anastomotic bursting pressure on day 14 was not significantly different between SA group ((27.1±2.6)kPa) and HA group ((28.3±1.7) kPa) (P=0.388). The hydroxyproline concentrations were not significantly different.Conclusions The stent anastomosis was not considered to be more difficult than a sutured anastomosis. This method is proved to be safe and feasible compared with the traditional hand-sewn method in the porcine model. The method increases early

  20. Bricker's ileal conduit urinary diversion with a simple non-refluxing uretero ileal anastomosis

    DEFF Research Database (Denmark)

    Bernstein, I T; Bennicke, K; Rørdam, P;

    1991-01-01

    Fifty consecutive patients had ileal conduits constructed with a technically and quick simple antireflux ureteroileal anastomosis. Complications related to the ureteral implantation were studied retrospectively, and at follow-up (8 months-12 years later, median 3 years) conduit dysfunction...... anastomosis. which was treated successfully by two weeks drainage. Hydronephrosis deteriorated in 18 (26%) of the renal units, remained unchanged in 39 (57%) and improved in 11 (16%). Increases in plasma creatinine concentrations up to 200 mumol/l were found in eight patients, and in one patient it increased...

  1. Comparative Study of High Powerful Magnet with Conventional Repair of Suture in the Intestinal Anastomosis of Rats

    Directory of Open Access Journals (Sweden)

    Marjan Joudi

    2016-02-01

    Full Text Available Background In this study, given the importance of gastrointestinal anastomosis in surgical procedures, attempts have been made to compare the results of employing magnetic compression anastomosis and magnetic coils in intestinal anastomosis of rats. Materials and Methods This study was an experimental trial on 60 rats which had been randomly divided into two experiment (30 and control (30 groups. First, the rat intestine was cut off from a relatively fixed point and then magnet anastomosis was performed at the both ends of bowel in the control group and manual suture in the experiment group.  Anastomosis was then examined 10 days after the surgery for possible complications with a histological analysis of the indices of tissue repair. Results The mean time required for performing anastomosis of the rat intestine was 735 and 366 seconds for the control and experiment groups, respectively. Also, the laparotomy performed 10 days after the first operation did not show any significant difference between two groups in terms of surgical complications such as infiltration factor of inflammatory cell and fibroblast activity (P>0.05. The microscopic examination indicated that the tissue reaction in the anastomosis site was better in terms of tissue repair of neo-angiogenesis intestine and collagen deposition in the magnet group(P>0.05.   Conclusion Given the shorter duration of the anastomosis by magnets and more favorable histological results reported in the experiment group, as well as the lack of any significant difference in complications of the two techniques, magnetic compressive anastomosis can be used as a new technique for intestinal surgeries and pertaining anastomosis. Although, we recommend that study will be done with large sample size to obtain reliable results.

  2. An Approach to Persistent Scatterer Interferometry

    Directory of Open Access Journals (Sweden)

    Núria Devanthéry

    2014-07-01

    Full Text Available This paper describes a new approach to Persistent Scatterer Interferometry (PSI data processing and analysis, which is implemented in the PSI chain of the Geomatics (PSIG Division of CTTC. This approach includes three main processing blocks. In the first one, a set of correctly unwrapped and temporally ordered phases are derived, which are computed on Persistent Scatterers (PSs that cover homogeneously the area of interest. The key element of this block is given by the so-called Cousin PSs (CPSs, which are PSs characterized by a moderate spatial phase variation that ensures a correct phase unwrapping. This block makes use of flexible tools to check the consistency of phase unwrapping and guarantee a uniform CPS coverage. In the second block, the above phases are used to estimate the atmospheric phase screen. The third block is used to derive the PS deformation velocity and time series. Its key tool is a new 2+1D phase unwrapping algorithm. The procedure offers different tools to globally control the quality of the processing steps. The PSIG procedure has been successfully tested over urban, rural and vegetated areas using X-band PSI data. Its performance is illustrated using 28 TerraSAR-X StripMap images over the metropolitan area of Barcelona.

  3. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

    Science.gov (United States)

    Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

    2015-01-01

    Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  4. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  5. Ultrastructural view of colon anastomosis under propolis effect by transmission electron microscopy

    Institute of Scientific and Technical Information of China (English)

    Sibel Serin Kilicoglu; Bulent Kilicoglu; Esra Erdemli

    2008-01-01

    AIM: To evaluate the effect of propolis administration on the healing of colon anastomosis with light and transmission electron microscopes.METHODS: Forty-eight Wistar-Albino female rats were divided into two groups and had colon resection and anastomosis.In group Ⅰ,rats were fed with standard rat chow pre- and postoperatively.The rats in group Ⅱ were fed with standard rat chow and began receiving oral supplementation of propolis 100 mg/kg per day beginning 7 d before the operation and continued until they were sacrificed.Rats were sacrificed 1,3,7 and 14 d after operation,and anastomotic bursting pressures measured.After the resection of anastomotic segments,histopathological examination was performed with light and transmission electron microscopes by two blinded histologists and photographed.RESULTS: The colonic bursting pressures of the propolis group were statistically significantly better than the control group.Ultrastructural histopathological analysis of the colon anastomosis revealed that propolis accelerated the phases of the healing process and stimulated mature granulation tissue formation and collagen synthesis of fibroblasts.CONCLUSION: Bursting pressure measurements and ultra structural histopathological evaluation showed that administration of propolis accelerated the healing of colon anastomosis following surgical excision.

  6. Improved survival using oxygen free radical scavengers in the presence of ischemic bowel anastomosis.

    Science.gov (United States)

    Bergren, C T; Bodzin, J H; Cortez, J A

    1988-06-01

    A rat model was developed to determine the efficacy of oxygen free radical scavenger compounds in improving small bowel anastomotic healing in ischemia. 50 Sprague-Dawley rats underwent laparotomy and were divided into groups: I. sham operation; II. ischemia produced by ligation of mesenteric vessels along 3-5 cm of bowel; III. bowel transection and anastomosis; IV. ligation of vessels with bowel transection and anastomosis; V. ligation of vessels, bowel transection and IV administration of superoxide dismutase (SOD) (5000 U/kg) prior to anastomosis. All surviving animals were sacrificed after 2 weeks. Anastomotic tensile strength and histology were evaluated. Percent survival and the average length of survival for all groups is seen in the table below. (table: see text) A significant decrease in survival was present with the anastomotic group and the ischemic anastomotic group when compared with controls. An improved survival similar to ischemia alone was present in SOD group. No significant difference was noted between SOD and control groups. The results of this study indicate an improved survival rate and length of survival similar to controls in animals undergoing ischemic and penetrating injury to the bowel with the use of oxygen free radical scavenger compounds prior to anastomosis.

  7. Fibrin sealant prevents gastrointestinal anastomosis dehiscence in intra-abdominal sepsis.

    Science.gov (United States)

    Wang, Xinbo; Ren, Jianan; Zhu, Weiming; Li, Ning; Li, Jieshou

    2007-01-01

    We observed the potential use of fibrin sealant as a therapeutic modality for successful resolution of gastrointestinal anastomosis dehiscence in intra-abdominal sepsis. Forty-eight patients (33 men and 15 women) suffering from intra-abdominal sepsis were subjected to prophylactic appliance of fibrin sealant during immediate primary anastomosis during the laparotomy. The perioperative management invariably involved fluid resuscitation, active suction drainage of the abdominal liquor puris, nutritional supplementation, and growth hormone. The total surgical-related success ratio was 91.7% (44/48) for primary anastomosis with fibrin sealant in intra-abdominal sepsis. Anastomotic leakage occurred in the other four patients, two of which died because of leakage complications in our hospital. The hospital stay after the operation was 30.2 +/- 12.0 days. There has been no sign of recurrence over a follow-up period of 1-15 months. It is concluded that fibrin sealant may be useful in preventing gastrointestinal anastomosis dehiscence in intra-abdominal sepsis.

  8. J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis

    DEFF Research Database (Denmark)

    Wewer, Vibeke; Hesselfeldt, Peter; Qvist, Niels

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents colitis. METHODS: Data...

  9. Completely obstructed colorectal anastomosis: a new non-electrosurgical endoscopic approach before balloon dilatation.

    Science.gov (United States)

    Curcio, Gabriele; Spada, Marco; di Francesco, Fabrizio; Tarantino, Ilaria; Barresi, Luca; Burgio, Gaetano; Traina, Mario

    2010-10-07

    Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife. We report a case of a colorectal anastomosis web occlusion, treated without electrocision. Gastrografin enema and sigmoidoscopy showed complete obstruction at the anastomotic site due to the presence of an anastomotic occlusive web. In order to avoid thermal injuries, we decided to use a suprapapillary biliary puncture catheter. The Artifon catheter was inserted into the center of the circular staple line at the level of the anastomosis, and fluoroscopic identification of the proximal bowel was obtained with dye injection. A 0.025-inch guidewire was then passed through the catheter into the colon and progressive pneumatic dilatation was performed. The successful destruction of the occlusive web facilitated passage of the colonoscope, allowing evaluation of the entire colon and stoma closure after three months of follow-up. The patient tolerated the procedure well, with no complications. This report highlights an alternative non-electrosurgical approach that uses a new device that proved to be safe and useful.

  10. End-to-side caval anastomosis in adult piggyback liver transplantation

    NARCIS (Netherlands)

    Polak, Wojciech G.; Nemes, Balazs A.; Miyamoto, Shungo; Peeters, Paul M. J. G.; de Jong, Koert P.; Porte, Robert J.; Slooff, Maarten J. H.

    2006-01-01

    No consensus exists regarding the optimal reconstruction of the cavo-caval anastomosis in piggyback orthotopic liver transplantation (PB-LT). The aim of this study was to analyze our experience with end-to-side (ES) cavo-cavostomy. Outcome parameters were patient and graft survival and surgical

  11. Aberrant cervical vasculature anastomosis as cause of neck pain and successful treatment with embolization technique.

    Science.gov (United States)

    He, Lucy; Ladner, Travis R; Cobb, Mark; Mocco, J

    2016-01-27

    We report a patient with non-dermatomal radiating neck pain without focal neurologic deficit. Traditional workup could not identify an anatomic or biomechanical cause. Imaging showed a deep cervical vessel centered in the region of pain. Angiography later identified an aberrant anastomosis of this vessel with the occipital artery. Subsequent endovascular embolization of this arterial trunk resulted in complete pain relief.

  12. Effect of Previous Irradiation on Vascular Thrombosis of Microsurgical Anastomosis: A Preclinical Study in Rats.

    Science.gov (United States)

    Barrera-Ochoa, Sergi; Gallardo-Calero, Irene; López-Fernández, Alba; Romagosa, Cleofe; Vergés, Ramona; Aguirre-Canyadell, Marius; Soldado, Francisco; Velez, Roberto

    2016-11-01

    The objective of the present investigation was to compare the effect of neoadjuvant irradiation on the microvascular anastomosis in cervical bundle using an experimental model in rats. One hundred forty male Sprague-Dawley rats were allocated into 4 groups: group I, control, arterial microanastomosis; group II, control, venous microanastomosis; group III, arterial microanastomosis with previous irradiation (20 Gy); and group IV, venous microanastomosis with previous irradiation (20 Gy). Clinical parameters, technical values of anastomosis, patency, and histopathological parameters were evaluated. Irradiated groups (III and IV) and vein anastomosis groups (II and IV) showed significantly increased technical difficulties. Group IV showed significantly reduced patency rates (7/35) when compared with the control group (0/35). Radiotherapy significantly decreased the patency rates of the vein (7/35) when compared with the artery (1/35). Groups III and IV showed significantly reduced number of endothelial cells and also showed the presence of intimal thickening and adventitial fibrosis as compared with the control group. Neoadjuvant radiotherapy reduces the viability of the venous anastomosis in a preclinical rat model with a significant increase in the incidence of vein thrombosis.

  13. Primary resection with and without anastomosis for perforation of acute diverticulitis.

    Science.gov (United States)

    Saccomani, G E; Santi, F; Gramegna, A

    1993-01-01

    The results of management of perforated large bowel diverticulitis were retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age of patients was 63 years (range 30-85 years). Depending on the symptoms, the spreading of the peritonitis and associated cardiovascular and pulmonary disease and diabetes mellitus, 4 types of operation were performed: primary left hemicolectomy and anastomosis with and without defunctioning colostomy, Hartmann procedure, suture and drainage with diverting colostomy. The overall mortality was 10.5%: resection and primary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Hartmann procedure (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complication rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary resection and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allows removal of the diseased colon but in a great proportion of cases reconstitution of continuity is not performed; nevertheless staged operation entailing major mortality and morbidity, expose these aged patients to remarkable hazard. Prerequisite of safe primary excision and anastomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstruction is present.

  14. Biomedical Engineering Approach to Evaluate Anastomosis Methods for Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    M.Umezu; J.Kawai; J.Suehiro; M.Arita; Y.Shiraishi; K.Iwasaki; T.Tanaka; H.Niinami

    2004-01-01

    There are two different methods for coronary artery bypass grafting: end-to-side and side-to-side anastomosis. In vitro mock test, flow visualization and animal experiments were performed in parallel to compare the hemodynamic effect between two methods. Thus, bioengineers can provide practical useful information to the clinical team.

  15. Sutureless end-to-end bowel anastomosis in rabbit using Iow-power CO2 laser

    Institute of Scientific and Technical Information of China (English)

    Zhong Rong Li; Yong Long Chi; Run Cong Ke

    2000-01-01

    The use of laser energy to weld biological tissues and produce sutureless anastomosis has its advantages over conventional silk-sutured anastomosis since it was reported in small vessels[1] and fallopian tubes[2], in the late 1970s. Since then, more investigators have welded a larger variety of tissues[3-13] and have expanded its application to welding trials of entertomies of rabbit and rat small intestine[14-17] Sauer et al[18] reported results from Nd: YAG laser in reconstruction of end-to-end welding in rabbit small intestine. Recently, controlled temperature during YAG and argon laser-assisted welding of entertomies of rabbit and rat was implemented to eliminate exponential increases in the rate of denaturation associated with rapidly increasing temperature[19,20]. Yet there was no report of sutureless end-to-end bowel anastomosis using low-power CO2 laser. This is a report of a circumferential end-to-end laser welding bowel anastomosis in rabbit by using 3 different CO2 laser powers to explore the feasibility of CO2 laser welding of a circumferential intestinal tissue and to determine the optimal laser-welding parameter. Then the appropriate CO2 laser power was chosen to weld bowels in rabbit and its long-term healing effect was evaluated.

  16. Complications after a Bidirectional Cavopulmonary Anastomosis with Accessory Sources of Pulmonary Blood Flow.

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2016-12-01

    Creating an accessory source of pulsatile pulmonary blood flow in a patient with a bidirectional cavopulmonary anastomosis may have advantages and disadvantages. In relation to the latter, we report the complications seen in a cyanotic congenital heart disease patient who developed a superior vena cava syndrome plus severe swelling of his right hand that evolved satisfactorily after percutaneous and medical treatment.

  17. Ex Vivo Anatomical Characterization of Handsewn or Stapled Jejunocecal Anastomosis in Horses by Computed Tomography Scan.

    Science.gov (United States)

    Giusto, Gessica; Iotti, Bryan; Sammartano, Federica; Valazza, Alberto; Gandini, Marco

    2014-01-01

    The aim of this study is to compare handsewn and stapled jejunocecal anastomosis with different stomal lengths in terms of anatomical differences. Group 1 underwent a two-layer handsewn jejunocecal side-to-side anastomosis (HS); Group 2 received a stapled jejunocecal side-to-side anastomosis (GIA). Each group was divided into two subgroups (HS80 and HS100, GIA80 and GIA100). Specimens were inflated and CT scanned. The stomal/jejunal area ratio and blind end pouch volume/area were measured and compared. Effective length of the stoma was measured and compared with the initial length. Stomal/jejunal area ratio was 1.1 for both 80 techniques, 1.6 for the GIA100, and 1.9 for the HS100 technique. Both HS and GIA techniques produced a blind end pouch and exhibited a mean increase of the final stomal length ranging from 6 to 11% greater than the original stomal length. All techniques will exhibit a length increase of the final stomal length compared to the intended stomal length, with a consequent increase in stomal area. Stapled techniques consistently produced a large distal blind end pouch. Length of a jejunocecal anastomosis should be selected in accordance with the diameter of afferent jejunum, and the 80 mm stomal length could be deemed sufficient in horses.

  18. Ex Vivo Anatomical Characterization of Handsewn or Stapled Jejunocecal Anastomosis in Horses by Computed Tomography Scan

    Directory of Open Access Journals (Sweden)

    Gessica Giusto

    2014-01-01

    Full Text Available The aim of this study is to compare handsewn and stapled jejunocecal anastomosis with different stomal lengths in terms of anatomical differences. Group 1 underwent a two-layer handsewn jejunocecal side-to-side anastomosis (HS; Group 2 received a stapled jejunocecal side-to-side anastomosis (GIA. Each group was divided into two subgroups (HS80 and HS100, GIA80 and GIA100. Specimens were inflated and CT scanned. The stomal/jejunal area ratio and blind end pouch volume/area were measured and compared. Effective length of the stoma was measured and compared with the initial length. Stomal/jejunal area ratio was 1.1 for both 80 techniques, 1.6 for the GIA100, and 1.9 for the HS100 technique. Both HS and GIA techniques produced a blind end pouch and exhibited a mean increase of the final stomal length ranging from 6 to 11% greater than the original stomal length. All techniques will exhibit a length increase of the final stomal length compared to the intended stomal length, with a consequent increase in stomal area. Stapled techniques consistently produced a large distal blind end pouch. Length of a jejunocecal anastomosis should be selected in accordance with the diameter of afferent jejunum, and the 80 mm stomal length could be deemed sufficient in horses.

  19. Evaluation and further development of the Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique

    NARCIS (Netherlands)

    van Doormaal, T.P.C.

    2010-01-01

    The research described in this thesis had 2 main goals. The first goal was to evaluate the clinical results of the Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique. The most important subgroups of patients were separately evaluated in the first part of this thesis (chapters 2 to 5)

  20. [Organisation and early outcome of restorative proctocolectomy and ileal pouch-anal anastomosis

    DEFF Research Database (Denmark)

    Ljungmann, K.; Bendixen, A.; Laurberg, S.;

    2008-01-01

    INTRODUCTION: Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with ulcerative colitis and familial polyposis. However, the procedure is complex with a long learning curve, and carries a risk of both early and late complications...

  1. Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    Guo Wang; Xiao-Yi Sun; Ming-Fa Wei; Yi-Zhen Weng

    2005-01-01

    AIM: To study the long-term therapeutic effect of "heartshaped" anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage "heart-shaped" anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our "heartshaped anastomosis" procedure. "Heart-shaped"anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.

  2. Burned after reading: the so-called list of Alexandrian librarians in P. Oxy. X 1241 Brûlée après lecture : la liste dite des Bibliothécaires d'Alexandrie dans le P.Oxy. X 1241 Burned after reading; la cosiddetta lista di bibliotecari alessandrini in P.Oxy. X 1241

    Directory of Open Access Journals (Sweden)

    Jackie Murray

    2012-06-01

    être réexaminée, car il semble probable que nous ayons affaire à une œuvre littéraire manquée.This article calls into question the value and reliability of the contents of P.Oxy. X 1241, the so-called list of Alexandria Librarians. Rather than treating the list of grammarians at col. i.5-ii.30 by itself, as scholars have done ever since the papyrus was published, this paper considers the document in its entirety. This closer reading of P.Oxy. X 1241 demonstrates that there is clear thematic continuity between the list of grammarians and the military catalogues that follow which has never been observed before, precisely because the two parts have always been treated separately. Challenges to three crucial assumptions of the original editors, B. P. Grenfell and A. S. Hunt emerge: (1 Is the list at col. i.5-ii.30 in fact a list of the heads of the Alexandrian library? (2 Is the work a copy or compilation of some earlier scholarly piece that dates back to the Hellenistic period, and not a product of a circa second century CE scholar/grammarian? (3 Do the contents of the papyrus reflect the work of a competent scholar/grammarian who was well enough informed about the chronology of the Ptolemaic period to produce an historically accurate account of the succession of individuals connected to the Ptolemaic court and the Alexandrian Library? While it is true to say that in its content and use of learned citations P.Oxy. X 1241 shares many similarities with Hellenistic and Imperial prose catalogues, the strategies of learned discourse deployed by the author in the military catalogue do not conform to the norms of reliable scholarly examples. Accordingly, the value of the text as documentary evidence of the history of the Alexandrian library needs to be reconsidered as it seems likely that we are dealing with a failed literary work.Questo articolo mette in dubbio il valore e l’attendibilità del contenuto di P.Oxy. X 1241, la cosiddetta lista dei bibliotecari

  3. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass.

    Science.gov (United States)

    Baretta, Giorgio A P; Alhinho, Helga C A W; Matias, Jorge Eduardo F; Marchesini, João Batista; de Lima, João Henrique F; Empinotti, Celso; Campos, Josemberg M

    2015-01-01

    The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18-24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been postulated is the dilation of the gastrojejunal anastomosis. The objective was to evaluate the safety and efficacy of the serial use of argon plasma coagulation (APC) in reducing the diameter of the dilated gastrojejunal anastomosis and post-RYGB weight regain. We carried out a prospective, nonrandomized study of 30 patients, with no control or sham group, monitoring RYGB weight regain associated with dilation of the gastrojejunal anastomosis over a postoperative period of 18 months. Each patient underwent three sessions of APC in the anastomosis separated by 8 weeks, with a final endoscopic examination 8 weeks after the last session. There was a loss of 15.48 kg (range = 8.0-16.0 kg) of the 19.6 kg (range = 7.0-39.0 kg) of regained weight after RYGB and a reduction of 66.89 % in the final anastomotic diameter, with statistically significant reductions between each APC session. Previous body mass index significantly decreased up to the final examination, and the final weight was close to but not at the same level as the nadir. Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.

  4. Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis

    Directory of Open Access Journals (Sweden)

    Goriainov Vitali

    2010-01-01

    Full Text Available Aims :A prospective clinical audit of all patients undergoing laparoscopic surgery with the intention of primary colonic left-sided intracorporeal stapled anastomosis to identify the rate of anastomotic leaks on an intention to treat basis with or without defunctioning stoma. Materials and Methods : All patients undergoing laparoscopic colorectal surgery resulting in left-sided stapled anastomosis were included with no selection criteria applied. All operations were conducted by the same surgical team and the same preparation and intraoperative methods were used. The factors analyzed for this audit were patient demographics (age and sex, indication for operation, procedure performed, height of anastomosis, leak rate and the outcome, inpatient stay, mortality, rate of defunctioning stomas, and rate of conversion to open procedure. Results for anastomotic leakage were compared with known results from the Wessex Colorectal Audit for open colorectal surgery. Results : A total of 69 patients (43 females, 26 males; median age 69 years, range 19 - 86 years underwent colonic procedures with left-sided intracorporeal stapled anastomoses. Of these, 14 patients underwent reversal of Hartmann′s, 42 - Anterior Resection, 11 - Sigmoid Colectomy, 2 - Left Hemicolectomy. Excluding reversals of Hartmann′s, 29 operations were performed for malignant and 26 for benign disease. Five patients were defunctioned, and 3 were subsequently reversed. The median height of anastomosis was 12 cm, range 4 - 18 cm from anal verge as measured either intra-operatively, or by rigid sigmoidoscopy post-operatively. Four cases were converted to open surgery. There was 1 post-operative death within 30 days. There was 1 anastomotic leak (the patient that died, and 1 patient developed a colo-vesical fistula. Median post-operative stay was 7 days, range 2-19. Conclusion : This clinical audit confirms that the anastomotic leak rate for left-sided colorectal stapled anastomosis is no

  5. SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS WITH GASTROJEJUNAL LINEAR MECHANICAL ANASTOMOSIS: TECHNICAL ASPECTS

    Science.gov (United States)

    PALERMO, Mariano; SERRA, Edgardo

    2016-01-01

    ABSTRACT Background: Gastric bypass is a restrictive and malabsorptive surgery. The restrictive part consists in the creation of a small gastric pouch. The gastrointestinal bypass serves as the malabsorptive element. Aim: To describe a simplified gastric bypass approach for morbid obese patients, showing our results, and also remarking the importance of this technique for reducing the learning curve. Method: The patient is positioned in a split legs position and carefully strapped to the operating room table, with the surgeon between the patient's legs. Five trocars are inserted after pneumoperitoneum at the umbilicus. Dissection of the esophagogastric angle and lesser curvature is mandatory before the gastric pouch manufacturing. This pouch is done with two blue load staplers. Using a blue load linear stapler inserted only half way into the hole in the pouch is used to perform the gastrojejunal anastomosis and in order to create an anastomosis that is about 2 cm in length. A side-to-side jejunojejunostomy is done with a white load linear stapler. The last step of the gastric bypass consists in the cut of the jejunum between the two anastomosis with a white load linear stapler. Blue test is performed in order to detect leaks. Results: From January 2012 to December 2015, 415 simplified RYGB were performed. Gender: 67% female and 33 % males. Average of BMI 44.7. Mean age was 42 years old. Mean operative time 79 min. 39 % of this sample had T2 diabetes. Regarding complications were observed, one fistula, one gastrojejunal stenosis and one obstruction due to a bezoar. Conclusion: The described technique is a simplified approach in which all the anastomosis are performed in the upper part of the abdomen, allowing the surgeons to be more systematized and avoiding them to make mistakes in the confection of the Roux-en-Y anastomosis. This simplified gastric bypass is a safe and reproducible technique. PMID:27683785

  6. Prevention of leakage by sealing colon anastomosis: experimental study in a mouse model.

    Science.gov (United States)

    Slieker, Juliette C; Vakalopoulos, Konstantinos A; Komen, Niels A; Jeekel, Johannes; Lange, Johan F

    2013-10-01

    In colorectal surgery, anastomotic leakage (AL) is the most significant complication. Sealants applied around the colon anastomosis may help prevent AL by giving the anastomosis time to heal by mechanically supporting the anastomosis and preventing bacteria leaking into the peritoneal cavity. The aim of this study is to compare commercially available sealants on their efficacy of preventing leakage in a validated mouse model for AL. Six sealants (Evicel, Omnex, VascuSeal, PleuraSeal, BioGlue, and Colle Chirurgicale Cardial) were applied around an anastomosis constructed with five interrupted sutures in mice, and compared with a control group without sealant. Outcome measures were AL, anastomotic bursting pressure, and death. In the control group there was a 40% death rate with a 50% rate of AL. None of the sealants were able to diminish the rate of AL. Furthermore, use of the majority of sealants resulted in failure to thrive, increased rates of ileus, and higher mortality rates. If sealing of a colorectal anastomosis could achieve a reduction of incidence of clinical AL, this would be a promising tool for prevention of leakage in colorectal surgery. In this study, we found no evidence that sealants reduce leakage rates in a mouse model for AL. However, the negative results of this study make us emphasize the need of systemic research, investigating histologic tissue reaction of the bowel to different sealants, the capacity of sealants to form a watertight barrier, their time of degradation, and finally their results in large animal models for AL. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Improved technique of vascular anastomosis for small intestinal transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    Yuan Xin Li; Jie Shou Li; Ning Li

    2000-01-01

    AIM To establish a new improved vascular anastomotic technique to simplify the surgical technique and increase the survivsl rate of small intestinal transplantation in rats. METHODS The graft removed en bloc consisted of entire small intestine, portal vein and aortic segment with superior mesenteric artery. The graft was perfused in situ and the gut lumen was irrigated during the operation.Heterotopic small bowel transplantation was performed by microvascular end-to-side anastomosis between the donor aortic segment with superior mesenteric artery and the recipient abdominal aorta, and by the formation of a "Cuff" anastomosis between the donor portal vein and the recipient left renal vein. Both ends of the grafts were exteriorized as stomas. RESULTS A total of 189 intestinal transplantations were performed in rats, 33 of which were involved in the formal experimental group, with a survival rate of 84.8%. The average time for the donor surgery was 80min ±10min; for graft repair 10min ± 3min; and for recipient surgery 95min ± 15min. The average time for the arterial anastomosis and the vein anastomosis was 18min ± 5min and imin,respectively. The warm ischemic time and cold ischemic time were 22min ± 5min and less than 60min, respectively. The whole operation was completed by a single surgeon, the operative time being about 3 hours. CONCLUSION The vascular anastomosis used in this study could simplify surgical technique,reduce the operative time and elevate the survival rate of small intestinal transplantation in rats.

  8. Does the site of anastomosis for esophagectomy affect long-term quality of life?

    Science.gov (United States)

    Wormald, J C R; Bennett, J; van Leuven, M; Lewis, M P N

    2016-01-01

    Long-term survival after esophagectomy is improving, and hence, quality of life (QOL) of these patients has become a priority. There has been extensive debate regarding the optimal site of surgical anastomosis (cervical or intrathoracic). We aimed to evaluate the impact of anastomotic site on long-term QOL postesophagectomy. Quality of life questionnaires (European Organisation for Research and Treatment of Cancer [EORTC] C-30 and OG-25) were sent to patients surviving over 3 years following esophagectomy. The data were analyzed by site of esophagogastric anastomosis: intrathoracic or cervical. EORTC C-30 data were compared against the reference population data. Of the patients, 62 responded (82%) with a median time postsurgery of 6.1 years (range 3-12 years). Patient demographics were comparable. There was no significant difference between cervical or intrathoracic anastomosis groups for functional or symptom scores, focusing on dysphagia (cervical = 8.8 vs. intrathoracic = 17.6, P = 0.24), odynophagia (cervical = 13.4 vs. intrathoracic = 16.1, P = 0.68) and swallowing problems (cervical = 8.1 vs. intrathoracic = 13.4, P = 0.32). There was no difference in overall health score between groups (cervical = 70.5 vs. intrathoracic = 71.6, P = 0.46). Overall general health score was comparable with the reference population (esophagectomy group P = 70.9 ± 22.1 vs. reference population = 71.2 ± 22.4, P = 0.93). There is no difference in long-term QOL after esophagectomy between patients with a cervical or intrathoracic anastomosis. Scores compare favorably with EORTC reference data. Survival after esophagectomy is associated with recovery of QOL in the long term, regardless of site of anastomosis and despite worse gastrointestinal-related symptoms.

  9. Venous anastomosis in free flap reconstruction after radical neck dissection: is the external jugular vein a feasible option?

    Science.gov (United States)

    Reiter, Maximilian; Baumeister, Philipp

    2017-01-13

    Free microvascular tissue transfer has become a reliable and wellestablished technique in reconstructive surgery. Success rates greater than 95% are constantly reported in the literature. End-to-end anastomosis to the external jugular vein (EJ) is supposed to be equally successful as anastomosis to the internal jugular vein (IJ) in patients treated with selective neck dissection. No data has been published so far when the IJ had to be resected during neck dissection. The purpose of this study was to evaluate the success rate and complications of end-to-end anastomosis to the EJ in cases of (modified) radical neck dissection with resected IJ. A retrospective mono-center cohort study was performed. All patients with end-to-end anastomosis to either the IJ or EJ-system were reviewed. 423 free-tissue transfers performed between 2009 and 2016 were included. The overall success rate was 97.0% with an anastomotic revision rate due to venous thrombosis of 12.3%. In patients when the IJ had to be resected and the venous anastomosis was performed at the ipsilateral side to the EJ (n = 53), overall flap loss was significantly higher (5/53; 9.4%). The revision rate in these cases was 22.6%. Success rate of anastomosis to the EJ when the ipsilateral IJ was still intact was 100% (n = 20). Success rate when the anastomosis was performed at the contralateral side was 100%. End-to-end anastomosis to the EJ in cases with resected IJ is more likely to result in free flap loss. Furthermore, it is associated with a higher revision rate. Therefore, in cases with resected IJ, we suggest to plan the operation beforehand with anastomosis at the contralateral side whenever possible.

  10. Persistência da artéria hipoglossa primitiva Persistent hypoglossal artery: a case report

    Directory of Open Access Journals (Sweden)

    Otto F. Campano Vera

    1969-09-01

    Full Text Available É relatado o terceiro caso registrado na literatura de diagnóstico em vida de persistência da artéria hipoglossa primitiva, sendo o achado casual, feito durante exploração angiográfica em paciente de 42 anos de idade que sofrerá traumatismo crânio-encefálico. É referida a possibilidade de existência de outros vasos anômalos, assim como da concomitância de tais anomalias com malformações vasculares e aneurismas.El autor presenta un caso de persistencia de la arteria hipoglosa primitiva, descubierta por casualidad al afectuar artriografia cerebral en paciente traumatisado. Hace un breve resumen histórico y anatómico de otros vasos anómalos y vierte la opinión y hallazgos de otros autores, sobretodo a la asociación de aneurismas y malformaciones vasculares.The third case registered in medical literature of persistent hypoglossal artery diagnosed intra-vitamis reported. The anomaly was found incidentally in a 42 years old patient submited to an angiographic examination after head trauma. The ocurrence of other persistent anomalous anastomosis and the possibility of its association with vascular malformations is discussed.

  11. “Layer-to-Layer” Esophagogastric Anastomosis Combined with Intrathoracic Esophageal Mucosal Extention in Patients with Esophageal and Cardia Cancer

    Institute of Scientific and Technical Information of China (English)

    SHIZhongqi; CAIPing; YANYu; CHENYinchun; LIUJunhua; YOUQinshen; CAIJixiang; XIZhongxia

    2005-01-01

    Objective: To evaluate the clinical value of intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric “layer-to-layer”anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results:There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.

  12. A recommended technique of renal vein anastomosis in rat kidney transplantation for trainee

    Institute of Scientific and Technical Information of China (English)

    Ye Dongming; Heng Baoli; Lai Caiyong; Guo Zexiong; Su Zexuan

    2014-01-01

    Background Various rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity.However,vascular anastomosis,especially renal vein,is still very difficult for trainees.The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the currant method for trainees.Methods Male Wistar rats were used as donors and recipients,respectively.Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis,combining the end-to-end sutures with epidural catheter.Meanwhile,the survival rate,warm ischemia time,renal venous anastomosis time,and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein.Two trainees took part in the learning of the models in two methods for performing 30 operations,respectively.Results The difference in warm ischemia time (from (57.25±7.30) minutes in the first 10 operations to (30.05±1.85)minutes in the third 10 operations) and renal vein anastomosis time (from (32.80±3.80) minutes in the first 10 operations to (19.30±0.98) minutes in the third 10 operations) was significantly short (P<0.01) and the survival rate was statistically high (from (25±7)% in the first 10 operations to 70% in the third 10 operations) in equal number of operations (P<0.01) by comparing with the current recommended method ((47.60±7.19) minutes to (22.8±1.85) minutes,(22.40±3.10) minutes to (9.95±1.50) minutes,45%±7% to 80%±0,respectively).The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased (P<0.01).Conclusions The technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation.It may replace the currently recommended technique of rat renal vein for trainees.

  13. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial.

    LENUS (Irish Health Repository)

    Lobo, Melvin D

    2015-01-22

    Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension.

  14. J-pouch Ileoanal Anastomosis in Children and Adolescents with Ulcerative Colitis: Functional Outcome, Satisfaction and Impact on Social Life

    DEFF Research Database (Denmark)

    Wewer, V; Hesselfeldt, Peter; Qvist, N

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents

  15. Primary diffuse large B cell lymphoma developing at the ileocolonic anastomosis site after right hemicolectomy for adenocarcinoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hye Yeon; Choi, Seung Joon; Kim, Hyung Sik; Kim, Jeong Ho; Choi, Hye Young [Dept. of Radiology, Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2014-04-15

    Lymphoma is rarely associated with ileocolonic surgery. We report the imaging findings of primary diffuse large B-cell lymphoma arising in an ileocolonic anastomosis site, found five years after a right hemicolectomy for adenocarcinoma in the ascending colon.

  16. Evaluation of strategies for the control of canola and lupin seedling diseases caused by Rhizoctonia anastomosis groups

    Science.gov (United States)

    Several methods with potential for the management of Rhizoctonia diseases of canola and lupin including several methods with potential for the management of Rhizoctonia plant resistance, fungicide seed treatment and biological control using binucleate Rhizoctonia anastomosis groups (AGs) were evalua...

  17. J-pouch Ileoanal Anastomosis in Children and Adolescents with Ulcerative Colitis: Functional Outcome, Satisfaction and Impact on Social Life

    DEFF Research Database (Denmark)

    Wewer, V; Hesselfeldt, Peter; Qvist, N;

    2005-01-01

    OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents

  18. The comparative study of the outcomes of early and late oral feeding in intestinal anastomosis surgeries in children

    Directory of Open Access Journals (Sweden)

    Omid Amanollahi

    2013-01-01

    Full Text Available Background: A leakage of intestinal anastomosis is typically regarded as a devastating post-operative complication. Traditionally its believed that long fasting after intestinal surgery protect anastomosis site and most surgeons applied this method. Post-operative long fasting has many physical and mental adverse effects, especially in children, but its benefit has not proven yet. This study aimed to compare the outcomes of early and late oral feeding in intestinal resection and anastomosis surgery in children. Patients and Methods: This randomized, double-blind controlled trial evaluated the outcome of early-feeding following in children aged 1 month to 12 years who underwent intestinal resection and anastomosis and compared the results with those who had late-feeding. The results were anlysed for fever, nausea and vomiting, abdominal distension, first passage of gas and stool were also evaluated hospital stay time, major post-operative complications such as anastomosis leakage, wound infection or dehiscence, intra-abdominal abscess between the two groups. Results: The mean time of first oral feeding in the early feeding group (study group was 2.5 ± 0.7 days but it was 5.3 ± 0.6 days in the late feeding group (control group. There was no mortality in both groups. There was no difference in major complications in both groups (anastomosis leakage. In the study group, first defecation time was shorter than the control group (3.7 days v. 4.4 days and they had less hospital stay also (5.2 days vs. 8.3 days and lower cost of hospitalization. Conclusion: Early oral feeding after intestinal resection and anastomosis in children is a safe method, it has many benefits and does not increase the major or minor post-operative complications (anastomosis leakage long time fasting is not necessary and has not any beneficial effect and early feeding increases satisfaction of the parents and children, and reduce hospital stay and costs.

  19. Modified esophagogastrostomy in laparoscopy-assisted proximal gastrectomy: A reverse-Tornado anastomosis.

    Science.gov (United States)

    Kubota, Keisuke; Suzuki, Akihiro; Fujikawa, Aoi; Watanabe, Takayuki; Sekido, Yuki; Shiozaki, Hironori; Taketa, Takashi; Shimada, Gen; Ohigashi, Seiji; Sakurai, Shintaro; Kishida, Akihiro

    2017-02-01

    The aim of this study was to introduce and examine a modified mechanical end-to-side esophagogastrostomy method ("reverse-Tornado" anastomosis) in laparoscopy-assisted proximal gastrectomy. Five patients with gastric cancer who underwent laparoscopy-assisted proximal gastrectomy were analyzed retrospectively. Esophagogastrostomy in the anterior wall was performed in three patients, and esophagogastrostomy in the posterior wall was performed in two patients. Clinicopathological features, operative outcomes (operative time, operative blood loss), and postoperative outcomes (complications, postoperative hospital stay, reflux esophagitis) were evaluated. Operative time was normal (278 min). There was no marked operative blood loss, postoperative complications, prolonged hospital stay, or reflux esophagitis. Esophagogastrostomy was completed in a normal time with reverse-Tornado anastomosis. This method can be safe and can enable good postoperative quality of life. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  20. Cannieu-Riche anastomosis of the ulnar to median nerve in the hand: case report.

    Science.gov (United States)

    Paraskevas, G; Ioannidis, O; Martoglou, S

    2010-01-01

    We observed in a male cadaver the presence of a new type of very long Cannieu-Riche anastomosis between the proximal portion of the deep branch of the ulnar nerve for the adductor pollicis and ramus of the recurrent branch of the median nerve to the superficial head of the flexor pollicis brevis. The clinical relevance of such a communication is the possible preservation of the function of all or part of thenar muscles from the ulnar nerve in case of median nerve lesion. The ignorance of that anomaly can induce obscure clinical, surgical and electroneuromyographical findings. We report on the incidence, the double innervation and the clinical significance of Cannieu-Riche anastomosis and provide a new classification of the various types of this nerval connection.

  1. Abdominoendorectal resection with peranal anastomosis in the treatment of radiation injuries of the rectum

    Energy Technology Data Exchange (ETDEWEB)

    Athanasiadis, S.; Girona, J.

    1982-01-01

    During the period 1974-1980 39 patients underwent operations at the Prosper Hospital in Recklinghausen for radiation injuries to the rectum or rectosigmoid. They comprised 22 patients with rectovaginal fistulas, 6 with ulcers, 3 suffering from severe hemorrhagic proctitis, 5 with rectal strictures, 1 with necrosis, and 2 with radiation ulcers and carcinoma. A sphincter-saving operative method of treating postirradiation damage of the rectum is presented. The technique involves the peranal anastomosis of healthy colon to the midanal canal using a sleeve anastomosis. Technical and functional results of resectional surgery for the rectal complications of radiation therapy are reported. Subjectively, total continence was present in 78%, only 1 patient was incontinent because of flatus and watery stools.

  2. A meta-analysis of aneurysm formation in laser assisted vascular anastomosis (LAVA)

    Science.gov (United States)

    Chen, Chen; Peng, Fei; Xu, Dahai; Cheng, Qinghua

    2009-08-01

    Laser assisted vascular anastomosis (LAVA) is looked as a particularly promising non-suture method in future. However, aneurysm formation is one of the main reasons delay the clinical application of LAVA. Some scientists investigated the incidence of aneurysms in animal model. To systematically analyze the literature on reported incidence of aneurysm formation in LAVA therapy, we performed a meta-analysis comparing LAVA with conventional suture anastomosis (CSA) in animal model. Data were systematically retrieved and selected from PUBMED. In total, 23 studies were retrieved. 18 studies were excluded, and 5 studies involving 647 animals were included. Analysis suggested no statistically significant difference between LAVA and CSA (OR 1.24, 95%CI 0.66-2.32, P=0.51). Result of meta analysis shows that the technology of LAVA is very close to clinical application.

  3. Laser assisted vascular anastomosis (LAVA): a promising nonsuture technique for surgery

    Science.gov (United States)

    Chen, Chen; Peng, Fei; Xu, Dahai; Cheng, Qinghua

    2009-08-01

    The first successful experiment of laser vascular welding was reported in 1979. Laser assisted vascular anastomosis (LAVA) is looked as a particularly promising non-suture method in future. We performed a Medline literature search on laser vessel welding combined with cross-referencing. According to the former experimental animal studies, CO2-, argon-, diode-, KTP-, Holmium:YAG-, and Nd:YAG-lasers have been used for LAVA. Almost all lasers have been used in combination with stay suture and/or solders in order to improve the strength on anastomosis site. Advantages of LAVA are minimal vessel damage, faster operation and the potential for minimally invasive application. However, the clinical application of LAVA is still seldom employed because of aneurysm formation. In conclusion of the literature study, the diode laser is the most popular, but long-term evaluation is required.

  4. A new anastomosis technique for intestinal diseases with proximal dilated segments

    Directory of Open Access Journals (Sweden)

    Metin Gündüz

    2016-01-01

    Full Text Available A number of techniques have been described for intestinal anastomosis. We describe a different, simple, and safe technique that can be used in patients with intestinal diseases, such as jejunoileal atresia and perforation that has proximal dilated segments. In this technique, an atraumatic bowel clamp was applied on the proximal dilated bowel at a 90° angle. In the narrow distal segment, we resected the bowel at a 0° angle and continued at a 30° angle from the antimesenteric side. Finally, a two-layer interrupted anastomosis was performed. We applied this technique to a 31-day-old patient who had a divided jejunostomy due to malrotation and perforation with a proximal dilated bowel. Neither anastomotic complications nor feeding and passage problems were seen postoperatively.

  5. The C-seal trial: colorectal anastomosis protected by a biodegradable drain fixed to the anastomosis by a circular stapler, a multi-center randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bakker Ilsalien S

    2012-11-01

    Full Text Available Abstract Background Anastomotic leakage is a major complication in colorectal surgery and with an incidence of 11% the most common cause of morbidity and mortality. In order to reduce the incidence of anastomotic leakage the C-seal is developed. This intraluminal biodegradable drain is stapled to the anastomosis with a circular stapler and prevents extravasation of intracolonic content in case of an anastomotic dehiscence. The aim of this study is to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses, as assessed by anastomotic leakage leading to invasive treatment within 30 days postoperative. Methods The C-seal trial is a prospective multi-center randomized controlled trial with primary endpoint, anastomotic leakage leading to re-intervention within 30 days after operation. In this trial 616 patients will be randomized to the C-seal or control group (1:1, stratified by center, anastomotic height (proximal or distal of peritoneal reflection and the intention to create a temporary deviating ostomy. Interim analyses are planned after 50% and 75% of patient inclusion. Eligible patients are at least 18 years of age, have any colorectal disease requiring a colorectal anastomosis to be made with a circular stapler in an elective setting, with an ASA-classification Discussion This Randomized Clinical trial is designed to evaluate the effectiveness of the C-seal in preventing clinical anastomotic leakage. Trial registration NTR3080

  6. Partial recovery of respiratory function and diaphragm reinnervation following unilateral vagus nerve to phrenic nerve anastomosis in rabbits.

    Directory of Open Access Journals (Sweden)

    Junxiang Wen

    Full Text Available Respiratory dysfunction is the leading cause of mortality following upper cervical spinal cord injury (SCI. Reinnervation of the paralyzed diaphragm via an anastomosis between phrenic nerve and a donor nerve is a potential strategy to mitigate ventilatory deficits. In this study, anastomosis of vagus nerve (VN to phrenic nerve (PN in rabbits was performed to assess the potential capacity of the VN to compensate for lost PN inputs. At first, we compared spontaneous discharge pattern, nerve thickness and number of motor fibers between these nerves. The PN exhibited a highly rhythmic discharge while the VN exhibited a variable frequency discharge pattern. The rabbit VN had fewer motor axons (105.3±12.1 vs. 268.1±15.4. Nerve conduction and respiratory function were measured 20 weeks after left PN transection with or without left VN-PN anastomosis. Compared to rabbits subjected to unilateral phrenicotomy without VN-PN anastomosis, diaphragm muscle action potential (AP amplitude was improved by 292%, distal latency by 695%, peak inspiratory flow (PIF by 22.6%, peak expiratory flow (PRF by 36.4%, and tidal volume by 21.8% in the anastomosis group. However, PIF recovery was only 28.0%, PEF 28.2%, and tidal volume 31.2% of Control. Our results suggested that VN-PN anastomosis is a promising therapeutic strategy for partial restoration of diaphragm reinnervation, but further modification and improvements are necessary to realize the full potential of this technique.

  7. Exteriorized colon anastomosis for unprepared bowel: An alternative to routine colostomy

    Institute of Scientific and Technical Information of China (English)

    Sami K Asfar; Hilal M Al-Sayer; Talib H Juma

    2007-01-01

    AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel.METHODS: The cohort is composed of 103 patients,of these, 86 patients presented as emergencies (selfinflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia).Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound.One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure.RESULTS: The mean hospital stay (± SD) was 11.5 ±2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophagojejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure(MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed.CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.

  8. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2014-12-01

    Full Text Available Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy.

  9. Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study

    Directory of Open Access Journals (Sweden)

    Tannuri Uenis

    1999-01-01

    Full Text Available For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment. The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.

  10. An intraluminal prosthesis may improve healing of a one-layer colonic anastomosis

    DEFF Research Database (Denmark)

    Buch, N; Glad, H; Svendsen, P;

    2002-01-01

    OBJECTIVE: To compare healing of one-layer colonic anastomoses with or without a soluble intraluminal prosthesis (* SBS-tube). DESIGN: Randomised, partly blinded controlled study. SETTING: University hospital, Denmark. SUBJECTS: 16 female Danish country strain pigs, of which 8 had the SBS tube...... of the anastomosis and may improve healing, possibly because of better apposition of the cut ends and reduced tension in the sutures....

  11. New device for saphenous vein-to-aorta proximal anastomosis without side-clamping

    Directory of Open Access Journals (Sweden)

    Tappainer Ernesto

    2007-05-01

    Full Text Available Abstract Background Side clamping to perform saphenous vein-to-aorta proximal anastomosis is a well known cause of cerebral embolization during coronary bypass surgery. Automatic and manual devices have been introduced to avoid aortic clamping and facilitate proximal anastomosis but the manual ones only allow the traditional hand-sewing running suture. Nevertheless, they are not easy to use and very expensive to buy. Methods We developed a simple object that helps to perform a manual proximal anastomosis without the need to clamp the side of the aorta. This device is a steel bar which blocks the aortic hole and simultaneously it provides a slit to receive the needle. Through the slit comes out a thin, sharp, straight, but also well directed and predictable jet of blood which could be easily controlled during the suture. Results The function of the object is quite different from other devices. Nothing is deployed in the aorta. The object is only placed on the aorta with the small appendage slipped into the hole. The main advantage of the device is that while manipulation of the aorta is avoided no foreign bodies are incorporated in the suture and – most importantly – the aortic intima is not touched at all. The main drawback of the device is the blood jet coming from the slit so that the blood pressure has to be lowered by vasodilators during the anastomosis. Moreover, the suture has to change direction and the needle has to enter the aortic wall first to slip out through the slit. Conclusion The object was named "Slit Device" and is not a routine instrument. It would be only an alternative to other anastomotic devices with the same surgical indications. In the case of ascending aortic disease and saphenous vein grafting, the Slit Device avoids aortic clamping thereby preventing atheroembolism and also avoiding the need for hypothermic circulatory arrest in patients with unclampable aorta.

  12. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance.

    Science.gov (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).

  13. Gallstone obstructive ileus 3 years post-cholecystectomy to a patient with an old ileoileal anastomosis.

    Science.gov (United States)

    Papavramidis, T S; Potsi, S; Paramythiotis, D; Michalopoulos, A; Papadopoulos, V N; Douros, V; Pantoleon, A; Foutzila-Kalogera, A; Ekonomou, I; Harlaftis, N

    2009-12-01

    The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.

  14. Real-time 3D Fourier-domain optical coherence tomography guided microvascular anastomosis

    Science.gov (United States)

    Huang, Yong; Ibrahim, Zuhaib; Lee, W. P. A.; Brandacher, Gerald; Kang, Jin U.

    2013-03-01

    Vascular and microvascular anastomosis is considered to be the foundation of plastic and reconstructive surgery, hand surgery, transplant surgery, vascular surgery and cardiac surgery. In the last two decades innovative techniques, such as vascular coupling devices, thermo-reversible poloxamers and suture-less cuff have been introduced. Intra-operative surgical guidance using a surgical imaging modality that provides in-depth view and 3D imaging can improve outcome following both conventional and innovative anastomosis techniques. Optical coherence tomography (OCT) is a noninvasive high-resolution (micron level), high-speed, 3D imaging modality that has been adopted widely in biomedical and clinical applications. In this work we performed a proof-of-concept evaluation study of OCT as an assisted intraoperative and post-operative imaging modality for microvascular anastomosis of rodent femoral vessels. The OCT imaging modality provided lateral resolution of 12 μm and 3.0 μm axial resolution in air and 0.27 volume/s imaging speed, which could provide the surgeon with clearly visualized vessel lumen wall and suture needle position relative to the vessel during intraoperative imaging. Graphics processing unit (GPU) accelerated phase-resolved Doppler OCT (PRDOCT) imaging of the surgical site was performed as a post-operative evaluation of the anastomosed vessels and to visualize the blood flow and thrombus formation. This information could help surgeons improve surgical precision in this highly challenging anastomosis of rodent vessels with diameter less than 0.5 mm. Our imaging modality could not only detect accidental suture through the back wall of lumen but also promptly diagnose and predict thrombosis immediately after reperfusion. Hence, real-time OCT can assist in decision-making process intra-operatively and avoid post-operative complications.

  15. Coloanal anastomosis in the management of benign and malignant rectal disease

    Energy Technology Data Exchange (ETDEWEB)

    Drake, D.B.; Pemberton, J.H.; Beart, R.W. Jr.; Dozois, R.R.; Wolff, B.G.

    1987-11-01

    The aim was to determine the efficacy, safety, and long-term clinical and functional results of coloanal anastomosis in patients with complicated benign and malignant rectal disease. Twenty-nine patients underwent coloanal or colopouch-anal anastomosis for either carcinoma of the rectum not technically amenable to conventional low anterior resection, severe radiation injury, large benign lower third tumors, or complications of previous operations. The mean age of the patients was 61 years and 82% were men. A diverting colostomy was constructed in 55% of the patients. The mean (+/- SEM) length of follow-up was 20 +/- 3 months. There was no operative mortality. Transient urinary retention, however, occurred in 40%, anastomotic stricture in 28%, and anastomotic leakage in 3.4%. Four patients (14%) could not have intestinal continuity restored and therefore were considered failures. The stool frequency for all remaining patients (N = 25) was 3 +/- 1 per day (mean +/- SEM) and did not vary with age, sex, or indication for operation. Complete continence was achieved by 84% of patients, but no patient was incapacitated by poor bowel function. In patients in whom a conventional colorectostomy is impractical or unwise, coloanal anastomosis is a safe and efficacious alternative operation that preserves anal continence.

  16. Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report.

    Science.gov (United States)

    Gennaro, P; Gabriele, G; Mihara, M; Kikuchi, K; Salini, C; Aboh, I; Cascino, F; Chisci, G; Ungari, C

    2016-11-01

    Lymphoedema of the extremities is a widespread pathological condition that mostly occurs as a complication of cancer resections, especially in women. Conventional therapy refers to conservative and physiotherapeutic approaches. Surgical strategies have been widely reported in the literature and are still challenging. Part of this literature focuses on the supra microsurgical lymphaticovenular anastomosis (LVA) technique. LVA is characterized by a high success rate, minimal invasivity and broad indications. Furthermore, this procedure can be performed under local anesthesia. From October 2011 through October 2014, 69 patients affected by lymphedema underwent LVA surgery in Siena University Hospital, Italy. Preoperative and postoperative evaluations were taken. Totally, 366 anastomosis have been performed. The average rate was 5.3 anastomosis per patient. All patients registered a decrease in the size of the affected side. The average volume reduction was 50%. Patients also showed a reduction of lymphangitis episodes and reduction of compression garments class. Moreover, a satisfaction index was evaluated. The majority of patients (72.5%) was extremely satisfied of the surgery. LVA has demonstrated to be an effective surgical strategy to treat lymphoedema, especially in secondary cases in early stages. Although LVA is widely discussed in the literature, the majority of works relates to Japanese authors and few reports exist outside Japan. This paper represents the very first retrospective analysis of the adoption of LVA technique in Italy and one of the few outside Japan.

  17. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review.

    Science.gov (United States)

    Ghista, Dhanjoo N; Kabinejadian, Foad

    2013-12-13

    In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs.

  18. The effect of erythropoietin on healing of obstructive vs nonobstructive left colonic anastomosis: an experimental study

    Directory of Open Access Journals (Sweden)

    Renda Nurten

    2007-05-01

    Full Text Available Abstract Background Anastomotic leakage is an important problem following primary resection in the left colon and is even more prominent when obstruction is present. We aimed to evaluate the possible effects of erythropoietin on the healing of anastomosis under both obstructive and non-obstructive states. Methods Forty male Wistar albino rats were divided into four groups. In group I, two cm left colonic resection and primary anastomosis were done. In group II, left colon were completely ligated and 24 hours later animals were re-operated for segmental resection. The same procedures were performed for rats in group III and IV in respect to group I and II and, 500 IU/kg a day erythropoietin were given in the latter two groups for seven days. For the quantative description of anastomotic healing mechanical, biochemical and histopathological parameters were employed on the seventh day and the animals were sacrificied. Results Although erythropoietin had positive effects on bursting pressure in group IV when compared to group II, it has no effect in group III. Despite the increased tissue hydroxyproline levels in group IV, erythropoietin failed to show any effects in group III. Erythropoietin had positive effects on neovascularization, fibroblast proliferiation and storage of collagen in group IV. Conclusion We failed to find any direct and evident effects of erythropoietin on healing of left colonic anastomosis. On the other hand, erythropoietin might prevent negative effects of obstruction on healing.

  19. Inhibitory effects of alkaloids from Sophora alopecuroids on feeding,development and reproduction of Clostera anastomosis

    Institute of Scientific and Technical Information of China (English)

    Yang Zhende; Zhao Boguang; Zhu Lin; Fang Jie; Xia Luqing

    2006-01-01

    Alkaloids from Sophora alopecuroids were bioassayed with Clostera anastomosis for their antifeedant and growth inhibitory effects.The antifeedant rate in choice test reached 62%-86% at the dose 2.5 mg/mL,while in non-choice bioassay the rate was only 20%-29%.In choice bioassay,the anfifeedant rate increased with larval instars of C anastomosis and did not in non-choice experiment.The alkaloids also imposed a strong influence on the growth of C anastomosis larvae,i.e.,after feeding on the leaves treated with alkaloid,the larvae lost their weight,weight gain,and relative growth rate (RGR) significantly when compared with the controls.In the second day after treatment with the dose at 10 mg/mL of the alkaloid,the RGR reduced by 39.8%,and the food intake and the feces weight were respectively 57.7% and 57.4% of the controls.The approximate digestibility (AD) increased significantly,and the efficiency in converting digested food (ECD),and the efficiency in converting ingested food (ECI) decreased greatly after feeding the treated leaves.Moreover,the eggs laid per female were also inhibited by this alkaloid.The significance and prospect of the alkaloids in controlling forest insect pests were also discussed.

  20. Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer.

    Science.gov (United States)

    Olagne, E; Baulieux, J; de la Roche, E; Adham, M; Berthoux, N; Bourdeix, O; Gerard, J P; Ducerf, C

    2000-12-01

    The aim of this study was to assess functional outcomes of patients who had a delayed coloanal anastomosis for a lower third rectal cancer after preoperative radiotherapy. From January 1988 to December 1997, 35 patients with an adenocarcinoma of the lower third of the rectum received preoperative radiotherapy (45Gy) followed by a rectal resection, combining an abdominal and transanal approach. Colorectal resection was performed about 32 days after the end of the radiotherapy. The distal colon stump was pulled through the anal canal. On postoperative day 5 the colonic stump was resected and a direct coloanal anastomosis performed without colostomia diversion. There was no mortality. There was no leakage. One patient had a pelvic abscess. One patient had a necrosis of the left colon requiring reoperation. Another delayed coloanal anastomosis could be performed. Median followup was 43 months (range 6 to 113 months). Functional results were evaluated with a new scoring system including 13 items. Function was considered good in 59% and 70% at 1 and 2 years, respectively. This new procedure is a safe and effective sphincter-preserving operation that avoids a diverting stoma for patients with rectal cancer of the lower third of the rectum. This technique is well adapted for patients receiving preoperative radiotherapy, with low local morbidity and good functional results. Further adaptation could be imagined for a coelioscopic approach.

  1. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review

    Science.gov (United States)

    2013-01-01

    In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs. PMID:24330653

  2. Technique of totally robotic delta-shaped anastomosis in distal gastrectomy

    Directory of Open Access Journals (Sweden)

    Hidehiko Kitagami

    2017-01-01

    Full Text Available Background: We aimed to clarify the utility of delta-shaped anastomosis (Delta, an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG, in robot-assisted distal gastrectomy (RADG. Methods: RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler. Results: The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission. Conclusions: Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

  3. In vivo perfusion assessment of an anastomosis surgery on porcine intestinal model (Conference Presentation)

    Science.gov (United States)

    Le, Hanh N. D.; Opferman, Justin; Decker, Ryan; Cheon, Gyeong W.; Kim, Peter C. W.; Kang, Jin U.; Krieger, Axel

    2016-04-01

    Anastomosis, the connection of two structures, is a critical procedure for reconstructive surgery with over 1 million cases/year for visceral indication alone. However, complication rates such as strictures and leakage affect up to 19% of cases for colorectal anastomoses and up to 30% for visceral transplantation anastomoses. Local ischemia plays a critical role in anastomotic complications, making blood perfusion an important indicator for tissue health and predictor for healing following anastomosis. In this work, we apply a real time multispectral imaging technique to monitor impact on tissue perfusion due to varying interrupted suture spacing and suture tensions. Multispectral tissue images at 470, 540, 560, 580, 670 and 760 nm are analyzed in conjunction with an empirical model based on diffuse reflectance process to quantify the hemoglobin oxygen saturation within the suture site. The investigated tissues for anastomoses include porcine small (jejunum and ileum) and large (transverse colon) intestines. Two experiments using interrupted suturing with suture spacing of 1, 2, and 3 mm and tension levels from 0 N to 2.5 N are conducted. Tissue perfusion at 5, 10, 20 and 30 min after suturing are recorded and compared with the initial normal state. The result indicates the contrast between healthy and ischemic tissue areas and assists the determination of suturing spacing and tension. Therefore, the assessment of tissue perfusion will permit the development and intra-surgical monitoring of an optimal suture protocol during anastomosis with less complications and improved functional outcome.

  4. Icodextrin and Seprafilm do not interfere with colonic anastomosis in rats.

    Science.gov (United States)

    Baca, B; Boler, D E; Onur, E; Akca, O; Hamzaoglu, I; Karahasanoglu, T; Erdamar, S; Atukeren, P; Dirican, A

    2007-01-01

    Physical barriers and instilled solutions have been studied to prevent intra-abdominal adhesions. However, undesirable side effects of these substances on the healing of intestinal anastomoses may limit their use. This study was designed to compare the effects of antiadhesives on the healing of colonic anastomosis in rats. Sixty female Sprague-Dawley rats were divided into 3 groups of 20. The animals received isotonic saline and 7.5% icodextrin, intraperitoneally after standard left colonic anastomosis. In group 3, Seprafilm was wrapped around the anastomosis and also laid over the abdominal viscera. Half of the animals from each group were killed on postoperative day (POD) 4 and the remaining half on POD 21. Adhesion scoring, bursting pressure and tissue hydroxyproline measurements and histopathological assessment were performed. Mean hydroxyproline levels were significantly higher in groups receiving icodextrin and Seprafilm compared with the control group, whereas mean bursting pressures were significantly higher in the group that received icodextrin (p icodextrin resulted in significant reduction of adhesion formation on POD 21 (p icodextrin does, but its effect on the healing of colonic anastomoses is similar. Copyright 2007 S. Karger AG, Basel.

  5. Clinical analysis on the treatment of biliary complications after bilioenteric anastomosis via jejunal loop endoscopy

    Directory of Open Access Journals (Sweden)

    Guo-ping LIU

    2011-12-01

    Full Text Available Objective The present study summarizes the treatment of biliary complications after bilioenteric anastomosis via jejunal loop endoscopy.Methods The clinical data of nine cases(12 times of biliary complications after bilioenteric anastomosis were retrospectively analyzed.The patients were admitted to the Endoscopy Department of the General Hospital of the Shenyang Military Area from December 2005 to July 2011 and were treated via jejunal loop endoscopy.Results The success probability of the operation was 100%(12/12,and the incidence rate of anastomotic stenosis during operation was 88.9%(8/9.Seven cases experienced alleviation or no recurrence of reflux cholangitis after the operation.Bilirubin decreased significantly in six cases,and the stone clearance rate was 100%(3/3.Biliary metal stents were implanted in two cases,plastic stents were employed in five,and naso-biliary tubes were used in the other two.After operation,intestinal fistula occurred in one case,liver abscess occurred in another,and incision infection occurred in three other cases.Conclusion Jejunal loop endoscopy is a highly effective and minimally invasive treatment for biliary complications after bilioenteric anastomosis and,thus,should be widely applied in clinical practice.

  6. Immediate primary anastomosis for isolated oesophageal atresia: A single-centre experience

    Directory of Open Access Journals (Sweden)

    Ibrahim Uygun

    2015-01-01

    Full Text Available Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy. Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%, from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100 g. Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4 within 10 (median 3 days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months. Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.

  7. Microvascular anastomosis in rodent model evaluated by Fourier domain Doppler optical coherence tomography

    Science.gov (United States)

    Huang, Yong; Tong, Dedi; Zhu, Shan; Wu, Lehao; Ibrahim, Zuhaib; Lee, WP Andrew; Brandacher, Gerald; Kang, Jin U.

    2014-03-01

    Vascular and microvascular anastomosis are critical components of reconstructive microsurgery, vascular surgery and transplant surgery. Imaging modality that provides immediate, real-time in-depth view and 3D structure and flow information of the surgical site can be a great valuable tool for the surgeon to evaluate surgical outcome following both conventional and innovative anastomosis techniques, thus potentially increase the surgical success rate. Microvascular anastomosis for vessels with outer diameter smaller than 1.0 mm is extremely challenging and effective evaluation of the outcome is very difficult if not impossible using computed tomography (CT) angiograms, magnetic resonance (MR) angiograms and ultrasound Doppler. Optical coherence tomography (OCT) is a non-invasive high-resolution (micron level), high-speed, 3D imaging modality that has been adopted widely in biomedical and clinical applications. Phaseresolved Doppler OCT that explores the phase information of OCT signals has been shown to be capable of characterizing dynamic blood flow clinically. In this work, we explore the capability of Fourier domain Doppler OCT as an evaluation tool to detect commonly encountered post-operative complications that will cause surgical failure and to confirm positive result with surgeon's observation. Both suture and cuff based techniques were evaluated on the femoral artery and vein in the rodent model.

  8. Crohn's-like complications in patients with ulcerative colitis after total proctocolectomy and ileal pouch-anal anastomosis.

    Science.gov (United States)

    Goldstein, N S; Sanford, W W; Bodzin, J H

    1997-11-01

    Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become an established surgical procedure for ulcerative colitis. Occasional patients who have undergone IPAA develop persistent or recurrent episodes of pouchitis (chronic pouchitis), from which a subset also develop gastrointestinal and systemic complications that are identical to those seen in Crohn's disease. These complications include enteric stenoses or fistulas in the pouch or pouch inlet segment, perianal fistulas or abscesses, pouch fistulas, arthritis, iridocyclitis, and pyoderma gangrenosum. The development of Crohn's-like gastrointestinal complications in a patient with chronic pouchitis frequently engenders concern that the pathologist misinterpreted the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease. We describe eight patients who developed chronic pouchitis and Crohn's-like complications after IPAA and total proctocolectomy. In each case, concern was voiced about misinterpretation of the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease after the development of the Crohn's-like complications. Preoperatively, all eight patients had characteristic clinical, radiographic, and pathologic features of ulcerative colitis. Review of the pathology specimens indicated that all eight had ulcerative colitis. Crohn's-like complications are most likely related to chronic pouchitis, which probably is a form of recrudescent ulcerative colitis within the novel environment of the pouch. A diagnosis of Crohn's disease after IPAA surgery should only be made when reexamination of the original proctocolectomy specimen shows typical pathologic features of Crohn's disease, Crohn's disease arises in parts of the gastrointestinal tract distant from the pouch, pouch biopsies contain active enteritis with granulomas, or excised pouches show the characteristic features of Crohn's disease, including granulomas. There were no histologic differences in the total

  9. Active control synthesis for flexible space structures excited by persistent disturbances

    Science.gov (United States)

    Wie, Bong; Gonzalez, Marcelo

    1990-01-01

    Both classical and state-space synthesis methods for active control of flexible space structures in the presence of persistent disturbances are presented. The methods exploit the so-called internal model principle for asymptotic disturbance rejection. A generic example of flexible space structures is used to illustrate the simplicity of the proposed design methodologies. The concept of a disturbance rejection filter dipole is introduced from a classical control viewpoint. It is shown that the proposed design methods will invariably make use of non-minimum-phase compensation for a class of noncolocated control problems. The need for tradeoffs between performance and parameter robustness is discussed.

  10. MEMS-based handheld fourier domain Doppler optical coherence tomography for intraoperative microvascular anastomosis imaging.

    Directory of Open Access Journals (Sweden)

    Yong Huang

    Full Text Available To demonstrate the feasibility of a miniature handheld optical coherence tomography (OCT imager for real time intraoperative vascular patency evaluation in the setting of super-microsurgical vessel anastomosis.A novel handheld imager Fourier domain Doppler optical coherence tomography based on a 1.3-µm central wavelength swept source for extravascular imaging was developed. The imager was minimized through the adoption of a 2.4-mm diameter microelectromechanical systems (MEMS scanning mirror, additionally a 12.7-mm diameter lens system was designed and combined with the MEMS mirror to achieve a small form factor that optimize functionality as a handheld extravascular OCT imager. To evaluate in-vivo applicability, super-microsurgical vessel anastomosis was performed in a mouse femoral vessel cut and repair model employing conventional interrupted suture technique as well as a novel non-suture cuff technique. Vascular anastomosis patency after clinically successful repair was evaluated using the novel handheld OCT imager.With an adjustable lateral image field of view up to 1.5 mm by 1.5 mm, high-resolution simultaneous structural and flow imaging of the blood vessels were successfully acquired for BALB/C mouse after orthotopic hind limb transplantation using a non-suture cuff technique and BALB/C mouse after femoral artery anastomosis using a suture technique. We experimentally quantify the axial and lateral resolution of the OCT to be 12.6 µm in air and 17.5 µm respectively. The OCT has a sensitivity of 84 dB and sensitivity roll-off of 5.7 dB/mm over an imaging range of 5 mm. Imaging with a frame rate of 36 Hz for an image size of 1000(lateral×512(axial pixels using a 50,000 A-lines per second swept source was achieved. Quantitative vessel lumen patency, lumen narrowing and thrombosis analysis were performed based on acquired structure and Doppler images.A miniature handheld OCT imager that can be used for intraoperative evaluation of

  11. Hypoglossal-facial nerve anastomosis in the rabbits using laser welding.

    Science.gov (United States)

    Hwang, Kun; Kim, Sun Goo; Kim, Dae Joong

    2008-10-01

    The aim of this study is to compare laser nerve welding of hypoglossal-facial nerve to microsurgical suturing and a result of immediate and delayed repair, and to evaluate the effectiveness of laser nerve welding in reanimation of facial paralysis of the rabbit models. The first group of 5 rabbits underwent immediate hypoglossal-facial anastomosis (HFA) by microsurgical suturing and the second group of 5 rabbits by CO2 laser welding. The third group of 5 rabbits underwent delayed HFA by microsurgical suturing and the fourth group of 5 rabbits by laser nerve welding. The fifth group of 5 rabbits sustained intact hypoglossal and facial nerve as control. In all rabbits of the 4 different groups, cholera toxin subunit B (CTb) was injected in the epineurium distal to the anastomosis site on the postoperative sixth week and in normal hypoglossal nerve in the 5 rabbits of control group. Neurons labeled CTb of hypoglossal nuclei were positive immunohistochemically and the numbers were counted. In the immediate HFA groups, CTb positive neurons were 1416 +/- 118 in the laser welding group (n = 5) and 1429 +/- 90 in the microsurgical suturing group (n = 5). There was no significant difference (P = 0.75). In the delayed HFA groups, CTb positive neurons were 1503 +/- 66 in the laser welding group (n = 5) and 1207 +/- 68 in the microsurgical suturing group (n = 5). Difference was significant (P = 0.009). There was no significant difference between immediate and delayed anastomosis in the laser welding group (P = 0.208), but some significant difference was observed between immediate and delayed anastomosis in the microsurgical suturing group (P = 0.016). Injected CTb in intact hypoglossal neurons (n = 5) were labeled 1970 +/- 165. No dehiscence was seen on the laser welding site of nerve anastomosis in all the rabbits as re-exploration was done for injection of CTb. This study shows that regeneration of the anastomosed hypoglossal-facial nerve was affected similarly by either

  12. Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis.

    Science.gov (United States)

    Pachler, Frederik R; Brandsborg, Søren B; Laurberg, Søren

    2017-06-01

    Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied. This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis. This was a retrospective registry-based cohort study that was performed over a 30-year period. Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered. All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases. The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis. We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years). Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%. Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical

  13. Effects of intraperitoneal nitroglycerin on the strength and healing attitude of anastomosis of rat intestines with ischemia-reperfusion injury

    Directory of Open Access Journals (Sweden)

    Ahmet Oktay Cihan

    2011-01-01

    Full Text Available Background: Ischemic conditions in the intestine result in deterioration of anastomosis healing process. In this study, our aim was to evaluate the possible effects of intraperitoneal nitroglycerin on the intestinal anastomosis healing and anastomosis burst pressures in rats with ischemia and reperfusion injury (I/R. Materials and Methods: Fifty four Wistar albino rats were divided into six groups. In the first two groups, the rats underwent I/R. In the Group 1, the rats had normal saline (S and in Group 2, the rats had nitroglycerin (N injection. In the 3 rd and 4 th groups, an intestinal anastomosis was made at the 10 cm proximally to the ileocecal valve. In Group 3, S and in Group 4, N were injected. In Group 5, the rats received I/R, intestinal anastomosis and intraperitoneal S injection. I/R, intestinal anastomosis and intraperitoneal N injection were made in Group 6 rats. All nitroglycerin (50 ΅g/kg injections were made at postoperative days of 0, 1, 2, 3, 4, 5 consecutively. On the sixth day, all rats were killed. In all rats with anastomosis, anastomotic burst pressure (ABP was measured. Histopathological specimens were collected from all rats and evaluated under light microscopy. Results: Serious tissue damage was only detected in the Group 1 histopathologically (8 rats had grade 4 damage. In Group 2, there was a decrease in tissue damage according to histopathologic examination (5 rats had grade 1 damage. The effect onto the healing was similar in S and N groups. Nitroglycerin was noted to have a positive effect on collagen production. Nitroglycerin increased the ABP levels in rats both with and without I/R (the means are 17.93, 21.10, 14.67, and 17.63 in Groups 3, 4, 5, and 6, respectively. Conclusion: I/R may weaken the strength of intestinal anastomosis. Intraperitoneal application of nitroglycerin may prevent the histopathologic changes within a limited degree. Intraperitoneal nitroglycerin has also positive effects on the healing

  14. Anastomosis Martin-Gruber: Aspectos anatómicos y electrofisiológicos Martin-Gruber Anastomosis: Anatomical and electrophysiological issues

    Directory of Open Access Journals (Sweden)

    Esperanza Herrera

    2009-08-01

    Full Text Available La anastomosis de Martin Gruber (AMG es una de las variaciones anatómicas más frecuentes que consiste en la contribución de axones motores desde el nervio mediano hacia el ulnar en el antebrazo. Factores filogenéticos y genéticos se asocian con la aparición de la AMG. Entre tanto, otros factores como género, raza o lateralidad no parecen tener importancia en la aparición de la rama comunicante. Las clasificaciones de la AMG han sido establecidas según los hallazgos anatómicos, electrofisiológicos e histológicos y también según el lugar de origen y destino de la anastomosis. El objetivo de este artículo es revisar los factores asociados a la presencia de la AMG, así como las descripciones y clasificaciones anatómicas y electrofisiológicas. Esta revisión aporta información relevante para el reconocimiento de los patrones clásico y variante de inervación de la musculatura intrínseca de la mano. Dicho reconocimiento permite diagnosticar e intervenir apropiadamente las alteraciones de los nervios periféricos de la extremidad superior. Salud UIS 2009; 41: 157-168The Martin Gruber Anastomosis (MGA is one of the most common anatomical variants of the upper limb, which consists of motor axons crossing through the forearm from the median nerve to the ulnar nerve. Phylogenetic and hereditary factors have been associated whit the MGA. However, gender, race, or laterality, do not seem to have importance in the appearance of the communicating branch. The MGA has been categorized according to findings in anatomy, electrophysiology and histology, in relation to the source and destination of the communicating branch. The aim of this article is to review the factors related to the presence of MGA, as well as the descriptions and classifications according to anatomy and electrophysiology. This revision contributes with important information relevant to the recognition of differences between the classic pattern and the variant pattern of the

  15. T-Stenting-and-Small-Protrusion Technique for Bifurcation Stenoses After End-to-Side Anastomosis of Transplant Renal Artery and External Iliac Artery: Report of Two Cases

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yong, E-mail: cheny102@163.com; Ye, Peng, E-mail: thomas19871223@163.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China); Jiang, Wen-jin, E-mail: 18653501187@163.com [Yantai Yuhuangding Hospital (China); Ma, Shuo-yi, E-mail: mazelong123456789@126.com; Zhao, Jian-bo, E-mail: zhaojianbohgl@163.com; Zeng, Qing-le, E-mail: doctorzengqingle@126.com [Southern Medical University, Department of Interventional Radiology, Nanfang Hospital (China)

    2015-10-15

    Bifurcation stenoses after end-to-side anastomosis of transplant renal artery (TRA) and external iliac artery (EIA), including stenoses at the anastomosis and the iliac artery proximal to the TRA, are rare. In the present article, we report two successfully managed cases of bifurcation stenoses after end-to-side anastomosis of the TRA and EIA using the technique of T-stenting and small protrusion (TAP stenting)

  16. Pressure drops in a distensible model of end-to-side anastomosis in systemic-to-pulmonary shunts.

    Science.gov (United States)

    Migliavacca, Francesco; Pennati, Giancarlo; Di Martino, Elena; Dubini, Gabriele; Pietrabissa, Riccardo

    2002-06-01

    The modified Blalock-Taussig shunt is a surgical procedure used as a palliation to treat complex congenital heart defects. It consists of an interposing prosthetic tube between the innominate/subclavian artery and the right pulmonary artery. Previous experience indicates that the pressure drop across the shunt is affected by the pulmonary pressure at the distal anastomosis combined with the distensibility of the anastomosis. In this study, a computational fluid-structure interaction approach is presented to investigate the haemodynamic behaviour. Steady-state fluid dynamics and structural analyses were carried out using commercial codes based on the finite element method (FIDAP and ABAQUS) coupled by means of a purposely-developed procedure to transfer boundary conditions. Both prosthetic tube and artery walls were characterised by non-linear material properties. Three different pulmonary pressures (2, 5 and 15 mmHg) and two volume flow rates (0.4 and 0.8 l/min) were investigated. Results indicate that the effects of distensibility at the distal anastomosis on the shunt pressure drop are relevant only when the distal anastomosis on the shunt pressure drop are relevant only when the distal anastomosis is not fully distended, which occurs when the pulmonary pressure is lower than 5 mmHg.

  17. 08, with the 20th commemoration of the so-called Battle Of Cuito ...

    African Journals Online (AJOL)

    Willem Scholtz

    historian‟s perception is also influenced by all the facts he has marshalled. “The .... In the following review, I have to stress that I do not care what researchers‟ political ..... While they do bring forth a host of very valuable information, it seems as if he ..... Fidel Castro's 1977 Southern Africa tour: A report to Honecker. 3 April.

  18. A qualitative investigation into the so-called ministry of deliverance

    Directory of Open Access Journals (Sweden)

    J. Janse van Rensburg

    2010-07-01

    Full Text Available Since the publication of the book“The occult debate” (Janse van Rensburg, 1999 it has become clear that epistemological views on occultism within the reformed tradition have drastically diverged. During the General Synod of the Dutch Reformed Church in 2007, the report of the Algemene Taakspan vir Leer en Aktuele Sake (ATLASon a ministry of deliverance denied the existence of the devil and claimed that it would be un-scientific to embark on an empirical research in this regard, because of the impossibility to verify information gathered in this manner. However, it is the hypothesis of this article that qualitative information could assist in attaining a clearer under-standing of the need for a ministry of deliverance. In this article the methodology of the qualitative research is explained and the narratives of participants are revealed. Thereafter the respon-ses of the participants are evaluated.

  19. Digestion of so-called resistant starch sources in the human small intestine

    NARCIS (Netherlands)

    Vonk, RJ; Hagedoorn, RE; de Graaff, R; Elzinga, H; Tabak, S; Yang, YX; Stellaard, F

    2000-01-01

    Background: Resistant starch sources, which are only partially digested in the small intestine, can be used to increase colonic availability of short-chain fatty acids. Objective: To study the characteristics of the fermentation of resistant starch, the digestion of resistant starch in the small int

  20. The So-called Overseas Ethnography%所谓"海外民族志"

    Institute of Scientific and Technical Information of China (English)

    王铭铭

    2011-01-01

    @@ 我曾跟一个国个同行聊天,他问起我教什么课.我提到的几门,如"人类学原著选读"、"社会人类学与中国研究"之类,他都比较熟悉,故面无表情,但我一提到"海外民族志",他面露茫然.

  1. An Exegetic Study of the So-Called Proposition of Confucian Aesthetics

    Science.gov (United States)

    Wang, Yi; Fu, Xiaowei

    2008-01-01

    Since Wang Guowei and Cai Yuanpei introduced the concepts of aesthetics and aesthetic education, respectively, to China in the early twentieth century, there has been a strong tendency in many of the aesthetic discussions to examine ancient texts and materials using modern concepts of aesthetics. In particular, sentences with the character-word…

  2. Theoretical foundations of the so-called cross-reference structures

    DEFF Research Database (Denmark)

    Tarp, Sven

    1999-01-01

    A discussion of the concept of "structure" related to the concept of "cross-reference". On the basis of the distribution structures a completely new way of viewing the lexicographical cross-references of all sorts is presented.......A discussion of the concept of "structure" related to the concept of "cross-reference". On the basis of the distribution structures a completely new way of viewing the lexicographical cross-references of all sorts is presented....

  3. [Assessment of the coronary circulation regulation by means of the so-called isometric contraction index].

    Science.gov (United States)

    Urbaszek, W; Löwe, H R; Rentsch, W; Pankau, H; Günther, K

    1976-08-01

    The index of isometric contraction formed from the quotient period of isometric contraction in the erect position by period of isometric contraction in lying position gives the possibility to separate between cardially sufficient and cardially insufficient patients with adequately disturbed regulation of the cardiac circulation. The recognition of early stages of the disturbed left-ventricular function is possible. The use of an adequate exact technique in gaining the primary data is to be presumed. Corrections of the frequency of the index of isometric contraction do not improve the evidence. In the borderline region of the index of isometric contraction with values between 1.03 and 1.1 in questionable cases a further differentiation into still normal or already latent insufficient will do by the analysis of the trend of the index of isometric contraction after the application of medicaments. The determination of the change of the direction of the index of isometric contraction after peroral application of nitroglycerin would be justifiable in routine work after the recognition of the initiaction increases in patients with latent heart insufficiency, in patients with a healthy heart it decreases. The clinical value of the index of isometric contraction as a simple test of the circulatory function is highly to be estimated.

  4. Cause of death--so-called designed event acclimaxing timed happenings.

    Directory of Open Access Journals (Sweden)

    Kothari M

    2000-01-01

    Full Text Available Cause-of-death as an established global medical institution faces its greatest challenge in the commonplace observation that the healthy do not necessarily survive and the diseased do not necessarily die. A logical analysis of the assumed relationships between disease and death provides some insights that allow questioning the taken-for-granted relationship between defined disease/s and the final common parameter of death. Causalism as a paradigm has taken leave of all advanced sciences. In medicine, it is lingering on for anthropocentric reasons. Natural death does not come to pass because of some (replaceable missing element, but because the evolution of the individual from womb to tomb has arrived at its final destination. To accept death as a physiologic event is to advance thanatology and to disburden medical colleges and hospitals of a lot of avoidable thinking and doing.

  5. Informal value transfer systems and criminal organizations: A study into so-called underground banking networks

    OpenAIRE

    Passas, N.

    1999-01-01

    This report presents the findings of a preliminary study into what is commonly called 'underground banking systems'. As the conventional banking industry is increasingly being regulated many fear that criminal organizations may turn to alternatives, such as underground banking systems - or informal value transfer systems (IVTS). The methods for this project consistes in a combination of archival, legal and historical analyses with unstructered interviews with regulators, law enforcement agent...

  6. Informal value transfer systems and criminal organizations : A study into so-called underground banking networks

    NARCIS (Netherlands)

    Passas, N.

    1999-01-01

    This report presents the findings of a preliminary study into what is commonly called 'underground banking systems'. As the conventional banking industry is increasingly being regulated many fear that criminal organizations may turn to alternatives, such as underground banking systems - or informal

  7. Modification of radiosensitivity by the so-called tissue recovery stimulator, 1; Radiosensitizing effects of solcoseryl

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Ashok; Kimura, Hiroshi; Aoyama, Takashi (Shiga University of Medical Science, Otsu (Japan)); Sugahara, Tsutomu

    1992-12-01

    The effect of solcoseryl on the growth, radiosensitization and ability of V79 cells to recover from X-ray-induced damage has been observed. Solcoseryl at 0.8 mg/ml was the optimal concentration for the stimulation of cell growth. Increased sensitivity to X-irradiation was found in the shoulder region of V79 cells treated before and after irradiation with solcoseryl (0.8 mg/ml). The Dq and extrapolation number (n) decreased. Solcoseryl treatment apparently dose not reduce split dose recovery or inhibit the repair of potentially lethal damage. Flow cytofluorometry studies of the cell cycle distribution and mitotic index show that solcoseryl inhibits the expression of radiation-induced cell arrest in the G[sub 2] phase of the cell cycle. Although this action increases radiation sensitization, additional mechanisms probably exist. (author).

  8. Modification of radiosensitivity by the so-called tissue recovery stimulator. I. Radiosensitizing effects of solcoseryl.

    Science.gov (United States)

    Kumar, A; Kimura, H; Aoyama, T; Sugahara, T

    1992-12-01

    The effect of solcoseryl on the growth, radiosensitization and ability of V79 cells to recover from X-ray-induced damage has been observed. Solcoseryl at 0.8 mg/ml was the optimal concentration for the stimulation of cell growth. Increased sensitivity to X-irradiation was found in the shoulder region of V79 cells treated before and after irradiation with solcoseryl (0.8 mg/ml). The Dq and extrapolation number (n) decreased. Solcoseryl treatment apparently does not reduce split dose recovery or inhibit the repair of potentially lethal damage. Flow cytofluorometry studies of the cell cycle distribution and mitotic index show that solcoseryl inhibits the expression of radiation-induced cell arrest in the G2 phase of the cell cycle. Although this action increases radiation sensitization, additional mechanisms probably exist.

  9. So-Called Giftedness and Teacher Education: Issues of Equity and Inclusion

    Science.gov (United States)

    Mazzoli Smith, Laura; Campbell, Robert James

    2016-01-01

    The education of students identified as "gifted" has had a highly problematic history, having been judged as conceptually confused, socially and ethnically discriminatory, and educationally exclusive. Despite this, it is argued that contemporary research and scholarship critiquing the concepts of giftedness and gifted education…

  10. [Regarding respiration and the so-called "animal heat." An historical sketch].

    Science.gov (United States)

    de Micheli, A

    2001-01-01

    According to Aristotle and Galen, the essential function of the respiration phenomenon was to cool the blood. Towards the middle of the XVI Century, Miguel Servet suggested, in his treatise Christianismi restitutio..., that the inspired air could have other functions besides cooling the blood. Later, Joseph Black thought that respiration was a combustion. In the light of the advances in chemistry achieved in the XVII Century, the English scientist Adair Crawford and the French chemist Antoine-Laurent Lavoisier conceived, in the second half of that century, the first general and quantitative theories on the origin of animal heat. Both these authors had the conviction that the "inflammable element", which will be called oxygen, was not formed in the pulmonary territory, but could be absorbed by the blood. Oxygen, foreseen by Mayow at the end of XVII Century, was discovered by Joseph Priestley in 1774. Lavoisier gave the name of oxygen to this gas and firmly established that the respiration phenomenon consists essentially in a process of combustion. The mathematician Joseph-Louis Lagrange, native of Turin, suggested that animal heat originates in all breathing tissues. This phenomenon was verified and described in detail by the biologist Lazzaro Spallanzani, professor at the University of Pavia. Dissemination, in the scientific world, of the new chemical nomenclature and of the respiratory theory, closely related to it, was based fundamentally on the works "Méthode de nomenclature chimique..." (1787) and "Traité élémentaire de chimie..." (1789). During the XIX Century, studies on the phenomenon of animal respiration continued and fundamental discoveries in this subject were attained, such as conversion of hemoglobin to oxyhemoglobin once oxygen had been fixed. Now it is possible to study the regulating mechanisms of the energetic metabolism of the myocardium in vivo, which allows decisive interventions in certain cardiopathies, such as in acute ischemic cardiopathy.

  11. Development of the so-called third stage laser Thomson scattering diagnostics of plasmas

    Science.gov (United States)

    Muraoka, Katsunori; Yamagata, Yukihiko; Hisano, Taishi; Uchino, Kiichirou; Miyazaki, Koichi

    2003-10-01

    In the recent review article,^1) we indicated that the incoherent laser Thomson scattering (LTS) diagnostics of plasmas for measurements of electron densities and temperatures (or more generally EEDFs) be classified as having evolved from the first stage where a whole Thomson spectrum be obtained during a single laser pulse from plasmas having electron density of above 10^18 m-3, through the second stage where data accumulation be prerequisite for ne below 10^18 m-3, and to the third stage where a strong suppression of stray light in addition to the data accumulation be necessary to measure at an extremely small size of less than 100 μm near to material surfaces. The third stage LTS was first demonstrated for a PDP (plasma display panel)-like discharge three years ago employing a triple grating polychromator. In order to further expand its applicable ranges, we are pursuing a more general approach by taking into account such factors as laser divergence, stray light suppression and other aspects. The present status is presented. 1) K. Muraoka, K. Uchino, Y. Yamagata, Y. Noguchi, M. Mansour, P. Suanpoot, S. Narishige, and M. Noguchi, Plasma Sources Sci. Technol. 11 (2002) A143.

  12. Informal value transfer systems and criminal organizations : A study into so-called underground banking networks

    NARCIS (Netherlands)

    Passas, N.

    1999-01-01

    This report presents the findings of a preliminary study into what is commonly called 'underground banking systems'. As the conventional banking industry is increasingly being regulated many fear that criminal organizations may turn to alternatives, such as underground banking systems - or informal

  13. Theory and experiment in so-called pulse-interval pitch.

    Science.gov (United States)

    Whitfield, I C

    1981-01-01

    Moore [1980] has criticised the conclusions of Whitfield [1979] who used an alternating pulsatile stimulus [Seebeck, 1843], and found that the predominating interpulse intervals produced in a single auditory nerve fibre did not correspond to the perceived pitch. Moore's criticism depends on an assumption he makes that is not in fact borne out by the experiments.

  14. Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms

    Directory of Open Access Journals (Sweden)

    Beghi M

    2015-09-01

    Full Text Available Massimiliano Beghi,1,2 Paola Beffa Negrini,1 Cecilia Perin,1,3 Federica Peroni,1,3 Adriana Magaudda,4 Cesare Cerri,1,3 Cesare Maria Cornaggia1,3 1Department of Surgery and Translational Medicine, University of Milano-Bicocca, 2Department of Mental Health, “Guido Salvini” Hospital, Garbagnate Milanese, Milan, Italy; 3Rehabilitation Medicine, Istituti Clinici Zucchi, Carate Brianza, Monza and Brianza, Italy; 4Epilepsy Center, Department of Neuroscience, University of Messina, Messina, Italy Abstract: In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation or horizontal (repression. The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial. PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES and need usually a different treatment (pharmacological or psychological. Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders. Keywords: epilepsy, PNES, defense mechanisms, comorbidity

  15. ACTIVE IMMUNITY PRODUCED BY SO CALLED BALANCED OR NEUTRAL MIXTURES OF DIPHTHERIA TOXIN AND ANTITOXIN.

    Science.gov (United States)

    Smith, T

    1909-03-01

    The foregoing and earlier data taken together demonstrate that an active immunity lasting several years can be produced in guinea-pigs, by the injection of toxin-antitoxin mixtures which have no recognizable harmful effect either immediate or remote. They also show, what might have been anticipated, that under the same conditions mixtures which produce local lesions and which, therefore, contain an excess of toxin produce a much higher degree of immunity than the neutral mixtures, and that an excess of antitoxin reduces the possibility of producing an active immunity, and may extinguish it altogether. There is, therefore, a certain definite relation between the components of the mixture and the degree of immunity producible. Furthermore, toxin-antitoxin mixtures do not change materially within five days at room temperature. They are apparently more efficacious at the end of forty-eight hours than immediately after preparation. The experiments finally prove that a relatively high degree of active immunity can be induced by a harmless procedure, whereas the use of toxin alone leading to very severe local lesions is incapable of producing more than an insignificant protection. The method, therefore, invites further tests in regard to its ultimate applicability to the human being. Unless the subcutis of the guinea-pig reacts to toxin-antitoxin mixtures in a manner peculiar to itself, a practical, easily controlled method for active immunization can be worked out which should afford a larger protection than the serum alone and avoid the complications associated with horse serum. That proportion of toxin and antitoxin which would produce the highest desirable immunity consistent with the least discomfort would have to be carefully worked out for the human subject. From the nature of the immunity induced it is obvious, however, that such a method of immunization cannot take the place of a large dose of antitoxin in exposed individuals who must be protected at once. It would be applicable only as a general protective measure without reference to any immediate danger, since it would take several weeks, perhaps longer, to perfect the attainable immunity. Passing to the theoretical aspects of the facts observed, we find no publications bearing directly upon the subject before us. Madsen has, however, approached it very closely in his experiments on the immunization of animals with mixtures not fully balanced, or, in other words, in which the "toxones" were still free. He found that the injection of such mixtures in rabbits, goats and horses produces an active immunity. He makes the significant remark that perhaps in the immunizing capacity we may possess the keenest reagent for a poison which is not able to exert any toxic action in the body. This is fully borne out by the experiments described, for in these we pass beyond the visible spectrum, so to speak, of the toxin-antitoxin effects, and we are able to recognize toxic action only by the lasting immunizing effects. Another publication which touches upon some phases of the same problem is that of Morgenroth on the union between toxin and antitoxin. Morgenroth brought out the fact that a given toxin-antitoxin mixture is more toxic when injected directly into the circulation than when injected under the skin. Thus, an L(+) dose of 0.78 c.c. toxin + one unit antitoxin applied subcutaneously was of the same toxicity as 0.68 c.c. toxin + one unit antitoxin injected into the circulation. When the mixture had stood twenty-four hours this (L(+)) dose was still 0.78 c.c. subcutaneously, but it had risen to 0.74 c.c. when introduced by the intracardiac route. The author makes two deductions from these results. He assumes that the velocity of reaction between toxin and antitoxin is slow, and that the union is not completed until the mixture has stood twenty-four hours. Hence, the L(+) dose of toxin injected into the blood is higher after twenty-four hours than immediately after mixing the toxin and antitoxin. He furthermore explains the fact that the subcutaneous L(+) dose remains the same

  16. Kondratiev cycles and so-called long waves. The early research

    NARCIS (Netherlands)

    J. Tinbergen (Jan)

    1981-01-01

    textabstractThis paper recalls some early work of the Dutch pioneers of long-wave research which anticipated many of the contemporary debates. Various explanations which have been advanced for the existence of long waves are reviewed, and the applicability of long-wave theories in a number of

  17. Prescriptivism, Linguistic Variation, and the So-Called Privilege of the Nonnative Speaker.

    Science.gov (United States)

    Kerr, Betsy J.

    This paper responds to Claire Kramsch's essay on the demise of the notion of the idealized native speaker as the model for second language learning and implications for second languages and cultures education. Focusing on French, this paper suggests that it is not certain whether the elevation of the native speaker model ever was as real or…

  18. So-Called Giftedness and Teacher Education: Issues of Equity and Inclusion

    Science.gov (United States)

    Mazzoli Smith, Laura; Campbell, Robert James

    2016-01-01

    The education of students identified as "gifted" has had a highly problematic history, having been judged as conceptually confused, socially and ethnically discriminatory, and educationally exclusive. Despite this, it is argued that contemporary research and scholarship critiquing the concepts of giftedness and gifted education…

  19. [Techniques of radiotherapy in so-called operable carcinoma of the breast].

    Science.gov (United States)

    Pierquin, B

    1973-06-01

    The techniques of radiotherapy alone in carcinoma of the breast are determined by the possibilities of durable cure of the tumoral process using locoregional treatment. It seems undisputable that the risk of metastases at a distance from the tumor is related to the topographical as well as volum extension of lymph node involvement. Such risk is low with N-; it rapidly increases with lower axillary N+; it predominates with medial mammary N+; it becomes almost constant with upper axillary (subclavian) and supraclavicular N+. This explains why dose distribution should aim at curing, even at the price of some cosmetic or functional risk, tumoral lesions of the mammary gland, of the lower axillary area and, to a certain extent, of the medial mammary area. On the contrary, it is illusory to deliver an overdosage at ultrahigh dose-rates to the sub- and supraclavicular areas, where the chances for durable cure are almost nul if lymph nodes are invaded. This explains why curative radiotherapy alone appears only indicated in little developed cancers in their mammary (T1 or T2) as well as lymph node (N0 or N1 a) aspects. This also explains why such a responsability implies for the radiotherapist absolutely perfect technical conditions of spotting, centring and dose-measurements; careful protection of all healthy structures surrounding the target-volumes should, in particular, be obtained (for instance, accurate delimitation of beams, use of lead shields or even compensatory wedges should provide appropriate protection to the lung parenchyma, pectoral muscle, head of the humerus, laryngotracheal system). Finally, it is in the axillary area that the major technical hazards are encountered with: an insufficient dose is liable to cause lymph node recurrence, an excessive dose is liable to provoke irreversible muscular, articular, vascular or nervous sequelae. Provided a high level of technicity, it should be admitted to-day that a durable locoregional cure can be obtained in the vast majority of cases with but minimal tissue sequelae.

  20. Rhizophores in Rhizophora mangle L: an alternative interpretation of so-called ''aerial roots''

    Directory of Open Access Journals (Sweden)

    Menezes Nanuza L. de

    2006-01-01

    Full Text Available Rhizophora mangle L., one of the most common mangrove species, has an aerial structure system that gives it stability in permanently swampy soils. In fact, these structures, known as "aerial roots" or "stilt roots", have proven to be peculiar branches with positive geotropism, which form a large number of roots when in contact with swampy soils. These organs have a sympodial branching system, wide pith, slightly thickened cortex, collateral vascular bundles, polyarch stele and endarch protoxylem, as in the stem, and a periderm produced by a phellogen at the apex similar to a root cap. They also have the same type of trichosclereid that occurs in the stem, with negative geotropism, unlike true Rhizophora roots, which do not form trichosclereids at all. On the other hand, these branches do not form leaves and in this respect they are similar to roots. These peculiar branches are rhizophores or special root-bearing branches, analogous to those found in Lepidodendrales and other Carboniferous tree ferns that grew in swampy soils.

  1. How Real Is the So-called China Threat to U.S. Backyard?

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ The nascent U. S. nervous screams at Chinese activities in Latin America catch the eye with their dubious timing, hysterical content and relevance to China-U. S. relations. Why such a fuss over normal Chinese moves in that region? Can the imports of Chinese goods there possibly imply any imaginary security risk to the United States? Is there any ground for skepticism about Chinese intentions?How should China interact with the United States in that region?These are all upshots of closer Chinese ties with the United States and its southern neighbors, fresh issues that claim removal of misunderstandings between Washington and Beijing.

  2. Looking at Intelligence from So-Called Noncognitive Traits: Be Open to Change

    Directory of Open Access Journals (Sweden)

    Matthias Ziegler

    2014-01-01

    Full Text Available Within this commentary, I will try to extend the views presented in Johnson’s, as well as Hunt and Jaeggi’s, commentaries. Both commentaries address the issue of intelligence development. I will try to broaden the discussion by including noncognitive traits as predictors of cognitive development. These ideas are founded within the environmental enrichment hypothesis and the Openness-Fluid-Crystallized-Intelligence (OFCI model.

  3. Could post-liver transplantation course be helpful for the diagnosis of so called cryptogenic cirrhosis?

    Science.gov (United States)

    Duclos-Vallée, Jean-Charles; Yilmaz, Funda; Johanet, Catherine; Roque-Afonso, Anne-Marie; Gigou, Michelle; Trichet, Catherine; Féray, Cyrille; Ballot, Eric; Dussaix, Elisabeth; Castaing, Denis; Bismuth, Henri; Samuel, Didier; Guettier, Catherine

    2005-10-01

    Cryptogenic cirrhosis (CC) is diagnosed in 5-30% of cirrhotic patients overall and 7% of patients who undergo liver transplantation for cirrhosis. In our series of patients transplanted for CC, pre-transplant clinical and histological data and the post-transplant course were reexamined in an attempt to identify the aetiology. Among the 881 patients transplanted in our centre between 1987 and 2000, 28 patients with a median age of 46 yr (range: 18-69) at transplantation were initially classified as having CC. Two patients were excluded because of intense ischaemic lesions caused by chemoembolization prevented histological analysis of the native liver (n = 1) and because of cryptic HBV infection (n = 1). Among the remaining 26 patients, four groups were individualized: (i) patients with chronic inflammatory liver disease with autoimmune features (n = 14, 54%); (ii) patients with features suggestive of non-alcoholic fatty liver disease (n = 3, 11.5%); (iii); patients with incomplete septal cirrhosis (ISC) and vascular liver disease (n = 3), and (iv) patients with unresolved CC (n = 6, 23%). In the autoimmune liver disease group, the median International Autoimmune Hepatitis score was 12.5 (range: 11-19) after reevaluation and review of the post-transplantation course was helpful to confirm the diagnosis with the occurrence of active graft hepatitis in nine patients, with autoantibodies in five patients. The vascular group was characterized by lesions of obliterative portal venopathy and ISC in all native livers. Diagnosis of NAFLD was based on the clinical background of obesity and/or type 2 diabetes and the presence of steatosis or steatohepatitis in native livers and graft biopsies. A definite aetiological diagnosis can be achieved in the majority of patients initially diagnosed with CC. Autoimmune liver disease emerged as the main aetiology (14 of 26 patients, 54%) and frequently recurred on the grafted liver (nine cases). In all cases a precise diagnosis is obviously of practical interest for better management of post-transplant survey and treatment.

  4. On the so-called rogue waves in the nonlinear Schr\\"odinger equation

    CERN Document Server

    Li, Y Charles

    2015-01-01

    The mechanism of a rogue water wave is still unknown. One popular conjecture is that the Peregrine wave solution of the nonlinear Schr\\"odinger equation (NLS) provides a mechanism. A Peregrine wave solution can be obtained by taking the infinite spatial period limit to the homoclinic solutions. In this article, from the perspective of the phase space structure of these homoclinic orbits in the infinite dimensional phase space where the NLS defines a dynamical system, we exam the observability of these homoclinic orbits (and their approximations). Our conclusion is that these approximate homoclinic orbits are the most observable solutions,and they should correspond to the most common deep ocean waves rather than the rare rogue waves. We also discuss other possibilities for the mechanism of a rogue wave: rough dependence on initial data or finite time blow up.

  5. On the origin of the so-called Meckelian ossicles in the nasal skull of odontocetes.

    Science.gov (United States)

    Klima, M; van Bree, P J

    1990-01-01

    Although Cave (1987) accepts the theory that the Meckelian ossicles originate from the maxilloturbinals, evidence given in his study in fact supports the opinion of Klima and van Bree (1985) that the Meckelian ossicles arise from elements of the nasal floor, solum nasi, of the embryonic nasal capsule, in particular from the lamina transversalis anterior and the cartilago paraseptalis.

  6. So-called "immature dentinoma": a case presentation and histological comparison with ameloblastic fibrodentinoma.

    Science.gov (United States)

    Takeda, Y

    1994-02-01

    The existence of the "dentinoma" as an independent entity has not been fully accepted, recently being regarded as an ameloblastic fibroma with formation of dentin and named an ameloblastic fibrodentinoma. However, there are histological differences between the several cases reported previously as "immature dentinoma" and the ameloblastic fibrodentinoma. This paper presents a case report of a dentin-forming intraosseous benign tumor without any histological features of ameloblastic fibroma. The patient was a 30-year-old woman with a rather well-circumscribed intraosseous lesion of the mandibular left premolar area. Histologically, the lesion consisted of dentin-like tissue with a tubular structure and globular calcifications, numerous epithelial strands and islands without enamel organ-like structure, and a cellular fibrous component without a primitive dental papilla-like appearance. The present case and a review of the literature suggest that epithelial elements in odontogenic fibroma-like lesions may occasionally have an inductive effect for dentin or dentin-like tissue formation.

  7. The So-Called “Islamic Terrorism”: A Tale of the Ambiguous Terminology

    Directory of Open Access Journals (Sweden)

    Dwi Surya Atmaja

    2016-06-01

    Full Text Available "What does the term "terrorism" mean." Why does the term “terrorism” often identified as Islam? "If terrorism is an ism that affects "terror" that it generates, while Islam which literally means "peace", then the two terms certainly mismatch! Such question and statement show Muslims’ concern over frequent phenomena of "terrorism" using Islamic religious symbols. The research undertaken proved that there are three explanations. First, a close tripartite network connection between “terrorism experts” and the circles of power policy holders who are also supported by senior journalists in the international media influence. Second, a long tradition of Orientalist studies in the study of the Middle East region and the study of religion in the Arab culture. Figures such as Bernard Lewis, Noah Feldman, Raphael Patai and other Middle East experts often sit with other experts in the field of terrorism (the first factor and become main advisors and expert staff for the US government in the formulation of action to counter terror. It was the catalyst for the transmission of viewpoint which then decorated orientalist discourse of Islamic terrorism in the process of political policies. Third, a lot of Islamic terrorism discourse refers to the long tradition of cultural stereotypes and biased representations of the media that often portray Islam and Muslims as ‘the enemy’. The reason is that it reflects the perspective of socio-Western culture that fears and worries the other oriental parties which has been stereotyped since the imperial era. Many also argue that the dichotomy of the orientalist views are deliberately preserved as a form of new style imperialism

  8. [The so-called "chocolate cyst"--frequently misinterpreted as ovarian endometriosis?].

    Science.gov (United States)

    Christensen, B; Schindler, A E

    1996-09-01

    Limitation of morphological diagnostic and possible misinterpretations are shown in a patient with anamnestic ovarian endometriosis. In cases of "chocolate cysts" it is necessary to differentiate between ovarian endometriosis and functional cysts. Hints for the existence of a functional cyst are an atypical past history or perioperative findings. Biochemical analysis of the cyst fluid may lead to a correct diagnosis.

  9. [Pathomorphological changes in the organs of cattle dying in so-called sudden death].

    Science.gov (United States)

    Zhelev, V; de Pino, A M

    1984-01-01

    Studied were morphologically the organs of 10 cattle originating from two provinces of Cuba that suddenly succumbed ( muerte subita ). There were hemorrahagic diathesis, and histologically--general activation of the reticulo-endothelial system, nonsuppurative encephalomyocarditis, interstitial nonsuppurative hepatitis, nephritis, and pneumonia as well as catarrhal hemorrhagic gastroenteritis. In all cases there were among the lymphoid proliferations diffusely disseminated eosinophile leukocytes ( hyperergia ). This finding showed that the disease had run a subacute or chronic course which was made acute by the action of some stress factors (continuous running, intoxications oligoelement disturbances, etc.). The finding was also characteristic of reactive processes taking place under the action of some specific virus that probably took part in the etiology of the disease and required an intermediary host that remained unknown at the time.

  10. Editorial: Hurricane Katrina rekindles thoughts about fallacies of a so-called “natural” disaster

    Directory of Open Access Journals (Sweden)

    Michael H. Glantz

    2005-10-01

    Full Text Available When it comes to disasters, people have to be careful about making sweeping generalizations, because they will not necessarily be evaluated for their validity. Myths of all kinds, like unfounded rumors, are very misleading and can have dangerous long-lasting consequences for societies, as well as for the victims of natural hazard-related disasters in the distant, as well as near-term, future.

  11. Did Sutton and Boveri propose the so-called Sutton-Boveri chromosome hypothesis?

    Directory of Open Access Journals (Sweden)

    L.A.-C.P. Martins

    1999-06-01

    Full Text Available The "Sutton-Boveri chromosome hypothesis" attempted to establish a parallel between cytological chromosome behavior and the principles followed by Mendelian factors. Today, this hypothesis is well accepted; however, it was not completely accepted at its proposal (1902-3. The aim of the present study is to elucidate the meaning of the chromosome hypothesis based on the original scientific works, taking into account the scientific context of that time. The negative treatment this hypothesis received is evaluated. I conclude that it was unfair to include Boveri's name beside that of Sutton's as one of the proponents of the chromosome hypothesis of Mendelian heredity, because he did not publish any hypothesis of that kind during the relevant period (1902-1903. Moreover, no coherent chromosome hypothesis existed during that period. Sutton and other researchers of that time were strongly influenced both by cytological knowledge grounded in observations and theoretical presuppositions that led to interpretations with no observational basis. The chromosome hypothesis was not proposed as a result of experimental cytological research.

  12. Did Sutton and Boveri propose the so-called Sutton-Boveri chromosome hypothesis?

    Directory of Open Access Journals (Sweden)

    Martins L.A.-C.P.

    1999-01-01

    Full Text Available The "Sutton-Boveri chromosome hypothesis" attempted to establish a parallel between cytological chromosome behavior and the principles followed by Mendelian factors. Today, this hypothesis is well accepted; however, it was not completely accepted at its proposal (1902-3. The aim of the present study is to elucidate the meaning of the chromosome hypothesis based on the original scientific works, taking into account the scientific context of that time. The negative treatment this hypothesis received is evaluated. I conclude that it was unfair to include Boveri's name beside that of Sutton's as one of the proponents of the chromosome hypothesis of Mendelian heredity, because he did not publish any hypothesis of that kind during the relevant period (1902-1903. Moreover, no coherent chromosome hypothesis existed during that period. Sutton and other researchers of that time were strongly influenced both by cytological knowledge grounded in observations and theoretical presuppositions that led to interpretations with no observational basis. The chromosome hypothesis was not proposed as a result of experimental cytological research.

  13. Staged microvascular anastomosis training program for novices:transplantation of both kidneys from one rat donor

    Institute of Scientific and Technical Information of China (English)

    Zhou Shoujun; Li Enchun; He Jun; Weng Guobin; Yuan Hexing; Hou Jianquan

    2014-01-01

    Background Rat renal transplantation is an essential experimental model and requires greater microsurgical skills.Thus,training novices to perform quick and reliable microvascular anastomosis is of vital importance for rat renal transplantation.In this study,we developed and evaluated a staged microvascular anastomosis training program for novices,harvesting and transplanting both kidneys from one rat donor.Methods Five trainees without any prior microsurgical experience underwent a training program in which the goals were staged according to difficulty.Each trainee had to achieve satisfactory results as evaluated by a mentor before entering the next stage.Rat renal transplantation was accomplished by end-to-end technique with a bladder patch.In the intensive rat renal transplantation stage,the trainees required an average of 20 independent attempts at isotransplantation as final training assessment.Results After 2 months of intensive practice,all trainees had achieved stable and reproducible rat renal transplantation,with a satisfactory survival rate of 85.9% at postoperative Day 7.The total mean operative time was 78.0 minutes and the mean hot ischemia time was 26.2 minutes.With experience increasing,the operative time for each trainee showed a decreasing trend,from 90-100 minutes to 60-70 minutes.After 20 cases,the mean operative time of the trainees was not statistically significantly different from that of the mentor.Conclusion Harvesting and transplanting both kidneys from one rat donor after a staged microvascular anastomosis training program is feasible for novices without any prior microsurgical skills.

  14. Laparoscopic colorectal anastomosis using the novel Chex(®) circular stapler: a case-control study.

    Science.gov (United States)

    Maggiori, L; Bretagnol, F; Ferron, M; Chevalier, Y; Panis, Y

    2011-06-01

    The purpose of this study was to assess the safety and effectiveness of a new cost-effective circular stapler for colorectal anastomosis, the Chex(®) CS. From 2007 to 2009, a case-control study was conducted of 54 patients who underwent left colectomy with stapled anastomosis using the Chex stapler. The patients were matched to 64 patients in whom the anastomoses were performed using the CDH(®) stapler or the EEA(®) stapler. The following criteria were matched: sex, age, body mass index, American Society of Anesthesiology grade, diagnosis, formation of a temporary stoma and surgical approach. Primary end-points were postoperative mortality and morbidity. The surgeon was asked to fill out a questionnaire to assess the ergonomics of the device using an analogue visual scale. A cost analysis was performed to compare the cost of the different devices. There were no postoperative deaths. Morbidity, including anastomotic leakage (9%vs 8%, P = 1.000), was similar in the two groups. The surgeon's overall appreciation was scored at 8.1/10 (3-9.5), including the best score for stapler removal (9.5). No major device failure was observed during the study. Mean surgical costs were significantly lower in the Chex group: € 903 ± 73 (885-1192) vs the control group € 971 ± 61 (956-1263) (P < 0.0001). This study suggests that colorectal anastomosis using the Chex circular stapler is safe and does not increase overall morbidity. In particular, this device did not have a higher rate of anastomotic leakage in our patients than more expensive models currently used in our hospital. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  15. A clinical application of laser direction in anastomosis for inferior canalicular laceration

    Institute of Scientific and Technical Information of China (English)

    LIANG Tao; ZHAO Ke-xiao; ZHANG Ling-yun

    2006-01-01

    Objective:To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.Methods: Forty-nine patients ( 49 eyes ) suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal punctum and the nasal broken end of lacerated lacrimal canaliculus was more than 6 mm. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6months.Results: In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was (5.75 ± 1.49) minutes and the mean time of operation was (49.21±3.37) minutes; both were significantly shorter than that of the control group(P <0.01). The cure rate of the laser-directing group was96.55 %, higher than that of the control group but without statistical significance (P > 0.05).Conclusions: The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

  16. Ovarian cancer mimicking recurrence at colorectal anastomosis: report of a case.

    LENUS (Irish Health Repository)

    Reardon, C M

    2012-02-03

    PURPOSE: The aim of this article is to emphasize the increased risk of developing metachronous ovarian tumors after resection of rectal cancer. METHOD AND RESULTS: We report the case of a postmenopausal female patient who, five years after anterior resection, developed a primary ovarian malignancy that invaded a rectal anastomosis and in so doing mimicked a recurrence of a Dukes A rectal cancer. To our knowledge, such an occurrence has not been described previously in the literature. CONCLUSION: This case illustrates the possible benefits of routine prophylactic oophorectomy at the time of colorectal cancer resection.

  17. A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy.

    Science.gov (United States)

    Varca, Virginia; Benelli, Andrea; Pietrantuono, Francesco; Suardi, Nazareno; Gregori, Andrea; Gaboardi, Franco

    2017-06-19

    The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only

  18. Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

    Institute of Scientific and Technical Information of China (English)

    Paulo; Herman; Marcos; V; Perini; Vincenzo; Pugliese; Julio; Cesar; Pereira; Marcel; Autran; C; Machado; William; A; Saad; Luiz; AC; D; Albuquerque; Ivan; Cecconello

    2010-01-01

    AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of...

  19. The effect of peritoneal lavage on the postoperative course after colonic anastomosis and perforation in the rat.

    Science.gov (United States)

    Arnesjö, B; Breland, U; Petersson, B G

    1975-01-01

    Peritoneal lavage was given during four days to rats subjected either to transection and re-anastomosis or perforation of the descending part of the colon or caecum. Control rats were treated in the smae way but did not receive peritoneal lavage. The rats which were treated with a colonic anastomosis and peritoneal lavage had significantly less abdominal adhesions, peritonitis and peritoneal fluid observed at autopsy 11 or 60 days after surgery. No rats developed anastomosis insufficiency and all survived. Peritoneal lavage in rats subjected to colonic or caecal perforation increased the survival time and reduced the mortality rate, the frequency of adhesions and the signs of peritonitis. An increased frequency of peritoneal adhesions was observed after extensive mobilization of the colon during operation when no peritoneal lavage had been given. The peritoneal lavage catheter per se did not cause adhesions.

  20. Outcome of 132 consecutive reconstructive operations for intestinal fistula--staged operation without primary anastomosis improved outcome in retrospective analysis

    DEFF Research Database (Denmark)

    Runström, B; Hallböök, O; Nyström, P O

    2013-01-01

    AIM: To study factors that influenced healing and survival after attempted closure of enterocutaneous fistula. MATERIAL AND METHODS: Retrospective analysis of prospective data concerning 101 patients operated on 132 instances for 110 enterocutaneous fistulae at two hospitals. RESULTS: In all, 96...... (87%) of the 110 fistulae healed and 92 (91%) patients survived. A total of 9 patients with unhealed fistula died. Multivariate analysis revealed jaundice as an independent factor for both death and failed closure and operation without anastomosis as an independent positive factor for healing. Failure...... rate was lower after an operation with stoma without anastomosis (6 of 43, 14%) than after an operation with anastomosis (30 of 89, 34%) p = 0.0213. Of the 36 instances with unhealed fistula, 13 (36%) could be ascribed to inadvertent bowel lesions at the reconstructive operation. In addition...

  1. Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

    Directory of Open Access Journals (Sweden)

    Burcu Dirim

    2015-01-01

    Full Text Available Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR by using two different flap anastomosis patterns and skin incision types. Methods. This study included 79 patients (88 eyes with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A underwent E-DCR by suturing anterior and posterior flaps (H-flap of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B DCR was performed by suturing only anterior flaps (U-flap with W skin incision. Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%. In terms of groups, patency was 44 eyes (88.0% in group A and 34 eyes (89.5% in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores. Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.

  2. Demographics of antibiotic persistence

    DEFF Research Database (Denmark)

    Steiner, Ulrich; Kollerova, Silvia; Jouvet, Lionel

    2016-01-01

    Persister cells, cells that can survive antibiotic exposure but lack heritable antibiotic resistance, are assumed to play a crucial role for the evolution of antibiotic resistance. Persistence is a stage associated with reduced metabolic activity. Most previous studies have been done on batch...... cultures, rather than the individual level. Here, we used individual level bacteria data to confirm previous studies in how fast cells switch into a persistence stage, but our results challenge the fundamental idea that persistence comes with major costs of reduced growth (cell elongation) and division due...... even play a more prominent role for the evolution of resistance and failures of medical treatment by antibiotics as currently assumed....

  3. Evaluation of a novel thermosensitive heparin-poloxamer hydrogel for improving vascular anastomosis quality and safety in a rabbit model.

    Directory of Open Access Journals (Sweden)

    Ying-Zheng Zhao

    Full Text Available Despite progress in the design of advanced surgical techniques, stenosis recurs in a large percentage of vascular anastomosis. In this study, a novel heparin-poloxamer (HP hydrogel was designed and its effects for improving the quality and safety of vascular anastomosis were studied. HP copolymer was synthesized and its structure was confirmed by Fourier transform infrared spectroscopy (FTIR and nuclear magnetic resonance spectroscopy ((1H-NMR. Hydrogels containing HP were prepared and their important characteristics related to the application in vascular anastomosis including gelation temperature, rheological behaviour and micromorphology were measured. Vascular anastomosis were performed on the right common carotid arteries of rabbits, and the in vivo efficiency and safety of HP hydrogel to achieve vascular anastomosis was verified and compared with Poloxamer 407 hydrogel and the conventional hand-sewn method using Doppler ultrasound, CT angiograms, scanning electron microscopy (SEM and histological technique. Our results showed that HP copolymer displayed special gel-sol-gel phase transition behavior with increasing temperature from 5 to 60 °C. HP hydrogel prepared from 18 wt% HP solution had a porous sponge-like structure, with gelation temperature at approximately 38 °C and maximum elastic modulus at 10,000 Pa. In animal studies, imaging and histological examination of rabbit common jugular artery confirmed that HP hydrogel group had similar equivalent patency, flow and burst strength as Poloxamer 407 group. Moreover, HP hydrogel was superior to poloxamer 407 hydrogel and hand-sewn method for restoring the functions and epithelial structure of the broken vessel junctions after operation. By combining the advantages of heparin and poloxamer 407, HP hydrogel holds high promise for improving vascular anastomosis quality and safety.

  4. Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Feng Xu; Liang Xiao; Wang Yifan; He Shilin; Cai Xiujun

    2014-01-01

    Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple,feasible,and safe in our porcine model.In this study,we evaluated its impact on the colonic physiologic functions.Methods A total of 20 pigs were assigned randomly to either a stent anastomosis group (SA,n=10) or a conventional anastomosis group (CA,n=10).Colonic anastomosis with a degradable stent was performed in the SA group,and conventional hand-sewn anastomosis was performed in the CA group.Body weight,fecal weight,total colonic transit time,immunohistochemistry staining of interstitial cells of Cajal (ICC),plasma diamine oxidases (DAO) levels,and Western blotting analysis of occludin were evaluated before and after anastomosis.Results No obvious diarrhea or constipation was observed in all pigs.No significant difference in body weight between the groups was detected at any time.Yet,the fecal weight was less in the CA group compared with the SA group on postoperative day (POD) 7.No observable colonic paralysis or retention occurred.For total colonic transit time,there was no significant difference between the two groups at any time or among different time points in the same group.The integrated optical density of ICC showed no significant difference on either POD 14 or 30.The plasma DAO levels were remarkably elevated after surgery,and began to decrease since POD 3.However,there was no significant difference between both two groups in plasma DAO levels at any time either.For both groups,the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30.Conclusions According to these results,this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.

  5. Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Jae-Gahb Park; Min Ro Lee; Seok-Byung Lim; Chang Won Hong; Sang Nam Yoon; Sung-Bum Kang; Seung Chul Heo; Seung-Yong Jeong; Kyu Joo Park

    2005-01-01

    AIM: There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CAA)in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CAA in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vs the straight CAA.METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales].RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo afterileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown.Furthermore, we found that FISI scores highly correlated with FIQL scales.CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE forlow-lying rectal cancer.

  6. Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: An evaluation of short-term outcomes.

    Science.gov (United States)

    Jian-Cheng, Tu; Shu-Sheng, Wang; Bo, Zhang; Jian, Fang; Liang, Zhou

    2016-11-01

    Laparoscopic right hemicolectomy with extracorporeal anastomosis is a widely used procedure; several authors have published their approach to intracorporeal anastomosis. In this paper, we present an approach developed by us and compare short-term outcomes with those of extracorporeal anastomosis in colon cancer patients.Retrospective review of colon cancer patients treated with laparoscopic right hemicolectomy either with intracorporeal anastomosis (TLG group) or extracorporeal anastomosis (LG group) at the Zhangjiagang Hospital Affiliated to Soochow University between January 2011 and October 2015. Operative and postoperative data are compared.Around 85 patients underwent laparoscopic hemicolectomy (56 TLG and 29 LG) during the reference period for this study. Age, gender, body mass index (BMI), stage of cancer, operation time, number of lymph nodes harvested, and length of hospital stay were comparable between the 2 groups. In the TLG group, the ileocolic anastomosis time was significantly shorter (9.9-15.5 minutes vs 13.5-18.2 minutes in LG; P anastomosis for colon cancer is a safe and reliable procedure. Its advantages include short anastomosis time, less intraoperative blood loss, less postoperative pain, and early bowel function recovery.

  7. Restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A narrative review.

    Science.gov (United States)

    Sofo, Luigi; Caprino, Paola; Sacchetti, Franco; Bossola, Maurizio

    2016-08-27

    Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the gold standard surgical treatment for ulcerative colitis. However, despite the widespread use of RP-IPAA, many aspects of this treatment still remain controversial, such as the approach (open or laparoscopic), number of stages in the surgery, type of pouch, and construction type (hand-sewn or stapled ileal pouch-anal anastomosis). The present narrative review aims to discuss current evidence on the short-, mid-, and long-term results of each of these technical alternatives as well as their benefits and disadvantages. A review of the MEDLINE, EMBASE, and Ovid databases was performed to identify studies published through March 2016. Few large, randomized, controlled studies have been conducted, which limits the conclusions that can be drawn regarding controversial issues. The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases. Regarding 2- and 3-stage RP-IPAA, patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables, making any comparisons extremely difficult. The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly, although the J pouch is generally preferred by surgeons. Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages, and there is no clear benefit of one technique over the other.

  8. Magnetic compression anastomosis for bile duct stenosis after donor left hepatectomy: a case report.

    Science.gov (United States)

    Oya, H; Sato, Y; Yamanouchi, E; Yamamoto, S; Hara, Y; Kokai, H; Sakamoto, T; Miura, K; Shioji, K; Aoyagi, Y; Hatakeyama, K

    2012-04-01

    Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Plastic Changes of Synapses and Excitatory Neurotransmitter Receptors in Facial Nucleus Following Facial-facial Anastomosis

    Institute of Scientific and Technical Information of China (English)

    Pei CHEN; Jun SONG; Linghui LUO; Shusheng GONG

    2008-01-01

    The remodeling process of synapses and eurotransmitter receptors of facial nucleus were observed. Models were set up by facial-facial anastomosis in rat. At post-surgery day (PSD) 0, 7, 21 and 60, synaptophysin (p38), NMDA receptor subunit 2A and AMPA receptor subunit 2 (GIuR2) were observed by immunohistochemical method and emi-quantitative RT-PCR, respectively. Meanwhile, the synaptic structure of the facial motorneurons was observed under a transmission electron microscope (TEM). The intensity of p38 immunoreactivity was decreased, reaching the lowest value at PSD day 7, and then increased slightly at PSD 21. Ultrastructurally, the number of synapses in nucleus of the operational side decreased, which was consistent with the change in P38 immhnoreactivity. NMDAR2A mRNA was down-regulated significantly in facial nucleus after the operation (P000.05). The synapses innervation and the expression of NMDAR2A and AMPAR2 mRNA in facial nucleus might be modified to suit for the new motor tasks following facial-facial anastomosis, and influenced facial nerve regeneration and recovery.

  10. Anastomotic salvage after rectal cancer resection using the Turnbull–Cutait delayed anastomosis

    Science.gov (United States)

    Hallet, Julie; Bouchard, Alexandre; Drolet, Sébastien; Milot, Hélène; Desrosiers, Emilie; Lebrun, Aude; Grégoire, Roger Charles

    2014-01-01

    Background Turnbull–Cutait abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) was first described in 1961. Studies have described its use for challenging colorectal conditions. We reviewed our experience with Turnbull–Cutait DCA as a salvage procedure for complex failure of colorectal anastomosis. Methods We performed a retrospective cohort study from October 2010 to September 2011, with analysis of postoperative morbidity and mortality. Results Seven DCAs were performed for anastomotic complications (3 chronic leaks, 2 rectovaginal fistulas, 1 colovesical fistula, 1 colonic ischemia) following surgery for rectal cancer. Six patients had a diverting ileostomy constructed as part of previous treatment for anastomotic complications before the salvage procedure. No anastomotic leaks were observed. All procedures but 1 were completed successfully. One patient who underwent DCA subsequently required an abdominoperineal resection and a permanent colostomy for postoperative extensive colonic ischemia. No 30-day mortality occurred. Conclusion Salvage Turnbull–Cutait DCA appears to be a safe procedure and could be offered to patients with complex anastomotic complications. This procedure could be added to the surgeon’s armamentarium as an alternative to the creation of a permanent stoma. PMID:25421083

  11. Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema.

    Science.gov (United States)

    Akita, Shinsuke; Mitsukawa, Nobuyuki; Kuriyama, Motone; Kubota, Yoshitaka; Hasegawa, Masakazu; Tokumoto, Hideki; Ishigaki, Tatsuya; Togawa, Takashi; Kuyama, Junpei; Satoh, Kaneshige

    2015-05-01

    Vascularized lymph node transfer has become a popular surgical option to improve lower extremity lymphedema (LEL), although potential donor sites are limited. The free supraclavicular flap with deep cervical lymph nodes has been recently associated with a minimal risk of secondary lymphedema caused by donor site dissection. However, the effectiveness of this procedure has not yet been evaluated. Vascularized supraclavicular lymph node transfer (VSLNT) was performed for patients with International Society of Lymphology late stage II or more severe LEL. The results were compared with lymphaticovenular anastomosis (LVA) performed for patients with the same stages of severity. To evaluate improvement in lymphatic function, indocyanine green lymphography and lymphoscintigraphy were performed. Vascularized supraclavicular lymph node transfer was performed in 13 limbs of 13 patients. The results were compared with 43 limbs of 33 patients who underwent multiple LVA. No severe complications were observed in either group. Improvement in lymphatic function, as measured by the LEL index, was 26.5 ± 4.4 and 21.2 ± 2.0 in the VSLNT and LVA groups, respectively. Lymphatic function was improved in 7 cases in the VSLNT group and 10 cases in the LVA group. Vascularized supraclavicular lymph node transfer is an effective technique for the treatment of advanced stage LEL. Lymphaticovenular anastomosis is also effective, but to a lesser degree than VSLNT. However, LVA is less invasive and requires a shorter hospital stay.

  12. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last two decades.

    Science.gov (United States)

    Aurello, Paolo; Magistri, Paolo; D'Angelo, Francesco; Valabrega, Stefano; Sirimarco, Dario; Tierno, Simone Maria; Nava, Andrea Kazemi; Ramacciato, Giovanni

    2015-05-01

    Esophagojejunal anastomosis leakage is one of the major complications after total gastrectomy for gastric cancer and is an independent predictor of survival. Our aim is to systematically review the literature and discuss the reported therapeutic approaches to identify the best therapeutic approach. Pubmed, EMbase, Cochrane Library, CILEA Archive, BMJ Clinical Evidence, and Up ToDate databases were screened limiting the research to articles written in English from January 1992 through December 2013. This way a total of 474 manuscripts were retrieved for furthermore evaluation. Eleven manuscripts were considered eligible and the study is focused on those works. We analyzed a total of 3,893 patients and 114 cases of esophagojejunal anastomosis leakage. Different treatments were grouped into three main categories: conservative approach (66 cases), endoscopic approach (21 cases), and surgical approach (27 cases). The overall mortality rate is 26.32 per cent and surgical approach showed the higher rate. According to the reported data, a complete resolution of the leakage can be achieved in an interval ranging from 7 to 28 days in the group treated conservatively. Conservative approach should always be considered as the treatment of choice. Reoperation may be necessary in case of wide dehiscence or when other treatments fail; therefore, the high mortality rate related to this procedure is due to the comorbidities of patients undergoing relaparotomy. Finally, endoscopic approach with endoclips seems promising but needs furthermore studies.

  13. An effect of wrapping peripheral nerve anastomosis with pedicled muscle flap on nerve regeneration in experiment

    Directory of Open Access Journals (Sweden)

    Naumenko L.Yu.

    2010-01-01

    Full Text Available Despite intrinsic capacity of peripheral nerves to regenerate, functional outcomes of peripheral nerves injury remain poor. Nerve ischemia, intra-/perineurial fibrosis and neuroma formation contribute a lot to that. Several authors demonstrated beneficial effects of increased vascularization at the site of injury on peripheral nerves regeneration. The use of highly vascularized autologous tissues (greater omentum as a source of peripheral nerves neovascularization shows promising re-sults. We proposed a surgical technique in which injured peripheral nerves anastomosis was wrapped in a pedicled muscular flap and performed morphological assessment of the efficacy of such technique with the aid of immunohistochemistry. 14 rats (which underwent sciatic nerve transection were operated according to proposed technique. Another 14 rats, in which only end-to-end nerve anastomosis (without muscular wrapping was performed served as controls. Morphological changes were evaluated at 3 weeks and 3 months periods. Higher blood vessel and axon counts were observed in experimental groups at both checkpoints. There was also an increase in Schwann cells and macrophages counts, and less collagen content in pe-ripheral nerves of experimental groups. Axons in neuromas of experimental groups showed a higher degree of arrangement. We conclude that proposed surgical technique provides better vascularisation of injured peripheral nerves, which is beneficial for nerve regeneration.

  14. Pancreatectomy for Intraductal Papillary Mucinous Neoplasm of the Pancreas: Could Pancreaticogastrostomy Be the Anastomosis of Choice?

    Directory of Open Access Journals (Sweden)

    Stavros Gourgiotis

    2010-07-01

    Full Text Available Dear Sir, Surgical resection is the treatment of choice for intraductal papillary mucinous neoplasms (IPMNs of the pancreas. The aim of resection in the management of IPMNs is to remove all the adenomatous or malignant mucosa and to minimize the chance of recurrence in the pancreatic remnant. However, even after partial pancreatectomy with negative surgical margins for non-invasive IPMN, the tumour can recur as disseminated disease or as locally invasive or noninvasive disease in the pancreatic remnant [1]. For non-invasive IPMNs, the overall disease recurrence rate reported is 1.3 to 9.3% while, for invasive IPMNs, the overall disease recurrence rate is 12 to 68% [2]. The overall recurrence rate for IPMNs varies from 7% to 43% [2]. Our question relates to the issue of the high risk of recurrence in both non-invasive and invasive IPMNs after partial pancreatectomy. Has pancreaticogastric anastomosis been utilized in patients with IPMNs and is it something we should all think about in patients who undergo resections of the head and require surveillance with subsequent endoscopic retrograde cholangiopancreatography (ERCP? Would pancreaticogastrostomy be something we should all be doing in order to follow-up patients having a pancreatic remnant with endoscopic surveillance? Several techniques of anastomosing the pancreatic remnant to the stomach have been proposed: invagination of the stump of the pancreas, implantation of the pancreatic duct, and anastomosis between the pancreatic duct and the gastric mucosa.

  15. Intraoperative assessment of microperfusion with visible light spectroscopy in colorectal anastomosis

    Science.gov (United States)

    Karliczek, Anne; Benaron, David A.; Baas, Peter; van der Stoel, Anne; Wiggers, Theo; van Dam, Gooitzen M.

    2007-07-01

    In gastrointestinal surgery, leakage of anastomoses in general is a challenging problem because of the related mortality and morbidity1,2. The highest incidence of anastomotic leakage is found at the most proximal and most distal parts of the digestive tract, i.e. esophageal and colorectal anastomoses. Increased strain and limited vascular supply at the anastomoses are the two main reasons of leakage, especially in the absence of a serosal layer at these sites2,3,4. Apart from these local risk factors, several general risk factors attributed to the occurrence of anastomotic failure, of which smoking, cardiovascular disease, gender, age and malnutrition are the most important2,5-8. Most of these factors suggest local ischemia as an important cause of anastomotic dehiscence. In colorectal anastomosis the vascular supply is compromised due to resection of the diseased bowel segment. The vascular supply of the rectal stump is compromised by resection of the proximal feeding sigmoidal vessels. Apart from co-existing morbidities such as sepsis, cardiovascular and several systemic diseases, the altered vascular supply frequently compromises the microcirculation at both ends of the anastomosis, and is as such responsible for the higher rate of leakage compared to small and other large bowel anastomoses9,10.

  16. Eficacitatea combaterii larvelor de Clostera anastomosis L. la ieșirea din hibernare [Treatment efficacy of Clostera anastomosis L. caterpillars control in postdormancy phase

    Directory of Open Access Journals (Sweden)

    Duduman Mihai-Leonard

    2015-12-01

    Full Text Available Clostera anastomosis is an important poplar and willow defoliator which, especially since 1950, caused important damages to intensive hybrid poplar crops in Europe and Asia. The need to reduce the loss caused by this insect, often led to radical control tactics, consisting in spraying chemical insecticides with low specificity and high impact on biodiversity. Other control methods (biological control had not the expected effect. Considering the above mentioned aspects and the fact that C. anastomosis overwinters as larvae, mainly in bark crevices of the stems of infested trees, it was tested the possibility of controlling this pest, by chemical control of the larvae, early in spring. There were designed two trials in lab and in field, in order to test the efficacy of 5 insecticides [Proteus (thiacloprid + deltamethrin, Ovipron (horticultural oil, Nuprid (imidacloprid, Confidor (imidacloprid and Karate Zeon (lambda-cyhalothin], sprayed directly on the stem of the poplar trees colonized with overwintering larvae nests. The treatment efficacy was assessed based on the survival rate of larvae after chemical spraying, by comparing it to the control samples. All surviving larvae were trapped in sticky barriers placed around the stems, above the sprayed area. Of the tested insecticides, the most efficient was Confidor, causing mortality of the 90.2 ± 1.8% of the larvae, significantly higher than the rest of the tested insecticides (Proteus, Ovipron, Nuprid. In field conditions, Confidor caused the decrease of the larvae population with 78.2 ± 7.4% for poplar clone AF2, and with 92.9 ± 6.4% for poplar clone AF8, and Karate Zeon caused 100% mortality. Control of the larvae in spring was efficient. It is a matter of course that this control method will have a lower environmental impact due to both the application moment (early spring, before poplars flush, and high control of the sprayed area (only the lower section of the infested tree stems

  17. Safer intestinal invagination for a solid pancre-atico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct

    Institute of Scientific and Technical Information of China (English)

    Francesco Giudici; Benedetta Pesi; Daniela Zambonin; Stefano Scaringi; Paolo Bechi; Giacomo Batignani

    2015-01-01

    Pancreatico-jejunal anastomosis after pancreato-duodenectomy still represents the Achilles’ heel of the proce-dure: the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic ifstula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico-jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia-tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

  18. Safer intestinal invagination for a solid pancre-atico-jejunal anastomosis in presence of a soft texture pancreatic remnant and non-dilated duct

    Institute of Scientific and Technical Information of China (English)

    Francesco Giudici; Benedetta Pesi; Daniela Zambonin; Stefano Scaringi; Paolo Bechi; Giacomo Batignani

    2016-01-01

    Pancreatico-jejunal anastomosis after pancreato-duodenectomy still represents the Achilles’ heel of the proce-dure: the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic ifstula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico-jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia-tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

  19. Demographics of antibiotic persistence

    DEFF Research Database (Denmark)

    Kollerova, Silvia; Jouvet, Lionel; Steiner, Ulrich

    Persister cells, cells that can survive antibiotic exposure but lack heritable antibiotic resistance, are assumed to play a crucial role for the evolution of antibiotic resistance. Persistence is a stage associated with reduced metabolic activity. Most previous studies have been done on batch...... even play a more prominent role for the evolution of resistance and failures of medical treatment by antibiotics as currently assumed....

  20. A persistent particle ontology for QFT in terms of the Dirac sea

    CERN Document Server

    Deckert, Dirk-Andre; Oldofredi, Andrea

    2016-01-01

    We show that the Bohmian approach in terms of persisting particles that move on continuous trajectories following a deterministic law can be literally applied to QFT. By means of the Dirac sea model -- exemplified in the electron sector of the standard model neglecting radiation -- we explain how starting from persisting particles, one is led to standard QFT employing creation and annihilation operators when tracking the dynamics with respect to a reference state, the so-called vacuum. Since on the level of wave functions, both formalisms are mathematically equivalent, this proposal provides for an ontology of QFT that includes a dynamics of individual processes, solves the measurement problem and explains the appearance of creation and annihilation events.

  1. Using Persistent Homology to Identify Localised Defects in Rayleigh Bénard Convection

    Science.gov (United States)

    Suri, Balachandra; Tithof, Jeffrey; Schatz, Michael; Levanger, Rachel; Cyranka, Jacek; Mischaikow, Konstantin; Xu, Mu; Paul, Mark; Kramar, Miroslav

    2016-11-01

    Complex spatiotemporal convective roll patterns are observed when a sufficiently large temperature gradient is created across a thin layer of fluid. These roll patterns are often characterized by the presence of localised defects such as centers, spirals, disclinations, grain boundaries, which play a crucial dynamical role. Our research focuses on using persistent homology (a branch of algebraic topology) to identify these defects in an experimental realization of the Rayleigh Bénard convection in a cylindrical container. Persistent homology provides a powerful mathematical formalism in which the topological characteristics of a pattern (shadowgraph image in our case) are encoded in a so-called persistence diagram. By identifying several instants in the experiment that correspond to the appearance of a certain type of defect and computing the persistence diagrams for the corresponding shadowgraph images, we extract signatures in the persistence diagram which characterize the defect. Then, for a spatiotemporally resolved series of shadowgraph images we show that using signatures from the persistence diagrams one can automate identifying the instants when localized defects appear. NSF Grants DMS-1125302, CMMI-234436.

  2. 不同肠管吻合方式对吻合口愈合的影响%Comparison of single-layer anastomosis and double-layer anastomosis of small intestine in dogs

    Institute of Scientific and Technical Information of China (English)

    沈凯; 周刚; 叶颖江; 梁斌

    2012-01-01

    目的 观察不同吻合方法对犬小肠手术后吻合口愈合的影响,探讨其有效性及安全性.方法 成年犬12条,根据吻合部位不同随机分为A、B2组,A组距离屈式韧带100 cm小肠采用双层吻合,距离屈式韧带200 cm小肠采用单层吻合;B组反之.术中记录2种吻合方式的操作时间.术后7d再次手术,找到吻合口并评价吻合口周围粘连分级,测量吻合破裂压(ABP)、小肠浆肌层破裂压.结果 单层吻合与双层吻合后局部粘连分级末见明显差异;单层吻合与双层吻合的ABP分别为(325.83±88.03)和(331.25±70.33) cmH2O(1 cm H2O=0.098 kPa,P>0.05);单层吻合与双层吻合的浆肌层破裂压分别为(185.42±40.87)和(182.08±20.72) cm H2O(P>0.05);单层吻合和双层吻合时间分别为(17.08±3.20)和(23.50±2.50) min(P <0.01).结论 单层吻合法是一种安全、有效的小肠吻合方法.%Objective To evaluate the effectiveness and safety of single-layer anastomosis and double-layer anastomosis of small intestine.Methods Twelve dogs were divided into two groups:group A ( single-layer anastomosis at small intestine 100 cm after Treitz ligament and double-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6) ; group B (double-layer anastomosis at small intestine 100 cm after Treitz ligament and single-layer anastomosis at small intestine 200 cm after Treitz ligament,n =6).The time used for each anastomosis were recorded.The second operations were performed on postoperative day 7 on all the dogs to determine in situ anastomostic bursting pressures (ABP) and the pressures while the serosa layer was tom.Results No anastomosis leak was found in twenty-four stoma of the twelve dogs.There was no significant difference between the stoma created by single-layer anastomosis and double-layer anastomosis on intraperitoneal adhesions.The averaged ABP in the single-layer anastomosis group and the double-layer anastomosis group was (325.83 ± 88

  3. Persistent Transport Barrier on the West Florida Shelf

    CERN Document Server

    Olascoaga, M J; Brand, L E; Brown, M G; Halliwell, G R; Rypina, I I; Shay, L K

    2006-01-01

    Analysis of drifter trajectories in the Gulf of Mexico has revealed the existence of a region on the southern portion of the West Florida Shelf (WFS) that is not visited by drifters that are released outside of the region. This so-called ``forbidden zone'' (FZ) suggests the existence of a persistent cross-shelf transport barrier on the southern portion of the WFS. In this letter a year-long record of surface currents produced by a Hybrid-Coordinate Ocean Model simulation of the WFS is used to identify Lagrangian coherent structures (LCSs), which reveal the presence of a robust and persistent cross-shelf transport barrier in approximately the same location as the boundary of the FZ. The location of the cross-shelf transport barrier undergoes a seasonal oscillation, being closer to the coast in the summer than in the winter. A month-long record of surface currents inferred from high-frequency (HF) radar measurements in a roughly 60 km $\\times$ 80 km region on the WFS off Tampa Bay is also used to identify LCSs,...

  4. Biofilm-associated persistence of food-borne pathogens.

    Science.gov (United States)

    Bridier, A; Sanchez-Vizuete, P; Guilbaud, M; Piard, J-C; Naïtali, M; Briandet, R

    2015-02-01

    Microbial life abounds on surfaces in both natural and industrial environments, one of which is the food industry. A solid substrate, water and some nutrients are sufficient to allow the construction of a microbial fortress, a so-called biofilm. Survival strategies developed by these surface-associated ecosystems are beginning to be deciphered in the context of rudimentary laboratory biofilms. Gelatinous organic matrices consisting of complex mixtures of self-produced biopolymers ensure the cohesion of these biological structures and contribute to their resistance and persistence. Moreover, far from being just simple three-dimensional assemblies of identical cells, biofilms are composed of heterogeneous sub-populations with distinctive behaviours that contribute to their global ecological success. In the clinical field, biofilm-associated infections (BAI) are known to trigger chronic infections that require dedicated therapies. A similar belief emerging in the food industry, where biofilm tolerance to environmental stresses, including cleaning and disinfection/sanitation, can result in the persistence of bacterial pathogens and the recurrent cross-contamination of food products. The present review focuses on the principal mechanisms involved in the formation of biofilms of food-borne pathogens, where biofilm behaviour is driven by its three-dimensional heterogeneity and by species interactions within these biostructures, and we look at some emergent control strategies.

  5. Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study

    NARCIS (Netherlands)

    J.J.B.F.G. Schepens; B.W.J. Mol; M.A.H.M. Wiegerinck; S. Houterman; C.A.M. Koks

    2011-01-01

    BACKGROUND: Female sterilization is a widely used contraceptive method but in a small group of women, post-sterilization regret occurs. A dilemma for these women is the choice between surgical re-anastomosis and IVF. We evaluated the factors that affected pregnancy rate after laparoscopic tubal re-a

  6. Pouchitis-Associated Iritis (Uveitis Following Total Proctocolectomy and Ileal Pouch-to-Anal Anastomosis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Hugh James Freeman

    2001-01-01

    Full Text Available A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  7. Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Nanashima

    2016-01-01

    Conclusion: By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.

  8. Pouchitis-associated iritis (uveitis) following total proctocolectomy and ileal pouch-to-anal anastomosis in ulcerative colitis.

    Science.gov (United States)

    Freeman, H J

    2001-02-01

    A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  9. Sir Charles Alfred Ballance (1856-1936) and the introduction of facial nerve crossover anastomosis in 1895

    NARCIS (Netherlands)

    Van de Graaf, Robert C.; Ijpma, Frank F. A.; Nicolai, Jean-Philippe A.

    2009-01-01

    Sir Charles Ballance (1856-1936) was the first surgeon in history to perform a facial nerve crossover anastomosis in 1895. Although, recently, several papers on the history of facial nerve surgery have been published, little is known about this historically important operation, the theoretical reaso

  10. Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

    Directory of Open Access Journals (Sweden)

    Shimpei Miyamoto, MD

    2014-03-01

    Conclusions: This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.

  11. Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass

    Science.gov (United States)

    Bai, Ri-Xing; Yan, Wen-Mao; Li, You-Guo; Xu, Jun; Zhong, Zhi-Qiang; Yan, Ming

    2016-01-01

    AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Seventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed. RESULTS All patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis (1.3%) and six patients complicated with incomplete intestinal obstruction (7.8%). BMI and HbA1c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA1c (%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too. CONCLUSION Present surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications. PMID:27729746

  12. Anastomosis of germ tubes and nuclear migration of nuclei in germ tube networks of the soybean rust pathogen, Phakopsora pachyrhizi

    Science.gov (United States)

    Parasexual recombination through hyphal anastomosis is an important mechanism for genetic diversity in filamentous fungi. In this study, we observed fusion of germ tubes in germinating urediniospores of Phakopsora pachyrhizi resulting in a complex hyphal network. Staining of the germinating uredinio...

  13. Faecal microbiota transplantation for recurring Clostridium difficile infection in a patient with Crohn's disease and ileorectal anastomosis

    DEFF Research Database (Denmark)

    Oppfeldt, Asser Mathiassen; Dahlerup, Jens F; Christensen, Lisbet A;

    2016-01-01

    ileorectal anastomosis following colectomy. She had recurrent CDIs that were refractory to metronidazole, pulse-tapered vancomycin and fidaxomicin treatments. She underwent 2 FMTs, which were performed via sigmoidoscopy; her mother served as a donor. Follow-up was conducted for 12 months and indicated...

  14. DNA fingerprinting and anastomosis grouping reveal similar genetic diversity in Rhizoctonia species infecting turfgrasses in the transition zone of USA

    Science.gov (United States)

    Rhizoctonia blight (sensu lato) is a common and serious disease of many turfgrass species. The most widespread causal agent, R. solani, consists of several genetically different subpopulations. Though hyphal anastomosis reactions have been used to group Rhizoctonia species, they are time consuming a...

  15. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  16. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Marc Manganiello

    2012-02-01

    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  17. Laser solder repair technique for nerve anastomosis: temperatures required for optimal tensile strength

    Science.gov (United States)

    McNally-Heintzelman, Karen M.; Dawes, Judith M.; Lauto, Antonio; Parker, Anthony E.; Owen, Earl R.; Piper, James A.

    1998-01-01

    Laser-assisted repair of nerves is often unsatisfactory and has a high failure rate. Two disadvantages of laser assisted procedures are low initial strength of the resulting anastomosis and thermal damage of tissue by laser heating. Temporary or permanent stay sutures are used and fluid solders have been proposed to increase the strength of the repair. These techniques, however, have their own disadvantages including foreign body reaction and difficulty of application. To address these problems solid protein solder strips have been developed for use in conjunction with a diode laser for nerve anastomosis. The protein helps to supplement the bond, especially in the acute healing phase up to five days post- operative. Indocyanine green dye is added to the protein solder to absorb a laser wavelength (approximately 800 nm) that is poorly absorbed by water and other bodily tissues. This reduces the collateral thermal damage typically associated with other laser techniques. An investigation of the feasibility of the laser-solder repair technique in terms of required laser irradiance, tensile strength of the repair, and solder and tissue temperature is reported here. The tensile strength of repaired nerves rose steadily with laser irradiance reaching a maximum of 105 plus or minus 10 N.cm-2 at 12.7 W.cm-2. When higher laser irradiances were used the tensile strength of the resulting bonds dropped. Histopathological analysis of the laser- soldered nerves, conducted immediately after surgery, showed the solder to have adhered well to the perineurial membrane, with minimal damage to the inner axons of the nerve. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fiber optic radiometer and thermocouple respectively, also rose steadily with laser irradiance. At 12.7 W.cm-2, the temperatures reached at the surface and at the interface were 85 plus or minus 4 and 68 plus or minus 4 degrees Celsius respectively

  18. Outcome of 132 consecutive reconstructive operations for intestinal fistula--staged operation without primary anastomosis improved outcome in retrospective analysis.

    Science.gov (United States)

    Runström, B; Hallböök, O; Nyström, P O; Sjödahl, R; Olaison, G

    2013-01-01

    To study factors that influenced healing and survival after attempted closure of enterocutaneous fistula. Retrospective analysis of prospective data concerning 101 patients operated on 132 instances for 110 enterocutaneous fistulae at two hospitals. In all, 96 (87%) of the 110 fistulae healed and 92 (91%) patients survived. A total of 9 patients with unhealed fistula died. Multivariate analysis revealed jaundice as an independent factor for both death and failed closure and operation without anastomosis as an independent positive factor for healing. Failure rate was lower after an operation with stoma without anastomosis (6 of 43, 14%) than after an operation with anastomosis (30 of 89, 34%) p = 0.0213. Of the 36 instances with unhealed fistula, 13 (36%) could be ascribed to inadvertent bowel lesions at the reconstructive operation. In addition, univariate analysis revealed that patients with previous multiple laparotomies or with multiple operations for enterocutaneous fistula healed less likely and had higher mortality. A low serum albumin, high white blood cell count, high C-reactive protein concentration, high fistula output, total parenteral nutrition, and operation for recurrent fistula were associated with death together with long operation time and operative bleeding, both indicators of surgical complexity. Over time, staged surgery avoiding anastomosis increased from 27% to 57%. Mortality decreased from 12% to 6%, and healing increased from 73% to 94%. Chronic inflammation, malnutrition, and liver failure causing an impaired healing capacity are important reasons for failure. Staged operation without primary anastomosis may allow the patient to reverse this condition and improve outcome. The high surgical complexity is a negative factor that requires careful planning of the operation.

  19. Is Inflation Persistence Over?

    Directory of Open Access Journals (Sweden)

    Fernando N. de Oliveira

    2014-09-01

    Full Text Available We analyze inflation persistence in several industrial and emerging countries in the recent past by implementing unit root tests in the presence of unknown structural breaks and by estimating reduced-form models of inflation dynamics. We select a very representative group of 23 industrial and 17 emerging economies. Our sample period is comprised of quarterly data and differs for each country. Our results indicate that inflation persistence is decreasing over time for the great majority of industrial economies. Many emerging economies, however, show increasing persistence and even a few have highly persistent inflationary processes. We also observe structural breaks in all inflation processes we study with the exception of the inflation processes of Germany and Austria. Our results are robust to different reduced forms of the inflation processes and different econometric techniques.

  20. Glyphosate persistence in seawater.

    Science.gov (United States)

    Mercurio, Philip; Flores, Florita; Mueller, Jochen F; Carter, Steve; Negri, Andrew P

    2014-08-30

    Glyphosate is one of the most widely applied herbicides globally but its persistence in seawater has not been reported. Here we quantify the biodegradation of glyphosate using standard "simulation" flask tests with native bacterial populations and coastal seawater from the Great Barrier Reef. The half-life for glyphosate at 25 °C in low-light was 47 days, extending to 267 days in the dark at 25 °C and 315 days in the dark at 31 °C, which is the longest persistence reported for this herbicide. AMPA, the microbial transformation product of glyphosate, was detected under all conditions, confirming that degradation was mediated by the native microbial community. This study demonstrates glyphosate is moderately persistent in the marine water under low light conditions and is highly persistent in the dark. Little degradation would be expected during flood plumes in the tropics, which could potentially deliver dissolved and sediment-bound glyphosate far from shore.

  1. Robotic Assisted Laparoscopic Prostatectomy in Men with Proctocolectomy and Restorative Ileal Pouch-Anal Anastomosis

    Directory of Open Access Journals (Sweden)

    Michael Leapman

    2014-01-01

    Full Text Available We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125 mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch.

  2. Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases.

    Science.gov (United States)

    Mahieu, J; Mansvelt, B; Veys, E

    2014-01-01

    Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.

  3. Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Hennild, V.; Kjaergaard, H.; Kuld Hansen, L.

    A radiologic investigation was performed in 26 patients subjected to colectomy, mucosal proctectomy and endorectal ileo-anal anastomosis after the creation of an ileal reservoir. The patients had suffered from ulcerative colitis or familial polyposis. The reservoir and its efferent leg was best demonstrated by contrast enema. The size and position of the reservoir and the efferent leg was demonstrated, and stenoses, abscesses and fistulae could be identified. Examination of the small bowel with a contrast medium showed slight dilatation of the ileum orally to the reservoir in all instances and one patient had a stenosis at the junction of the afferent leg of the reservoir. Erect and supine projections of the abdomen showed gas in the intestine and fluid levels in the reservoir. These radiographic findings should not be confused with ileus or pelvic abscess. Radiology was of great value in disclosing postoperative complications.

  4. An augmented reality system in lymphatico-venous anastomosis surgery†

    Science.gov (United States)

    Nishimoto, Soh; Tonooka, Maki; Fujita, Kazutoshi; Sotsuka, Yohei; Fujiwara, Toshihiro; Kawai, Kenichiro; Kakibuchi, Masao

    2016-01-01

    Indocyanine green lymphography, displayed as infrared image, is very useful in identifying lymphatic vessels during surgeries. Surgeons refer the infrared image on the displays as they proceed the operation. Those displays are usually placed on the walls or besides the operation tables. The surgeons cannot watch the infrared image and the operation field simultaneously. They have to move their heads and visual lines. An augmented reality system was developed for simultaneous referring of the infrared image, overlaid on real operation field view. A surgeon wore a see-through eye-glasses type display during lymphatico-venous anastomosis surgery. Infrared image was transferred wirelessly to the display. The surgeon was able to recognize fluorescently shining lymphatic vessels projected on the glasses and dissect them out. PMID:27154749

  5. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury

    Energy Technology Data Exchange (ETDEWEB)

    Browning, G.G.P.; Varma, J.S.; Smith, A.N.; Small, W.P.; Duncan, W.

    1987-01-01

    Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n=7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.

  6. Single incision laparoscopic total abdominal colectomy with ileorectal anastomosis for synchronous colon cancer.

    Science.gov (United States)

    Bardakcioglu, O; Ahmed, S

    2010-09-01

    Single incision laparoscopy is currently performed mostly for basic laparoscopic procedures involving single abdominal quadrants. The aim of this case report is to show that single incision laparoscopic techniques can be utilized for complex abdominal laparoscopic procedures with a large target organ and a working space involving all quadrants of the abdominal cavity. A single incision laparoscopic total abdominal colectomy with an ileorectal anastomosis and intraoperative CO(2) colonoscopy was performed for a patient with synchronous adenocarcinoma of the cecum and the sigmoid colon. The patient was discharged home on postoperative day 4 and had no immediate postoperative complications. Single incision laparoscopy is feasible for complex colorectal procedures. Some of the techniques used may be adapted further to achieve colonic resection via a natural orifice in the future.

  7. Anastomosis in minimally invasive Ivor lewis esophagectomy via two ports provides equivalent perioperative outcomes to open

    Directory of Open Access Journals (Sweden)

    Y Zhao

    2014-01-01

    Full Text Available Objective: Minimally invasive esophagectomy (MIE is becoming a selective treatment of esophageal cancer; however, it′s a complex and technically demanding surgical operation. MIE can be performed in high volume centers in a variety of ways using different techniques. Transthoracic staplers have traditionally been used in open transthoracic Ivor Lewis Esophagectomy (ILE with good success. An investigation of the safety and utility of transthoracic stapler via two ports on thorax for esophageal anastomosis in minimally invasive ILE is reviewed. Methods: Patients of esophageal cancer were selected between November 2012 and July 2014. All the patients received minimally invasive (MIE or open transthoracic ILE. Transthoracic stapler for MIE anastomosis was performed through the major port located at subaxillary region. Patients′ demographics, indications for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, 7 and in-hospital mortality were evaluated. Results: Totally, 63 consecutive patients underwent MIE or ILE. All the patients were Han with a mean age of 60 years (52-74. The indication of surgery is esophageal cancer, and squamous cell carcinoma was defined by pathologist before operation. None of the patients had neoadjuvant chemotherapy or radiation. All the MIE patients were no conversions to open thoracotomy or laparotomy. Mean operative time was 4.5 h. One patient (3.03% suffered postoperative pneumonia, no leak from the gastric conduit staple line or esophageal anastomoses, no postoperative complication required surgical intervention was observed. The median hospital length of stay was 13 days (range 7-18. There were no in-hospital mortalities. Conclusions: In our study, transthoracic stapler through the major port at subaxillary seems technically feasible and safe for minimally invasive ILE with comparable morbidity and oncologic data to open.

  8. Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension(26 years clinical observation)

    Institute of Scientific and Technical Information of China (English)

    CHEN Jisheng; HUO Jinshan; ZHANG Hongwei; SHANG Changzhen; CHEN Rufu; ZHANG Jie; Obetien Mapudengo; CHEN Yajin; ZHANG Lei

    2007-01-01

    The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.In this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal dynamics.From 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery treatment.From 1999 to 2002,a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation.From 1994 to 2004,another RCT.was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MR.A) investigation after operation.Among 274 patients (mean age 41.8 years),the emergency operative mortality (4.4%),selective operative mortality (2.2%),complication rate (17.9%),morbidity of hepatic encephalopathy ( < 1%),bleeding rate of portal hypertension gastritis (PHG) (9.1%),and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation;the spleen immunology function (Tuftsin,IgM)decreased among the groups 2 months after operation.Through 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group.Splenic auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial bleeding.It can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

  9. Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis.

    Science.gov (United States)

    Hanna, Mark H; Hwang, Grace S; Phelan, Michael J; Bui, Thanh-Lan; Carmichael, Joseph C; Mills, Steven D; Stamos, Michael J; Pigazzi, Alessio

    2016-09-01

    The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). A retrospective chart review of 195 consecutive patients who underwent laparoscopic right hemicolectomy by four colorectal surgeons at three institutions from March 2005 to June 2014 was performed. Multivariate regression analysis was used to compare postoperative and oncologic outcomes. A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising

  10. Endoluminal laser-assisted vascular anastomosis-an in vivo study in a pig model.

    Science.gov (United States)

    Mbaidjol, Zacharia; Kiermeir, David; Schönfeld, Annemarie; Arnoldi, Jörg; Frenz, Martin; Constantinescu, Mihai A

    2017-08-01

    Microvascular surgery is time consuming and requires high expertise. Laser-assisted vascular anastomosis (LAVA) is a promising sutureless technique that has the potential to facilitate this procedure. In this study, we evaluate the handling of our soldering material and the 1-week patency rate in a porcine model. Six pigs were subjected to LAVA. For each pig, the saphenous artery on one side was transected while the contralateral side was used as control. A porous polycaprolactone scaffold soaked in 40% (w/w) bovine serum albumin solution in combination with 0.1% (w/w) indocyanine green was wrapped at the anastomosis site and at the control site. Both sides were then soldered with a diode laser coupled into a light diffuser fiber emitting radiation with a wavelength of 808 nm and a power of 2-2.2 W. Vessels were successfully soldered with a 100% immediate patency rate. The 1-week patency rate was 83% for the anastomoses versus 67% for the control side. Vessels irradiated for 80 to 90 s tended to maintain the highest patency rate. Macroscopically, there was no difference between the two sides. The patch was easy to handle provided that the environment could be kept dry. This study shows the potential and the limitations of endoluminal LAVA as a one-step procedure without the use of stay sutures. Further studies are needed to improve the soldering material, the long-term patency rate, and standardized irradiation parameters. The long-term effects of laser soldering on the vessel wall remain to be determined.

  11. Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study.

    Science.gov (United States)

    Andriesse, G I; Gooszen, H G; Schipper, M E; Akkermans, L M; van Vroonhoven, T J; van Laarhoven, C J

    2001-05-01

    To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA. Eleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples. Median stool frequency decreased from 15/24 hours (10-25) to 6/24 hours (4-11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7-2.8) v 1.5 (0.4-2.2) and 1.4 (0.8-3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50-118) v 96 (39-176) (NS) and 122 (56-185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8-24) v 22 (8-34) (NS) and 26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up. The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.

  12. [Clinico-morphological assessment of early and late results of laser therapy of the anastomosis area after radical surgeries for stomach cancer].

    Science.gov (United States)

    Zyrianov, B N; Vusik, M V; Kritskaia, N G

    2003-01-01

    The study included 52 patients after gastrectomy for carcinoma of the proximal part of the stomach. Endoscopic laser therapy was made in 32 patients to reduce inflammation in the anastomosis zone 2-3 weeks after surgery. Drug therapy was made in 20 patients within the same time period. Histochemical study of the biopsy material of esophageal and intestinal part of the anastomosis was carried out. It is revealed that application of copper vapor laser early after surgery reduces edema and inflammation in the anastomosis zone for 2 weeks as well as accelerates the growth of granulation tissue forming a delicate scar thus preventing formation of scar stenosis.

  13. Persistence and financial markets

    Science.gov (United States)

    Jain, S.

    2007-09-01

    The persistence phenomenon is studied in a financial context by using a novel mapping of the time evolution of the values of shares in a portfolio onto Ising spins. The method is applied to historical data from the London Financial Times Stock Exchange 100 index (FTSE 100) over an arbitrarily chosen period. By following the time dependence of the spins, we find evidence for a power law decay of the proportion of shares that remain either above or below their ‘starting’ values. As a result, we estimate a persistence exponent for the underlying financial market to be ≈0.5. Preliminary results from computer simulations on persistence in the economic dynamics of a toy model appear to reproduce the behaviour observed in real markets.

  14. Why do delusions persist?

    Directory of Open Access Journals (Sweden)

    Philip R Corlett

    2009-07-01

    Full Text Available Delusions are bizarre and distressing beliefs that characterize certain mental illnesses. They arise without clear reasons and are remarkably persistent. Recent models of delusions, drawing on a neuroscientific understanding of learning, focus on how delusions might emerge from abnormal experience. We believe that these models can be extended to help us understand why delusions persist. We consider prediction error, the mismatch between expectancy and experience, to be central. Surprising events demand a change in our expectancies. This involves making what we have learned labile, updating and binding the memory anew: a process of memory reconsolidation. We argue that, under the influence of excessive prediction error, delusional beliefs are repeatedly reconsolidated, strengthening them so that they persist, apparently impervious to contradiction.

  15. Visual persistence and cinema?

    Science.gov (United States)

    Galifret, Yves

    2006-01-01

    In Faraday and Plateau's days, both apparent motion and the fusion of intermittent lights, two phenomena that are hardly connected, were explained by retinal persistence. The works of Exner and of the 'Gestalt' psychologists, as well as the modern works on 'sampled' motion and smooth motion, disregarded retinal persistence. One tried, originally, to measure this persistence using intermittent stimulation, but under the pressure of practical concern, what was established in 1902 was the logarithmic relation between fusion frequency and the intensity of the stimulation. One had to wait until the 1950s for the use of harmonic analysis to finally allow a renewal in which many problems that, for decades, had only given rise to discussions that led nowhere and to groundless assertions, were correctly stated and easily solved. To cite this article: Y. Galifret, C. R. Biologies 329 (2006).

  16. Financial Markets and Persistence

    CERN Document Server

    Jain, S

    2005-01-01

    Persistence is studied in a financial context by mapping the time evolution of the values of the shares quoted on the London Financial Times Stock Exchange 100 index (FTSE 100) onto Ising spins. By following the time dependence of the spins, we find evidence for power law decay of the proportion of shares that remain either above or below their ` starting\\rq values. As a result, we estimate a persistence exponent for the underlying financial market to be $\\theta_f\\sim 0.5$.

  17. Persistence in financial markets

    Science.gov (United States)

    Jain, S.; Buckley, P.

    2006-03-01

    Persistence is studied in a financial context by mapping the time evolution of the values of the shares quoted on the London Financial Times Stock Exchange 100 index (FTSE 100) onto Ising spins. By following the time dependence of the spins, we find evidence for power law decay of the proportion of shares that remain either above or below their 'starting' values. As a result, we estimate a persistence exponent for the underlying financial market to be θf˜0.5.

  18. PERSISTENT LEFT SUPERIOR VENACAVA

    Directory of Open Access Journals (Sweden)

    Devinder Singh

    2014-05-01

    Full Text Available A Persistent Left Superior Venacava (PLSVC is the most common variation of the thoracic venous system and rare congenital vascular anomaly and is prevalent in 0.3% of the population. It may be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. Incidental rotation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography. Condition is usually asymptomatic. Here we present a rare case of persistent left superior vena cava presented in OPD with dyspnoea & palpitations.

  19. Application of a new-type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute bile duct injury in dogs

    Institute of Scientific and Technical Information of China (English)

    Jianhui Li; Yi Lü; Bo Qu; Zhiyong Zhang; Chang Liu; Yuan Shi; Bo Wang; Xuewen Ji; Liang Yu

    2007-01-01

    Objective: To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute bile duct injury in dogs).Methods: Establishing an animal model of acute bile duct injury with severe inflammation and bile peritonitis in dogs. The newtype sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results: The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable bile leakage and infection. Conclusion: It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute bile duct injury in dogs.

  20. Analysis of outcome of end-to-end and end-to-side internal iliac artery anastomosis in renal transplantation: Our initial experience with a case series.

    Science.gov (United States)

    Pal, Dilip Kumar; Sanki, Prakash Kumar; Roy, Sayak

    2017-01-01

    In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique. A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups. The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable. The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.

  1. Can a nickel-titanium memory-shape device serve as a substitute for the stapler in gastrointestinal anastomosis? A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Ning-Ning; Zhao, Wen-Tao; Wu, Xiao-Ting

    2016-03-01

    Recently, a nickel-titanium (NiTi) memory-shape device has been successfully used in gastrointestinal anastomosis. The aim of this study was to investigate the feasibility and safety of the device. Four databases, reference lists, and the World Health Organization International Clinical Trials Registry Platform were systematically searched for randomized controlled trials assessing the clinical efficacy of a NiTi memory-shape device compared with that of a stapler in gastrointestinal or colorectal anastomosis. Seven randomized controlled trials regarding the use of compression anastomosis clips (CACs) were enrolled for meta-analysis. The use of CACs was associated with a significant reduction in hospital duration (mean = -0.88 d; 95% confidence interval [CI], -1.38 to -0.38), the time to flatus (mean = -0.36 d; 95% CI, -0.08 to -0.04), and the start of oral intake (mean = -0.45 d; 95% CI, -0.83 to -0.06), as well as a nonsignificant change in postoperative complications and mortality. These clinical outcomes did not significantly change with the use of compression anastomosis rings. Colonic anastomosis with a CAC is likely to reduce hospital duration, time to flatus, and the start of oral intake without influencing mortality or postoperative complications and may be a safe and preferable choice in colonic anastomosis. Further well-designed trials should be performed to determine the safety and efficacy of the newly developed compression anastomosis ring in both ileocolic and colorectal anastomosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Entero-enteric fistula from the stump of an end-to-side ileocolic anastomosis mimicking cancer recurrence.

    Science.gov (United States)

    Elsafty, N; Clancy, C; Bajwa, R; Memeh, K; Joyce, M R

    2015-09-15

    Enteric fistulae are a complex and technically frustrating complication of any bowel surgery. The constellation of associated non-specific symptoms often leads to extensive investigation and, in this case, suspicion of disease recurrence. A 71-year-old gentleman with a history of previous colorectal cancer presented with chronic diarrhoea, weight loss and left lower quadrant pain. Elective exploratory laparoscopy was performed to investigate possible disease recurrence due to elevated carcinoembryonic antigen levels and a positron emission tomography positive area within the mesentery. A jejunal-ileal fistula was found at laparotomy where the blind ileal stump of the end-to-side ileocolic anastomosis had fistulated into the jejunum. Resection of the affected jejunum was performed with end-to-end jejuno-jejunal re-anastomosis and stapling of the ileal stump. Specimen histology was negative for recurrence. Intestinal fistulae represent a diagnostic challenge. This is the first case report describing an enteric fistula mimicking cancer recurrence.

  3. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  4. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    Science.gov (United States)

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.

  5. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2015-01-01

    Full Text Available Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve. We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

  6. Concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis for synchronous carcinoma.

    Science.gov (United States)

    Jafari Giv, M; Ho, Y H

    2007-03-01

    An extensive large bowel resection with a single anastomosis is the accustomed management option for widely spaced synchronous colorectal neoplasms. We report a successful case of concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis in an 85-year-old man with synchronous cancers of the hepatic flexure and lowrectum. This surgical technique is advantageous for elderly patients as it provides the benefits of multiple segmental resection and laparoscopic surgery while potentially reducing mortality, time of procedure, postoperative pain, ileus, length of hospitalization and direct cost of care, and improving independence at discharge. The technique for efficient multiple extractions of specimens and effective reconstitution of pneumoperitoneum for a multistaged procedure is discussed.

  7. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  8. The Persistence of PCBs.

    Science.gov (United States)

    Boyle, Robert H.; Highland, Joseph H.

    1979-01-01

    PCB's are one of the most persistent chemicals ever introduced into the environment by man. From very early in their history of manufacture PCB's were suspected of being hazardous to health, but public awareness of the hazard was slow in coming. (RE)

  9. Introduction: Persistent Modelling

    DEFF Research Database (Denmark)

    Ayres, Phil

    2012-01-01

    , familiar contemporary and, perhaps, not so familiar emerging manifestations of this relation. What persists from this probing, fully intact, is that representation and the represented remain inextricably related in our contemporary and emerging practices. What comes into focus is that the nature...

  10. Is corruption really persistent?

    NARCIS (Netherlands)

    Seldadyo, H.; de Haan, J.

    2011-01-01

    Theoretical and empirical research on corruption generally concludes that corruption is persistent. However, using International Country Risk Guide data for the period 1984-2008 for 101 countries, we find strong evidence that corruption changes over time. In the present study, corruption levels of m

  11. Chilly Ties Persist

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Sino-Japanese relations seem unlikely to improve under the leadership of Shinzo Abe The deteriorating state of relations between China and Japan may persist under the government of Shinzo Abe, who won the presidential election of the ruling Liberal Democratic Party (LDP) on September 20 and was

  12. Contributions to Persistence Theory

    Directory of Open Access Journals (Sweden)

    Du Dong

    2014-12-01

    Full Text Available Persistence theory discussed in this paper is an application of algebraic topology (Morse Theory [29] to Data Analysis, precisely to qualitative understanding of point cloud data, or PCD for short. PCD can be geometrized as a filtration of simplicial complexes (Vietoris-Rips complex [25] [36] and the homology changes of these complexes provide qualitative information about the data. Bar codes describe the changes in homology with coefficients in a fixed field. When the coefficient field is ℤ2, the calculation of bar codes is done by ELZ algorithm (named after H. Edelsbrunner, D. Letscher, and A. Zomorodian [20]. When the coefficient field is ℝ, we propose an algorithm based on the Hodge decomposition [17]. With Dan Burghelea and Tamal K. Dey we developed a persistence theory which involves level sets discussed in Section 4. We introduce and discuss new computable invariants, the “relevant level persistence numbers” and the “positive and negative bar codes”, and explain how they are related to the bar codes for level persistence. We provide enhancements and modifications of ELZ algorithm to calculate such invariants and illustrate them by examples.

  13. Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis

    Institute of Scientific and Technical Information of China (English)

    Liu Jianfeng; Chen Bin; Ni Yong; Zhan Yongqiang; Gao Haibin

    2014-01-01

    Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional (3D) media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope (arterial microscope group) were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system (arterial 3D group).For the other 20 rats,10 femoral vein anastomoses using a conventional microscope (venous microscope group) were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system (venous 3D group).The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows:anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively (P >0.05).The average venous anastomotic time of the venous microscope group and

  14. A new anastomosis method for choledochojejunostomy by the way behind antrue pyloricum

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-wei; YANG Jue; WANG Kui; ZHANG Bao-hua; SHEN Feng; WU Meng-chao

    2013-01-01

    Background Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy.In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.Methods Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University,China between January 2007 and December 2010 were retrospectively analyzed.Among the patients,38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group,IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group,CG).Changes in the incidence of cholangitis,the time of beginning to eat liquid meals,post-operative delayed gastric emptying and liver function between the two groups were compared.Results There was no statistical difference in the levels of alanine transaminase,alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups.The time of beginning to eat liquid meals was significantly shorter in IG than CG (P <0.05).The incidence of delayed gastric emptying was lower in IG than CG,with statistical tendency between the two groups (P=0.052).Among nine patients with different degrees of acute cholangitis in the two groups,one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge,but with no statistical difference between the two groups (P >0.05).Of the nine patients with acute cholangitis,none in IGand four in CG were hospitalized for further treatment (P >0.05).Conclusions Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying.This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.

  15. Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years.

    Science.gov (United States)

    Dalla Toffola, Elena; Pavese, Chiara; Cecini, Miriam; Petrucci, Lucia; Ricotti, Susanna; Bejor, Maurizio; Salimbeni, Grazia; Biglioli, Federico; Klersy, Catherine

    2014-01-01

    Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XIIVII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.

  16. Acrodermatitis enteropathica-like skin eruption in a case of short bowel syndrome following jejuno-transverse colon anastomosis.

    Science.gov (United States)

    Suchithra, N; Sreejith, P; Pappachan, Joseph M; George, Josemon; Rajakumari, P K; Cheriyan, George

    2007-07-13

    Acrodermatitis enteropathica is a rare autosomal recessive disorder of zinc deficiency. Zinc is an essential trace element in human metabolism and acquired zinc deficiency may manifest with skin eruptions simulating acrodermatitis enteropathica. We report an unusual case of acrodermatitis enteropathica-like skin eruption due to deficiency of zinc and other nutritional factors in a patient who has undergone extensive small bowel resection and jejuno-transverse colon anastomosis for mesenteric ischemia.

  17. Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Charles Y., E-mail: charles.kim@duke.edu; Tandberg, Daniel J.; Rosenberg, Michael D.; Miller, Michael J.; Suhocki, Paul V.; Smith, Tony P. [Duke University Medical Center, Division of Vascular and Interventional Radiology (United States)

    2012-08-15

    Purpose: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. Methods: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. Results: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). Conclusion: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

  18. Development, validation and operating room-transfer of a six-step laparoscopic training program for the vesicourethral anastomosis.

    Science.gov (United States)

    Klein, Jan; Teber, Dogu; Frede, Tom; Stock, Christian; Hruza, Marcel; Gözen, Ali; Seemann, Othmar; Schulze, Michael; Rassweiler, Jens

    2013-03-01

    Development and full validation of a laparoscopic training program for stepwise learning of a reproducible application of a standardized laparoscopic anastomosis technique and integration into the clinical course. The training of vesicourethral anastomosis (VUA) was divided into six simple standardized steps. To fix the objective criteria, four experienced surgeons performed the stepwise training protocol. Thirty-eight participants with no previous laparoscopic experience were investigated in their training performance. The times needed to manage each training step and the total training time were recorded. The integration into the clinical course was investigated. The training results and the corresponding steps during laparoscopic radical prostatectomy (LRP) were analyzed. Data analysis of corresponding operating room (OR) sections of 793 LRP was performed. Based on the validity, criteria were determined. In the laboratory section, a significant reduction of OR time for every step was seen in all participants. Coordination: 62%; longitudinal incision: 52%; inverted U-shape incision: 43%; plexus: 47%. Anastomosis catheter model: 38%. VUA: 38%. The laboratory section required a total time of 29 hours (minimum: 16 hours; maximum: 42 hours). All participants had shorter execution times in the laboratory than under real conditions. The best match was found within the VUA model. To perform an anastomosis under real conditions, 25% more time was needed. By using the training protocol, the performance of the VUA is comparable to that of an surgeon with experience of about 50 laparoscopic VUA. Data analysis proved content, construct, and prognostic validity. The use of stepwise training approaches enables a surgeon to learn and reproduce complex reconstructive surgical tasks: eg, the VUA in a safe environment. The validity of the designed system is given at all levels and should be used as a standard in the clinical surgical training in laparoscopic reconstructive urology.

  19. Development of a robotic manipulator of human tubular tissues for suture and support in anastomosis surgery interventions

    OpenAIRE

    Tornero García, José Antonio; Domènech Trujillo, M. Carmen; Cano Casas, Francesc

    2009-01-01

    The aim of the project is to develop a surgical robotic manipulator device focused in the improvement of surgical interventions with anastomosis. These interventions consist basically in doing a cross-cutting of a tubular tissue (usually the intestine) removing a piece of it and uniting again the resulting ends. This is a common procedure in the treatment of cancer of colon, which has big incidence in occidental population.

  20. Clinical Study on Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis in Pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Ke Dong; Wei Xiong; Xiao-jiong Yu; Chun Gu

    2013-01-01

    Objective To study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis (SPDJCS) on the incidence of pancreatic fistula after pancreaticoduodenectomy,and to analyze its applicability,safety,and efficacies. Methods A prospective controlled trial was conducted with 165 cases receiving pancreati-coduodenectomy in the Department of Hepatopancreatobiliary Surgery from January 2010 to May 2012. The patients were divided into Group A (end-to-end/end-to-side invaginated anastomosis,n=52),Group B (end-to-side mucosal anastomosis,n=48),and Group C (SPDJCS,n=65). The preoperative data,intra-operative data,and operative outcomes (incidence of pancreatic fistula,operation time,intraoperative blood loss,peritoneal drainage,peritoneal hemorrhage,peritoneal abscess,delayed gastric emptying,pulmonary infection,postoperative infection,blood transfusion,and perioperative mortality) were com-pared among the 3 groups. Results The total incidence of pancreatic fistula was 13.9% (23/165) in all the 165 patients. The inci-dence in Group A and Group B was 23.1% (12/52) and 18.8% (9/48),both higher than that in Group C [3.1% (2/65),both P0.05). As complications other than pancreatic fistula were concerned,the three groups were not different from each other (P>0.05). Conclusions SPDJCS may have the effect of reducing the incidence of pancreatic fistula after pan-creaticoduodenectomy. It could be safe,practical and convenient technique of anastomosis for pancreaticoje-junostomy.

  1. [The method of biliary tracts drainage of patients with biliodigestive anastomosis at obstructive jaundice and acute cholangitis].

    Science.gov (United States)

    Agaev, B A; Agaev, R M; Gasymov, R Sh

    2011-01-01

    The internal draining of biliary tracts of patients with obstructive jaundice and acute cholangitis is considered most acceptable, but deficiency of this method is anastomosis failure, stricture and purulent-septic complications hazard. The investigations performed on 79 patients with obstructive jaundice, 36 of which were included in control group, 43 - in main group. To patients of main group with internal draining intraoperatively through the nose and biliodigestive anastomosis into the biliary tract transmitted tube with quartz optical monofiber for endocholedocheal laser irradiation in one lumen and hollow other, serve for drainage and irrigation of bile-excreting way with ozonized physiological solution. The application of endocholedocheal laser radiation and ozonetherapy in combination with suggested at biliodigestive anastomosis biliary tract drainage method allowed to earlier elimination of inflammatory process biliary tract, correct the bile lipids per oxidations disturbances and elevate activity of antioxidant protection system, to reduced the time of patients stay at hospital after surgery period from 20,3±1,24 day in control group to 12,7±0,653 day in main group (pjaundice and acute cholangitis.

  2. An investigation of the effects of suture patterns on mechanical strength of intestinal anastomosis: an experimental study.

    Science.gov (United States)

    Khoorjestan, Sanaz Mosafer; Rouhi, Gholamreza; Toolabi, Karamollah

    2017-08-28

    How the distance of sutures from the edge of tissue and the horizontal distance between stitches affect the mechanical strength of anastomosis is investigated. In this study, 180 bovine intestines were used to investigate the optimum pattern in 18 groups by considering a 4, 6, and 8 mm horizontal distance between stitches, and a 3, 5, and 7 mm distance from the edge of tissue with 3-0 Silk and 3-0 PDS sutures to maximize the strength of anastomosis (10 specimens in each group). Also, 80 specimens were used to investigate the maximum effective distance of sutures from the edge of tissue in eight groups of: 3, 5, 7, and 10 mm distance from the edge, with the same type of sutures. Tensile tests with an elongation rate of 5 mm/min were performed for all the groups. Based on the results, the pattern of 7-6 (distance from the edge-distance between stitches) for both 3-0 Silk and 3-0 PDS, 5-6 and 7-4 for 3-0 Silk, and 5-6 and 7-4 for 3-0 PDS can be considered as the best options among 18 different combinations. It was also found that increasing the distance from the edge from 7 mm to 10 mm does not cause a significant difference in mechanical strength. Results can help surgeons to improve the intestinal anastomosis and employ it as an input for automatic suturing devices.

  3. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    Science.gov (United States)

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools.

  4. Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid vovulus

    Institute of Scientific and Technical Information of China (English)

    Sacid Coban; Mehmet Yilmaz; Alpaslan Terzi; Fahrettin Yildiz; Dincer Ozgor; Cengiz Ara; Saim Yologlu; Vedat Kirimlioglu

    2008-01-01

    AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus.METHODS: From March 2000 to September 2007,77 patients with acute sigmoid volvulus were treated.A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy.Twenty-five patients received RPA (Group A),and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B).The clinical course and postoperative complications of the two groups were compared.RESULTS: The mean hospital stay,wound infection and mortality did not differ significantly between the groups.Superficial wound infection rate was higher in group A (32% vs 9.1%).Anastomotic leakage was observed only in group A,with a rate of 6.3%.The difference was numerically impressive but was statistically not significant.CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results.It is easy to perform and may become a method of choice in patients with sigmoid volvulus.Further studies are required to further establish its role in the treatment of sigmoid volvulus.

  5. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass

    Directory of Open Access Journals (Sweden)

    Yannick Fringeli

    2015-01-01

    Full Text Available Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7% with a median follow-up of 38 months (range 24–62 months. Of these patients 16 patients (7.7% experienced complications at the gastrojejunostomy. Four patients (1.9% had stenoses and 12 patients (5.7% marginal ulcers, one of them with perforation (0.5%. No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

  6. Effects of hyperbaric oxygen and Pgg-glucan on ischemic colon anastomosis

    Institute of Scientific and Technical Information of China (English)

    Suna Guzel; Oguzhan Sunamak; Abdullah AS; Varol Celik; Mehmet Ferahman; Muhammed MK Nuri; Ertugrul Gazioglu; Pinar Atukeren; Ozgur Mutlu

    2006-01-01

    AIM: In colorectal surgery, anastomotic failure is still a problem in ischemia. Here, we analyzed the effects of hyperbaric oxygen and beta-glucan on colon anastomoses in ischemic condition.METHODS: Colonic resection and anastomosis in rectosigmoid region were done in forty Wistar-Albino rats of four groups of equal number. Colon mesentery was ligated to induce ischemia. The first group was the control group. The subjects of second group were treated with hyperbaric oxygen; the third group with glucan and the forth group were treated with both. At the forth day, rats were sacrificed, anastomotic segment was resected and burst pressures and hydroxyproline levels of anastomotic line were measured.RESULTS: The burst pressure difference of second and third groups from the control group were meaningful (P< 0.01); the forth group differed significantly from the control (P<0.001). There was no difference between the treated groups on burst pressure level (P> 0.05).The hydroxyproline levels in all treated groups were different from the control group significantly (P< 0.001).Hydroxyproline levels in the forth group were higher than those of the second and the third groups (P< 0.001).There were no significant differences between the second and the fourth groups in burst pressure and hydroxyproline levels (P> 0.05).CONCLUSION: Hyperbaric oxygen and glucan improve healing in ischemic colon anastomoses by anti-microbic,immune stimulating properties and seem to act synergistically when combined together.

  7. Operação de Glenn bidirecional Bidirectional Glenn anastomosis

    Directory of Open Access Journals (Sweden)

    Paulo Chaccur

    1992-09-01

    Full Text Available A cirurgia de Gleen bidirecional tem sido empregadacomo uma opção ao tratamento cirúrgico de pacientes considerados candidatos "não ideais" à cirurgia de derivação átrio-pulmonar. A operação consiste na anastomose da veia cava superior com a artéria pulmonar (anastomose término-lateral, permitindo o fluxo sanguíneo também para o pulmão contra-lateral. A partir de janeiro de 1990 até fevereiro de 1992, 20 pacientes foram operados em nosso Serviço, com idade variando de 5 meses a 8 anos (média de 37,7 meses. Oito pacientes eram do sexo feminino e o peso variou de 6,3 a 18,8 Kg (média - 12,4 kg. A indicação cirúrgica foi considerada primária em 10 casos. Sete casos de atresia tricúspide e 3 de ventrículo único, que apresentavam acentuada diminuição do fluxo pulmonar e não eram candidatos a correção total funcional. Os demais pacientes tiveram a indicação considerada secundária, ou seja, já haviam sido submetidos a operação de shunt artério-venoso, cerclagem do tranco pulmonar, ou atriosseptostomia, 8 casos de atresia tricúspide, 3 de ventrículo único com estenose ou cerclagem pulmonar e 1 caso de DVSVD com ventrículo superior-inferior. A operação foi realizada com desvio da veia cava-átrio direito em 12 casos e com o uso de CEC em 8. Durante o procedimento cirúrgico, os pacientes foram monitorizados com oxímetro pulsátil e a saturação de oxigênio média pré-correção foi de 75,5% (71% a 86% e após, de 95% (91% a 98%. Não ocorreu óbito hospitalar e o único óbito tardio foi devido a infecção pulmonar no 2º mês de pós-operatório. Achamos, portanto, que a operação de Glenn bidirecional estará bem indicada como primeira etapa da correção definitiva, pois não aumenta o trabalho cardíaco e a resistência vascular pulmonar não produz distorções em artéria pulmonar como shunt tipo Blalock-Taussig.The bidirectional Glenn anastomosis has bee used as an effective mean of palliating

  8. Cavopulmonary Anastomosis in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy With Severe Right Ventricular Dysfunction.

    Science.gov (United States)

    Vaidyanathan, Swaminathan; Kothandam, Sivakumar; Kumar, Rajesh; Indrajith, Sujatha Desai; Agarwal, Ravi

    2017-01-01

    A 26-year-old lady presented with exertional dyspnea, palpitations, central cyanosis, and oxygen saturations of 80% in room air. Her electrocardiogram, echocardiogram, and cardiac magnetic resonance were diagnostic of arrhythmogenic right ventricular dysplasia. There was no documented ventricular arrhythmia or syncopal episodes and Holter recordings were repeatedly normal. Cardiac hemodynamics showed right to left shunt through atrial septal defect, low pulmonary blood flow, normal atrial pressures, and minimally elevated right ventricular end-diastolic pressures. Since her presenting symptoms and cyanosis were attributed to reduced pulmonary blood flow, she underwent off-pump cavopulmonary anastomosis between right superior vena cava and right pulmonary artery. As we intended to avoid the adverse effect of extracorporeal circulation on the myocardial function and pulmonary vasculature, we did not attempt to reduce the size of the atrial septal defect. Her postoperative period was uneventful; oxygen saturation improved to 89% with significant improvement in effort tolerance. At 18-month follow-up, there were no ventricular arrhythmias on surveillance. The clinical presentation of this disease may vary from serious arrhythmias warranting defibrillators and electrical ablations at one end to right ventricular pump failure warranting cardiomyoplasty or right ventricular exclusion procedures at the other end. However, when the presentation was unusual with severe cyanosis through a stretched foramen ovale leading to reduced pulmonary blood flows, Glenn shunt served as a good palliation and should be considered as one of the options in such patients.

  9. Ventricular Assist Device in Single-Ventricle Heart Disease and a Superior Cavopulmonary Anastomosis.

    Science.gov (United States)

    Niebler, Robert A; Shah, Tejas K; Mitchell, Michael E; Woods, Ronald K; Zangwill, Steven D; Tweddell, James S; Berger, Stuart; Ghanayem, Nancy S

    2016-02-01

    Our objective is to describe the use of a ventricular assist device (VAD) in single-ventricle patients with circulatory failure following superior cavopulmonary anastomosis (SCPA). We performed a retrospective chart review of all single-ventricle patients supported with a VAD following SCPA. Implantation techniques, physiologic parameters while supported, medical and surgical interventions postimplant, and outcomes were reviewed. Four patients were supported with an EXCOR Pediatric (Berlin Heart Inc., The Woodlands, TX, USA) following SCPA for a median duration of 10.5 days (range 9-312 days). Selective excision of trabeculae and chords facilitated apical cannulation in all patients without inflow obstruction. There were two pump exchanges in the one patient supported for 312 days. Two patients were evaluated by cardiac catheterization while supported. Three of four patients were successfully bridged to transplantation. One patient died while supported. All patients had significant bleeding at the time of transplantation, and one required posttransplant extracorporeal membrane oxygenation with subsequent full recovery. VAD support can provide a successful bridge to transplantation in patients with single-ventricle circulation following SCPA. A thorough understanding of the challenges encountered during this support is necessary for successful outcomes.

  10. Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

    Directory of Open Access Journals (Sweden)

    Mathe Z

    2010-07-01

    Full Text Available Abstract Objective Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation. Methods We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well. Results A total of 157 patients were enrolled to a stent (ST and 153 patients to a no-stent (NST group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65. Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%. Conclusion Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.

  11. Etiopathogenesis of Nephrolithiasis in Ulcerative Colitis Patients with the Ileal Pouch Anal Anastomosis.

    Science.gov (United States)

    Arora, Zubin; Mukewar, Saurabh; Lopez, Rocio; Camino, Debra; Shen, Bo; Hall, Phillip

    2017-05-01

    Our previous study showed that nephrolithiasis is a common complication in ulcerative colitis patients after ileal pouch anal anastomosis (IPAA). However, the pathogenesis of nephrolithiasis in IPAA patients has not been studied. The aim of this study was to compare urine and serum metabolic compositions in IPAA patients with nephrolithiasis and controls with IPAA and no nephrolithiasis. Using cross-sectional study design, serum and 24-hour urine metabolic compositions were compared between IPAA patients with nephrolithiasis (the study group) and those without (the control group). Urinary supersaturation of calcium oxalate, calcium phosphate, and uric acid was calculated. A total of 40 patients were enrolled in the study. There were no significant differences in serum electrolytes, vitamin D, parathyroid hormone, and kidney function tests between the study (n = 20) and control groups (n = 20). Patients in the study group were found to have a significantly higher 24-hour urine supersaturation of calcium oxalate (8.8 versus 5.0, P = 0.037) and calcium phosphate (0.61 versus 0.27, P = 0.028) as compared with controls. Nineteen (95%) patients in the study group were symptomatic due to nephrolithiasis with several requiring procedural intervention for treatment, including ureteroscopy in 3 (15%) patients, lithotripsy in 5 (25%) patients, and percutaneous surgery in 1 (5%) patient. Ulcerative colitis-IPAA patients are at risk for the development of calcium oxalate and calcium phosphate stones. Nephrolithiasis is symptomatic in a majority of the patients and frequently requires procedural intervention for treatment.

  12. Clinical Characteristics of Stoma-Related Obstruction after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis.

    Science.gov (United States)

    Okita, Yoshiki; Araki, Toshimitsu; Kondo, Satoru; Fujikawa, Hiroyuki; Yoshiyama, Shigeyuki; Hiro, Junichiro; Inoue, Mikihiro; Toiyama, Yuji; Kobayashi, Minako; Ohi, Masaki; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2017-03-01

    We defined small bowel obstruction occurring around the limbs of the ileostomy as stoma-related obstruction (SRO) and investigated the clinical characteristics and predictive factors of SRO. From January 2002 to March 2016, 309 consecutive patients who underwent ileal pouch-anal anastomosis (IPAA) for ulcerative colitis were enrolled. Two-stage IPAA with diverting ileostomy was analyzed. We assessed the possible associations between SRO and clinical factors. A total of 205 patients met the inclusion criteria. Fifty-three (25.8%) patients with SRO before ileostomy closure were identified for review. All patients with SRO were at least transiently resolved by intubation though orifice of ileostomy (98.1%) or nasally (3.7%). In 18 (33.9%) patients, the ileostomy was taken down ahead of schedule and the small bowel obstruction improved in all cases. Multivariate analysis revealed that age at surgery SRO (P = 0.013 and 0.0012, respectively). Younger age at surgery and low body mass index may be significant predictive factors for SRO after IPAA with diverting ileostomy in patients with ulcerative colitis.

  13. Heterokaryon incompatibility is suppressed following conidial anastomosis tube fusion in a fungal plant pathogen.

    Science.gov (United States)

    Ishikawa, Francine H; Souza, Elaine A; Shoji, Jun-Ya; Connolly, Lanelle; Freitag, Michael; Read, Nick D; Roca, M Gabriela

    2012-01-01

    It has been hypothesized that horizontal gene/chromosome transfer and parasexual recombination following hyphal fusion between different strains may contribute to the emergence of wide genetic variability in plant pathogenic and other fungi. However, the significance of vegetative (heterokaryon) incompatibility responses, which commonly result in cell death, in preventing these processes is not known. In this study, we have assessed this issue following different types of hyphal fusion during colony initiation and in the mature colony. We used vegetatively compatible and incompatible strains of the common bean pathogen Colletotrichum lindemuthianum in which nuclei were labelled with either a green or red fluorescent protein in order to microscopically monitor the fates of nuclei and heterokaryotic cells following hyphal fusion. As opposed to fusion of hyphae in mature colonies that resulted in cell death within 3 h, fusions by conidial anastomosis tubes (CAT) between two incompatible strains during colony initiation did not induce the vegetative incompatibility response. Instead, fused conidia and germlings survived and formed heterokaryotic colonies that in turn produced uninucleate conidia that germinated to form colonies with phenotypic features different to those of either parental strain. Our results demonstrate that the vegetative incompatibility response is suppressed during colony initiation in C. lindemuthianum. Thus, CAT fusion may allow asexual fungi to increase their genetic diversity, and to acquire new pathogenic traits.

  14. Heterokaryon incompatibility is suppressed following conidial anastomosis tube fusion in a fungal plant pathogen.

    Directory of Open Access Journals (Sweden)

    Francine H Ishikawa

    Full Text Available It has been hypothesized that horizontal gene/chromosome transfer and parasexual recombination following hyphal fusion between different strains may contribute to the emergence of wide genetic variability in plant pathogenic and other fungi. However, the significance of vegetative (heterokaryon incompatibility responses, which commonly result in cell death, in preventing these processes is not known. In this study, we have assessed this issue following different types of hyphal fusion during colony initiation and in the mature colony. We used vegetatively compatible and incompatible strains of the common bean pathogen Colletotrichum lindemuthianum in which nuclei were labelled with either a green or red fluorescent protein in order to microscopically monitor the fates of nuclei and heterokaryotic cells following hyphal fusion. As opposed to fusion of hyphae in mature colonies that resulted in cell death within 3 h, fusions by conidial anastomosis tubes (CAT between two incompatible strains during colony initiation did not induce the vegetative incompatibility response. Instead, fused conidia and germlings survived and formed heterokaryotic colonies that in turn produced uninucleate conidia that germinated to form colonies with phenotypic features different to those of either parental strain. Our results demonstrate that the vegetative incompatibility response is suppressed during colony initiation in C. lindemuthianum. Thus, CAT fusion may allow asexual fungi to increase their genetic diversity, and to acquire new pathogenic traits.

  15. Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography

    Energy Technology Data Exchange (ETDEWEB)

    Mihara, M., E-mail: mihara@keiseigeka.name [Department of Plastic Surgery and Reconstructive Surgery, University of Tokyo, Tokyo (Japan); Hayashi, Y. [Department of Plastic Surgery and Reconstructive Surgery, University of Tokyo, Tokyo (Japan); Murai, N. [Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Saitamaken (Japan); Moriguchi, H.; Iida, T.; Hara, H.; Todokoro, T.; Narushima, M.; Uchida, G.; Koshima, I. [Department of Plastic Surgery and Reconstructive Surgery, University of Tokyo, Tokyo (Japan)

    2011-08-15

    Aim: To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema. Materials and methods: Preoperative elastography and LVA were performed in 11 patients (11 legs) with leg lymphoedema, including two cases of primary oedema and nine of secondary oedema. Results: The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six. Conclusions: These results demonstrate the value of ultrasound elastography for the diagnosis of early-stage lymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.

  16. Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report

    Directory of Open Access Journals (Sweden)

    Abeysuriya Vasitha

    2008-02-01

    Full Text Available Abstract Introduction The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. Case presentation During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. Conclusion Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.

  17. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis

    Directory of Open Access Journals (Sweden)

    Srinivas Samavedi

    2014-01-01

    Full Text Available Vesico-urethral anastomosis (VUA is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.

  18. Advantageous swirling flow in 45° end-to-side anastomosis

    Science.gov (United States)

    Ha, Hojin; Choi, Woorak; Park, Hanwook; Lee, Sang Joon

    2014-12-01

    The effects of swirling flow on the flow field in 45° end-to-side anastomosis are experimentally investigated using a particle image velocimetry technique to reveal fluid dynamic advantages of swirling flow in the vascular graft. Non-swirling Poiseuille inlet flow unnecessarily induces pathological hemodynamic features, such as high wall shear stress (WSS) at the `bed' side and large flow separation at the `toe' side. The introduction of swirling flow is found to equalize the asymmetric WSS distribution and reduces the peak magnitude of WSS. In particular, the intermediate swirling intensity of S = 0.45 induces the most uniform axial velocity and WSS distributions compared with weaker or stronger swirling flows, which addresses the importance of proper selection of swirling intensity in the vascular graft to obtain optimum flow fields at the host vessel. In addition, swirling flow reduces the size of flow separation because it disturbs the formation of Dean-type vortices in secondary flow and inhibits secondary flow collision. The beneficial fluid dynamic features of swirling flow obtained in this study are helpful for designing better vascular graft suppressing pathological hemodynamic features in the recipient host vessel.

  19. Intraoperative assessment of microperfusion with visible light spectroscopy in oesophageal and colorectal anastomosis

    Science.gov (United States)

    Karliczek, Anne; Benaron, David A.; Baas, Peter; van der Stoel, Anne; Wiggers, Theo; Plukker, John; van Dam, Gooitzen M.

    2007-07-01

    In gastrointestinal surgery, leakage of anastomoses in general is a challenging problem because of the related mortality and morbidity1,2. The highest incidence of anastomotic leakage is found at the most proximal and most distal parts of the digestive tract, i.e. esophageal and colorectal anastomoses. Increased strain and limited vascular supply at the anastomoses are the two main reasons of leakage, especially in the absence of a serosal layer at these sites2,3,4. Apart from these local risk factors, several general risk factors attributed to the occurrence of anastomotic failure, of which smoking, cardiovascular disease, gender, age and malnutrition are the most important2,5-8. Most of these factors suggest local ischemia as an important cause of anastomotic dehiscence. In esophageal resection the blood supply to the remaining esophageal end is compromised due to ligation of arteries and resection of surrounding mediastinal tissue. Furthermore, the gastric conduit, usually only based on the right gastroepiploic artery, is transposed from its anatomical abdominal position into the thoracic cavity and cervical region. Apart from co-existing morbidities such as sepsis, cardiovascular and several systemic diseases, the altered vascular supply frequently compromises the microcirculation at both ends of the anastomosis, and is as such responsible for the higher rate of leakage compared to small and other large bowel anastomoses9,10.

  20. Esophageal Anastomosis Medial to Preserved Azygos Vein in Esophageal Atresia with Tracheoesophageal Fistula: Restoration of Normal Mediastinal Anatomy

    Directory of Open Access Journals (Sweden)

    Kumar Abdul Rashid

    2012-09-01

    Full Text Available Objective: We intended to prospectively study the technical feasibility and advantages of esophageal anastomosis medial to the preserved azygos vein in neonates diagnosed with esophageal atresia with tracheoesophageal fistula (EA/TEF. The results were compared to the cases where azygos vein was either not preserved, or the anastomosis was done lateral to the arch of preserved azygos vein. Material and methods: A total of 134 patients with EA/TEF were admitted between January 2007 and July 2008 of which 116 underwent primary repair. Eleven patients with long gap esophageal atresia with or without tracheoesophageal fistula and 7 patients who expired before surgery were excluded. Patients were randomly divided in three groups comparable with respect to the gestational age, age at presentation, sex, birth weight, associated anomalies and the gap between the pouches after mobilization: Group A (azygos vein ligated and divided, Group B (azygos vein preserved with esophageal anastomosis lateral to the vein, and Group C azygos vein preserved with esophageal anastomosis medial to the vein. All the patients were operated by extra-pleural approach. The three groups were compared with respect to operative time and early postoperative complications like pneumonitis, anastomotic leaks and mortality. Odds ratio and Chi square test were used for the statistical analysis. Results: Group A, B and C had 35, 43 and 38 patients respectively. No significant difference was observed in average operative time in the 3 groups. Though incidence of postoperative pneumonitis was higher in group A (28% as compared to group B (13.95% and group C (11.62%, it was not statistically significant (p > 0.005. Anastomotic leak occurred in 7 patients in group A (20%, 6 patients in group B (13.95% and 4 patients (10.52% in group C (p > 0.005. Group A had 3 major and 4 minor anastomotic leaks; group B had 2 major and 4 minor leaks and group C had 1 major and 3 minor leaks. There were10

  1. Large scale dynamics of the Persistent Turning Walker model of fish behavior

    CERN Document Server

    Degond, Pierre

    2007-01-01

    This paper considers a new model of individual displacement, based on fish motion, the so-called Persistent Turning Walker (PTW) model, which involves an Ornstein-Uhlenbeck process on the curvature of the particle trajectory. The goal is to show that its large time and space scale dynamics is of diffusive type, and to provide an analytic expression of the diffusion coefficient. Two methods are investigated. In the first one, we compute the large time asymptotics of the variance of the individual stochastic trajectories. The second method is based on a diffusion approximation of the kinetic formulation of these stochastic trajectories. The kinetic model is a Fokker-Planck type equation posed in an extended phase-space involving the curvature among the kinetic variables. We show that both methods lead to the same value of the diffusion constant. We present some numerical simulations to illustrate the theoretical results.

  2. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Poulikakos Dimos

    2007-09-01

    Full Text Available Abstract Purpose Coronary artery bypass graft (CABG surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS, in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD. Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT. Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis

  3. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete

    2016-01-01

    , clinical features, consequences, central and peripheral mechanisms, diagnostic criteria (DC/TMD), and principles of management. For each of the neuropathic facial pain entities, the definitions, prevalence, clinical features, and diagnostics are described. The current understanding of the pathophysiology......Persistent facial pains, especially temporomandibular disorders (TMD), are common conditions. As dentists are responsible for the treatment of most of these disorders, up-to date knowledge on the latest advances in the field is essential for successful diagnosis and management. The review covers...... TMD, and different neuropathic or putative neuropathic facial pains such as persistent idiopathic facial pain and atypical odontalgia, trigeminal neuralgia and painful posttraumatic trigeminal neuropathy. The article presents an overview of TMD pain as a biopsychosocial condition, its prevalence...

  4. Computing multidimensional persistence

    Directory of Open Access Journals (Sweden)

    Gunnar Carlsson

    2010-11-01

    Full Text Available The theory of multidimensional persistence captures the topology of a multifiltration - a multiparameter family of increasing spaces.  Multifiltrations arise naturally in the topological analysis of scientific data.  In this paper, we give a polynomial time algorithm for computing multidimensional persistence.  We recast this computation as a problem within computational commutative algebra and utilize algorithms from this area to solve it.  While the resulting problem is EXPSPACE-complete and the standard algorithms take doubly-exponential time, we exploit the structure inherent withing multifiltrations to yield practical algorithms.  We implement all algorithms in the paper and provide statistical experiments to demonstrate their feasibility.

  5. Persistent facial pain conditions

    DEFF Research Database (Denmark)

    Forssell, Heli; Alstergren, Per; Bakke, Merete

    2016-01-01

    TMD, and different neuropathic or putative neuropathic facial pains such as persistent idiopathic facial pain and atypical odontalgia, trigeminal neuralgia and painful posttraumatic trigeminal neuropathy. The article presents an overview of TMD pain as a biopsychosocial condition, its prevalence......Persistent facial pains, especially temporomandibular disorders (TMD), are common conditions. As dentists are responsible for the treatment of most of these disorders, up-to date knowledge on the latest advances in the field is essential for successful diagnosis and management. The review covers......, clinical features, consequences, central and peripheral mechanisms, diagnostic criteria (DC/TMD), and principles of management. For each of the neuropathic facial pain entities, the definitions, prevalence, clinical features, and diagnostics are described. The current understanding of the pathophysiology...

  6. Persistent Hiccups Following Stapedectomy

    Directory of Open Access Journals (Sweden)

    Aidonis I

    2010-10-01

    Full Text Available Objective: We report a case of a 37 year-old man who developed persistent hiccups after elective stapedectomy. Method and Results: The diagnostic approach is discussed as well as the non-pharmacologic and pharmacologic treatments and overall management. The aim is to stress that there is a variety of potential factors that can induce hiccups perioperatively and in cases like this a step by step approach must be taken. Conclusion: Persistent hiccups are very rare following stapedectomy, control of them is crucial for the successful outcome. The trigger may be more than one factors and the good response to treatment may be due to dealing successfully with more than one thing.

  7. Numeric invariants from multidimensional persistence

    Energy Technology Data Exchange (ETDEWEB)

    Skryzalin, Jacek [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Carlsson, Gunnar [Stanford Univ., Stanford, CA (United States)

    2017-05-19

    In this paper, we analyze the space of multidimensional persistence modules from the perspectives of algebraic geometry. We first build a moduli space of a certain subclass of easily analyzed multidimensional persistence modules, which we construct specifically to capture much of the information which can be gained by using multidimensional persistence over one-dimensional persistence. We argue that the global sections of this space provide interesting numeric invariants when evaluated against our subclass of multidimensional persistence modules. Lastly, we extend these global sections to the space of all multidimensional persistence modules and discuss how the resulting numeric invariants might be used to study data.

  8. Persistent benign pleural effusion.

    Science.gov (United States)

    Porcel, J M

    In this narrative review we describe the main aetiologies, clinical characteristics and treatment for patients with benign pleural effusion that characteristically persists over time: chylothorax and cholesterol effusions, nonexpansible lung, rheumatoid pleural effusion, tuberculous empyema, benign asbestos pleural effusion and yellow nail syndrome. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Intergenerational Top Income Persistence

    DEFF Research Database (Denmark)

    Munk, Martin D.; Bonke, Jens; Hussain, M. Azhar

    2016-01-01

    In this paper, we investigate intergenerational top earnings and top income mobility in Denmark. Access to administrative registers allowed us to look at very small fractions of the population. We find that intergenerational mobility is lower in the top when including capital income in the income...... measure— for the rich top 0.1% fathers and sons the elasticity is 0.466. Compared with Sweden, however, the intergenerational top income persistence is about half the size in Denmark....

  10. Performance Persistence of Dutch Pension Funds

    NARCIS (Netherlands)

    Huang, Xiaohong; Mahieu, Ronald

    2010-01-01

    This paper studies the investment performance of pension funds with a focus on their ability in implementing the investment strategy. We use a sample of Dutch industry-wide pension funds, which are obliged by law to report their investment performance according to the so-called z-score. The z-score

  11. Poverty persistence and poverty dynamics

    OpenAIRE

    Biewen, Martin

    2014-01-01

    A considerable part of the poverty that is measured in a single period is transitory rather than persistent. In most countries, only a portion of people who are currently poor are persistently poor. People who are persistently poor or who cycle into and out of poverty should be the main focus of anti-poverty policies. Understanding the characteristics of the persistently poor, and the circumstances and mechanisms associated with entry into and exit from poverty, can help to inform governments...

  12. Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia

    Institute of Scientific and Technical Information of China (English)

    Livia Biancone; Francesco Pallone; Emma Calabrese; Giampiero Palmieri; Carmelina Petruzziello; Sara Onali; Giuseppe Sigismondo Sica; Marta Cossignani; Giovanna Condino; Kiron Moy Das

    2008-01-01

    AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA),ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium.METHODS:A total of 19 patients with IRA under regular follow up were enrolled,including 11.UC and 8 controls (6 Crohn's disease,CD;1 familial adenomatous polyposis,FAP;1 colon cancer,colon K).Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump.Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5,hTMS (CG3).Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS:Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient.The neo-terminal ileum was therefore investigated in 10/11 UC patients.Ileal ulcers were detected in 7/10 UC,associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC.In controls,recurrence occurred in 4/6 CD,associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3.CONCLUSION:Present findings suggest that in UC,ileal lesions associated with changes towards colonic epithelium may develop also after IRA.Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia,leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

  13. Transumbilical laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis.

    Science.gov (United States)

    Fernández, José Ignacio; Ovalle, Cristian; Farias, Carlos; de la Maza, Jaime; Cabrera, Carolina

    2013-01-01

    Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach.

  14. Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia

    Science.gov (United States)

    Biancone, Livia; Calabrese, Emma; Palmieri, Giampiero; Petruzziello, Carmelina; Onali, Sara; Sica, Giuseppe Sigismondo; Cossignani, Marta; Condino, Giovanna; Das, Kiron Moy; Pallone, Francesco

    2008-01-01

    AIM: To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated. RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present findings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA. PMID:18785281

  15. In vivo laser assisted end-to-end anastomosis with ICG-infused chitosan patches

    Science.gov (United States)

    Rossi, Francesca; Matteini, Paolo; Esposito, Giuseppe; Scerrati, Alba; Albanese, Alessio; Puca, Alfredo; Maira, Giulio; Rossi, Giacomo; Pini, Roberto

    2011-07-01

    Laser assisted vascular repair is a new optimized technique based on the use of ICG-infused chitosan patch to close a vessel wound, with or even without few supporting single stitches. We present an in vivo experimental study on an innovative end-to-end laser assisted vascular anastomotic (LAVA) technique, performed with the application of ICGinfused chitosan patches. The photostability and the mechanical properties of ICG-infused chitosan films were preliminary measured. The in vivo study was performed in 10 New Zealand rabbits. After anesthesia, a 3-cm segment of the right common carotid artery was exposed, thus clamped proximally and distally. The artery was then interrupted by means of a full thickness cut. Three single microsutures were used to approximate the two vessel edges. The ICG-infused chitosan patch was rolled all over the anastomotic site and welded by the use of a diode laser emitting at 810 nm and equipped with a 300 μm diameter optical fiber. Welding was obtained by delivering single laser spots to induce local patch/tissue adhesion. The result was an immediate closure of the anastomosis, with no bleeding at clamps release. Thus animals underwent different follow-up periods, in order to evaluate the welded vessels over time. At follow-up examinations, all the anastomoses were patent and no bleeding signs were documented. Samples of welded vessels underwent histological examinations. Results showed that this technique offer several advantages over conventional suturing methods: simplification of the surgical procedure, shortening of the operative time, better re-endothelization and optimal vascular healing process.

  16. Persistence probabilities \\& exponents

    CERN Document Server

    Aurzada, Frank

    2012-01-01

    This article deals with the asymptotic behaviour as $t\\to +\\infty$ of the survival function $P[T > t],$ where $T$ is the first passage time above a non negative level of a random process starting from zero. In many cases of physical significance, the behaviour is of the type $P[T > t]=t^{-\\theta + o(1)}$ for a known or unknown positive parameter $\\theta$ which is called a persistence exponent. The problem is well understood for random walks or L\\'evy processes but becomes more difficult for integrals of such processes, which are more related to physics. We survey recent results and open problems in this field.

  17. Persistent BioPerl

    OpenAIRE

    Hilmar Lapp

    2007-01-01

    I present BioSQL, a generic and highly extensible relational model for storing biological sequences, sequence clusters, genes, sequence features, sequence and feature annotation, and ontology terms. BioSQL also represents the interoperable persistence API among the Bio* life science programming toolkits (BioPerl, Biojava, Biopython, BioRuby), each of which has a language-binding to the BioSQL schema. I specifically present the Bioperl-db software, which in a transparent manner makes BioPerl o...

  18. Exoproteome analysis reveals higher abundance of proteins linked to alkaline stress in persistent Listeria monocytogenes strains.

    Science.gov (United States)

    Rychli, Kathrin; Grunert, Tom; Ciolacu, Luminita; Zaiser, Andreas; Razzazi-Fazeli, Ebrahim; Schmitz-Esser, Stephan; Ehling-Schulz, Monika; Wagner, Martin

    2016-02-02

    The foodborne pathogen Listeria monocytogenes, responsible for listeriosis a rare but severe infection disease, can survive in the food processing environment for month or even years. So-called persistent L. monocytogenes strains greatly increase the risk of (re)contamination of food products, and are therefore a great challenge for food safety. However, our understanding of the mechanism underlying persistence is still fragmented. In this study we compared the exoproteome of three persistent strains with the reference strain EGDe under mild stress conditions using 2D differential gel electrophoresis. Principal component analysis including all differentially abundant protein spots showed that the exoproteome of strain EGDe (sequence type (ST) 35) is distinct from that of the persistent strain R479a (ST8) and the two closely related ST121 strains 4423 and 6179. Phylogenetic analyses based on multilocus ST genes showed similar grouping of the strains. Comparing the exoproteome of strain EGDe and the three persistent strains resulted in identification of 22 differentially expressed protein spots corresponding to 16 proteins. Six proteins were significantly increased in the persistent L. monocytogenes exoproteomes, among them proteins involved in alkaline stress response (e.g. the membrane anchored lipoprotein Lmo2637 and the NADPH dehydrogenase NamA). In parallel the persistent strains showed increased survival under alkaline stress, which is often provided during cleaning and disinfection in the food processing environments. In addition, gene expression of the proteins linked to stress response (Lmo2637, NamA, Fhs and QoxA) was higher in the persistent strain not only at 37 °C but also at 10 °C. Invasion efficiency of EGDe was higher in intestinal epithelial Caco2 and macrophage-like THP1 cells compared to the persistent strains. Concurrently we found higher expression of proteins involved in virulence in EGDe e.g. the actin-assembly-inducing protein ActA and the

  19. Inflation Targeting and Inflation Persistence

    Institute of Scientific and Technical Information of China (English)

    GEORGE; J.BRATSIOTIS; JAKOB; MADSEN; CHRISTOPHER; MARTIN

    2015-01-01

    This paper argues that the adoption of an inflation target reduces the persistence of inflation.We develop the theoretical literature on inflation persistence by introducing a Taylor Rule for monetary policy into a model of persistence and showing that inflation targets reduce inflation persistence.We investigate changes in the time series properties of inflation in seven countries that introduced inflation targets in the late 1980s or early 1990s.We find that the persistence of inflation is greatly reduced or eliminated following the introduction of inflation targets.

  20. Molecular mechanisms underlying bacterial persisters

    DEFF Research Database (Denmark)

    Maisonneuve, Etienne; Gerdes, Kenn

    2014-01-01

    All bacteria form persisters, cells that are multidrug tolerant and therefore able to survive antibiotic treatment. Due to the low frequencies of persisters in growing bacterial cultures and the complex underlying molecular mechanisms, the phenomenon has been challenging to study. However, recent...... technological advances in microfluidics and reporter genes have improved this scenario. Here, we summarize recent progress in the field, revealing the ubiquitous bacterial stress alarmone ppGpp as an emerging central regulator of multidrug tolerance and persistence, both in stochastically and environmentally...... induced persistence. In several different organisms, toxin-antitoxin modules function as effectors of ppGpp-induced persistence....

  1. Persistence of airline accidents.

    Science.gov (United States)

    Barros, Carlos Pestana; Faria, Joao Ricardo; Gil-Alana, Luis Alberiko

    2010-10-01

    This paper expands on air travel accident research by examining the relationship between air travel accidents and airline traffic or volume in the period from 1927-2006. The theoretical model is based on a representative airline company that aims to maximise its profits, and it utilises a fractional integration approach in order to determine whether there is a persistent pattern over time with respect to air accidents and air traffic. Furthermore, the paper analyses how airline accidents are related to traffic using a fractional cointegration approach. It finds that airline accidents are persistent and that a (non-stationary) fractional cointegration relationship exists between total airline accidents and airline passengers, airline miles and airline revenues, with shocks that affect the long-run equilibrium disappearing in the very long term. Moreover, this relation is negative, which might be due to the fact that air travel is becoming safer and there is greater competition in the airline industry. Policy implications are derived for countering accident events, based on competition and regulation. © 2010 The Author(s). Journal compilation © Overseas Development Institute, 2010.

  2. Bacterial persistence: a winning strategy?

    CERN Document Server

    Schinazi, Rinaldo B

    2011-01-01

    It has long been known that antibiotic treatment will not completely kill off a bacteria population. For many species a small fraction of bacteria is not sensitive to antibiotics. These bacteria are said to persist. Recently it has been shown that persistence is not a permanent state and that in fact a bacterium can switch back and forth between persistent and non persistent states. We introduce two stochastic models for bacteria persistence. In both models there are mass killings of non persistent bacteria at certain times. The first model has deterministic killing times and the second one has random killing times. Both models suggest that persistence may be a successful strategy for a wide range of parameter values.

  3. Crohn's disease recurrence in patients with ileocolic anastomosis: Value of computed tomography enterography with water enema

    Energy Technology Data Exchange (ETDEWEB)

    Paparo, Francesco [Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa (Italy); Revelli, Matteo; Puppo, Cristina [School of Radiology, University of Genoa, Via Leon Battista Alberti 4, 16132 Genoa (Italy); Bacigalupo, Lorenzo; Garello, Isabella [Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa (Italy); Garlaschi, Alessandro [School of Radiology, University of Genoa, Via Leon Battista Alberti 4, 16132 Genoa (Italy); Biscaldi, Ennio [Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa (Italy); Rollandi, Ludovica [School of Medicine, University of Genoa, Via Leon Battista Alberti 4, 16132 Genoa (Italy); Binda, Gian Andrea [Division of General Surgery, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa (Italy); Rollandi, Gian Andrea, E-mail: rollandi@galliera.it [Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa (Italy)

    2013-09-15

    Objectives: the main objective of the present work was to determine the diagnostic value of CT-enterography with water enema (CTe-WE) in the assessment of the ileocolic anastomosis in patients with Crohn's disease (CD). The prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomosis was also determined. Further, the association between the type of ileocolic anastomosis and the behavior (i.e. inflammatory, stricturing, penetrating) of CD recurrence was evaluated. Methods: 51 patients were retrospectively included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35). Ileocolic anastomoses were: 18 (35.3%) stapled side-to-side, 17 (33.3%) end-to-side, and 16 (31.4%) end-to-end. CTe-WEs were reviewed in consensus by two gastrointestinal radiologists. Endoscopy and medical records were used as reference standards. Results: CTe-WE yielded 95.35% sensitivity (CI 95%: 84.19–99.43%), 75.00% specificity (CI 95%: 34.91–96.81%), and 92.15% diagnostic accuracy (CI 95%: 81.31–98.02%). Anastomotic recurrence was found in 41/51 (80.4%) patients, including 30/41 (73.2%) cases of isolated anastomotic recurrence, and 11/41 (26.8%) cases of anastomotic recurrence with a SIL. A significant lower prevalence of stricturing recurrence was observed in patients with stapled side-to-side anastomoses (p = 0.033). Conclusions: CTe-WE provides a good distension of both sides of ileocolic anastomoses allowing the detection of SILs.

  4. Mini-mastoidectomía para anastomosis hipogloso-facial con sección parcial del nervio hipogloso

    Science.gov (United States)

    Campero, Álvaro; Ajler, Pablo; Socolovsky, Mariano; Martins, Carolina; Rhoton, Albert

    2012-01-01

    Introducción: La anastomosis hipogloso-facial es la técnica de elección para la reparación de la parálisis facial cuando no se dispone de un cabo proximal sano del nervio facial. La técnica de anastomosis mediante fresado mastoideo y sección parcial del hipogloso minimiza la atrofia lingual sin sacrificar resultados a nivel facial. Método: La porción mastoidea del nervio facial transcurre por la pared anterior de la AM, a un promedio de 18+/-3 mm de profundidad respecto de la pared lateral. Se debe reconocer la cresta supramastoidea, desde la cual se marca una línea vertical paralela al eje mayor de la AM, 1 cm por detrás de la pared posterior del CAE El fresado se comienza desde la línea medio mastoidea hasta la pared posterior del CAE. Una vez encontrado el nervio facial en el tercio medio del canal mastoideo, el mismo es seguido hacia proximal y distal. Resultados: El abordaje descripto permite acceder al nervio facial intratemporal en su porción mastoidea, y efectuar un fresado óseo sin poner en riesgo al nervio o a estructuras vasculares cercanas. Se trata de un procedimiento técnicamente más sencillo que los abordajes amplios habitualmente utilizados al hueso temporal; no obstante su uso debe ser restringido mayormente a la anastomosis hipogloso-facial. Conclusión: Esta es una técnica relativamente sencilla, que puede ser reproducida por cirujanos sin mayor experiencia en el tema, luego de su paso por el laboratorio de anatomía. PMID:23596555

  5. [Rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction with deep inferior epigastric perforator flap].

    Science.gov (United States)

    Zeng, Ang; Zhu, Lin; Liu, Zhifei; Wang, Xiaojun; Zhang, Hailin; Bai, Ming; Wang, Zhi

    2014-11-01

    To explore the feasibility and reliability of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator (DIEP) flaps. Between November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years (range, 33-65 years). Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm x 9 cm to 28 cm x 12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases. In all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes (range, 38-65 minutes). The mean exposure length of the internal mammary vessels was 1.7 cm (range, 1.3-2.2 cm). All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months (mean, 12 months). All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred. The rib-sparing technique for internal mammary vessels exposure and anastomosis is a reliable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.

  6. Surgical palliation of primary pulmonary arterial hypertension by a unidirectional valved Potts anastomosis in an animal model.

    Science.gov (United States)

    Bui, Minh Thanh; Grollmus, Oswin; Ly, Mohamedou; Mandache, Anca; Fadel, Elie; Decante, Benoit; Serraf, Alain

    2011-11-01

    Patients with idiopathic pulmonary hypertension are at risk for right-sided heart failure and sudden death. Despite improvement in pharmacologic management, some still require lung transplantation. Potts anastomosis has been demonstrated as a good palliation in children to alleviate symptoms and medical therapy despite desaturation in the lower part of the body. Young adult patients with pulmonary hypertension and isosystemic pressure remain at risk, particularly at exercise. The goal of this research was to find a palliation for patients in whom suprasystemic pulmonary hypertension developed at exercise. Creating a Potts anastomosis involved a unidirectional valve between the left pulmonary artery and the descending aorta. Experimental study was performed on 14 pigs. A prosthetic patch of polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Newark, Del) was used to create the unidirectional valve and implanted in the Potts anastomosis. Via a left thoracotomy, an aorto-aortic shunt between the aortic isthmus and the distal descending thoracic aorta was instituted, allowing a safe surgical procedure. Intrapulmonary injection of Erciplex glue (Peters Surgical, Bobigny, France), diluted in 70% alcohol, was used to create acute pulmonary hypertension. The right to left shunt across the unidirectional valvular patch was evaluated after clamping the aorta in the acute phase of pulmonary hypertension by echo-pulsed Doppler at the level of the descending thoracic aorta by withdrawal of blood gas (arterial carbon dioxide tension, alveolar carbon dioxide tension) and assessment of peripheral oxygen saturation. Similar reevaluation of the shunt was performed at a mean interval of 13 ± 2.5 weeks. In the first series, Erciplex glue increased pulmonary artery pressure from 15.3 ± 3.1 mm Hg to 38.7 ± 6.0 mm Hg. Mean peripheral oxygen saturation decreased from 100% to 85% ± 1.5%. Mean partial pressure of carbon dioxide increased from 31.9 ± 9.1 mm Hg to 46.2 ± 12

  7. Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyong [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2015-08-15

    Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.

  8. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  9. New daily persistent headache

    Directory of Open Access Journals (Sweden)

    Alok Tyagi

    2012-01-01

    Full Text Available New daily persistent headache (NDPH is a chronic headache developing in a person who does not have a past history of headaches. The headache begins acutely and reaches its peak within 3 days. It is important to exclude secondary causes, particularly headaches due to alterations in cerebrospinal fluid (CSF pressure and volume. A significant proportion of NDPH sufferers may have intractable headaches that are refractory to treatment. The condition is best viewed as a syndrome rather than a diagnosis. The headache can mimic chronic migraine and chronic tension-type headache, and it is also important to exclude secondary causes, particularly headaches due to alterations in CSF pressure and volume. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine. A small group of NDPH sufferers may have intractable headaches that are refractory to treatment.

  10. Persistent postsurgical pain

    DEFF Research Database (Denmark)

    Werner, Mads Utke; Bischoff, Joakim Mutahi

    2014-01-01

    The prevalences of severe persistent postsurgical pain (PPP) following breast cancer surgery (BCS), groin hernia repair (GHR), and lung cancer surgery (LCS) are 13, 2, and 4-12 %, respectively. Estimates indicate that 80,000 patients each year in the U.S.A. are affected by severe pain...... and debilitating impairment in the aftermath of BCS, GHR, and LCS. Data across the three surgical procedures indicate a 35-65 % decrease in prevalence of PPP at 4-6 years follow-up. However, this is outweighed by late-onset PPP, which appears following a pain-free interval. The consequences of PPP include severe...... impairments of physical, psychological, and socioeconomic aspects of life. The pathophysiology underlying PPP consists of a continuing inflammatory response, a neuropathic component, and/or a late reinstatement of postsurgical inflammatory pain. While the sensory profiles of PPP-patients and pain...

  11. Persistent Temporal Streams

    Science.gov (United States)

    Hilley, David; Ramachandran, Umakishore

    Distributed continuous live stream analysis applications are increasingly common. Video-based surveillance, emergency response, disaster recovery, and critical infrastructure protection are all examples of such applications. They are characterized by a variety of high- and low-bandwidth streams as well as a need for analyzing both live and archived streams. We present a system called Persistent Temporal Streams (PTS) that supports a higher-level, domain-targeted programming abstraction for such applications. PTS provides a simple but expressive stream abstraction encompassing transport, manipulation and storage of streaming data. In this paper, we present a system architecture for implementing PTS. We provide an experimental evaluation which shows the system-level primitives can be implemented in a lightweight and high-performance manner, and an application-based evaluation designed to show that a representative high-bandwidth stream analysis application can be implemented relatively simply and with good performance.

  12. Persistent Aerial Tracking

    KAUST Repository

    Mueller, Matthias

    2016-04-13

    In this thesis, we propose a new aerial video dataset and benchmark for low altitude UAV target tracking, as well as, a photo-realistic UAV simulator that can be coupled with tracking methods. Our benchmark provides the rst evaluation of many state of-the-art and popular trackers on 123 new and fully annotated HD video sequences captured from a low-altitude aerial perspective. Among the compared trackers, we determine which ones are the most suitable for UAV tracking both in terms of tracking accuracy and run-time. We also present a simulator that can be used to evaluate tracking algorithms in real-time scenarios before they are deployed on a UAV "in the field", as well as, generate synthetic but photo-realistic tracking datasets with free ground truth annotations to easily extend existing real-world datasets. Both the benchmark and simulator will be made publicly available to the vision community to further research in the area of object tracking from UAVs. Additionally, we propose a persistent, robust and autonomous object tracking system for unmanned aerial vehicles (UAVs) called Persistent Aerial Tracking (PAT). A computer vision and control strategy is applied to a diverse set of moving objects (e.g. humans, animals, cars, boats, etc.) integrating multiple UAVs with a stabilized RGB camera. A novel strategy is employed to successfully track objects over a long period, by \\'handing over the camera\\' from one UAV to another. We integrate the complete system into an off-the-shelf UAV, and obtain promising results showing the robustness of our solution in real-world aerial scenarios.

  13. Autologous nerve graft repair of different degrees of sciatic nerve defect: stress and displacement at the anastomosis in a three-dimensional fnite element simulation model

    Directory of Open Access Journals (Sweden)

    Cheng-dong Piao

    2015-01-01

    Full Text Available In the repair of peripheral nerve injury using autologous or synthetic nerve grafting, the magnitude of tensile forces at the anastomosis affects its response to physiological stress and the ultimate success of the treatment. One-dimensional stretching is commonly used to measure changes in tensile stress and strain however, the accuracy of this simple method is limited. Therefore, in the present study, we established three-dimensional finite element models of sciatic nerve defects repaired by autologous nerve grafts. Using PRO E 5.0 finite element simulation software, we calculated the maximum stress and displacement of an anastomosis under a 5 N load in 10-, 20-, 30-, 40-mm long autologous nerve grafts. We found that maximum displacement increased with graft length, consistent with specimen force. These findings indicate that three-dimensional finite element simulation is a feasible method for analyzing stress and displacement at the anastomosis after autologous nerve grafting.

  14. Autologous nerve graft repair of different degrees of sciatic nerve defect:stress and displacement at the anastomosis in a three-dimensional finite element simulation model

    Institute of Scientific and Technical Information of China (English)

    Cheng-dong Piao; Kun Yang; Peng Li; Min Luo

    2015-01-01

    In the repair of peripheral nerve injury using autologous or synthetic nerve grafting, the mag-nitude of tensile forces at the anastomosis affects its response to physiological stress and the ultimate success of the treatment. One-dimensional stretching is commonly used to measure changes in tensile stress and strain; however, the accuracy of this simple method is limited. There-fore, in the present study, we established three-dimensional ifnite element models of sciatic nerve defects repaired by autologous nerve grafts. Using PRO E 5.0 ifnite element simulation software, we calculated the maximum stress and displacement of an anastomosis under a 5 N load in 10-, 20-, 30-, 40-mm long autologous nerve grafts. We found that maximum displacement increased with graft length, consistent with specimen force. These ifndings indicate that three-dimensional ifnite element simulation is a feasible method for analyzing stress and displacement at the anas-tomosis after autologous nerve grafting.

  15. [Interposition of the small intestine between the colon and the rectum as a way of achieving a pelvic anastomosis without pressure].

    Science.gov (United States)

    Enríquez-Navascues, Jose M; Rodríguez, Araceli; Placer, Carlos; Saralegui, Yolanda; Carrillo, Alberto

    2013-11-01

    There are some circumstances in which the descending colon does not reach the pelvis to complete a colorectal anastomosis without tension. Re-establishing intestinal continuity by interposing small bowel as a bridge between the colon and the rectum could be an acceptable surgical alternative. We describe the interposition of one or two segments of small bowel as a way of restoring continuity of the colon and rectum in three patients in whom it was not possible to perform a colorectal anastomosis without tension due to ischaemic colon, synchronous cancer or difficulty in accessing the supramesocolic space, respectively. Intestinal continuity was re-established in all patients with no significant morbidity and good intestinal function. The interposition of small bowel segments between the colon and the rectum should be considered a valid surgical option when it is not possible to achieve a well-perfused, tension-free pelvic colorectal anastomosis. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  16. Management of Anastomosis Leakage Post-RALP: A Simple Trick for a Complex Situation.

    Science.gov (United States)

    Diamand, Romain; Al Hajj Obeid, Walid; Accarain, Anna; Limani, Ksenija; Hawaux, Eric; van Velthoven, Roland; Peltier, Alexandre

    2017-05-01

    A case of 74 years old male patient who underwent RALP with bladder neck reconstruction. Persistent vesicourethral anastomotic leak was seen at cystography. A self-made side fenestrated Foley catheter was used and on the day after, a complete reversal in fluid output between the Foley catheter and the drain was seen.

  17. The Development of Diabetes after Subtotal Gastrectomy with Billroth II Anastomosis for Peptic Ulcer Disease

    Science.gov (United States)

    Chen, Chien-Hua; Hsu, Che-Ming; Lin, Cheng-Li

    2016-01-01

    Purpose A duodenal bypass after a Roux-en-Y gastric bypass operation for obesity can ameliorate the development of diabetes mellitus (DM). We attempted to determine the subsequent risk of developing DM after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) for peptic ulcer disease (PUD). Methods We identified 662 patients undergoing SGBIIA for PUD between 2000 and 2011 from the Longitudinal Health Insurance Database as the study cohort, and we randomly selected 2647 controls from the peptic ulcer population not undergoing SGBIIA and were frequency-matched by age, sex, and index year for the control cohort. All patient cases in both cohorts were followed until the end of 2011 to measure the incidence of DM. We analyzed DM risk by using a Cox proportional hazards regression model. Results The patients who underwent SGBIIA demonstrated a lower cumulative incidence of DM compared with the control cohort (log-rank test, P < .001 and 6.73 vs 12.6 per 1000 person-y). The difference in the DM risk between patients with and without SGBIIA increased gradually with the follow-up duration. Age and sex did not affect the subsequent risk of developing DM, according to the multivariable Cox regression model. Nevertheless, the SGBIIA cohort exhibited a lower DM risk after we adjusted for the comorbidities of hypertension, hyperlipidemia, and coronary artery disease (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.40–0.78). The incidence rate ratio (IRR) of DM in the SGBIIA cohort was lower than that in the control cohort for all age groups (age ≤ 49 y, IRR: 0.40, 95% CI: 0.16–0.99; age 50–64 y, IRR: 0.54, 95% CI: 0.31–0.96; age ≧ 65 y, IRR: 0.57, 95% CI: 0.36–0.91). Moreover, the IRR of DM was significantly lower in the SGBIIA cohort with comorbidities (IRR: 0.50, 95% CI: 0.31–0.78) compared with those without a comorbidity (IRR: 0.65, 95% CI: 0.40–1.04). Conclusion The findings of this population-based cohort study revealed that

  18. Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

    Institute of Scientific and Technical Information of China (English)

    Liu Gang; Han Hongqiu; Liu Tong; Fu Qiang; Lyu Yongcheng

    2014-01-01

    Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing,while little information on surgical treatment has been reported.This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China.Methods Ninety-five consecutive patients,who suffered CUC and had surgical indications,were carefully selected.All patients underwent IPAA.Data on patient characteristics,surgical indications,surgical details,postoperative complications,functional outcome,and quality of life were collected.Results The mean patient age at the time of the operation was 32 years.Twenty-nine (31%) patients underwent an emergency operation,and 66 (69%) underwent elective procedures.Four patients with severe dysplasia underwent operations,but no carcinoma was histologically confirmed.A two-stage operation was performed in 87 (92%) patients,and a hand-sewn technique was applied in 88 (93%) patients.Sixteen patients (17.0%) experienced early complications,and there was a significant difference between the emergency surgery group and the elective group (31.0% vs.10.6%,respectively; P <0.01).Five (5.3%) patients developed pouchitis as a late complication.The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight.According to the Kirwan grading scale,87 (91.8%) patients showed satisfactory anal continence function.The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P <0.01) according to the Cleveland Global Quality of Life index.Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China.However,some characteristics,such as the low incidence of pouchitis,require further study.

  19. ANASTOMOSIS ENTRE LA RAMA PROFUNDA DEL NERVIO CUBITAL Y EL NERVIO MEDIANO EN LA MANO. Anastomosis between the deep branch of the ulnar nerve and the median nerve in the hand

    Directory of Open Access Journals (Sweden)

    Luis E Criado del Río

    2016-03-01

    Full Text Available Introducción: La anastomosis de Riche-Cannieu (ARC es una variación anatómica formada entre la rama tenar del nervio mediano (NM y la rama profunda del nervio cubital (NC. Debido a la importancia clínica y electromiográfica su descripción anatómica es de gran interés, ya que debido a esta variación anatómica existen distintas formas de inervación motora a nivel de la mano. Materiales y Métodos: Se realizaron disecciones cadavéricas en 38 manos (19 cadáveres de ambos sexos formolizados en solución al 5 %, de entre 50 y 70 años de edad. Se utilizó instrumental y técnicas convencionales de disección. Resultados: En la rama profunda del NC no se evidenciaron variaciones y finalizaba su recorrido en el músculo aductor del pulgar. En el 86,84%  de los casos emerge una rama que se anastomosa con el NM de diferentes formas. Esta rama anastomótica, en el 50% de las manos, era una arcada nerviosa de considerable calibre entre el NC y NM, que daba ramas motoras a los músculos de la eminencia tenar. Discusión: El conocimiento de esta anastomosis es muy importante ya que, en casos de lesión del nervio mediano o cubital, puede causar confusión clínica, quirúrgica y en los hallazgos electromiográficos. Debido a su alta frecuencia fue considerada un rasgo anatómico normal. Introduction: The Riche-Cannieu anastomosis (RCA is an anatomic variation formed between the thenar branch of the median nerve and the deep branch of the ulnar nerve. Its anatomical description is of great interest because of its clinical and electromyographic relevance. Due to the RCA, there are various types of hand motor innervation. Materials and Methods: Thirty eight hands from 19 corpses (formolized in a 5% solution whose ages ranged from 50 to 70 years old were dissected. Conventional instruments and techn-iques were used. Results: The pathway of the deep branch of the ulnar nerve did not show variations and ended at the adductor pollicis muscle. In 86

  20. Detection of biliary stenoses in patients after liver transplantation: Is there a different diagnostic accuracy of MRCP depending on the type of biliary anastomosis?

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja, E-mail: Sonja.Kinner@uni-due.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Alexander [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Paul, Andreas [Department of General-, Visceral- and Transplant Surgery, University Hospital Essen (Germany); Umutlu, Lale; Ladd, Susanne C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Evelin Maldonado de; Zoepf, Thomas; Gerken, Guido [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany)

    2011-11-15

    Purpose: Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses or (b) choledocho-choledochostomy. Aim of this study was to assess the accuracy of MR cholangiopancreatography (MRCP) for the depiction of biliary stenoses in liver transplant patients depending on the type of biliary anastomosis. Method and materials: 24 liver transplant patients with clinical suspicion of biliary stenosis were studied (each 12 with bilio-digestive anastomosis/choledocho-choledochostomy). MRCP was performed on a 1.5T scanner (Magnetom Avanto, Siemens) including 2D single shot RARE, 2D T2w HASTE, TrueFISP and 3D high-resolution navigator corrected sequences. Presence of (a) anastomotic stenoses (AST) and (b) NAS (non-anastomotic strictures) were assessed. Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) were performed within 48 h after MRCP and served as the standard of reference. Results: In patients with bilio-digestive anastomoses sensitivities of MRCP for the detection of AST and NAS amounted to 50% and 67%, respectively with specificity values of 83% and 50%. In patients with choledocho-chledochostomy sensitivities (AST: 100%, NAS: 100%) and specificities (AST: 100%, NAS: 88%) were significantly higher. Conclusion: Biliary strictures after liver transplantation can be accurately detected by MRCP in patients after choledocho-chledochostomy. However, the diagnostic value of MRCP is lower if liver transplantation was performed in combination with a bilio-digestive anastomosis. This may be due to the less exact depiction of the anastomosis in the bowel wall. Thus, it is crucial to know the type of biliary anastomosis before choosing a diagnostic procedure.

  1. Persistent disruption of ciliated epithelium following paediatric lung transplantation.

    Science.gov (United States)

    Thomas, Biju; Aurora, Paul; Spencer, Helen; Elliott, Martin; Rutman, Andrew; Hirst, Robert A; O'Callaghan, Christopher

    2012-11-01

    It is unclear whether ciliary function following lung transplantation is normal or not. Our aim was to study the ciliary function and ultrastructure of epithelium above and below the airway anastomosis and the peripheral airway of children following lung transplantation. We studied the ciliary beat frequency (CBF) and beat pattern, using high speed digital video imaging and ultrastructure by transmission electron microscopy, of bronchial epithelium from above and below the airway anastomosis and the peripheral airway of 10 cystic fibrosis (CF) and 10 non-suppurative lung disease (NSLD) paediatric lung transplant recipients. Compared to epithelium below the anastomosis, the epithelium above the anastomosis in the CF group showed reduced CBF (median (interquartile range): 10.5 (9.0-11.4) Hz versus 7.4 (6.4-9.2) Hz; pepithelium above the anastomosis, the epithelium below the anastomosis showed marked ultrastructural abnormalities (median duration post-transplant 7-12 months). Ciliary dysfunction is a feature of native airway epithelium in paediatric CF lung transplant recipients. The epithelium below the airway anastomosis shows profound ultrastructural abnormalities in both CF and NSLD lung transplant recipients, many months after transplantation.

  2. Hemodynamics and changes after STA-MCA anastomosis in moyamoya disease and atherosclerotic cerebrovascular disease measured by micro-Doppler ultrasonography.

    Science.gov (United States)

    Morisawa, Hanako; Kawamata, Takakazu; Kawashima, Akitsugu; Hayashi, Masataka; Yamaguchi, Kohji; Yoneyama, Taku; Okada, Yoshikazu

    2013-07-01

    Moyamoya disease (MMD) and atherosclerotic cerebrovascular disease (ACVD) differ in angiographic appearance and probably hemodynamics. Pediatric MMD (PMMD) usually presents with cerebral ischemia, while intracranial hemorrhage is more common in adult MMD (AMMD), suggesting differences in cerebral hemodynamics. We analyzed the cortical flow velocity and direction of recipient arteries using micro-Doppler ultrasonography to evaluate the cortical circulation before and after anastomosis in MMD and ACVD. Twenty-eight patients with adult MMD (AMMD), 7 with pediatric MMD (PMMD), 16 with ACVD, and 12 control patients were studied. A micro-Doppler probe was applied on the cortical recipient artery (A4 or M4) before and after anastomosis. Systolic maximum flow velocity (V max) and blood flow direction were investigated at proximal and distal parts of anastomosed sites in recipient arteries. Pre- and postoperative regional cerebral blood flow was measured by cold xenon-computed tomography (Xe-CT). Before anastomosis, retrograde cortical flow was significantly more common in PMMD patients, and V max in cortical artery was significantly lower in AMMD patients. Bypass surgery changed the direction of blood flow from the anastomosis site to proximal and distal sites of the recipient artery in most patients, but pre-anastomosis flow direction was preserved more frequently in PMMD patients. The rate of V max increase after anastomosis was significantly higher in AMMD than in PMMD (11.6 ± 9.8 vs. 3.9 ± 1.8; P = 0.01). Micro-Doppler ultrasonography identified differences in cortical circulation among AMMD, PMMD, and ACVD. In AMMD, significantly low velocity in the cortical artery was observed before anastomosis, and bypass surgery reversed the flow and significantly increased flow velocity. The data of PMMD showed unique hemodynamics of the cortical artery before anastomosis, characterized by a higher frequency of retrograde flow and preserved velocity. The V max

  3. Salvage with a Secondary Infrahepatic Cavocavostomy of the Occluded Modified Piggyback Anastomosis during Split Liver Transplantation: A Case Report

    Directory of Open Access Journals (Sweden)

    Erdem Kinaci

    2014-01-01

    Full Text Available Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient’s infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia.

  4. Salvage with a Secondary Infrahepatic Cavocavostomy of the Occluded Modified Piggyback Anastomosis during Split Liver Transplantation: A Case Report.

    Science.gov (United States)

    Kinaci, Erdem; Kayaalp, Cuneyt; Yilmaz, Sezai; Otan, Emrah

    2014-01-01

    Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side) piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient's infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia.

  5. Suppressor of fusion, a Fusarium oxysporum homolog of Ndt80, is required for nutrient-dependent regulation of anastomosis.

    Science.gov (United States)

    Shahi, Shermineh; Fokkens, Like; Houterman, Petra M; Rep, Martijn

    2016-10-01

    Heterokaryon formation is an essential step in asexual recombination in Fusarium oxysporum. Filamentous fungi have an elaborate nonself recognition machinery to prevent formation and proliferation of heterokaryotic cells, called heterokaryon incompatibility (HI). In F. oxysporum the regulation of this machinery is not well understood. In Neurospora crassa, Vib-1, a putative transcription factor of the p53-like Ndt80 family of transcription factors, has been identified as global regulator of HI. In this study we investigated the role of the F. oxysporum homolog of Vib-1, called Suf, in vegetative hyphal and conidial anastomosis tube (CAT) fusion and HI. We identified a novel function for an Ndt80 homolog as a nutrient-dependent regulator of anastomosis. Strains carrying the SUF deletion mutation display a hyper-fusion phenotype during vegetative growth as well as germling development. In addition, conidial paring of incompatible SUF deletion strains led to more heterokaryon formation, which is independent of suppression of HI. Our data provides further proof for the divergence in the functions of different members Ndt80 family. We propose that Ndt80 homologs mediate responses to nutrient quality and quantity, with specific responses varying between species.

  6. Ivy signs on FLAIR images before and after STA-MCA anastomosis in patients with Moyamoya disease

    Energy Technology Data Exchange (ETDEWEB)

    Ideguchi, Reiko; Enokizono, Mikako; Uetani, Masataka (Dept. of Radiological Sciences, Nagasaki Univ. Graduate School of Biomedical Sciences, Nagasaki (Japan)), e-mail: qqtt37gd9@forest.ocn.ne.jp; Morikawa, Minoru (Dept. of Radiology, Nagasaki Univ. School of Medicine, Nagasaki (Japan)); Ogawa, Yoji (Dept. of Radiology, Hanwa Daini Senboku Hospital, Osaka (Japan)); Nagata, Izumi (Dept. of Neurosurgery, Nagasaki Univ. School of Medicine, Nagasaki (Japan))

    2011-04-15

    Background: Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR imaging is one of the features of Moyamoya disease. However, the correlation between ivy sign and cerebral perfusion status has not been fully evaluated. Purpose: To characterize ivy sign on FLAIR images in Moyamoya disease and compare this finding with hemodynamic alterations on perfusion single-photon emission CT (SPECT) obtained before and after bypass surgery. Material and Methods: Sixteen patients with angiographically confirmed Moyamoya disease who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis were included in the study. The presence of ivy sign on FLAIR images was classified as 'negative', 'minimal' and 'positive'. We evaluated the relationship between ivy sign and findings of SPECT, including cerebral vascular reserve (CVR) before and after surgery. Results: Minimal or positive ivy sign was seen in 13 (81%) of 16 patients, and 21 (66%) of 32 hemispheres. CVR in the areas with positive or minimal ivy sign was lower than that in the areas with negative ivy sign. After STA-MCA anastomosis, ivy sign disappeared or decreased in all 21 hemispheres demonstrating ivy sign. SPECT demonstrated apparent hemodynamic improvement in areas demonstrating disappearance or decrease of ivy sign. Conclusion: Ivy sign on FLAIR image is seen in areas with decreased cerebral perfusion. The sign is useful for non-invasive assessment of cerebral hemodynamic status before and after surgery

  7. Pathways of Student Persistence at RSC (Includes Persistence of Matriculants).

    Science.gov (United States)

    Fredericksen, Marlene

    In 1991, a study was conducted of semester-to-semester persistence patterns at Rancho Santiago College (RSC). The study involved tracking the attendance patterns of all RSC students entering as new students in fall 1983 and each subsequent fall until 1990; and comparing the persistence rates of matriculated and non-matriculated students in the…

  8. Lanreotide Autogel in the Treatment of Persistent Diarrhea following a Total Colectomy.

    Science.gov (United States)

    Schoeters, Patrick; De Pooter, Karl

    2015-01-01

    Diarrhea is one of the most common complications following colectomy in patients with slow transit constipation (STC). Early postoperative diarrhea is usually treated with opioid agonists; however, to date, published data on the management of persistent diarrhea after colectomy for STC are scarce. Here, we report a case of severe diarrhea after a total colectomy with ileorectal anastomosis. One year after the surgery, the patient presented with persistent diarrhea. Treatment with a long-acting somatostatin analogue, lanreotide Autogel, was initiated. One month after the first injection of lanreotide Autogel the diarrhea was resolved. The patient's stool transit was markedly improved (type 4 or type 5 according to the Bristol Stool Chart compared to type 7 before the treatment), positively affecting the patient's quality of life (mean score of 2.1 on the Irritable Bowel Syndrome Quality of Life questionnaire compared to 3.9 before the treatment). This case report describes a successful use of lanreotide Autogel in a patient with persistent diarrhea after a total colectomy.

  9. Lanreotide Autogel in the Treatment of Persistent Diarrhea following a Total Colectomy

    Directory of Open Access Journals (Sweden)

    Patrick Schoeters

    2015-01-01

    Full Text Available Diarrhea is one of the most common complications following colectomy in patients with slow transit constipation (STC. Early postoperative diarrhea is usually treated with opioid agonists; however, to date, published data on the management of persistent diarrhea after colectomy for STC are scarce. Here, we report a case of severe diarrhea after a total colectomy with ileorectal anastomosis. One year after the surgery, the patient presented with persistent diarrhea. Treatment with a long-acting somatostatin analogue, lanreotide Autogel, was initiated. One month after the first injection of lanreotide Autogel the diarrhea was resolved. The patient’s stool transit was markedly improved (type 4 or type 5 according to the Bristol Stool Chart compared to type 7 before the treatment, positively affecting the patient’s quality of life (mean score of 2.1 on the Irritable Bowel Syndrome Quality of Life questionnaire compared to 3.9 before the treatment. This case report describes a successful use of lanreotide Autogel in a patient with persistent diarrhea after a total colectomy.

  10. Interleukin-6 (IL-6 influence on colonic anastomosis healing in rats A influência da Interleucina-6 (IL-6 na cicatrizaç��o de anastomoses colônicas em ratos

    Directory of Open Access Journals (Sweden)

    Fernando Hintz Greca

    2007-04-01

    Full Text Available PURPOSE:To observe the effect of pro-inflamatory citokin, Interleukin-6 (IL-6, administration on the healing of colonic anastomosis in rats. METHODS: Thirty Wistar rats were divided into 2 groups of 15 animals each: a control group and an experiment group. The animals of the experiment group were submitted to injection of 500µg/kg of IL-6 Recombinant (Sandoz Phamarceutical® subcutaneously 24 and 12 hours preceding the surgery, and the control group, were submitted to the injection of saline solution, using the same volume of solution as well as the way of administration. The rats were submitted to an end to end colonic anastomosis, being sacrificed in the 7th post-operative day, the site of the anastomosis was evaluated regarding to the adhesions that was quantified and the presence of complications was observed. The colon containing the anastomosis was submitted to a tensiometric study and a sample were sent for histological studies with HE and Sirius Red dye. RESULTS: The macroscopic and the tensiometric study did not demonstrate any significant differences between the control and experiment group. Regarding the histological evaluation, there was a significant reduction of the chronic inflammatory process in the experiment group (p=0,0209 and a lesser granulation area (p=0,0099. The total amount of collagen was similar in both groups, however, the experimental group showed a predominant area of immature collagen (p=0.009. CONCLUSIONS: The longer persistence of the acute phase of wound healing in the experiment group, as well as a decreased of the mature collagen type I, demonstrating that the IL-6 was harmful to the colonic healing anastomosis in rats.OBJETIVO: Verificar a influência da administração da citocina pró-inflamatória, Interleucina-6 (IL-6, na cicatrização de anastomoses colônicas em ratos. MÉTODOS: Utilizaram-se 30 ratos Wistar, divididos em 2 grupos, controle e experimento, de 15 animais cada. Os animais do grupo

  11. Management of persistent vaginitis.

    Science.gov (United States)

    Nyirjesy, Paul

    2014-12-01

    With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis.

  12. Metabolic aspects of bacterial persisters

    Directory of Open Access Journals (Sweden)

    Marcel ePrax

    2014-10-01

    Full Text Available Persister cells form a multi-drug tolerant subpopulation within an isogenic culture of bacteria that are genetically susceptible to antibiotics. Studies with different Gram negative and Gram positive bacteria have identified a large number of genes associated with the persister state. In contrast, the revelation of persister metabolism has only been addressed recently. We here summarize metabolic aspects of persisters, which includes an overview about the bifunctional role of selected carbohydrates as both triggers for the exit from the drug tolerant state and metabolites which persisters feed on. Also alarmones as indicators for starvation have been shown to influence persister levels via different signaling cascades involving the activation of toxin-antitoxin systems and other regulatory factors. Finally, recent data obtained by 13C-isotopologue profiling demonstrated an active amino acid anabolism in Staphylococcus aureus cultures challenged with high drug concentrations. Understanding the metabolism of persister cells poses challenges but also paves the way for the development of anti-persister compounds.

  13. THE PERSISTENCE OF INSURERS PROFITABILITY

    Directory of Open Access Journals (Sweden)

    Maja Pervan

    2013-02-01

    Full Text Available Most of the academic researches have analyzed the persistence of profit for the manufacturing and (non-financial services sector. These studies were mainly conducted in advance market economies. In order to shed some light on the issue of persistence in corporate rates of return, this research aims to examine the persistence of profitability of financial entities i.e. non-life insurance companies operating in an emerging market economy, Croatia. In order to determine persistence of insurers’ profitability, a Markov Chains stochastic process is applied on the profitability classes that were formulated based on the changes of insurers’ ROA (return on assets indicator during the period from 2002 to 2011. The empirical results showed that profit persistence was more likely to occur within moderate profit classes/states.

  14. Mesial temporal lobe morphology in intractable pediatric epilepsy: so-called hippocampal malrotation, associated findings, and relevance to presurgical assessment.

    Science.gov (United States)

    Leach, James L; Awwad, Reem; Greiner, Hansel M; Vannest, Jennifer J; Miles, Lili; Mangano, Francesco T

    2016-06-01

    OBJECTIVE Diagnostic criteria for hippocampal malrotation (HIMAL) on brain MRI typically include a rounded hippocampus, vertical collateral sulcus, and architectural blurring. Relationship to epileptogenesis remains speculative, and usefulness for surgical guidance is unknown. The study was performed to determine the prevalence of hippocampal rotational anomalies in a cohort of pediatric patients with intractable epilepsy undergoing evaluation for surgery and to determine the significance of this finding in the context of surgical planning. METHODS Forty-eight surgically treated children with intractable epilepsy were compared with matched healthy subjects; reviewers were blinded to surgical side. Each temporal lobe was evaluated for rounded hippocampus, blurring, vertical collateral sulcus, wide choroidal fissure, enlarged temporal horn, low fornix, hippocampal signal, and findings of hippocampal sclerosis. A mesial temporal lobe (MTL) score was calculated by summing the number of features, and the collateral sulcus angle (CSA) was measured in each temporal lobe. Surgical side, pathological diagnosis, and imaging findings elsewhere in the brain were tabulated. Presence of HIMAL, associated imaging features, and MTL score were compared between sides, between epilepsy and control groups, in relationship to side of surgery, and in relationship to postoperative outcome. RESULTS Only 3 epilepsy patients (6.2%) and no controls exhibited all 3 features of HIMAL (p = 0.12). Eight of 48 (16.7%) epilepsy versus 2 of 48 (4.6%) control subjects had both a rounded hippocampus and vertical collateral sulcus (suggesting HIMAL) (p = 0.045). In control and epilepsy subjects, most findings were more prevalent on the left, and the left CSA was more vertical (p Epilepsy subjects had higher MTL scores (z = -2.95, p = 0.002) and more acute CSAs (p = 0.04) than controls. Only lateralizing raw MTL score had a significant association with surgical side (p = 0.03, OR 7.33); however, this was not significant when hippocampal sclerosis cases were excluded. HIMAL findings were more prevalent and MTL scores were higher in patients with resections involving the temporal lobes. On group analysis, HIMAL findings did not predict eventual surgical side and did not predict outcome, although the numbers are small. In 4 patients the abnormally rotated hippocampus was resected and showed hippocampal sclerosis and/or dysplastic changes on histopathology. All of these patients had a good outcome after surgery. CONCLUSIONS While increased in prevalence in children with intractable epilepsy, imaging findings of HIMAL did not have preoperative lateralizing utility in this group. Findings of HIMAL (including round hippocampus, architectural blurring, and vertical collateral sulcus) did not predict outcome after surgery, although the small number of patients with these findings limits evaluation. In the small number of patients in which the malrotated hippocampus was removed, outcome was good. Further research is needed to continue to define this association in children with intractable epilepsy, focusing on a temporal lobe cohort.

  15. Should Europe follow the US and declare obesity a disease?: a discussion of the so-called utilitarian argument

    DEFF Research Database (Denmark)

    Vallgårda, Signild; Nielsen, Morten Ebbe Juul; Hansen, Anne Katrine Kleberg

    2017-01-01

    In 2013, the American Medical Association (AMA) decided to recognize obesity as a disease. One of the main arguments presented in favor of this was broadly ‘utilitarian’: the disease label would, it was claimed, provide more benefits than harms and thereby serve the general good. Several individu......In 2013, the American Medical Association (AMA) decided to recognize obesity as a disease. One of the main arguments presented in favor of this was broadly ‘utilitarian’: the disease label would, it was claimed, provide more benefits than harms and thereby serve the general good. Several...

  16. The so-called verba hamzata, verba infirma and verba mediae geminatae in the dialect of Baghdad

    OpenAIRE

    Siwiec, Paweł

    2003-01-01

    Even the earliest Arab grammarians emphasized the distinctiveness of the verb stems with hamza and w or y as one of the root consonants. Similar attention was paid to the verbs of which the second and third radical are identical. A quite substantial part of Sībawaihi’s (750-793) Al-Kitāb deals with these issues. Sībawaihi presents in detail all the possible phonetic changes that result from such configurations of consonants in the Arabic verb stems. He does not limit himself to a rigid and st...

  17. Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes

    DEFF Research Database (Denmark)

    Leboeuf-Yde, Charlotte; Kjaer, Per; Bendix, Tom

    2008-01-01

    BACKGROUND: Recently, the MRI finding of "Modic changes" has been identified as pathologic spinal condition that probably reflects a vertebral inflammatory process (VIP), which coincides with spinal pain in most. We hypothesized that heavy smoking in combination with macro- or repeated microtraum...... and secondary prevention of LBP, because blue collar workers, who are most likely to experience the consequences of LBP, also are those who are most likely to smoke....

  18. Once again: The so-called open access system in power supply. Noch einmal: Zum sogenannten Netzzugang Dritter

    Energy Technology Data Exchange (ETDEWEB)

    Klaue, S.

    1993-04-20

    The author discusses the following arguments: Since article 103, sub-section 5, sentence 2, no. 4 (common carriage) of the GWB (German law against restraints on competition) already fully defines the right of access of third parties to power transmission networks, there is no need any more to give a justification in terms of regulatory policy of the relevant EC Directive being adopted as German national law. Also, the other argument says, there are already many decisions by the European Court of Justice and the German Constitutional Court, relating to cartels and competition, defining for many cases already the obligation of the market-dominating undertaking to allow third-parties and competitors access to their power transmission network in the domestic market. (orig./HP).

  19. Towards the issue on practical function of the medieval so called «reliquaries» of Еastern Europe

    Directory of Open Access Journals (Sweden)

    Kokorina Nina A.

    2014-06-01

    Full Text Available A specific type of items – horn tubes, common in the Khazar Kaganate and adjacent territories is considered. The author makes a conclusion that the term “reliquary” often used to denote them does not correspond to the initial purpose of these items. During the life of the owner, they had not been containers designed to store objects of worship. Written, visual, archaeological and ethnographic sources testify to the use of these items by pastoral peoples of Eurasian steppes as devices to inflate leather boat analogs when crossing rivers. At the same time, they were naturally objects of worship, as the means of saving lives at crossings. They were often placed in burials, playing the role of repositories for sacred objects, and were also used in burial rites as items necessary for the afterlife.

  20. On the problem of practical destination of so-called “reliquaries“ in medieval eastern europe

    Directory of Open Access Journals (Sweden)

    Kokorina Nina A.

    2014-06-01

    Full Text Available A specific type of items – horn tubes, common in the Khazar Kaganate and adjacent territories is considered. The author makes a conclusion that the term “reliquary” often used to denote them does not correspond to the initial purpose of these items. During the life of the owner, they had not been containers designed to store objects of worship. Written, visual, archaeological and ethnographic sources testify to the use of these items by pastoral peoples of Eurasian steppes as devices to inflate leather boat analogs when crossing rivers. At the same time, they were naturally objects of worship, as the means of saving lives at crossings. They were often placed in burials, playing the role of repositories for sacred objects, and were also used in burial rites as items necessary for the afterlife.

  1. On the mechanism of the so-called uncoupling effect of medium- and short-chain fatty acids

    NARCIS (Netherlands)

    Schönfeld, P.; Wojtczak, A. B.; Geelen, M.J.H.; Kunz, W.; Wojtczak, L.

    1988-01-01

    Octanoate applied to rat liver mitochondria respiring with glutamate plus malate or succinate (plus rotenone) under resting-state (State 4) conditions stimulates oxygen uptake and decreases the membrane potential, both effects being sensitive to oligomycin but not to carboxyatractyloside. Octanoate

  2. [Can meta-medicine bridge the gap between para-medicine and so-called school medicine?].

    Science.gov (United States)

    Spitzy, K H

    1990-02-28

    The concept of metamedicine is analogous to the concept of metaphysics. According to Kants perception, medicine has its origin in the human mind ("Gemüt") which is the source of all kinds of arts. Controversally to Kant, Fichte established I and non-I as a subject-object relationship. School philosophy, psychology and biology tend to banish the "subject" into mysticism but it comes up again in modern physics. Medicine as "art of healing" can only happen between subjects (physician and patient). Considering "metamedical" points of view, it cannot exist without the I/you respectively the you/I relationship. Following Plato, this means "loving-science" and is common to all kinds of medicine.

  3. [Methods of the multivariate statistical analysis of so-called polyetiological diseases using the example of coronary heart disease].

    Science.gov (United States)

    Lifshits, A M

    1979-01-01

    General characteristics of the multivariate statistical analysis (MSA) is given. Methodical premises and criteria for the selection of an adequate MSA method applicable to pathoanatomic investigations of the epidemiology of multicausal diseases are presented. The experience of using MSA with computors and standard computing programs in studies of coronary arteries aterosclerosis on the materials of 2060 autopsies is described. The combined use of 4 MSA methods: sequential, correlational, regressional, and discriminant permitted to quantitate the contribution of each of the 8 examined risk factors in the development of aterosclerosis. The most important factors were found to be the age, arterial hypertension, and heredity. Occupational hypodynamia and increased fatness were more important in men, whereas diabetes melitus--in women. The registration of this combination of risk factors by MSA methods provides for more reliable prognosis of the likelihood of coronary heart disease with a fatal outcome than prognosis of the degree of coronary aterosclerosis.

  4. Completion of cathode strip chamber (CSC) installation on the so-called YE+2 wheel of CMS on March 2005.

    CERN Multimedia

    Tejinder S. Virdee

    2005-01-01

    The pictures have been taken in the CMS construction hall in Cessy (neighbouring France), called SX5, in March 2005 and show the status of cathode strip chamber (CSC) assembly on the yoke disk YE+2. The chambers are labelled ME+3 and their installation has been completed on March 16th, 2005.

  5. Rheumatic diseases at the court of the Medici of Florence: the so-called “gout” of the Medici

    Directory of Open Access Journals (Sweden)

    G. Fornaciari

    2011-06-01

    Full Text Available According to the archive documents several members of the Medici family of Florence suffered from gout. The word “gout”, with which the Renaissance physicians indicated pain episodes localised to hands, feet, spine and shoulders, was in general improperly used, and hint other nosological entities. A paleopathological investigation carried out on the skeletal remains of the Grand Dukes of Florence and their relatives, revealed the true nature of the diseases they suffered from, allowing to diagnose two cases of diffuse idiopathic skeletal hyperostosis (DISH, a case of rheumatoid arthritis in an advanced stage, and a case of gout.

  6. On the mechanism of the so-called uncoupling effect of medium- and short-chain fatty acids

    NARCIS (Netherlands)

    Schönfeld, P.; Wojtczak, A. B.; Geelen, M.J.H.; Kunz, W.; Wojtczak, L.

    1988-01-01

    Octanoate applied to rat liver mitochondria respiring with glutamate plus malate or succinate (plus rotenone) under resting-state (State 4) conditions stimulates oxygen uptake and decreases the membrane potential, both effects being sensitive to oligomycin but not to carboxyatractyloside. Octanoate

  7. Obsessive-compulsive phenomenon in a so-called 'symptomarme schizophrenie': from the viewpoint of structural dynamics in defense mechanisms.

    Science.gov (United States)

    Shoda, H

    1996-01-01

    (1)'Antieidos' is a formlessness that results from the reverse intentionality of the life formation and is considered to be a principle of obsessive psychosis. 'Internal emptiness' is supposed to exist in the nucleus of schizophrenia. 'Antieidos' and 'internal emptiness' are in close proximity, partly overlapping each other. Obsessive psychosis and some types of simple schizophrenia are considered to have a common intentionality for the obsessive-compulsive phenomenon from the viewpoint of defensive structural dynamics. (2) The obsessive-compulsive phenomenon and the hypochondriacal phenomenon that coexist in simple schizophrenia are considered to be a 'noema' (something in which a meaning is given to the intended experience) that results from 'noesis' (action of consciousness seen in the intended experience) which has a defensive intentionality and as a result masks the basic disturbance in schizophrenia. Complementarity between the obsessive-compulsive phenomenon and the hypochondriacal phenomenon structured in this way can form one type of disease in the nonself-introspective category of simple schizophrenia.

  8. How do young people from so called “rough area” perceive the society where they are evolving?

    Directory of Open Access Journals (Sweden)

    Dalila Belgacem

    2011-06-01

    Full Text Available What young people see from the society they are evolving in gives us a clue about and an understanding of the reasons why they sometimes become violent. Young people are revolted because they feel like a lot of things are unfair; they miss “moral values” and “points of reference”, as if nothing made “sense” anymore. Then, consumer society leads some young people into confusing reality with fictional fact and ultimately creates envy and jealousy. With the evolution of society and the fact that traditional rites “disappear”, young people are faced with the only rite that still exists to “jump” from childhood to grow-up world: school. But those who are not going to school will have to find and search for other “ rites of passage ” and we think that this is a major risk for young people, because this is where they could be “separated” from the society. Having to deal with this evolution, young people have some problems finding people they can identify themselves with.

  9. How do young people from so called “rough area” perceive the society where they are evolving?

    Directory of Open Access Journals (Sweden)

    Dalila Belgacem

    2011-01-01

    Full Text Available What young people see from the society they are evolving in gives us a clue about and an understanding of the reasons why they sometimes become violent. Young people are revolted because they feel like a lot of things are unfair; they miss “moral values” and “points of reference”, as if nothing made “sense” anymore. Then, consumersociety leads some young people into confusing reality with fictional fact and ultimately creates envy and jealousy. With the evolution of society and the fact that traditional rites “disappear”, young people are faced with the only rite that still exists to “jump” from childhood to grow-up world: school. But those who are not going to school will have to find and search for other “ rites of passage ” and we think that this is a major risk for young people, because this is where they could be “separated” from the society. Having to deal with this evolution, young people have some problems finding people they can identify themselves with.

  10. Current results of an arachnological survey of some sandstone rock sites in Bohemia (so-called "rock cities"

    Directory of Open Access Journals (Sweden)

    Růžička, Vlastimil

    1992-07-01

    Full Text Available The spider fauna of the Adrspach-Teplice rockswas investigated. Some records on spider fauna of other nine sandstone rock areas are included. The phenomenon of "rock cities" manifests itself in three aspects: (1 In the bottom parts are microclimatically cold spaces, frequently hosting northern ot mountain species of invertebrates, which here have an azonal occurence. (2 the sun exposed tops of rocks can host thermophilous species. (3 Some species are limited to the surface of rocks and boulders. These are referred to as lithophilous or lithobiont species.

  11. Association of Dioxin and Other Persistent Organic Pollutants (POPs) with Diabetes: Epidemiological Evidence and New Mechanisms of Beta Cell Dysfunction

    Science.gov (United States)

    De Tata, Vincenzo

    2014-01-01

    The worldwide explosion of the rates of diabetes and other metabolic diseases in the last few decades cannot be fully explained only by changes in the prevalence of classical lifestyle-related risk factors, such as physical inactivity and poor diet. For this reason, it has been recently proposed that other “nontraditional” risk factors could contribute to the diabetes epidemics. In particular, an increasing number of reports indicate that chronic exposure to and accumulation of a low concentration of environmental pollutants (especially the so-called persistent organic pollutants (POPs)) within the body might be associated with diabetogenesis. In this review, the epidemiological evidence suggesting a relationship between dioxin and other POPs exposure and diabetes incidence will be summarized, and some recent developments on the possible underlying mechanisms, with particular reference to dioxin, will be presented and discussed. PMID:24802877

  12. Association of dioxin and other persistent organic pollutants (POPs) with diabetes: epidemiological evidence and new mechanisms of beta cell dysfunction.

    Science.gov (United States)

    De Tata, Vincenzo

    2014-05-05

    The worldwide explosion of the rates of diabetes and other metabolic diseases in the last few decades cannot be fully explained only by changes in the prevalence of classical lifestyle-related risk factors, such as physical inactivity and poor diet. For this reason, it has been recently proposed that other "nontraditional" risk factors could contribute to the diabetes epidemics. In particular, an increasing number of reports indicate that chronic exposure to and accumulation of a low concentration of environmental pollutants (especially the so-called persistent organic pollutants (POPs)) within the body might be associated with diabetogenesis. In this review, the epidemiological evidence suggesting a relationship between dioxin and other POPs exposure and diabetes incidence will be summarized, and some recent developments on the possible underlying mechanisms, with particular reference to dioxin, will be presented and discussed.

  13. Association of Dioxin and Other Persistent Organic Pollutants (POPs with Diabetes: Epidemiological Evidence and New Mechanisms of Beta Cell Dysfunction

    Directory of Open Access Journals (Sweden)

    Vincenzo De Tata

    2014-05-01

    Full Text Available The worldwide explosion of the rates of diabetes and other metabolic diseases in the last few decades cannot be fully explained only by changes in the prevalence of classical lifestyle-related risk factors, such as physical inactivity and poor diet. For this reason, it has been recently proposed that other “nontraditional” risk factors could contribute to the diabetes epidemics. In particular, an increasing number of reports indicate that chronic exposure to and accumulation of a low concentration of environmental pollutants (especially the so-called persistent organic pollutants (POPs within the body might be associated with diabetogenesis. In this review, the epidemiological evidence suggesting a relationship between dioxin and other POPs exposure and diabetes incidence will be summarized, and some recent developments on the possible underlying mechanisms, with particular reference to dioxin, will be presented and discussed.

  14. Recent advances of anastomosis techniques of esophagojejunostomy after laparoscopic totally gastrectomy in gastric tumor%腹腔镜全胃切除食管空肠吻合技术研究进展

    Institute of Scientific and Technical Information of China (English)

    李溪; 柯重伟

    2015-01-01

    The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique , the transorally inserted anvil(OrVilTM) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.%腹腔镜全胃切除食管空肠吻合的消化道重建技术主要包括应用圆形吻合器的吻合技术和应用直线切割吻合器的吻合技术两大类。圆形吻合器吻合技术主要包括手工吻合法、荷包钳法、Hiki改良特殊抵钉座吻合技术、经口钉砧头系统(OrVilTM)和反穿刺器技术。直线切割吻合器吻合技术主要包括侧侧吻合技术和Overlap侧侧吻合技术。食管空肠吻合技术存在多种选择,不同技术存在不同优势及相应的限制,本文从吻合技术的发展及吻合技术的选择两方面介绍腹腔镜全胃切除食管空肠吻合技术研究进展。

  15. Tissue-specific alterations of binding sites for peripheral-type benzodiazepine receptor ligand [3H]PK11195 in rats following portacaval anastomosis.

    Science.gov (United States)

    Rao, V L; Audet, R; Therrien, G; Butterworth, R F

    1994-05-01

    Kinetics of binding of [3H]PK11195, an antagonist ligand with high selectivity for the peripheral-type (mitochondrial) benzodiazepine receptor (PTBR), was studied in homogenates of cerebral cortex, kidney, heart, and testis of portacaval shunted rats and sham-operated controls. Portacaval anastomosis resulted in a significant two- to threefold increase in the number of [3H]PK11195 binding sites in cerebral cortex and kidney. A reduction in the number of [3H]PK11195 binding sites was observed in testis preparations, while the number of binding sites in the heart remained unaltered. These differences in the response of PTBRs to portacaval anastomosis, in different organs suggest that the physiological function of these receptors and the factors regulating them are modulated by distinct mechanisms. The finding of increased densities of [3H]PK11195 binding sites in brain and kidney following portacaval anastomosis parallels the cellular hypertrophy in these tissues and, together with previous observations of similar increases of these binding sites in brain and kidney in congenital hyperammonemia, suggest a pathophysiologic role for ammonia in these changes. In contrast, the significant loss of [3H]PK11195 binding sites in testicular preparations following portacaval anastomosis together with the known effects of steroid hormones on these sites suggests a role for PTBRs in the pathogenesis of testicular atrophy in chronic liver disease.

  16. Curative effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Hao Sun

    2017-03-01

    Full Text Available AIM: To explore the effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction. METHODS: Totally 70 patients(70 eyeswith chronic dacryocystitis and nasolacrimal duct obstruction in our hospital from December 2011 to December 2014 were selected, and were randomly divided into control group and study group. The control group were treated with nasal cavity lacrimal sac anastomosis under nasal endoscope, and the study group were treated with nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope. Total effective rates and fistula areas at 1, 6 and 12mo before and after operation were compared between the two groups. RESULTS: At 1mo after operation, there was no significant difference in total effective rates between the control group(97%and the study group(100%; P>0.05. At 6mo after operation, the total effective rate in the study group(97%was significantly higher than that in the control group(77%; PPP>0.05, while fistula areas in the study group were larger than those in the control group at 6 and 12mo after operation(PCONCLUSION: The effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction are remarkable.

  17. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Severini, A.; Civelli, E.M.; Uslenghi, E.; Cozzi, G.; Salvetti, M.; Milella, M. [Department of Radiology, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy); Gallino, G.; Bonfanti, G.; Belli, F.; Leo, E. [Department of Surgery, National Cancer Institute of Milan, via Venezian 1, I-23100 Milan (Italy)

    2000-07-01

    Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula

  18. Persistence, resistance, resonance

    Science.gov (United States)

    Tsadka, Maayan

    form of musical consumption and experience. The three pieces draw lines connecting different aspects of persistence, resistance, and resonance.

  19. Energy landscapes and persistent minima

    Energy Technology Data Exchange (ETDEWEB)

    Carr, Joanne M.; Wales, David J., E-mail: dw34@cam.ac.uk [University Chemical Laboratories, University of Cambridge, Lensfield Road, Cambridge CB2 1EW (United Kingdom); Mazauric, Dorian; Cazals, Frédéric, E-mail: frederic.cazals@inria.fr [Inria Sophia Antipolis Méditerranée, 2004 route des Lucioles, F-06902 Sophia Antipolis (France)

    2016-02-07

    We consider a coarse-graining of high-dimensional potential energy landscapes based upon persistences, which correspond to lowest barrier heights to lower-energy minima. Persistences can be calculated efficiently for local minima in kinetic transition networks that are based on stationary points of the prevailing energy landscape. The networks studied here represent peptides, proteins, nucleic acids, an atomic cluster, and a glassy system. Minima with high persistence values are likely to represent some form of alternative structural morphology, which, if appreciably populated at the prevailing temperature, could compete with the global minimum (defined as infinitely persistent). Threshold values on persistences (and in some cases equilibrium occupation probabilities) have therefore been used in this work to select subsets of minima, which were then analysed to see how well they can represent features of the full network. Simplified disconnectivity graphs showing only the selected minima can convey the funnelling (including any multiple-funnel) characteristics of the corresponding full graphs. The effect of the choice of persistence threshold on the reduced disconnectivity graphs was considered for a system with a hierarchical, glassy landscape. Sets of persistent minima were also found to be useful in comparing networks for the same system sampled under different conditions, using minimum oriented spanning forests.

  20. Fusion body formation, germ tube anastomosis, and nuclear migration during the germination of urediniospores of the wheat leaf rust fungus, Puccinia triticina.

    Science.gov (United States)

    Wang, Xiben; McCallum, Brent

    2009-12-01

    ABSTRACT Vegetative or parasexual recombination is thought to be a key mechanism for the genetic diversity of cereal rust fungi. The process of germ tube fusion leading to hyphal anastomosis and nuclear recombination was analyzed in wheat leaf rust fungus, Puccinia triticina. Germ tube anastomosis was observed in 27 P. triticina isolates, each representing a different virulence phenotype. Germ tube fusion bodies (GFBs), which appeared as viscid globules formed at tips of germ tubes, were essential for germ tube anastomosis. The formation of GFBs was affected by the urediniospore density and the length of illumination during germination. GFBs were formed at the highest frequency when urediniospores were spread to a concentration of 1 x 10(6) urediniospores/ml and incubated in dark for 12 to 24 h during germination. GFB attached to either the side of another germ tube ("tip to side") or to another GFB formed at the tip of a second germ tube ("tip to tip"). In "tip to side" anastomosis, two nuclei in the germ tube bearing the GFB migrated into the second germ tube through the GFB which resulted in four nuclei within this germ tube. In "tip to tip" anastomosis, nuclei in both germ tubes migrated into the fused GFB and all four nuclei came into close proximity. Urediniospores of isolates MBDS-3-115 and TBBJ-5-11 were stained with DAPI (4',6'diamine-2-phenylindole) and Nuclear Yellow (Hoechst S769121), respectively, and then mixed and germinated on water agar. Some fused GFBs contained nuclei stained with DAPI and nuclei stained with Nuclear Yellow in close proximity, demonstrating the fusion between genetically different P. triticina isolates. In some fused GFBs, "bridge-like" structures connecting different nuclei were observed.