WorldWideScience

Sample records for anorrectal total reporte

  1. Total 2004 annual report

    International Nuclear Information System (INIS)

    2004-01-01

    This annual report of the Group Total brings information and economic data on the following topics, for the year 2004: the corporate governance, the corporate social responsibility, the shareholder notebook, the management report, the activities, the upstream (exploration and production) and downstream (refining and marketing) operating, chemicals and other matters. (A.L.B.)

  2. TOTAL annual report 2003

    International Nuclear Information System (INIS)

    2004-01-01

    This 2003 annual report of the Group Total provides economical results and information of the society on the following topics: keys data, the corporate governance (Directors charter, board of directors, audit committee, nomination and remuneration committee, internal control procedures, compensation of directors and executive officers), the corporate social responsibility (environmental stewardship, the future of energy management, the safety enhancement, the human resources, ethics and local development), the investor relations, the management report, the upstream exploration and production, the downstream refining, marketing, trading and shipping, the chemicals and financial and legal information. (A.L.B.)

  3. Total - annual report 2005

    International Nuclear Information System (INIS)

    2006-01-01

    This annual report presents the activities and results of TOTAL S.A., french society on oil and gas. It deals with statistics, the managers, key information on financial data and risk factors, information on the Company, unresolved Staff Comments, employees, major Shareholders, consolidated statements, markets, security, financial risks, defaults dividend arrearages and delinquencies, controls and procedures, code of ethics and financial statements. (A.L.B.)

  4. Total Water Management - Report

    Science.gov (United States)

    There is a growing need for urban water managers to take a more holistic view of their water resource systems as population growth, urbanization, and current operations put different stresses on the environment and urban infrastructure. Total Water Management (TWM) is an approac...

  5. Total Removals Reporting

    Data.gov (United States)

    Department of Homeland Security — Data used to report on ICE statistics are obtained through the ICE Integrated Decision Support (IIDS) system data warehouse. The records in this system are refreshed...

  6. Total 2004 annual report; TOTAL 2004 rapport annuel

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    This annual report of the Group Total brings information and economic data on the following topics, for the year 2004: the corporate governance, the corporate social responsibility, the shareholder notebook, the management report, the activities, the upstream (exploration and production) and downstream (refining and marketing) operating, chemicals and other matters. (A.L.B.)

  7. TOTAL annual report 2003; TOTAL rapport annuel 2003

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    This 2003 annual report of the Group Total provides economical results and information of the society on the following topics: keys data, the corporate governance (Directors charter, board of directors, audit committee, nomination and remuneration committee, internal control procedures, compensation of directors and executive officers), the corporate social responsibility (environmental stewardship, the future of energy management, the safety enhancement, the human resources, ethics and local development), the investor relations, the management report, the upstream exploration and production, the downstream refining, marketing, trading and shipping, the chemicals and financial and legal information. (A.L.B.)

  8. TOTAL FINA ELF. Annual report 2002

    International Nuclear Information System (INIS)

    2003-01-01

    This document is the annual report 2002 of Total-Fina-Elf society, great company on the hydrocarbons market. According to the company objective (set the standard not only with the financial performance, but also with stringent requirements in terms of social and environmental responsibility), it presents the Chairman message, the corporate governance, the social and environmental responsibility, the future of energy, the human resources policy, the investor relations, the overview of Total-Fina-Elf fiscal year with financial information and 2002 industrial events. (A.L.B.)

  9. TOTAL 2003 activities report in brief

    International Nuclear Information System (INIS)

    2004-01-01

    This activities report presents the activities of the petroleum industry Group Total for the year 2003. The following topics are detailed: the corporate social responsibility with the environment stewardship, the energy future management, the safety enhancing, the human resources and the ethics and local development; the shareholder information with the Total share and the share-holding structure; the activities with informations on the Group, the main events, the upstream exploration and production,, the downstream refining, marketing, trading and shipping, the chemicals with overview 2003, base chemical and polymers, performance and specialities. (A.L.B.)

  10. Assay development status report for total cyanide

    Energy Technology Data Exchange (ETDEWEB)

    Simpson, B.C. [Westinghouse Hanford Co., Richland, WA (United States); Jones, T.E.; Pool, K.H. [Pacific Northwest Lab., Richland, WA (United States)

    1993-02-01

    A validated cyanide assay that is applicable to a variety of tank waste matrices is necessary to resolve certain waste tank safety issues and for purposes of overall waste characterization. The target for this effort is an assay with an applicable range of greater than 1,000 ppM (0.10 wt%) total cyanide and a confidence level greater than 80%. Figure 1 illustrates the operating regime of the proposed cyanide assay method. The Assay Development Status Report for Total Cyanide will summarize the past experience with cyanide analyses on-tank waste matrices and will rate the status of the analytical methods used to assay total cyanide (CN{sup {minus}} ion) in the tank waste matrices as acceptable or unacceptable. This paper will also briefly describe the current efforts for improving analytical resolution of the assays and the attempts at speciation.

  11. NASA total quality management 1989 accomplishments report

    Science.gov (United States)

    Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

    1990-01-01

    NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

  12. Total productivity; strategy report in 2003

    International Nuclear Information System (INIS)

    2004-01-01

    This book gives KMA message, the actual conditions and results of manufacturing competitiveness and maintenance management in 2003, a good illustration of success strategies and best practice report. It has column, special edition and success strategy. Also it presents chage of manufacturing processes and customized production, new paradime 'preservation business management' acording to informationization. And it covers secore energy policy fit for world trend and high grade suggestion of correct objective.

  13. Estimation of Total Error in DWPF Reported Radionuclide Inventories

    International Nuclear Information System (INIS)

    Edwards, T.B.

    1995-01-01

    This report investigates the impact of random errors due to measurement and sampling on the reported concentrations of radionuclides in DWPF's filled canister inventory resulting from each macro-batch. The objective of this investigation is to estimate the variance of the total error in reporting these radionuclide concentrations

  14. Total Knee Replacement: a Preliminary Report Thirteen (13) Cases ...

    African Journals Online (AJOL)

    Methods: This is a prospective report of 13 cases of primary Total Knee Replacement (TKR) at the National Orthopaedic Hospital Lagos between August, 2001 and September, 2005. There were a total of 13 knee replacement surgeries in 11 patients. Ten were females while 1 was male. Consecutive patients with severe ...

  15. Total Gastric Necrosis: A Case Report and Literature Review

    African Journals Online (AJOL)

    2017-05-22

    May 22, 2017 ... Pancreas 2012;41:325-7. 2. Patocskai EJ, Thomas JM. Gastric necrosis in a patient with bulimia. Eur J Surg 2002;168:302-4. 3. Davis LL, Raffensperger J, Novak GM. Necrosis of the stomach secondary to ingestion of corrosive agents: Report of three cases requiring total gastrectomy. Chest 1972;62:48-51.

  16. Laparoscopic total pancreatectomy: Case report and literature review.

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.

  17. TOTAL PLACENTA PREVIA AND PERIPARTUM HYSTERECTOMY – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Vladimir Weber

    2018-02-01

    Full Text Available Background. Postpartum haemorrhage usually occurs due to uterus atonia, adherent placenta, placenta accreta, coagulopathy or uterus rupture. In total placenta previa haemorrhage occurs more often and usually is more severe. Case report. We presented the example of severe postpartum haemorrhage with parturient woman after scheduled Caesarean section, due to total placenta previa, which was ended by performing hysterectomy. Conclusions. In postpartum haemorrhage, the treatment is conservative and if there is no improvement timely surgery is required. Abdominal hysterectomy is the final option and in case of severe haemorrhage it proved to be life saving for parturient woman.

  18. Total spinal anesthesia in an achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Amiri H R

    2008-06-01

    Full Text Available Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

  19. Dislocation following total knee arthroplasty: A report of six cases

    Directory of Open Access Journals (Sweden)

    Villanueva Manuel

    2010-01-01

    Full Text Available Background: Dislocation following total knee arthroplasty (TKA is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4, an inadequate selection of implants (n=1, malrotation of components (n=1 leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC. The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR TKA designs: four were revised to a posterior stabilized (PS TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory.

  20. Total gastric necrosis: A case report and literature review | Huang ...

    African Journals Online (AJOL)

    During the surgery, we found a total of 3500ml unclotted blood in the abdomen, splenic infarction and gastric necrosis. Total gastrectomy with Roux-en-Y esophagojejunostromy and splenectomy was performed. However, the patient died on the second day after the surgery. This case suggests that surgical treatment should ...

  1. Total bilateral TMJ reconstruction for pain and dysfunction: Case report

    Directory of Open Access Journals (Sweden)

    Carlos Vinícius Ayres Moreira

    2018-01-01

    Conclusion: The use of total joint prostheses has been configured as a good therapeutic alternative for severe conditions of TMJ that do not respond to conservative treatments. However, further studies are needed to demonstrate whether these results are long term.

  2. Total Force Policy Report to the Congress. Supplement

    Science.gov (United States)

    1990-01-01

    5 Grissmer, David W. and Jennifer Kawata, Total Force Manpower Management: Personnel Flows Between Active and Reserve Components, The RAND...operating, and supporting forces and recognizes both short- and long-term effects on defense fuiding . When defense force structure is changed, the

  3. The eighth NASA total quality management accomplishments report, 1990

    Science.gov (United States)

    1990-01-01

    The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

  4. Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

    Science.gov (United States)

    Miki, Takaaki; Miki, Takahito; Nishiyama, Akihiro

    2014-01-15

    Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

  5. Case report: nephrotic syndrome associated with a total hydatidiform mole.

    Science.gov (United States)

    Komatsuda, A; Nakamoto, Y; Asakura, K; Yasuda, T; Imai, H; Miura, A B

    1992-05-01

    The authors describe a 51-year-old Japanese woman who developed nephrotic syndrome in association with a total hydatidiform mole. The nephrotic syndrome remitted completely following hysterectomy. A renal biopsy performed before the operation showed diffuse mesangial cell proliferation of a moderate degree, and thickened capillary walls with focal and segmental subendothelial deposits, as well as circumferential mesangial interposition. Occasional foci of the mesangiolysis were also observed. Immunofluorescence microscopy revealed granular staining of IgM along the glomerular capillary walls in a fringe pattern. A review of the literature revealed that this patient appears to be the first case of nephrotic syndrome associated with a total mole, although there have been two cases of nephrotic syndrome due to preeclamptic nephropathy associated with a partial or transitional mole.

  6. Total Corporate social responsibility report 2004. Sharing our energy

    International Nuclear Information System (INIS)

    2005-05-01

    This document presents the social and environmental activities of the group Total for the year 2004. It provides information on the ethical aspects of the governance, the industrial security, the environmental policy, the public health and the occupational safety, the social liability and the economical and social impact of the group activities in the local development, the contribution to the climatic change fight and the development of other energy sources. (A.L.B.)

  7. TOTAL HIP ARTHROPLASTY IN OSTEOPETROSIS – REPORT OF A CASE

    Directory of Open Access Journals (Sweden)

    Zmago Krajnc

    2004-04-01

    Full Text Available Background. Authors introduced a case of a 27-year men with osteopetrosis with hip arthrosis. He has an autosomal – dominant form of disease and he needed total hip arthroplasty. There are seven cases described in literature with developed hip arthrosis by osteopetrosis.Methods. TEP implantation represents the greates surgical challenge in this patients, especially creation of intramedullary canal in femur and implantation of the femoral stem because of the very dense and brittle bones. This article describes the operative technique used in the case involved. It proved to be a very good solution.Results. The patient was released from the hospital ten days after implantation of total hip endoprosthesis. Three months after the operation the patient started to walk without aid of canes, he had non pain, and his range of motion was almost normal.Conclusions. Severe coxarthrosis is a rare complication of osteopetrosis. Great care must be taken with implantation of total hip endoprosthesis, especially with preparation of medular canal. It was recommended hand drilling under x-rays to exercise maximal control because reaming can cause false root of stem and greater probability of fracture.

  8. Patient-reported outcomes for total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Collins, Natalie J; Roos, Ewa M.

    2012-01-01

    , and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need......, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved...... in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind...

  9. Total Energy Recovery System for Agribusiness. [Geothermally heated]. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Fogleman, S.F.; Fisher, L.A.; Black, A.R.; Singh, D.P.

    1977-05-01

    An engineering and economic study was made to determine a practical balance of selected agribusiness subsystems resulting in realistic estimated produce yields for a geothermally heated system known as the Total Energy Recovery System for Agribusiness. The subsystem cycles for an average application at an unspecified hydrothermal resources site in the western United States utilize waste and by-products from their companion cycles insofar as practicable. Based on conservative estimates of current controlled environment yields, produce wholesale market prices, production costs, and capital investment required, it appears that the family-operation-sized TERSA module presents the potential for marginal recovery of all capital investment costs. In addition to family- or small-cooperative-farming groups, TERSA has potential users in food-oriented corporations and large-cooperative-agribusiness operations. The following topics are considered in detail: greenhouse tomatoes and cucumbers; fish farming; mushroom culture; biogas generation; integration methodology; hydrothermal fluids and heat exchanger selection; and the system. 133 references. (MHR)

  10. Transanal total mesorectal excision for rectal cancer: a preliminary report.

    Science.gov (United States)

    Kang, Liang; Chen, Wen-Hao; Luo, Shuang-Ling; Luo, Yan-Xin; Liu, Zhi-Hua; Huang, Mei-Jin; Wang, Jian-Ping

    2016-06-01

    Currently, the majority cases of the novel down-to-up transanal total mesorectal excision (TaTME) were performed in a hybrid approach with conventional laparoscopic assistance because of less operative difficulty. However, although cases are limited, the successes of TaTME in a pure approach (without laparoscopic assistance) indicate that the costly and less mini-invasive hybrid TaTME could be potentially avoided. In the present single institutional, prospective study, we attempted to demonstrate the safety and feasibility of this approach in rectal cancer by evaluating the short-term results of our first 20 TaTME cases. For the majority of cases, we adopted a strategy that laparoscopic assistance was not introduced unless it was required during the planned pure TaTME procedure. A total of 20 patients (12 males and 8 females) were analyzed in this study, including 11 cases (55 %) of pure TaTME and 9 cases (45 %) of hybrid TaTME. Overall, the median operative time was 200 min (range 70-420), along with a median estimated blood loss of 50 ml (range 20-800). Morbidity rate was 20 % (one urethral injury, two urinary retentions, one anastomotic hemorrhage and one mild anastomotic leak). The median number of harvested lymph nodes was 12 (range 1-20). All specimens were intact in mesorectum without positive distal and circumferential resection margins. Among the 15 patients who were preoperatively scheduled to undertake pure TaTME, four patients (26.7 %) required converting to laparoscopic assistance. Moreover, among these 15 patients, the results of the comparative analysis between female and male subgroups favor the former, suggesting easier operation in them. This preliminary study demonstrates that TaTME in rectal cancer is safe and feasible. The strategy of not introducing laparoscopic assistance unless it is required while performing the planned pTaTME should be cautiously explored. Further studies with larger sample size and longer follow-up are warranted.

  11. Total body irradiation for myasthenia gravis with thymoma: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ki Mun; Choi, Ihl Bohng; Kim, In Ah [College of Medicine, Catholic Univ., Seoul (Korea, Republic of)

    1999-06-01

    Myasthenia Gravis (MG) is relatively rare occuring as one of important autoimmune disease to affect neuromuscular junction. This study was clinically to evaluate total body irradiation (TBI) against two patients including 33-year and 39-year females for chronic MG with thymoma who hospitalized in the St. Mary's Hospital, Catholic University since 1994 as well as who showed no response by thymectomy, immunotherapy and hormonal therapy. TBI designed by the dose of 150-180 cGy consisting of 10 cGy per fraction, three times a week, for 5-6 weeks using linear accelerator of 6 MV. During the treatment of TBI, they did complain acute side effect such as vomiting and also appear improved physical condition from 4-6 weeks after TBI. Through the follow-up period of 18 or 42 months after TBI, they did not have any symptomatic recurrence. Consequently, the results suggest that TBI can be used as an alternative tool for the patients concurrently for MG with thymoma who had been refractory to various conventional therapies like thymectomy, immunotherapy and hormonal therapy.

  12. Total body irradiation for myasthenia gravis with thymoma: case report

    International Nuclear Information System (INIS)

    Kang, Ki Mun; Choi, Ihl Bohng; Kim, In Ah

    1999-01-01

    Myasthenia Gravis (MG) is relatively rare occuring as one of important autoimmune disease to affect neuromuscular junction. This study was clinically to evaluate total body irradiation (TBI) against two patients including 33-year and 39-year females for chronic MG with thymoma who hospitalized in the St. Mary's Hospital, Catholic University since 1994 as well as who showed no response by thymectomy, immunotherapy and hormonal therapy. TBI designed by the dose of 150-180 cGy consisting of 10 cGy per fraction, three times a week, for 5-6 weeks using linear accelerator of 6 MV. During the treatment of TBI, they did complain acute side effect such as vomiting and also appear improved physical condition from 4-6 weeks after TBI. Through the follow-up period of 18 or 42 months after TBI, they did not have any symptomatic recurrence. Consequently, the results suggest that TBI can be used as an alternative tool for the patients concurrently for MG with thymoma who had been refractory to various conventional therapies like thymectomy, immunotherapy and hormonal therapy

  13. Estimation of total error in DWPF reported radionuclide inventories. Revision 1

    International Nuclear Information System (INIS)

    Edwards, T.B.

    1995-01-01

    The Defense Waste Processing Facility (DWPF) at the Savannah River Site is required to determine and report the radionuclide inventory of its glass product. For each macro-batch, the DWPF will report both the total amount (in curies) of each reportable radionuclide and the average concentration (in curies/gram of glass) of each reportable radionuclide. The DWPF is to provide the estimated error of these reported values of its radionuclide inventory as well. The objective of this document is to provide a framework for determining the estimated error in DWPF's reporting of these radionuclide inventories. This report investigates the impact of random errors due to measurement and sampling on the total amount of each reportable radionuclide in a given macro-batch. In addition, the impact of these measurement and sampling errors and process variation are evaluated to determine the uncertainty in the reported average concentrations of radionuclides in DWPF's filled canister inventory resulting from each macro-batch

  14. Patient-Reported Outcomes After Revision of Metal-on-Metal Total Bearings in Total Hip Arthroplasty.

    Science.gov (United States)

    Mata-Fink, Ana; Philipson, Daniel J; Keeney, Benjamin J; Ramkumar, Dipak B; Moschetti, Wayne E; Tomek, Ivan M

    2017-04-01

    Failure of metal-on-metal (MOM) total hip arthroplasty (THA) bearings is often accompanied by an aggressive local reaction associated with destruction of bone, muscle, and other soft tissues around the hip. Little is known about whether patient-reported physical and mental function following revision THA in MOM patients is compromised by this soft tissue damage, and whether revision of MOM THA is comparable with revision of hard-on-soft bearings such as metal-on-polyethylene (MOP). We identified 75 first-time MOM THA revisions and compared them with 104 first-time MOP revisions. Using prospective patient-reported measures via the Veterans RAND-12, we compared Physical Component Score and Mental Component Score function at preoperative baseline and postoperative follow-up between revision MOM THA and revision MOP THA. Physical Component Score did not vary between the groups preoperatively and at 1 month, 3 months, and 1 year postoperatively. Mental Component Score preoperatively and 1 and 3 months postoperatively were lower in patients in the MOM cohort compared with patients with MOP revisions (baseline: 43.7 vs 51.3, P revision cohorts. Postrevision physical function in revised MOM THA patients does not differ significantly from the outcomes of revised MOP THA. Mental function is markedly lower in MOM patients at baseline and early in the postoperative period, but does not differ from MOP patients at 1 year after revision. This information should be useful to surgeons and physicians facing MOM THA revision. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report.

    Science.gov (United States)

    Gonzalez-Heredia, Raquel; Garcia-Roca, Raquel; Benedetti, Enrico

    2016-01-01

    Total situs inversus" is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor nephrectomies. We report here the first right donor nephrectomy in a patient with total situs inversus that is performed using the Da Vinci platform. Published by Elsevier Ltd.

  16. Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report

    Directory of Open Access Journals (Sweden)

    Raquel Gonzalez-Heredia

    2016-01-01

    Full Text Available Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor nephrectomies. We report here the first right donor nephrectomy in a patient with total situs inversus that is performed using the Da Vinci platform.

  17. Hand-assisted robotic right donor nephrectomy in patient with total sinus inversus: A case report

    Science.gov (United States)

    Gonzalez-Heredia, Raquel; Garcia-Roca, Raquel; Benedetti, Enrico

    2016-01-01

    Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor neprectomies. We report here the first right donor nephrectomy in a patient with total sinus inversus that is performed using the Da Vinci platform. PMID:27085108

  18. Early patient-reported outcomes versus objective function after total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Luna, I E; Kehlet, H; Peterson, B

    2017-01-01

    AIMS: The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy). PATIENTS AND METHODS: A total of 80 pati...

  19. A Report Of Two Cases Of Uncemented Total Hip Replacement In ...

    African Journals Online (AJOL)

    This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement.

  20. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    Science.gov (United States)

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  1. Total Corporate social responsibility report 2004. Sharing our energy; TOTAL rapport societal and environnemental 2004. Notre energie en partage

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-05-15

    This document presents the social and environmental activities of the group Total for the year 2004. It provides information on the ethical aspects of the governance, the industrial security, the environmental policy, the public health and the occupational safety, the social liability and the economical and social impact of the group activities in the local development, the contribution to the climatic change fight and the development of other energy sources. (A.L.B.)

  2. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  3. Total Robotic Hysterectomy: Thailand’s First Case Report of Gynecologic Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Korakot Sirimai

    2016-01-01

    Full Text Available Objective: This study aimed to report the feasibility, trouble shooting and surgical technique in the total robotic hysterectomy for the patient with adenomyoma uteri. Methods: A 51 year-old patient was diagnosed with adenomyosis. Total robotic hysterectomy was performed. Results: Total operating time was 350 min, estimated blood loss was 50 ml, and length of hospitalization was 6 days. The pathologic section revealed adenomyosis with myoma uteri. The intraoperative and post-operative complications were unremarkable. The patient was in good conditions at 6th week, 3rd, 6th, 12th and 24th month. Conclusion: Total robotic hysterectomy for benign gynecologic condition, such as adenomyosis, is safe and feasible. However, the sustained high consuming cost must be weighted with the patient’s advantages.

  4. Commercial applications of solar total energy systems. Volume 4. Appendices. Final report. [Solar Total Energy System Evaluation Program (STESEP) code

    Energy Technology Data Exchange (ETDEWEB)

    Boobar, M.G.; McFarland, B.L.; Nalbandian, S.J.; Willcox, W.W.; French, E.P.; Smith, K.E.

    1978-07-01

    A methodology has been developed by Atomics International under contract to the Department of Energy to define the applicability of solar total energy systems (STES) to the commercial sector (e.g., retail stores, shopping centers, offices, etc.) in the United States. Candidate STES concepts were selected to provide on-site power generation capability, as well as thermal energy for both heating and cooling applications. Each concept was evaluated on the basis of its cost effectiveness (i.e., as compared to other concepts) and its ability to ultimately penetrate and capture a significant segment of this market, thereby resulting in a saving of fossil fuel resources. This volume contains the appendices. Topics include deterministic insolation model computer code; building energy usage data; computer simulation programs for building energy demand analysis; model buildings for STES evaluation; Solar Total Energy System Evaluation Program (STESEP) computer code; transient simulation of STES concept; solar data tape analysis; program listings and sample output for use with TRNSYS; transient simulation, and financial parameters sensitivities. (WHK)

  5. Combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma: A case report

    Directory of Open Access Journals (Sweden)

    Ryo Ohta

    Full Text Available Introduction: This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision. Presentation of case: An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle. Then a skin incision was made around the anus and the transperineal access platform was placed. The fat tissue of the ischioanal fossa was divided until the levator ani muscle was exposed. The oral side of the colon was transected and specimen was extracted through the perineal incision site. Then stoma was placed laparoscopically. Discussion: This procedure provides not only better exposure of the extralevator surgical field, but also efficient resection margins compared with the conventional andominoperineal resection. Conclusion: To the best of our knowledge, this is the first report of combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma. Our experience showed safety and feasible option for anorectal malignant diseases. Keywords: Anorectal malignant melanoma, Transanal total mesorectal excision, Laparoscopic abdominoperineal resection, Case report

  6. A Large Rice Body-Containing Cyst Mimicking Infection following Total Hip Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Wael Bayoud

    2017-01-01

    Full Text Available Introduction. Soft tissue mass following total hip arthroplasty raises several differential diagnoses not limited to infection, hematoma, wear debris, malignancy, and bursitis. Rice body formation in the hip region is an uncommon process denoting a chronic inflammation. We report here the second case of its kind in the medical literature of a wide symptomatic rice-like body cyst complicating a total hip arthroplasty. Case Presentation. This is the case of an 82-year-old white female, presenting with a warm, red, and inflated groin five years after revision of right total hip arthroplasty. Surgical intervention reveals a large well circumscribed cyst containing well-organized rice-like bodies. This eventuality was never reported in differential diagnosis of hip periprosthetic soft tissue masses before. Conclusion. This case report helps widening the array of the differential diagnosis in patients presenting with a slow growing soft tissue mass following total hip arthroplasty, making rice-like bodies cyst a valid one to consider.

  7. Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Bähr Mathias

    2011-05-01

    Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

  8. Intraoperative femoral head dislodgement during total hip arthroplasty: a report of four cases

    Directory of Open Access Journals (Sweden)

    Ahmed Siddiqi, DO

    2018-03-01

    Full Text Available Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

  9. Designing a Safety Reporting Smartphone Application to Improve Patient Safety After Total Hip Arthroplasty.

    Science.gov (United States)

    Krumsvik, Ole Andreas; Babic, Ankica

    2017-01-01

    This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

  10. An unusual case of persistent groin pain after total hip arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Friederich Niklaus F

    2011-02-01

    Full Text Available Abstract Introduction Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. Case presentation A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. Conclusions This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended

  11. Immediate and sustained benefits of a "total" implementation of speech recognition reporting.

    Science.gov (United States)

    Hart, J L; McBride, A; Blunt, D; Gishen, P; Strickland, N

    2010-05-01

    Speech recognition reporting was introduced in our institution to address the significant delay between report dictation and the appearance of a typed report on the Picture Archiving and Communication System (PACS). We report our experience of a "total" implementation of a speech recognition reporting (SRR) system, which became the sole means of radiology reporting from day 1 of introduction. Prospectively gathered Radiology Information System (RIS) data were examined to determine the monthly mean reporting times and completion times for all studies from January 2004 to February 2006 (11 months before introduction of SRR and 15 months after introduction). Studies were grouped for analysis according to referral source (casualty, general practice, inpatient or outpatient). A large, sustained reduction in time to completion was noted in all referral groups at both hospital sites within our institution (6.79 +/- 0.92 days pre-SRR and 2.20 +/- 0.78 days post-SRR, independent two-sample Student's t-test, pbenefits have not been fully realised. Our experience demonstrates the dramatic impact that a well-planned, organisation-wide implementation of SRR can have on radiology service delivery.

  12. Chronic asymptomatic dislocation of a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Lidder Surjit

    2009-08-01

    Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

  13. Patient-reported allergies cause inferior outcomes after total knee arthroplasty.

    Science.gov (United States)

    Hinarejos, Pedro; Ferrer, Tulia; Leal, Joan; Torres-Claramunt, Raul; Sánchez-Soler, Juan; Monllau, Joan Carles

    2016-10-01

    The main objective of this study was to analyse the outcomes after total knee arthroplasty (TKA) of a group of patients with at least one self-reported allergy and a group of patients without reported allergies. We hypothesized there is a significant negative influence on clinical outcome scores after TKA in patients with self-reported allergies. Four-hundred and seventy-five patients who had undergone TKA were analysed preoperatively and 1 year after surgery. The WOMAC, KSS and SF-36 scores were obtained. The patients' Yesavage depression questionnaire score was also recorded. The scores of the 330 (69.5 %) patients without self-reported allergies were compared to the scores of the 145 (30.5 %) patients with at least one self-reported allergy in the medical record. Preoperative scores were similar in both groups. The WOMAC post-operative scores (23.6 vs 20.4; p = 0.037) and the KSS-Knee score (91.1 vs 87.6; p = 0.027) were worse in the group of patients with self-reported allergies than in the group without allergies. The scores from the Yesavage depression questionnaire and in the SF-36 were similar in both groups. Patients with at least one self-reported allergy have worse post-operative outcomes in terms of the WOMAC and KSS-Knee scores after TKA than patients without allergies. These poor outcomes do not seem to be related to depression. Therefore, more research is needed to explain them. Reported allergies could be considered a prognostic factor and used when counselling TKA patients. I.

  14. Results of Total Knee Arthroplasty in Patients with Pigmented Villonodular Synovitis-Reporting Three Cases

    Directory of Open Access Journals (Sweden)

    Mahmoud Jabalameli

    2017-01-01

    Full Text Available Introduction The knee is the most commonly affected joint in the pigmented villonodular synovitis (PVNS. If misdiagnosed or mismanaged, PVNS, especially the diffused form can destroy joints and can result in terminal degenerative joint disease. Case Presentation We report 3 cases of diffuse form of PVNS with grade 3 osteoarhtritis that IS treated by total synovectomy and total knee arthroplasty (TKA. The mean duration of the follow-up was 46.5 (9, 11, 120 months. In 2 cases, staged posterior then anterior synovectomy and TKA were done with excellent results. In 1 case, simultaneous synovectomy and TKA was performed with hematoma formation postoperatively and quadriceps tendon rupture 10 weeks later with fair final result. Conclusions TKA in PVNS is a challenging procedure. We recommend open posterior synovectomy then anterior synovectomy and TKA in 2 separate operations. Quadriceps mechanism must be protected during synovectomy.

  15. Total rupture of hydatid cyst of liver in to common bile duct: a case report.

    Science.gov (United States)

    Robleh, Hassan; Yassine, Fahmi; Driss, Khaiz; Khalid, Elhattabi; Fatima-Zahra, Bensardi; Saad, Berrada; Rachid, Lefriyekh; Abdalaziz, Fadil; Najib, Zerouali Ouariti

    2014-01-01

    Rupture of hydatid liver cyst into biliary tree is frequent complications that involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts,but rarely rupture into common bile duct. The rupture of hydatid cyst is serious life threating event. The authors are reporting a case of total rupture of hydatid cyst of liver into common bile duct. A 50-year-old male patient who presented with acute cholangitis was diagnosed as a case of totally rupture of hydatid cyst on Abdominal CT Scan. Rupture of hydatid cyst of liver into common bile duct and the gallbladder was confirmed on surgery. Treated by cholecystectomy and T-tube drainage of Common bile duct.

  16. Changes in gait symmetry, gait velocity and self-reported function following total hip replacement.

    Science.gov (United States)

    Hodt-Billington, Caroline; Helbostad, Jorunn L; Vervaat, Willemijn; Rognsvåg, Turid; Moe-Nilssen, Rolf

    2011-09-01

    To investigate the magnitude of change at different time points in measures of gait symmetry, gait velocity and self-reported function following total hip replacement. Longitudinal with test occasions pre-surgery and 3, 6 and 12 months post-surgery. Thirty-four patients with hip osteoarthritis (mean age 63 years, standard deviation 11 years). Subjects walked back and forth along a 7-m walkway at slow, preferred and fast speed. Anteroposterior, vertical and mediolateral trunk symmetry was assessed by accelerometry, while single support symmetry, step-length symmetry and gait velocity was simultaneously assessed by an electronic walkway. Self-reported function was assessed by Hip disability and Osteoarthritis Outcome Score. Gait symmetry data were normalized for gait velocity. Changes between test occasions were reported as effect size. All measures showed effect sizes > 0.30 from pre-operative to 12-months postoperative assessments, and improvements were significant (p symmetry. In general, gait symmetry and gait velocity improved most 6 and 12 months postoperatively, while self-reported function improved most 3 months postoperatively. Early improvements were seen in self-reported function, suggesting immediate relief from stiffness and pain, while gait symmetry and velocity improved later postoperatively, suggesting that gait quality and performance require prolonged rehabilitation with postoperative guidance, muscular strengthening and motor relearning.

  17. Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report.

    Science.gov (United States)

    Shih, H N; Hsu, K Y; Tan, C F; Hsueh, S; Hsu, R W

    1997-09-01

    Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.

  18. Two breast metastases from thyroid carcinoma presented 6 years later after total thyroidectomy: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Gene Hyuk; Kang, Bong Joo; Kim, Sung Hun; Lee, Ah Won [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Jung, Na Young [Dept. of Radiology, Bucheon St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Bucheon (Korea, Republic of)

    2016-04-15

    Thyroid carcinoma is usually indolent with good prognosis, as compared to other malignancy. Distant metastases from thyroid cancer are rare and usually manifest as multiple lesions especially in lungs, bones and lymph nodes, in advanced stages of the disease. Metastasis to the breast from thyroid carcinoma is extremely rare, with about 16 cases reported in the English literature. Herein, we reported a case of metastatic poorly differentiated thyroid carcinoma, which presented as 2 breast masses in a 72-year-old woman, 6 years after total thyroidectomy for papillary thyroid carcinoma. Although the computed tomography (CT) and ultrasonography (USG) image findings are nonspecific oval mass with circumscribed or partially indistinct margin, metastases from thyroid cancer should be included in the differential diagnosis when recurrence of thyroid carcinoma is suspected. Also, fusion images of CT and USG are helpful to the radiologists in localizing the targeted lesion and conducting accurate USG-guided biopsy.

  19. Visor flap for total upper and lower lip reconstruction: a case report

    Directory of Open Access Journals (Sweden)

    Nthumba Peter

    2009-06-01

    Full Text Available Abstract Introduction Noma, aptly named the 'face of poverty', is a scourge with a mortality rate of up to 90% that affects some 140,000 people each year, predominantly children in the sub-Saharan 'noma belt'. Survivors of the acute attack suffer severe facial disfigurement from loss of facial tissue and scarring. Surgical reconstruction of noma defects is a major challenge, especially in Africa, where the majority of cases occur. Case presentation We report the case of a 40-year-old Somali man who presented with severe facial disfigurement, including total absence of both upper and lower lips. After a failed initial reconstruction, a combination of platysma flaps and a left deltopectoral flap provided mucosal lining, while a scalp visor flap served to recreate upper and lower lips, the beard and moustache. Conclusion The scalp visor flap offers a simple but extremely versatile tool for use in midfacial reconstruction, especially in the male, providing neo-lip tissue, a moustache and a beard. This is the first report of a simultaneous total upper and lower lip reconstruction using a scalp visor flap, in the English literature. We also emphasize on a process of transfer of skills to enable local surgeons to effectively manage the challenge that noma presents.

  20. Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review.

    Science.gov (United States)

    Ferri, Valentina; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Caruso, Riccardo; Malave, Luisi; Plaza, Carlos; Rodriguez, Silvia; Garcia, Lina; Perez, Virginia; Quijano, Yolanda; Vicente, Emilio

    2016-01-01

    Pancreatic disease can be complicated by extrabdominal manifestations such as panniculitis and polyarthritis. The symptomatic triad comprising pancreatic disease, panniculitis and polyarthritis is also known as PPP syndrome and is characterized by severe chronic sequels and high mortality rate. We describe a case of PPP syndrome successfully treated with spleen preserving total pancreatectomy; in addition we performed a literature review. A 67 years old male presented panniculitis and polyarthritis without clinical abdominal symptoms. Clinical presentation, laboratory values and radiological findings demonstrated an acute pancreatitis and a pancreatic cancer was suspected; failure of conservatory treatments and high suspicious of malignancy led to perform a spleen preserving total pancreatectomy. Finally histological examination excluded a pancreatic cancer and confirmed a chronic pancreatitis. Patient was discharged with complete resolution of the extrabdominal disease. In literature only 64 cases of PPP syndrome have been reported. Abdominal symptoms do not often appear at presentation and diagnosis may be delayed. Panniculitis develope in any part of the body but especially on the distal parts of the lower extremities, around the ankles and pretibial regions of the legs. Between osteo-articular manifestations polyarthritis is the most common one, although oligoarthritis, and monoarthritis in have been reported. PPP syndrome is a rare disease with a high mortality rate. A timely diagnosis and an aggressive treatment may improve the prognosis of this condition. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information Análisis prospectivo de la precisión diagnóstica en la patología anorrectal benigna: importancia de la información clínica

    Directory of Open Access Journals (Sweden)

    Jaime Jimeno

    2012-03-01

    Full Text Available Aim: the prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relationship between diagnostic accuracy and years of professional experience. Methods: seven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis. Results: forty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess: 100 vs. 80.6%, (p = 0.157; case 2 (fissure: 92.3 vs. 51.6% (p = 0.015; case 3 (thrombosed hemorrhoid: 92.3 vs. 74.2% (p = 0.321; case 4 (anal condyloma: 100 vs. 87.1% (p = 0.302; case 5 (rectal prolapse: 100 vs. 83.9% (p = 0.301; case 6 (prolapsed hemorrhoid: 92.3 vs. 29% (p = 0.001, and case 7 (fistula: 100 vs. 67.7% (p = 0.021. There were significant differences in the number of correctly diagnosed cases between groups (p Objetivo: la prevalencia de los trastornos anorrectales benignos en la población general es alta. El objetivo de este estudio es analizar la influencia de los síntomas clínicos en la precisión diagnóstica de la patología benigna anorrectal entre los diferentes especialistas y evaluar la relación entre el diagnóstico de la enfermedad y los años de experiencia profesional entre los profesionales participantes. Pacientes y métodos: se seleccionaron 7 casos típicos. En una primera entrevista, se mostró a los participantes las imágenes clínicas de cada caso y se les pidió que formularan un diagn

  2. Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty.

    Science.gov (United States)

    Postler, Anne E; Beyer, Franziska; Wegner, Tim; Lützner, Jörg; Hartmann, Albrecht; Ojodu, Ishaq; Günther, Klaus-Peter

    2017-03-31

    Patients who undergo either primary or revision total hip arthroplasty (THA) mainly expect improvement in pain, function/activity and quality of life. The purpose of the study was to measure the degree of short-term and medium-term improvement and the differences in patient-reported outcome that can be expected in patients undergoing revision THA, compared to patients undergoing primary THA. In this study, the results of patient-reported outcome measurements were compared in 124 matched patients, who underwent revision surgery and primary THA between 01/2007 and 12/2009. Assessment was performed at short-term and medium-term follow-up and included the WOMAC score, the UCLA activity score and EuroQol scores. 6 months after revision THA, the mean total WOMAC score improved by 22.1 points, the UCLA activity score by 0.6 points and the EuroQol-Index by 0.2 points. After primary THA, the improvement was 41.4 points on the WOMAC, 1.1 points on the UCLA and 0.3 points on the EuroQol-Index. At medium-term follow-up, 3.6 years after revision surgery and 2.3 years after primary THA, patients undergoing revision THA showed significantly less overall improvement, as well as lower final outcome scores, than patients undergoing primary THA. Patients undergoing revision arthroplasty, as well as patients undergoing primary THA, can expect major improvement in function, activity and quality of life postoperatively. However, overall level of improvement, as well as peak attainable outcome levels, are lower after revision surgery than after primary THA. Appropriate information for patients who undergo hip revision surgery is necessary in order to avoid unrealistic expectations and postoperative dissatisfaction.

  3. Solar total energy: large scale experiment, Shenandoah, Georgia Site. Annual report, June 1978-June 1979

    Energy Technology Data Exchange (ETDEWEB)

    Ney, E.J.

    1979-07-01

    A background summary and a complete description of the progress and current status of activities relative to the Cooperative Agreement for the Solar Total Energy - Large Scale Experiment at the Bleyle Knitwear Plant at Shenandoah, Georgia are presented. A statement of objectives and an abstract of progress to date are included. This is followed by a short introduction containing a project overview, a summary of the participants and their respective roles, a brief description of the Solar Total Energy System (STES) design concept, and a chronological summary of progress to date. A general description of the site is given, a detailed report of progress is reported, and drawings and equipment lists are included. The closed-loop solar energy system planned for Shenandoah begins with circulation of Syltherm 800, a heat transfer fluid of the Dow-Corning Corporation, through the receiver tubes of a parabolic dish solar collector field. As solar energy is focused on the receivers, the heat transfer fluid is heated to approximately 399/sup 0/C (750/sup 0/F) and is pumped to a heat exchanger for immediate use, or to a thermal storage system for later use. Once in the heat exchanger, the fluid heats a working fluid that produces the steam required for operating the turbine. After performing this task, the heat transfer fluid returns to the collectors to repeat the cycle, while the steam turbine-generator system supplies the electrical demands for the knitwear plant and the STES. During STES operation, maximum thermal and electrical requirements of the application are expected to be at 1.08 MWth and 161 kWe, respectively. During the power generation phase, some of the steam is extracted for use as process steam in the knitwear manufacturing process, while exhaust steam from the turbine is passed through a condenser to produce hot water for heating, domestic use, and absorption air conditioning. (WHK)

  4. Total Hip Arthroplasty Loosening Due to Mycobacterium Tuberculosis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Anis Tebourbi

    2017-04-01

    Full Text Available Context: Prosthetic joint infection due to Mycobacterium tuberculosis with no previous history of pulmonary or extra pulmonary tuberculosis is an extremely rare complication. Aims To report the case of a patient with tuberculous mycobacterial prosthetic hip infection, 14 years after surgery for post traumatic osteoarthritis, with no previous history of tuberculosis. Methods A 46-year-old male presented an acetabular loosening of a cemented total hip arthroplasty with subnormal biologic parameters. A one stage revision surgery was planned. Intraoperative findings suggested mycobacterial tuberculous infection with presence of periacetabular yellowish rice-shaped granules. Results A one-stage prosthesis exchange was performed; Culture on Löwenstein-Jensen medium grew MTB days after inoculation and histological examination confirmed tuberculous infection. Patient was treated by antituberculous agents for 12 months with optimal clinical and biological response and no prosthetic loosening signs at eighteen months follow up. Conclusions Total hip arthroplasty loosening due to mycobacterium tuberculosis is a rare entity, which should be evoked even when no inflammatory signs are shown. Discovery of yellowish rice-shaped granules is an indicator to investigate for tuberculosis. Management of prosthetic joint infection due to M.tuberculosis must involve both medical and surgical approach.

  5. Total occlusion of the left main and proximal right coronary artery: case report and review of the literature.

    Science.gov (United States)

    Leon, M N; Abu-Halawa, S; Ramanna, N; Kokotsakis, J N; Treistman, B; Anderson, H V

    1996-11-01

    Chronic total left main coronary artery occlusion at angiography is very rare, and there are only four cases reported with concomitant total right coronary artery occlusion. We describe a case of total left main and proximal right coronary artery occlusion and review the clinical and angiographic characteristics of this condition which represents the most severe from of coronary artery disease compatible with life.

  6. Functional Outcomes 18 Months After Total and Midarm Transplantation: A Case Report.

    Science.gov (United States)

    Iglesias, M; Ramírez-Berumen, M; Butrón, P; Alberú-Gómez, J; Salazar-Hernández, F; Macias-Gallardo, J; Leal-Villalpando, R P; Zamudio-Bautista, J; Acosta, V; Jauregui, L; Hernández-Campos, A; Espinosa-Cruz, V; Vázquez-Lamadrid, J; González-Sánchez, J; Cuellar-Rodriguez, J; Sierra-Madero, J G; Gaytan-Cervantes, R; Contreras-Barbosa, S; Navarro-Lara, A; Guzman-Gonzalez, J; Domínguez-Cherit, J; Vilatoba, M; Toussaint-Caire, S; Vega-Boada, F; Gómez-Pérez, F J; Mayorquin-Ruiz, M

    2018-03-16

    The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes. We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL. At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive. The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Final report for CCQM-K107: total elements and selenomethionine in human serum

    Science.gov (United States)

    Goenaga Infante, Heidi

    2016-01-01

    Routine tests that measure the concentration of electrolytes in serum are needed for diagnosis and management of renal, endocrine, acid-base, water balance and other conditions such as screening D- and A-vitamin disorders, kidney insufficiency, bone diseases and leukaemia. The diagnostic concentration ranges for many such markers are narrow, requiring reference methods with small uncertainty. Serum concentration of total selenium (Se) is important in health studies but there is increasing interest in the speciation of selenium compounds in clinical samples such as serum and individual Se- Species are bio-indicators of Se status. The last CCQM IAWG key comparison for elements in the clinical area (CCQM-K14: Ca in human serum) was organized in 2003 and the previous key comparison (CCQM-K60) for Se and Se species used a wheat flour sample. Therefore, the CCQM IAWG agreed that CCQM-K107 and a parallel pilot study CCQM-P146 should be carried out. The candidate human serum sample used for both CCQM-K107 and P146 is of high complexity and contains approximately 1000-fold lower concentrations of selenium methionine (SeMet) than those encountered in the CCQM-K60 wheat flour. This significantly broadens the scope and degree of difficulty of earlier measurements in this field. A total of eleven institutes participated in CCQM-K107 (11 participants for total elements and 7 for SeMet). The performance of the majority of the K107 participants for all the measurands was very good, illustrating their ability to obtain accurate results for analytes such as electrolytes at mg kg-1 level, essential elements at µg kg-1 level and selenium species at µg kg-1 level in a complex biological fluid. The range of agreement between participants was within the interval of ± 0.1% for Ca and up to ± 1.8% for Fe. CMC claims based on total elements in this study may include other elements with similar core competencies (e.g. Se, Cu, Zn) in a wide range of biological materials (including liquids

  8. Patient-reported outcomes in patients who undergo total hip arthroplasty after periacetabular osteotomy.

    Science.gov (United States)

    Osawa, Yusuke; Hasegawa, Yukiharu; Seki, Taisuke; Takegami, Yasuhiko; Amano, Takafumi; Ishiguro, Naoki

    2017-11-26

    There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone. We performed a case-control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction. The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up. Previous PAO affects the quality of physical function in patients who undergo subsequent THA. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  9. Total Energy Recovery System for Agribusiness: Lake County study. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Fogleman, S.F.; Fisher, L.A.; Black, A.R.

    1978-04-01

    A brief summary is given of the results of a previously reported study designed to evaluate the costs and viability of combined thermodynamic and biologic cycles in a system known as the Total Energy Recovery System for Agribusiness (TERSA). This conceptual system involved the combined geothermally assisted activities of greenhouse crop and mushroom growing, fish farming, and biogas generation in an integrated biologic system such that the waste or by-products of each subsystem cycle were recovered to service input needs of companion cycles. An updated direct use geothermal system based on TERSA that is viable for implementation in Lake County is presented. Particular consideration is given to: location of geothermal resources, availability of land and irrigation quality water, compatibility of the specific direct use geothermal activities with adjacent and local uses. Private interest and opposition, and institutional factors as identified. Factors relevant to local TERSA implementation are discussed, followed by sites considered, selection criteria, site slection, and the modified system resulting. Particular attention is paid to attempt to make clear the process followed in applying this conceptual design to the specific task of realistic local implementation. Previous publications on geothermal energy and Lake County are referenced where specific details outside the scope of this study may be found. (JGB)

  10. Flexion reminder device to discourage recurrent posterior dislocation of a total hip replacement: a case report

    Directory of Open Access Journals (Sweden)

    Wong King

    2008-07-01

    Full Text Available Abstract Introduction Recurrent dislocation of a total hip replacement prosthesis is a frustrating complication for both the surgeon and the patient. For positional dislocations with no indications for revision surgery, the current best treatment is physiotherapy, the use of abduction braces and avoidance of unsafe hip positions. Abduction braces can be cumbersome and have poor compliance. We report the successful use of a new lightweight flexion reminder device that can be used to treat people with this condition. Case presentation A 64-year-old British woman experienced recurrent positional posterior dislocation after primary hip replacement, particularly when involved in activities involving unsafe flexion of the operated hip. She disliked using an abduction brace and hence was given a simple 'flexion reminder device' that could be strapped to the thigh. Beyond the safe flexion limit, the padded top end of the device hitched against the groin crease and reminded her not to flex further, to avoid dislocation. She experienced no discomfort in wearing the device continuously throughout the day and was very satisfied. She has had no further dislocations in the 2 years since she began using it. Conclusion In cases of arthroplasty dislocation caused mainly by an unsafe hip position, and with no indication for revision surgery, this new lightweight and easily worn flexion reminder device may be a good option for avoiding such positional dislocations, particularly those caused by unsafe flexion.

  11. Status report and measurement of total cross-sections at the Pohang Neutron Facility

    International Nuclear Information System (INIS)

    Kim, G.N.; Meaze, A.K.M.M.H.; Ahmed, H.

    2004-01-01

    We report the status of the Pohang Neutron Facility which consists of an electron linear accelerator, a water-cooled Ta target, and an 11-m time-of-flight path. It has been equipped with a four-position sample changer controlled remotely by a CAMAC data acquisition system, which allows simultaneous accumulation of the neutron time of flight spectra from 4 different detectors. It is possible to measure the neutron total cross-sections in the neutron energy range from 0.1 eV to 100 eV by using the neutron time of flight method. A 6 LiZnS(Ag) glass scintillator was used as a neutron detector. The neutron flight path from the water-cooled Ta target to the neutron detector was 10.81±0.02 m. The background level was determined by using notch-filters of Co, In, Ta, and Cd sheets. In order to reduce the gamma rays from Bremsstrahlung and those from neutron capture, we employed a neutron-gamma separation system based on their different pulse shapes. The present measurements are in general agreement with the evaluated data in ENDF/B-VI. The resonance parameters were extracted from the transmission data from the SAMMY fitting and compared with the previous ones. (author)

  12. How does scapula motion change after reverse total shoulder arthroplasty? - a preliminary report

    Directory of Open Access Journals (Sweden)

    Kim Myung-Sun

    2012-10-01

    Full Text Available Abstract Background Arm elevation is composed of glenohumeral and scapulothoracic motion. Many reports have addressed changes of scapular position across a spectrum of shoulder disease. However, no study has examined changes in scapular position after reverse total shoulder arthroplasty (RTSA. The purpose of this study was to evaluate the changes in scapular position after RTSA compared to patients’ contralateral, nonoperated shoulder. Methods Seven patients that underwent RTSA for cuff tear arthropathy from July 2007 to October 2008 were enrolled. The distance between the long axis of the thoracic spine and the inferior pole of the scapula (lateralization of the scapula was measured on shoulder A-P radiographs at 0 degrees (the neutral position and at 30, 60, 90, and 120 degrees of shoulder abduction. In addition, the angle between the long axis of the thoracic spine and medial border of the scapula was measured and compared with the patients’ contralateral shoulder. Results Scapulohumeral rhythm was 2.4:1 on the operated shoulder and 4.1:1 on the nonoperated, contralateral shoulder at 120 degrees of abduction. The distance between the line of the interspinous process of upper thoracic vertebra and the inferior pole of the scapula showed a negative slope at 0 to 30 degrees abduction on the operated side, but beyond 30 degrees of abduction, this distance showed a more sudden increase than in the contralateral shoulder. The angle between the vertical vertebral line and the scapular medial border also showed greater increase beyond 30 degrees abduction on the operated limb. Conclusions The pattern of scapular position after RTSA, was found to differ from that of the contralateral shoulder, and showed a more scapular upward rotation.

  13. FY 1984 annual report on the research and development of automatic sewing systems. Total systems; 1984 nendo jido hosei system no kenkyu kaihatsu seika hokokusho. Total system

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1985-03-01

    The automatic sewing system technique research association has been commissioned by the Agency of Industrial Science and Technology for (research and development of automatic sewing systems). This program covers R and D of the elementary techniques for total systems and sewing preparation/processing, sewing/assembling, cloth handling, and system management/control. This report describes the results of the R and D efforts for the total systems. For producing diversified products in small quantities, which is the object of this R and D program, the target is set to reduce processing time by at least 50% from the current level. The efforts to achieve this target by solving the problems involved therein are made from the side of developing FMS and FA procedures, and apparel side. The program for the former investigates the required functions of individual sub-systems that constitute the total system, to clarify the technical targets of the core elementary techniques for each sub-system. The program for the latter analyzes the sewing steps for producing diversified clothes types, specifications for automatic operation, integration, standardization and coding of the steps, and so on, based on the results of studies on basic apparel types. (NEDO)

  14. Migração de parafuso em artroplastia total do joelho: relato clínico Screw migration in total knee arthroplasty: case report

    Directory of Open Access Journals (Sweden)

    Fernando Fonseca

    2010-01-01

    Full Text Available As complicações das artroplastias totais do joelho devidas ao material implantado são raras, exceto o desgaste do polietileno. O relato de migração de parafusos dentro da articulação do joelho é muito raro. Os autores relatam a migração intra-articular de um parafuso de segurança do polietileno numa artroplastia total do joelho com sacrifício do ligamento cruzado posterior (ATJ tipo Performance; Biomet, Warsaw, IN que obrigou a nova cirurgia para remoção do parafuso, substituição do componente de polietileno e aplicação de novo parafuso de fixação.Complications in total knee arthroplasty directly related to the implanted material are rare, with the exception of polyethylene wear. Descriptions of screw migration into the joint cavity are very rare. The authors report an intra-articular migration of a polyethylene safety screw in a total knee arthroplasty, with sacrifice of the posterior cruciate ligament (ATJ Performance type; Biomet, Warsaw, IN requiring a new surgery to remove the screw, replace the polyethylene insert and insert a new fixation screw.

  15. Total Ionizing Dose Test Report for the UC1823A Pulse Width Modulator

    Science.gov (United States)

    Chen, Dakai; Forney, James

    2017-01-01

    The purpose of this study is to examine the total ionizing dose susceptibility for the UC1823A pulse width modulator manufactured by Texas Instruments, Inc. The part is suspected to be vulnerable to enhanced low dose rate sensitivity (ELDRS).

  16. Memo Clarifying Requirements and State Reporting Guidance to Transition to the Revised Total Coliform Rule

    Science.gov (United States)

    This memorandum provides guidance to primacy agencies with enforcement responsibility under the Safe Drinking Water Act (SDWA) concerning the requirements to transition public water systems (PWSs) from the Total Coliform Rule (TCR) to the RTCR

  17. Total hip arthroplasty for surgical management of advanced tuberculous hip arthritis: Case report

    OpenAIRE

    Tan, Shi Ming; Chin, Pak Lin

    2015-01-01

    Tuberculosis (TB) arthritis of the hip is a debilitating disease that often results in severe cartilage destruction and degeneration of the hip. In advanced cases, arthrodesis of the hip confers benefits to the young, high-demand and active patient. However, many of these patients go on to develop degenerative arthritis of the spine, ipsilateral knee and contralateral hip, necessitating the need for a conversion to total hip arthroplasty. Conversion of a previously fused hip to a total hip ar...

  18. Regressão refrativa total pós-LASIK: relato de caso Total refractive regression post-LASIK: case report

    Directory of Open Access Journals (Sweden)

    Patrícia Ioschpe Gus

    2005-06-01

    Full Text Available Os corticoesteróides podem aumentar a pressão intra-ocular quando administrados de maneira tópica, sistêmica e até mesmo inalatória. É rotina sua utilização após cirurgias refrativas para diminuir ou prevenir reação inflamatória. No presente relato, apresentamos o caso de uma paciente de 36 anos que, após duas semanas de cirurgia de LASIK para correção de miopia leve, teve regressão total da miopia causada pela hipertensão ocular cortisônica. O objetivo desse relato é descrever como foi conduzido o caso, as hipóteses de diagnósticos que foram levantadas, e salientar a importância da mensuração da pressão intra-ocular no pós-operatório.Corticosteroids can increase intraocular pressure when administered topically, systemically and even when inhaled. They are routinely used after refractive surgeries to lower or prevent an inflammatory action. In this case history, we present a 36-year-old patient who had a total myopic regression two weeks after LASIK for low myopia, caused by steroid-induced ocular hypertension. The purpose of this report is to describe how the case was managed, the diagnostic hypothesis, and to stress the importance of intraocular pressure measurement after LASIK.

  19. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

    Science.gov (United States)

    Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

  20. INCIDENTALOMA FOUND IN A METAL-ON-METAL REVISION TOTAL HIP ARTHROPLASTY: A CASE REPORT.

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2014-04-01

    Full Text Available Metal-on-metal coupling in total hip replacements has traditionally been a valid alternative to other total hip bearings for young adults and very active elderly patients. Unfortunately, clinical experience has revealed that the difference in strength between the titanium alloy stem and the cobalt alloy-bearing surface leads to a conflict between the acetabular component and the head, which inturn leads to abnormal wear and osteolysis. The major problems are osteolysis, metal ion intoxication, potential genome toxicity, neoplasms, allergies and implant failure. The authors present an incidental finding of a pseudotumour of the external rotators of the hip in a total hip replacement (THR revision in a 68 year old female patient.

  1. Patient reported allergies are a risk factor for poor outcomes in total hip and knee arthroplasty.

    Science.gov (United States)

    Graves, Christopher M; Otero, Jesse E; Gao, Yubo; Goetz, Devon D; Willenborg, Melissa D; Callaghan, John J

    2014-09-01

    We evaluated 459 patients undergoing THA or TKA who completed preoperative and postoperative WOMAC and/or SF36 surveys. Medical comorbidities and reported allergies were also recorded. Evaluation of surveys was compared for patients with or without 4 or more reported allergies using statistical methods. Patients with 4 or more reported allergies had less improvement on SF36 Physical Component Score (∆PCS=4.2) than those with 0-3 allergies (∆PCS=10.0, P=0.0002). Regression analysis showed that this change was independent of self-reported comorbidities. Patients reporting 4 or more allergies also had less improvement in WOMAC function (∆F=21.4) than those with 0-3 allergies (∆F = 27.2, P=0.036). Similar nonsignificant trends occurred in SF36 mental and WOMAC pain and stiffness scores. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Incorporating Total Quality Management in an Engineering Design Course. Report 5-1993.

    Science.gov (United States)

    Wilczynski, V.; And Others

    One definition of creativity is the conviction that each and every existing idea can be improved. It is proposed that creativity in an engineering design process can be encouraged by the adoption of Total Quality Management (TQM) methods based on a commitment to continuous improvement. This paper addresses the introduction and application of TQM…

  3. Summary of the clinical use of the Symbion total artificial heart: a registry report.

    Science.gov (United States)

    Johnson, K E; Prieto, M; Joyce, L D; Pritzker, M; Emery, R W

    1992-01-01

    Several models of total artificial hearts have been used for transient or permanent circulatory support in patients with decompensation. The most successful and widely used device, however, has been the Symbion total artificial heart. From Dec. 12, 1982, to Jan. 1, 1991, 180 Symbion total artificial hearts were implanted in 176 patients in 28 centers. Five patients received a Symbion total artificial heart as a permanent circulatory support device, whereas 171 patients received the device as a bridge to heart transplantation. Of the 175 bridge devices (171 patients) 141 were Symbion J7-70 hearts and 34 were Symbion J7-100 hearts. Four patients received two total artificial hearts, the second one after the failure of a transplanted heart because of either rejection (two patients) or donor heart failure (2 patients). Most of the recipients were males (152). The age was 42 +/- 12 years (mean +/- SD) with a weight of 74 +/- 14 kg. The most common indications for implantation included deterioration while awaiting heart transplant (36%) and acute cardiogenic shock (32%). The cause of heart disease was primarily ischemic (52%) and idiopathic (35%) cardiomyopathy. Duration of implantation ranged from 0 to 603 days (mean 25 +/- 64 days). One hundred three (60%) patients had the device less than 2 weeks, 37 (22%) between 2 to 4 weeks and 31 (18%) more than 4 weeks. Complications during implantation included infection (37%), thromboembolic events (stroke 7%, transient ischemic attack 4%), kidney failure requiring dialysis (20%), bleeding requiring intervention (26%), and device malfunction (4%). Of the 171 patients, 118 (69%) underwent orthotopic heart transplantation. Actuarial survival for all patients with implants was 62% for 30 days and 42% for 1 year, and for patients with transplants was 72% for 30 days and 57% for 1 year. The main causes of death were sepsis (33%), multiorgan failure (21%), and posttransplant rejection (10%). The results indicate a relative success of

  4. Estimating Radiation Risk from Total Effective Dose Equivalent (TEDE) – ISCORS Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2003-01-01

    The Interagency Steering Committee on Radiation Standards (ISCORS) recently issued guidance on calculating radiation risk estimates from dose. An EH-41 Information Brief discussing the method and the ISCORS technical report, “A Method for Estimating Radiation Risk from TEDE,” are attached. Exposure-to-risk estimates have been tabulated in a 1999 report, Cancer Risk Coefficients for Environmental Exposure to Radionuclides, Federal Guidance Report No. 13. This report was distributed within DOE previously for limited review and comment and it is now available on the EH-41 web site: http://www.eh.doe.gov/oepa. Although the approach used in Federal Guidance Report # 13 is more appropriate for circumstances where a radiation risk assessment is required than the dose-to-risk approach in the attached report, it is applicable only when the intake of an inhaled or ingested radionuclide is known or the radionuclide concentration in air, water or on the ground is known. In many cases, doses (specifically the TEDE) are calculated directly from computer codes and estimates of the intake or radionuclide concentrations are not directly available. The attached document is intended to facilitate the estimation of risk in those situations where dose (TEDE) is calculated directly.

  5. Institutional applications of solar total-energy systems. Draft final report. Volume 2. Appendixes

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-07-01

    The appendices present the analytical basis for the analysis of solar total energy (STE) systems. A regional-climate model and a building-load requirements model are developed, along with fuel-price scenarios. Life-cycle costs are compared for conventional-utility, total energy, and STE systems. Thermal STE system design trade-offs are performed and thermal STE system performance is determined. The sensitivity of STE competitiveness to fuel prices is examined. The selection of the photovoltaic array is briefly discussed. The institutional-sector decision processes are analyzed. Hypothetical regional back-up rates and electrical-energy costs are calculated. The algorithms and equations used in operating the market model are given, and a general methodology is developed for projecting the size of the market for STE systems and applied to each of 8 institutional subsectors. (LEW)

  6. Arthroscopic Repair of Recurrent Posterior Shoulder Subluxation After Total Shoulder Arthroplasty: A Case Report.

    Science.gov (United States)

    Grieshaber-Bouyer, Ricardo; Gerber, Christian

    2017-01-01

    A 53-year-old man presented with osteoarthritis (Walch biconcave [B2] glenoid retroversion, 22°; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. Following anatomic total joint replacement, he developed disabling recurrent posterior subluxation despite a stable prosthesis and a correctly centered glenoid head, as observed with postoperative radiography and computed tomography. In order to avoid bone loss and the complications associated with revision arthroplasty, we performed arthroscopic reefing of the posterior capsule as an experimental minimally invasive treatment. The reduction in capsular volume successfully stabilized the shoulder for approximately 9 years; thereafter, the recurrence of instability ultimately required the conversion to a reverse prosthesis. Arthroscopic capsular reefing proved to be an effective treatment for posterior shoulder subluxations after total shoulder arthroplasty, and can be considered to avoid revision arthroplasty in young patients with a stable and correctly centered prosthesis.

  7. Total Ionizing Dose Test Report BFR92A NPN 5 GHz Wide Band Transistor from NXP

    Science.gov (United States)

    Phan, Anthony M.; Oldham, Timothy R.

    2011-01-01

    The purpose of this test was to characterize the Philips/NXP BFR92A NPN 5 gigahertz wide band silicon transistor for total dose response. This test shall serves as the radiation lot acceptance test (RLAT) for the lot date code (LDC) 1027. The BFR92A is packaged in a 3-pin plastic SOT23 package. Low dose rate (LDR/ELDRS) irradiations was performed.

  8. Total Intravenous Anesthesia for Repair of Congenital Diaphragmatic Hernia: A Case Report

    Directory of Open Access Journals (Sweden)

    Hung-Te Hsu

    2004-09-01

    Full Text Available Congenital diaphragmatic hernia is a cardiopulmonary anomaly that causes severe respiratory disorder. Traditionally, inhalational anesthetics with mechanical hyperventilation, opioids, and muscle relaxants are used in anesthesia for repair surgery. In this case, we used total intravenous anesthesia combined with high-frequency oscillatory ventilation and inhaled nitric oxide for surgical repair of the diaphragm. After surgery, the patient recovered well and was discharged from hospital 1 month later.

  9. Anterior Subluxation after Total Hip Replacement Confirmed by Radiographs: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Conor P. McGrory

    2011-01-01

    Full Text Available Demonstrable anterior subluxation of the femoral head after a total hip arthroplasty is a rare complication and is usually transient. Both a case of recurrent subluxation and a case of chronic subluxation are described in this paper, each one presenting with unexpected femoral head eccentricity in the acetabulum on radiograph. We show how this unusual complication can be successfully identified and treated.

  10. Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients.

    Science.gov (United States)

    Alcobía-Díaz, B; Lópiz, Y; García-Fernández, C; Rizo de Álvaro, B; Marco, F

    Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Mid-South solar total energy: institutional analysis. Final report, May 1, 1978-December 31, 1979

    Energy Technology Data Exchange (ETDEWEB)

    Powe, R.E.; Carley, C.T.; Forbes, R.E.; Johnson, L.R.; Stiffler, A.K.; Hodge, B.K.; Bouchillon, C.W.

    1979-01-01

    A comprehensive survey was undertaken to determine the current usage of energy by the Mississippi State University, considering electricity and fuel separately. A variety of individual components likely to be employed in total energy systems are then considered in detail, including: solar assisted space heating system, space cooling system design, solar electric system, flat plate solar collector system, central solar receiver, and geothermal heat pump system. Also, algorithms have been developed for the approximate prediction of building heating and cooling loads based on gross parameters such as floor area, type of wall construction, etc. System considerations and evaluation are then presented. (LEW)

  12. Spontaneous resolution of posterior ankle joint loose bodies after total ankle replacement: A case report.

    Science.gov (United States)

    Lee, Raymond P; Cheng, Sally H S

    2017-06-01

    Late stage ankle osteoarthritis often presents with debilitating pain. It is common to find osteophytes and loose body formation around the joint. Total ankle arthroplasty can preserve joint mobility and pain relieve for such patient. However, when trying to remove the osteophytes and loose bodies at the posterior ankle joint, there is risk of damaging posterior structures such as the neurovascular bundle during the procedure. We are presenting a case where the posterior loose bodies remained untouched during the operation, and patient showed spontaneous resolution of the lesions with time. Patient enjoyed good function outcome after the surgery. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  13. [Post total laryngectomy stomal recurrence. Case report and review of the literature].

    Science.gov (United States)

    Reséndiz-Colosia, Jaime Alonso; Gallegos-Hernández, José Francisco; Hernández-San Juan, Martín; Barroso-Bravo, Sinuhé; Flores-Díaz, Rutilio

    2003-01-01

    Development of stomal recurrence following total laryngectomy is a devastating scenario with an extremely poor prognosis. Overall rate of stomal recurrence ranges from 1.7%-40%, with an average rate of 7.5%. Irrespective of the etiology of stomal recurrence, it invariably consists of diffuse infiltration of tumor into the soft tissues of the neck and mediastinum, thereby making control of the disease difficult. Despite aggresive surgery, radiotherapy, and chemotherapy, salvage rate is poor. Prevention of stomal recurrence is therefore of paramount importance and the only means of reducing incidence. Systematic use of preventive surgical measures together with postoperative radiotherapy to the stoma and superior mediastinum have led to decrease in appearance of stomal recurrence. Intensive follow-up should be performed for patients with laryngeal carcinoma who had subglottic involvement, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.

  14. [Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases].

    Science.gov (United States)

    Tang, J; Lv, M; Zhou, Y X; Zhang, J

    2017-04-18

    To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA). We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed. We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (Ptechnique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral DAA THA.

  15. Anestesia venosa total em paciente portador de Osteogênesis imperfecta: relato de caso Anestesia venosa total en paciente portador de Osteogénesis imperfecta: relato de caso Total intravenous anesthesia in Osteogenesis imperfecta patient: case report

    Directory of Open Access Journals (Sweden)

    José Francisco Nunes Pereira das Neves

    2004-10-01

    ón fue monitorizado con ECG, FC, PANI y SpO2 y sometido a anestesia general venosa total con propofol, alfentanil y cisatracúrio. Después de IOT, fue acrecentada monitorización de la P ET CO2 y de la temperatura esofágica. En el período intra-operatorio y en la sala de recuperación pos-anestésica no presentó complicaciones. Tuvo alta hospitalar en el 5º día de post operatorio. CONCLUSIONES: El presente relato mostró una buena evolución intra y post operatoria de paciente con Osteogenesis Imperfecta sometido a anestesia general venosa total. La complexidad de la enfermedad mostró la necesidad de evaluación y monitorización adecuada por el anestesiologista.BACKGROUND AND OBJECTIVES: Osteogenesis Imperfecta is an uncommon genetic connective tissue disease with prevalence of 1/10000, primarily involving endochondral ossification, resulting in brittle bones, multiple fractures and skeletal deformities. This article aimed at reporting a case of Osteogenesis Imperfecta patient submitted to total intravenous anesthesia for fractured femur surgical repair. CASE REPORT: Male patient, 15 years old, 41 kg, 140 cm, with history of Osteogenesis Imperfecta and cardiopathy, scheduled for fractured femur surgical repair. In the operating room patient was monitored with ECG, HR, NIBP and SpO2 and was submitted to total intravenous anesthesia with propofol, alfentanil and cisatracurium. Monitoring of P ET CO2 and esophageal temperature was introduced after TI. There have been no complications both in the intraoperative period and in the post-anesthetic care unit. Patient was discharged 5 days later. CONCLUSIONS: This report has shown satisfactory intra and postoperative evolution of Osteogenesis Imperfecta patient submitted to total intravenous general anesthesia. Disease complexity has shown the need for anesthesiologist’s adequate evaluation and monitoring.

  16. [Total A-V block due to tuberous sclerosis. A case report].

    Science.gov (United States)

    Valente, N; Guidugli Neto, J; De Paola, A A; Pimenta, J

    1989-10-01

    Tuberous sclerosis is a neurologic disease affecting various organs with a triade: sebaceum adenoma, mental retardation and seizures. This report presents a case of a patient with tuberous sclerosis and third degree A-V block with complete invasive and non-invasive evaluation. The patient had sincope and complete A-V block with QRS complexes showing right bundle branch block morphology. The echocardiogram showed dilated cardiomyopathy with diffuse left ventricular dysfunction and had normal coronary arteriography. The eletrophysiologic evaluation showed complete infra-hisian A-V block and QRS with left bundle branch block pattern with normal sinus nodal and A-V nodal function. It was not possible to induce ventricular tachtyarrhythmias up to two extrastimuli. Histologic study showed normal myocardium under light and electronic microscopy. After permanent VVI pacemaker implant, the patient in follow-up for 16 years. This case seems to be the first in the international medical literature of tuberous sclerosis with complete heart block.

  17. SECTIONAL MANDIBULAR COMPLETE DENTURE FOR A TOTAL MAXILLECTOMY PATIENT WITH TRISMUS: A CLINICAL REPORT

    Directory of Open Access Journals (Sweden)

    Tamer ÇELAKIL

    2017-10-01

    Full Text Available This report presents the case of a 60-year-old male patient with trismus induced by radiotherapy and fabrication of a sectional mandibular complete denture to allow the insertion of the denture into the mouth. A mandibular sectional denture was designed in two pieces with a locking mechanism by using mini anchor and ball abutment housing with cap. Patients who have undergone maxillectomy often have constricted mouth openings, as a result of surgical intervention and radiotherapy, and complain of an inability to insert or remove dentures. A new approach is vital for sectional dentures because existing sectional denture fabrication techniques cannot meet the ongoing needs of trismus patients. The mini anchor system with ball abutment housing has better mechanical retention in acrylic resin and can provide favorable stabilization during masticatory function; thus, additional framework is not required for assisting in stabilization and retention.

  18. Sectional mandibular complete denture for a total maxillectomy patient with trismus: a clinical report.

    Science.gov (United States)

    Celakil, Tamer; Demir, Azize; Keskin, Haluk

    2017-01-01

    This report presents the case of a 60-year-old male patient with trismus induced by radiotherapy and fabrication of a sectional mandibular complete denture to allow the insertion of the denture into the mouth. A mandibular sectional denture was designed in two pieces with a locking mechanism by using mini anchor and ball abutment housing with cap. Patients who have undergone maxillectomy often have constricted mouth openings, as a result of surgical intervention and radiotherapy, and complain of an inability to insert or remove dentures. A new approach is vital for sectional dentures because existing sectional denture fabrication techniques cannot meet the ongoing needs of trismus patients. The mini anchor system with ball abutment housing has better mechanical retention in acrylic resin and can provide favorable stabilization during masticatory function; thus, additional framework is not required for assisting in stabilization and retention.

  19. Salmonella typhimurium infection in total knee arthroplasty: A case report with review of literature

    Science.gov (United States)

    Sebastian, Sujeesh; Dhawan, Benu; Malhotra, Rajesh; Gautam, Deepak; Kapil, Arti

    2017-01-01

    Salmonella enterica serotype Typhimurium is a rare cause of prosthetic joint infection (PJI). The recognized predisposing risk factors for Salmonella septic arthritis include diabetes mellitus, renal failure, human immunodeficiency virus infection and chronic corticosteroid use. We describe a case of PJI of the knee in a 74-year-old lady who was on antitubercular treatment. The patient presented with discharging sinus and raised inflammatory markers. She was successfully treated by the removal of prosthesis and debridement followed by ciprofloxacin therapy for 6 weeks. This case report highlights the potential virulence of Salmonella in immunocompromised patient with a joint prosthesis. Continuous monitoring and close collaboration of microbiologists and orthopedicians helped obtain the resolution of infection in our patient. PMID:28706395

  20. Salmonella typhimurium infection in total knee arthroplasty: A case report with review of literature

    Directory of Open Access Journals (Sweden)

    Sujeesh Sebastian

    2017-01-01

    Full Text Available Salmonella enterica serotype Typhimurium is a rare cause of prosthetic joint infection (PJI. The recognized predisposing risk factors for Salmonella septic arthritis include diabetes mellitus, renal failure, human immunodeficiency virus infection and chronic corticosteroid use. We describe a case of PJI of the knee in a 74-year-old lady who was on antitubercular treatment. The patient presented with discharging sinus and raised inflammatory markers. She was successfully treated by the removal of prosthesis and debridement followed by ciprofloxacin therapy for 6 weeks. This case report highlights the potential virulence of Salmonella in immunocompromised patient with a joint prosthesis. Continuous monitoring and close collaboration of microbiologists and orthopedicians helped obtain the resolution of infection in our patient.

  1. A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Fujio

    Full Text Available Introduction: Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA pseudoaneurysm following total remnant pancreatectomy. Presentation of case: A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. Discussion: To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Conclusion: Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable. Abbreviations: PPH, RHA, CT, IPMC, RCCs, POD, LHA, GIE, TAE, Keywords: Case report, Pseudoaneurysm, Total

  2. A Case Report of Dramatically Increased Thyroglobulin after Lymph Node Biopsy in Thyroid Carcinoma after Total Thyroidectomy and Radioiodine

    Directory of Open Access Journals (Sweden)

    Mandana Moosavi

    2016-01-01

    Full Text Available Thyroglobulin (Tg is an important modality for monitoring patients with thyroid cancers, especially after thyroidectomy followed by radioiodine (RAI. It is also used as a marker for burden of thyroid tissue whether malignant or benign. Although there have been several reports of rising serum Tg transiently after thyroid biopsy in intact glands and following palpation or trauma, there are no reports in the literature of elevation in Tg after biopsy of suspicious lesions in thyroidectomized patients. In this paper we report a fascinating case of a considerable and initially worrying, although ultimately transient, rise in Tg in a patient 2 years after total thyroidectomy and RAI ablation after fine needle aspiration (FNA of a suspicious thyroid bed nodule that was proven positive.

  3. Natural conception following total fertilization failure with intracytoplasmic sperm injection in a couple with unexplained infertility: a case report.

    Science.gov (United States)

    Codreanu, Dorina; Coricovac, Anca; Mirzan, Luminita; Dracea, Laura; Marinescu, B; Boleac, I

    2013-01-01

    With the introduction of intracytoplasmic sperm injection (ICSI), couples with severe male factor infertility have been able to achieve fertilization and clinical pregnancy rates comparable to other in vitro fertilization patients. However, despite the utilization of microsurgical sperm injection techniques, failure of fertilization still occurs in a few patients. How such fertilization failure after ICSI might impact later ICSI treatments is less understood. We report a case of total fertilization failure after ICSI using sperm from a normozoospermic husband of a patient with unexplained infertility. Six months after the cancelled cycle, the couple conceived naturally. Unfortunately, it was an ectopic pregnancy, which required laparoscopy and surgical removal of the right fallopian tube. This case shows that a failed ICSI cycle, therefore, does not imply a hopeless prognosis for future ICSI treatment. Moreover, in cases with unexplained ICSI failure, natural conception can subsequently occur. The aim of this study is two-fold: to discuss a rare case of a spontaneous pregnancy after total fertilization failure with ICSI and to develop counseling material for patients and doctors who are faced with such a rare situation. To our knowledge, this is the first report of a case of spontaneous pregnancy after total fertilization failure with ICSI.

  4. St. Francis Rain Garden Water Quality Sampling Interim Data Report; Total Nitrogen, Total Phosphorus, Sediments or Solids, and E. Coli for the period April to June, 2014

    Science.gov (United States)

    This interim data reported is being provided per request to the Metropolitan Sewer District (MSD) to provide summary statistics on a limited set of water quality parameters as measured at the St. Francis Rain Garden site in the Lick Run Valley as it pertains to MSD's Project Grou...

  5. Total energy cycle assessment of electric and conventional vehicles: an energy and environmental analysis. Volume 1: technical report

    Energy Technology Data Exchange (ETDEWEB)

    Cuenca, R.; Formento, J.; Gaines, L.; Marr, B.; Santini, D.; Wang, M. [Argonne National Lab., IL (United States); Adelman, S.; Kline, D.; Mark, J.; Ohi, J.; Rau, N. [National Renewable Energy Lab., Golden, CO (United States); Freeman, S.; Humphreys, K.; Placet, M. [Pacific Northwest National Lab., Richland, WA (United States)

    1998-01-01

    This report compares the energy use, oil use and emissions of electric vehicles (EVs) with those of conventional, gasoline-powered vehicles (CVs) over the total life cycle of the vehicles. The various stages included in the vehicles` life cycles include vehicle manufacture, fuel production, and vehicle operation. Disposal is not included. An inventory of the air emissions associated with each stage of the life cycle is estimated. Water pollutants and solid wastes are reported for individual processes, but no comprehensive inventory is developed. Volume I contains the major results, a discussion of the conceptual framework of the study, and summaries of the vehicle, utility, fuel production, and manufacturing analyses. It also contains summaries of comments provided by external peer reviewers and brief responses to these comments.

  6. Locally recurrent rectal cancer successfully treated by total pelvic exenteration with combined ischiopubic rami resection: report of a case.

    Science.gov (United States)

    Uehara, Keisuke; Yoshioka, Yuichiro; Taguchi, Yoshiro; Igami, Tsuyoshi; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Tsukushi, Satoshi; Nishida, Yoshihiro; Yoshino, Yasushi; Nagino, Masato

    2012-01-01

    A combined ischiopubic rami resection is extremely rare in the field of gastroenterologic surgery. We report a case of a locally recurrent rectal cancer that was successfully treated by total pelvic exenteration with combined ischiopubic rami resection. A 58-year-old male with locally recurrent rectal cancer and liver metastases was referred to our hospital. Computed tomography and magnetic resonance imaging showed a perineal tumor, which had invaded the prostate, urethra, and obturator internus muscle, and two liver metastases. Because the perineal tumor was very close to the dorsal vein complex and the pubic symphysis, it was considered difficult to approach and divide the dorsal vein complex, and still retain oncologic safety. To achieve R0 resection, total pelvic exenteration with ischiopubic rami resection, total emasculation and partial liver resection were performed. Pathological examination revealed that surgical margins were negative for cancer cells. Although reconstruction of the pelvic ring was not performed, his ambulatory function had recovered to an almost normal status at 6 months after the operation.

  7. Variability in the reported energy, total fat and saturated fat contents in fast-food products across ten countries.

    Science.gov (United States)

    Ziauddeen, Nida; Fitt, Emily; Edney, Louise; Dunford, Elizabeth; Neal, Bruce; Jebb, Susan A

    2015-11-01

    Fast foods are often energy dense and offered in large serving sizes. Observational data have linked the consumption of fast foods to an increased risk of obesity and related diseases. We surveyed the reported energy, total fat and saturated fat contents, and serving sizes, of fast-food items from five major chains across ten countries, comparing product categories as well as specific food items available in most countries. MRC Human Nutrition Research, Cambridge, UK. Data for 2961 food and drink products were collected, with most from Canada (n 550) and fewest from the United Arab Emirates (n 106). There was considerable variability in energy and fat contents of fast foods across countries, reflecting both the portfolio of products and serving size variability. Differences in total energy between countries were particularly noted for chicken dishes (649-1197 kJ/100 g) and sandwiches (552-1050 kJ/100g). When comparing the same product between countries variations were consistently observed in total energy and fat contents (g/100 g); for example, extreme variation in McDonald's Chicken McNuggets with 12 g total fat/100 g in Germany compared with 21·1 g/100 g in New Zealand. These cross-country variations highlight the possibility for further product reformulation in many countries to reduce nutrients of concern and improve the nutritional profiles of fast-food products around the world. Standardisation of serving sizes towards the lower end of the range would also help to reduce the risk of overconsumption.

  8. Fort Hood Solar Total Energy Project. Volume II. Preliminary design. Part 2. System performance and supporting studies. Final report

    Energy Technology Data Exchange (ETDEWEB)

    None,

    1979-01-01

    The preliminary design developed for the Solar Total Energy System to be installed at Fort Hood, Texas, is presented. System performance analysis and evaluation are described. Feedback of completed performance analyses on current system design and operating philosophy is discussed. The basic computer simulation techniques and assumptions are described and the resulting energy displacement analysis is presented. Supporting technical studies are presented. These include health and safety and reliability assessments; solar collector component evaluation; weather analysis; and a review of selected trade studies which address significant design alternatives. Additional supporting studies which are generally specific to the installation site are reported. These include solar availability analysis; energy load measurements; environmental impact assessment; life cycle cost and economic analysis; heat transfer fluid testing; meteorological/solar station planning; and information dissemination. (WHK)

  9. Bilateral Simultaneous Revision Total Knee Arthroplasty as a Single Staged Procedure: A Case Report and Review of Literature.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Jaiswal, Chirag; Vijay, Vipul; Vaish, Abhishek

    2017-03-23

    Bilateral revision total knee arthroplasty (TKA) is a surgical procedure, which is rarely done simultaneously as it is a difficult surgery and the safety of simultaneous bilateral single stage surgery remains unknown. We report a case of a 67-year-old woman who presented to us with bilateral painful and unstable TKA (right > left) of six months duration. The primary bilateral TKA were done 14 years ago. Bilateral simultaneous revision TKA was performed, using cemented, constrained, long-stem prostheses. The intraoperative and postoperative periods remained uneventful. At last follow-up at four years, she had a pain-free range of motion of up to 0-115°, and the patient had returned to the activities of daily living. She had stable knees with good function and no evidence of loosening or wear.

  10. Mid-south solar total energy institutional analysis. Semi-annual technical progress report, December 1978-May 1979

    Energy Technology Data Exchange (ETDEWEB)

    Powe, R.E.; Carley, C.T.; Forbes, R.E.; Johnson, L.R.

    1979-07-31

    During this reporting period a variety of individual components likely to be employed in total energy systems at Mississippi State University have been considered in detail. Also, algorithms have been developed for the approximate prediction of building heating and cooling loads based on gross parameters such as floor area, type of wall construction, etc. A comprehensive survey was undertaken to determine the current usage of energy by the university and correlation equations were used to project consumption rates for the next few years. The development of an algorithm for heating and cooling load calculations is described. Design and specifications are given for a solar-assisted space heating system, a solar air conditioning system, and a 1-MWe solar thermal power plant for the university. Flat-plate collectors for space heating or water heating at the MSU campus are assessed. Also the possibility of exploiting low-grade geothermal energy near MSU using heat pumps for space heating is discussed.

  11. Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sarkhell Radha

    2013-01-01

    Full Text Available Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR. The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation.

  12. Solar total energy-large scale experiment, Shenandoah, Georgia site. Annual report, June 1977--June 1978. [For Bleyle Knitwear Plant

    Energy Technology Data Exchange (ETDEWEB)

    None,

    1978-06-01

    The site was described in terms of location, suitably, accessibility, and other factors. Detailed descriptions of the Solar Total Energy-Large Scale Experiment Application (STE-LSE) (Bleyle of America, Inc., Knitwear Plant), the DOE owned Meteorology Station operating at the site, and the instrumentation provided by the Georgia Power Company to measure energy usage within the knitwear plant are included. A detailed report of progress is given at the Shenandoah Site, introduced by the STE-LSE schedule and the Cooperative Agreement work tasks. Progress is described in terms of the following major task areas: site/application; instrumentation/data acquisition; meteorology station; site to STES interface; information dissemination. A brief overview of milestones to be accomplished is given, followed by these appendices: solar easement agreement, interface drawing set, and additional site background data. (MHR)

  13. Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital.

    Science.gov (United States)

    Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Huang, Susan S

    2013-11-01

    Public reporting of surgical site infections (SSIs) by hospitals is largely limited to infections detected during surgical hospitalizations or readmissions to the same facility. SSI rates may be underestimated if patients with SSIs are readmitted to other hospitals. We assessed the impact of readmissions to other facilities on hospitals' SSI rates following primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). This was a retrospective cohort study of all patients who underwent primary THA or TKA at California hospitals between 1 January 2006 and 31 December 2009. SSIs were identified using ICD-9-CM diagnosis codes predictive of SSI assigned at any California hospital within 365 days of surgery using a statewide repository of hospital data that allowed tracking of patients between facilities. We used statewide data to estimate the fraction of each hospital's THA and TKA SSIs identified at the operative hospital versus other hospitals. A total of 91 121 THA and 121 640 TKA procedures were identified. Based on diagnosis codes, SSIs developed following 2214 (2.3%) THAs and 2465 (2.0%) TKAs. Seventeen percent of SSIs would have been missed by operative hospital surveillance alone. The proportion of hospitals' SSIs detected at nonoperative hospitals ranged from 0% to 100%. Including SSIs detected at nonoperative hospitals resulted in better relative ranking for 61% of THA hospitals and 61% of TKA hospitals. Limiting SSI surveillance to the operative hospital caused varying degrees of SSI underestimation and substantially impacted hospitals' relative rankings, suggesting that alternative methods for comprehensive postdischarge surveillance are needed for accurate benchmarking.

  14. Early loosening and secondary dislocation due to a broken trochanteric osteotomy wire following a Charnley total hip arthroplasty: a case report

    OpenAIRE

    Shahin, Yousef; Choudhary, Rakesh; Al-Naser, Saeed; Mullins, Mark

    2009-01-01

    We report a case of interposition of a broken trochanteric wire in the hip joint. This caused early wear of the prosthesis and dislocation of the Charnley total hip arthroplasty. The patient was treated with a revision total hip arthroplasty. This rare complication should be taken into consideration when performing a trochanteric osteotomy fixation with wiring in Charnley total hip arthroplasty.

  15. Heterotopic Mesenteric Ossification After Total Colectomy for Bleeding Diverticulosis of the Colon—A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Huang-Jen Lai

    2007-01-01

    Full Text Available Heterotopic bone formation within an abdominal incision is a rare sequela of abdominal surgery. Only a few previous reports have noted heterotopic ossification in the mesentery of the small intestine and periileostomy. Here, we report the case of a 60-year-old man who underwent emergent laparotomy and total colectomy with end ileostomy and developed this condition 1 month postoperatively. Heterotopic ossification in the peri-ileostomy tissue caused stenosis of the ileostoma. Laparotomy for re-anastomosis due to a large bone formation at an abdominal midline scar is very difficult and results in a massive abdominal wall defect. Therefore, we used a lower transverse incision to avoid the site of bone formation and resected the terminal ileum with its ossified mesentery. Then, we successfully carried out an anastomosis between the ileum and the rectum. The possible pathogenesis is a metaplastic mechanism of differentiation of immature multipotent mesechymal cells. Our case provides the experience of treatment and new perspective on currently held hypotheses of heterotopic bone formation. [J Formos Med Assoc 2007;106(2 Suppl:S32-S36

  16. Minimally Invasive Total Hip Replacement in an Ipsilateral Post-traumatic above-knee Amputation: A Case Report.

    Science.gov (United States)

    Patnaik, Sanjeev; Nayak, Biswaranjan; Sahoo, Akshaya Kumar; Sahu, Nabin Kumar

    2017-01-01

    Total hip replacement (THR) is a highly successful operation in alleviating pain and improving the overall function of the hip, in end-stage arthritis of the hip, in otherwise fit patients. However, THR as a surgical option in post-traumatic hip arthritis with ipsilateral above-knee amputation is rarely reported. We are presenting a case report of a 30-year-old male, who had previously underwent an above-knee amputation due to road-traffic accident, presenting 24 h after the injury with segmental fracture femur and popliteal artery laceration, for which the limb could not be salvaged. He had an impacted anteroinferior dislocation of the ipsilateral hip with significant cartilage damage of the femoral head which required open reduction. Subsequently, he developed traumatic arthritis of the involved hip which required conversion to an uncemented THR, using a minimally invasive (MIS) anterolateral approach. The preoperative management, surgical technique, and postoperative rehabilitation are described to highlight the technical challenges, these lower limb amputees may present along with review of literature of such rare cases. THR in an above-knee amputee with posttraumatic hip arthritis using MIS technique is an encouraging surgical option for early functional recovery and minimizing surgical complications.

  17. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  18. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: report of 14 cases.

    Science.gov (United States)

    Iglesias, Martin; Gonzalez-Chapa, Diego R

    2013-08-01

    Some authors have mentioned that the endoscopic harvesting of the latissimus dorsi muscle flap for breast reconstruction is an uncommon technique that has been abandoned due to its technical complexity. Therefore, its use for immediate breast reconstruction after skin-sparing total mastectomies is reported for only a few patients, without clinical images of the reconstructed breast or of the donor site. This report describes 14 breast reconstructions using the aforementioned approach, with the latissimus dorsi muscle flap harvested by endoscopy plus the insertion of a breast implant in a single surgical procedure. The objective is to show images of the long-range clinical aesthetic results, both in the reconstructed breast and at the donor site as well as the complications so the reader can evaluate the advantages and disadvantages of the technique. From 2008 to 2011, 12 women who experienced skin-sparing total mastectomy and 2 women who underwent modified radical mastectomy were reconstructed using the aforementioned technique. The average age was 42 years (range 30-58 years), and the average body mass index was 29 kg/m(2) (range 22-34 kg/m(2)). Three patients were heavy smokers: one had undergone a previous abdominoplasty; one had hepatitis C; and one had undergone massive weight loss. Immediate reconstructions were performed for 11 patients, and 3 reconstructions were delayed. The implant volume ranged from 355 to 640 ml. The average endoscopic harvesting time was 163.5 min (range 120-240 min), and the average bleeding was 300 ml. Four patients experienced seromas at the donor site. Acceptance of the reconstructed breast was good in six cases, moderate in seven cases, and poor in one case. Acceptance of the donor site was good in 13 cases and moderate for 1 case. Endoscopic harvesting of the latissimus dorsi muscle has technical difficulties that have limited its acceptance. However, this technique offers the same quality of breast reconstruction as the

  19. Estimating the reproductive number, total outbreak size, and reporting rates for Zika epidemics in South and Central America

    Directory of Open Access Journals (Sweden)

    Deborah P. Shutt

    2017-12-01

    Full Text Available As South and Central American countries prepare for increased birth defects from Zika virus outbreaks and plan for mitigation strategies to minimize ongoing and future outbreaks, understanding important characteristics of Zika outbreaks and how they vary across regions is a challenging and important problem. We developed a mathematical model for the 2015/2016 Zika virus outbreak dynamics in Colombia, El Salvador, and Suriname. We fit the model to publicly available data provided by the Pan American Health Organization, using Approximate Bayesian Computation to estimate parameter distributions and provide uncertainty quantification. The model indicated that a country-level analysis was not appropriate for Colombia. We then estimated the basic reproduction number to range between 4 and 6 for El Salvador and Suriname with a median of 4.3 and 5.3, respectively. We estimated the reporting rate to be around 16% in El Salvador and 18% in Suriname with estimated total outbreak sizes of 73,395 and 21,647 people, respectively. The uncertainty in parameter estimates highlights a need for research and data collection that will better constrain parameter ranges.

  20. Total nasal reconstruction with 3D custom made porous titanium prosthesis and free thoracodorsal artery perforator flap: A case report.

    Science.gov (United States)

    Qassemyar, Quentin; Assouly, Nathaniel; Madar, Yoni; Temam, Stéphane; Kolb, Frédéric

    2018-02-21

    Total nasal reconstruction is a challenging surgical procedure which usually involves a free flap, forehead flap, and cartilage grafts. In certain failure situations where patients do not accept the idea of anaplastology, possibilities become very limited. We report the case of a patient who underwent several reconstruction steps with multiple failures including free and local flaps and cartilage harvests which showed recurrent episodes of necrosis and infection leading to melting and collapse of reconstructed structures. Furthermore, the patient did not want any anaplastological rehabilitation. We proposed to the patient an innovative method that consists to print a three-dimensional custom-made porous titanium prosthesis, based on the original shape of his nose, to replace the cartilage support. This implant was first inserted in a thoracodorsal artery perforator flap for primary integration before the free transfer of the complete structure, two months later. The free transfer was successful without any complication. A stable reconstruction and satisfying result was obtained. The patient did not want additional surgical improvement 24 months post-operatively, and resumed his professional activities. The possibility of using three-dimensional custom titanium prostheses to replace the bone and cartilage support seems to be an interesting alternative for patients in the failure situation of nasal reconstruction. © 2018 Wiley Periodicals, Inc.

  1. Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report

    LENUS (Irish Health Repository)

    Boland, Michael

    2012-05-14

    AbstractIntroductionRivaroxaban, a new oral anticoagulant, is currently licensed for use in patients undergoing orthopedic surgery. It is more efficacious than other anticoagulants such as low molecular weight heparin and does not require daily monitoring. It has also been shown to be efficacious in patients with venous thromboembolism and acute coronary syndrome. Although hemorrhage is a known side effect of this new anticoagulant, we could find no case reports in the literature of patients suffering severe hemorrhage whilst taking rivaroxaban. Thus, we describe the first case of potentially fatal hemorrhage in a patient taking rivaroxaban.Case presentationWe report the case of a 58-year-old Caucasian man with acute-onset severe per rectal bleeding who had undergone total hip arthroplasty four weeks prior to the onset of symptoms and was taking rivaroxaban in the postoperative period. Rivaroxaban was discontinued immediately but, having required nine units of packed red blood cells in a peripheral hospital due to a rapidly decreasing hemoglobin level, our patient was transferred to our tertiary referral center where he required a further eight units of packed red blood cells over a 48-hour period to manage his ongoing hemorrhage and maintain hemodynamic stability. No source of bleeding was found on computed tomography angiography and our patient’s condition improved over the following 48 hours with cessation of the hemorrhage. Our patient was discharged home well several days later. A follow-up colonoscopy one week after his discharge was normal.ConclusionAlthough advantageous with regard to its oral availability and ongoing use without the need for daily monitoring, rivaroxaban does not come without rare but severe side effects. When severe per rectal bleeding occurs in a patient taking rivaroxaban, discontinuation of the offending agent and aggressive hematological replacement are the mainstays of treatment, especially when no source of bleeding can be found

  2. Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report

    Directory of Open Access Journals (Sweden)

    De Nardo Pasquale

    2012-01-01

    Full Text Available Abstract Introduction Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. Case presentation A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Conclusions Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected

  3. Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes.

    Science.gov (United States)

    Kumagai, Koshi; Hiki, Naoki; Nunobe, Souya; Sekikawa, Sayuri; Chiba, Takehiro; Kiyokawa, Takashi; Jiang, Xiaohua; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2015-01-01

    The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported. After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a delta-shaped intracorporeal gastrogastrostomy was made with linear staplers. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0%) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7%; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure. TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the well-established LAPPG with a hand-sewn gastrogastrostomy.

  4. 10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register.

    Science.gov (United States)

    Henricson, Anders; Nilsson, Jan-Åke; Carlsson, Ake

    2011-12-01

    There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint-excluding incidental exchange of the polyethylene meniscus. Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements-even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results.

  5. Self-reported TV and computer time do not represent accelerometer-derived total sedentary time in 10 to 12-year-olds

    NARCIS (Netherlands)

    Verloigne, M.; Van Lippevelde, W.; Maes, L.; Yildirim, M.; Chin A Paw, M.J.M.; Manios, Y.; Androutsos, O.; Kovacs, E.; Bringolf-Isler, B.; Brug, J.; de Bourdeaudhuij, I.

    2013-01-01

    Screen-time activities are often used as proxies for sedentary time. We studied associations of self-reported television (TV), computer and total screen-time with accelerometer-derived total sedentary time in European children (10-12 years). Analyses showed significant positive associations between

  6. Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature.

    Science.gov (United States)

    Thabet, Ahmed M; Catagni, Maurizio A; Guerreschi, Francessco

    2012-08-01

    Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome.

  7. Blindness and total ophthalmoplegia after aesthetic polymethylmethacrylate injection: case report Amaurose e oftalmoplegia total após injeção facial de polimetilmetacrilato: relato de caso

    Directory of Open Access Journals (Sweden)

    Marcus Tulius T. Silva

    2004-09-01

    Full Text Available Microspheres of polymethyl-methacrylate (PMMA are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Some reports of side effects of this procedure are basically in respect to dermal reaction, with late-onset granulomatous lesion with giant cells and vacuoles. We report blindness and total ophthalmoplegia after PMMA injection into glabellar area in a healthy woman and review the literature.A injeção de polimetilmetacrilato (PMMA é prática difundida na medicina estética como medida rejuvenecedora. No entanto, a injeção facial do PMMA carreia sérios riscos, especialmente se realizada na região glabelar. Descrevemos o caso de uma mulher que imediatamente após injeção glabelar de PMMA apresentou amaurose e oftalmoplegia total, revendo ainda a literatura pertinente.

  8. Hyperbaric oxygen in skeletal muscle of rats submitted to total acute left hindlimb ischemia: A research report.

    Science.gov (United States)

    da Silva, Luis Gustavo Campos; Dalio, Marcelo Bellini; Joviliano, Edwaldo Edner; Feres, Omar; Piccinato, Carlos Eli

    2015-01-01

    Determine the effect of hyperbaric oxygen treatment in skeletal muscle of rats submitted to total acute left hindlimb ischemia. An experimental study was designed using 48 Wistar rats divided into four groups (n = 12): Control; Ischemia (I)--total hindlimb ischemia for 270 minutes; Hyperbaric oxygen treatment during ischemia (HBO2)--total hindlimb ischemia for 270 minutes and hyperbaric oxygen during the first 90 minutes; Pre-treatment with hyperbaric oxygen (PHBO2)--90 minutes of hyperbaric oxygen treatment before total hindlimb ischemia for 270 minutes. Skeletal muscle injury was evaluated by measuring levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total creatine phosphokinase (CPK); muscular malondialdehyde (MDA), muscular glycogen, and serum ischemia-modified albumin (IMA). AST was significantly higher in I, HBO2 and PHBO2 compared with control (P = .001). There was no difference in LDH. CPK was significantly higher in I, HBO2 and PHBO2, compared with control (p = .014). MDA was significantly higher in PHBO2, compared with other groups (p = .042). Glycogen was significantly decreased in I, HBO2 and PHBO2, compared with control (p < .001). Hyperbaric oxygen treatment in acute total hindlimb ischemia exerted no protective effect on muscle injury, regardless of time of application. When applied prior to installation of total ischemia, hyperbaric oxygen treatment aggravated muscle injury.

  9. Can the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) be used to accurately report clinic total reproductive potential (TRP)?

    Science.gov (United States)

    Stern, Judy E; Hickman, Timothy N; Kinzer, Donna; Penzias, Alan S; Ball, G David; Gibbons, William E

    2012-04-01

    To assess whether total reproductive potential (TRP), the chance of a live birth from each fresh cycle (fresh cycle plus frozen transfers), could be calculated from the national Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database and whether information not available in SART CORS resulted in significant changes to the TRP calculation. Retrospective study using SART CORS and clinic data. Three assisted reproductive technology clinics. Women undergoing ART. None. Two- and three-year TRPs for 2005 and 2006 were calculated according to patient age at cycle start by linking fresh to frozen cycles up to first live birth. Clinic records were used to adjust for (remove) frozen cycles that used more than one fresh cycle as a source of embryos and for any embryos donated to other patients or research or shipped to another facility before a live birth. TRP was higher than fresh per-cycle rates for most ages at all clinics, although accuracy was compromised when there were fewer than 20 cycles per category. Two- and 3-year TRPs differed in only 2 of 24 calculations. Adjusted TRPs differed less than three percentage points from unadjusted TRPs when volume was sufficient. Clinic TRP can be calculated from SART CORS. Data suggest that calculations of clinic TRP from the national dataset would be meaningful. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Long-Term Outcome after Rehabilitation of Bilateral Total Hip Arthroplasty in Renal Transplant Recipient – A Case Report

    Directory of Open Access Journals (Sweden)

    Erieta Nikolikj Dimitrova

    2016-02-01

    CONCLUSION: Rehabilitation is integral part of multidisciplinary treatment of renal transplant recipient after total hip arthroplasty. Regular exercise training of these patients is very important for improving of their long-term outcome.

  11. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  12. The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function

    DEFF Research Database (Denmark)

    Lohmann-Jensen, Rasmus; Holsgaard-Larsen, Anders; Emmeluth, Claus

    2014-01-01

    BACKGROUND: Surgical treatment of osteoarthritis with total knee arthroplasty (TKA) usually takes place in a complete bloodless field using a tourniquet. However, doing the surgery without a tourniquet may reduce muscle damage, post-surgery pain and led to improved functional rehabilitation and m...

  13. Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

    DEFF Research Database (Denmark)

    Nissen, Nina; Douw, Karla; Overgaard, Søren

    2011-01-01

    The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head while...

  14. Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States.

    Science.gov (United States)

    Le, Margaret; Flores, David; May, Danica; Gourley, Eric; Nangia, Ajay K

    2016-05-01

    The evaluation and management of male hypogonadism should be based on symptoms and on serum testosterone levels. Diagnostically this relies on accurate testing and reference values. Our objective was to define the distribution of reference values and assays for free and total testosterone by clinical laboratories in the United States. Upper and lower reference values, assay methodology and source of published reference ranges were obtained from laboratories across the country. A standardized survey was reviewed with laboratory staff via telephone. Descriptive statistics were used to tabulate results. We surveyed a total of 120 laboratories in 47 states. Total testosterone was measured in house at 73% of laboratories. At the remaining laboratories studies were sent to larger centralized reference facilities. The mean ± SD lower reference value of total testosterone was 231 ± 46 ng/dl (range 160 to 300) and the mean upper limit was 850 ± 141 ng/dl (range 726 to 1,130). Only 9% of laboratories where in-house total testosterone testing was performed created a reference range unique to their region. Others validated the instrument recommended reference values in a small number of internal test samples. For free testosterone 82% of laboratories sent testing to larger centralized reference laboratories where equilibrium dialysis and/or liquid chromatography with mass spectrometry was done. The remaining laboratories used published algorithms to calculate serum free testosterone. Reference ranges for testosterone assays vary significantly among laboratories. The ranges are predominantly defined by limited population studies of men with unknown medical and reproductive histories. These poorly defined and variable reference values, especially the lower limit, affect how clinicians determine treatment. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women With Penoscrotal Hypoplasia

    NARCIS (Netherlands)

    Bouman, M.B.; Sluis, W.B. van der; Woudenberg Hamstra, L.E. van; Buncamper, M.E.; Kreukels, B.P.; Meijerink, W.J.H.J.; Mullender, M.G.

    2016-01-01

    INTRODUCTION: Puberty-suppressing hormonal treatment may result in penoscrotal hypoplasia in transgender women, making standard penile inversion vaginoplasty not feasible. For these patients, intestinal vaginoplasty is a surgical alternative, but knowledge on patient-reported postoperative outcomes

  16. Corporate social responsibility report 2003. Sharing our energies; Notre energie en partage. TOTAL rapport societal and environnemental 2003

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-05-15

    This document assesses the results of the group Total initiatives in the domain of the corporate social responsibility, for the year 2003. It presents the society policy and actions concerning: the ethics as a foundation of broader corporate, the environment stewardship and the safety enhancement, the equity and diversity of the labor relations and human resources, the broader responsibility to society and communities, the financial performance and a group portrait. (A.L.B.)

  17. Systems of differential forms, including Kuranishi's theory of total prolongations. Technical report No. 2

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, H.H.

    1956-01-01

    The theory of differential forms and their integral manifolds was created by E. Cartan in order to study the differential equations which occur in Lie groups and differential geometry. We present here a modern outline of this theory using refinements and notations taken from recent papers of Y. Matsushima and M. Kuranishi. Section III is devoted to an exposition of a paper of Kuranishi on total prolongations which was presented at the 1956 Summer Institute in Differential Geometry at the University of Washington.

  18. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome.

    Science.gov (United States)

    Varnum, Claus

    2017-03-01

    Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At

  19. Total recall in the SCAMP cohort: Validation of self-reported mobile phone use in the smartphone era.

    Science.gov (United States)

    Mireku, Michael O; Mueller, William; Fleming, Charlotte; Chang, Irene; Dumontheil, Iroise; Thomas, Michael S C; Eeftens, Marloes; Elliott, Paul; Röösli, Martin; Toledano, Mireille B

    2018-02-01

    Mobile phone use, predominantly smartphones, is almost ubiquitous amongst both adults and children. However adults and children have different usage patterns. A major challenge with research on mobile phone use is the reliability of self-reported phone activity for accurate exposure assessment. We investigated the agreement between self-reported mobile phone use data and objective mobile operator traffic data in a subset of adolescents aged 11-12 years participating in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. We examined self-reported mobile phone use, including call frequency, cumulative call time duration and text messages sent among adolescents from SCAMP and matched these data with records provided by mobile network operators (n = 350). The extent of agreement between self-reported mobile phone use and mobile operator traffic data use was evaluated using Cohen's weighted Kappa (ĸ) statistics. Sensitivity and specificity of self-reported low ( 30min of call/day or ≥ 11 text messages sent /day) use were estimated. Agreement between self-reported mobile phone use and mobile operator traffic data was highest for the duration spent talking on mobile phones per day on weekdays (38.9%) and weekends (29.4%) compared to frequency of calls and number of text messages sent. Adolescents overestimated their mobile phone use during weekends compared to weekdays. Analysis of agreement showed little difference overall between the sexes and socio-economic groups. Weighted kappa between self-reported and mobile operator traffic data for call frequency during weekdays was κ = 0.12, 95% CI 0.06-0.18. Of the three modes of mobile phone use measured in the questionnaire, call frequency was the most sensitive for low mobile phone users on weekdays and weekends (77.1, 95% CI: 69.3-83.7 and 72.0, 95% CI: 65.0-78.4, respectively). Specificity was moderate to high for high users with the highest for call frequency during weekdays (98.4, 95% CI: 96

  20. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report

    OpenAIRE

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    Introduction: The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. Presentation of case: We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip ...

  1. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome

    DEFF Research Database (Denmark)

    Varnum, Claus

    2017-01-01

    and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors...

  2. Total algorithms

    NARCIS (Netherlands)

    Tel, G.

    We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of

  3. People who undergo revision arthroplasty report more limitations but no decrease in physical activity compared with primary total hip arthroplasty : an observational study

    NARCIS (Netherlands)

    Stevens, Martin; Hoekstra, Tsjerk; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2009-01-01

    Question: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley

  4. Totally Leadless Dual-Device Implantation for Combined Spontaneous Ventricular Tachycardia Defibrillation and Pacemaker Function: A First Report.

    Science.gov (United States)

    Ahmed, Fozia Zahir; Cunnington, Colin; Motwani, Manish; Zaidi, Amir Masood

    2017-08-01

    Subcutaneous implantable cardioverter defibrillators (S-ICDs) provide effective defibrillation, while also reducing the risk of long-term lead problems. However, S-ICDs do not offer bradycardia or antitachycardia pacing and therefore use has been limited. Combined implantation of an S-ICD with a leadless pacemaker (LP) has been proposed to overcome this limitation. Although a handful of combined S-ICD/LP implantations have been reported for Nanostim (St Jude Medical, St Paul, MN) as well as Micra LP (Medtronic, Minneapolis, MN) systems, none have documented delivery of appropriate shock therapies for spontaneous ventricular tachycardia. We report the first case of effective defibrillation for spontaneous ventricular tachycardia in a patient with combined Micra LP and S-ICD. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. Total human exposure and indoor air quality: An automated bibliography (BLIS) with summary abstracts. Volume 2. Final report, January 1987-December 1989

    International Nuclear Information System (INIS)

    Dellarco, M.; Ott, W.

    1990-10-01

    The Bibliographical Literature Information System (BLIS) is a computer database that provides a comprehensive review of available literature on total human exposure to environmental pollution. Brief abstracts (often condensed versions of the original abstract) are included; if the original document had no abstract, one was prepared. Unpublished draft reports are listed, as well as final reports of the U.S. Government and other countries, reports by governmental research contractors, journal articles, and other publications on exposure models field data, and newly emerging research methodologies. Emphasis is placed on those field studies measuring all the concentrations to which people may be exposed, including indoors, outdoors, and in-transit

  6. Total energy cycle assessment of electric and conventional vehicles: an energy and environmental analysis. Volume 4: peer review comments on technical report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-01

    This report compares the energy use, oil use and emissions of electric vehicles (EVs) with those of conventional, gasoline-powered vehicles (CVs) over the total life cycle of the vehicles. The various stages included in the vehicles` life cycles include vehicle manufacture, fuel production, and vehicle operation. Disposal is not included. An inventory of the air emissions associated with each stage of the life cycle is estimated. Water pollutants and solid wastes are reported for individual processes, but no comprehensive inventory is developed. Volume IV includes copies of all the external peer review comments on the report distributed for review in July 1997.

  7. Application analysis of solar total energy systems to the residential sector. Volume III, conceptual design. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1979-07-01

    The objective of the work described in this volume was to conceptualize suitable designs for solar total energy systems for the following residential market segments: single-family detached homes, single-family attached units (townhouses), low-rise apartments, and high-rise apartments. Conceptual designs for the total energy systems are based on parabolic trough collectors in conjunction with a 100 kWe organic Rankine cycle heat engine or a flat-plate, water-cooled photovoltaic array. The ORC-based systems are designed to operate as either independent (stand alone) systems that burn fossil fuel for backup electricity or as systems that purchase electricity from a utility grid for electrical backup. The ORC designs are classified as (1) a high temperature system designed to operate at 600/sup 0/F and (2) a low temperature system designed to operate at 300/sup 0/F. The 600/sup 0/F ORC system that purchases grid electricity as backup utilizes the thermal tracking principle and the 300/sup 0/F ORC system tracks the combined thermal and electrical loads. Reject heat from the condenser supplies thermal energy for heating and cooling. All of the ORC systems utilize fossil fuel boilers to supply backup thermal energy to both the primary (electrical generating) cycle and the secondary (thermal) cycle. Space heating is supplied by a central hot water (hydronic) system and a central absorption chiller supplies the space cooling loads. A central hot water system supplies domestic hot water. The photovoltaic system uses a central electrical vapor compression air conditioning system for space cooling, with space heating and domestic hot water provided by reject heat from the water-cooled array. All of the systems incorporate low temperature thermal storage (based on water as the storage medium) and lead--acid battery storage for electricity; in addition, the 600/sup 0/F ORC system uses a therminol-rock high temperature storage for the primary cycle. (WHK)

  8. Successful treatment of skin infiltration in childhood hematological malignancies with total skin electron beam therapy. A report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Ohkawa, Masahito; Shikano, Takaaki; Ueno, Norihiro; Tsujii, Hirohiko; Tono-oka, Tatsuhito; Matsumoto, Takahide.

    1988-07-01

    Two children with cutaneous lymphoma and leukemia who were treated with total skin electron beam therapy (TSEB) are described here. Patient 1. A 7-year-old boy was admitted because of a mass over the bilateral parotis and anemia. The white blood cell count on admission was 5,000/ul. Bone marrow examination revealed 70 per cent monoblasts (M5a type by FAB classification). Complete remission was obtained following the regimen of daunomycin, cytosine arabinoside, 6-mercaptopurine and prednisolone. He was again admitted because of a skin nodule on the left thigh 19 months after initial diagnosis. A biopsy of the skin nodule demonstrated monoblastic infiltration. He received 20 Grays (Gy) to the left thigh and this led to resolution of the skin nodule. At that time, other skin nodules appeared on the right upper and lower extremities. He was treated with TSEB. Daily doses of 1 Gy were given twice a week with a 4 MeV electron beam and a total dose of 10 Gy was administered over a period of 4 weeks. Although he again had a isolated skin relapse on the right shoulder, he remained in remission for 6 years after completing TSEB. Patient 2. A 6-year-old boy was admitted because of multiple skin lesions. Physical examination revealed 22 discrete, indurated skin nodules. a biopsy of a skin nodule demonstrated lymphoblast infiltration, confirming the diagnosis of B cell cutaneous lymphoma (stage IV). He was treated with CHOP (consisting of cyclophosphamide, adriamycin, vincristine and prednisolone). After two courses of CHOP therapy, he was treated with TSEB using the same technique described above. To date, the patient remains in remission 5 years after initial diagnosis.

  9. [Total parenteral nutrition for recurrent episodes of acute pancreatitis during pregnancy. A case report and literature review].

    Science.gov (United States)

    Forget, S; Senesse, P; Burlet, G; Lacroix, N; Boulot, P

    2007-12-01

    We report on a 35-year-old woman who underwent at 15 weeks of pregnancy exclusive parenteral nutrition for recurrent episodes of acute pancreatitis. She had a pancreatico-jejunal anastomosis stenosis secondary to cephalic duodenopancreatectomy. Nocturnal exclusive parenteral nutrition was used 79 days during pregnancy and 12 days during post-partum. The fetal growth was normal and the foetal well-being was normal. She presented cholestasis at 30 weeks of pregnancy treated medically. She delivered at 33 weeks of pregnancy by cesarean section a healthy baby girl with normal birth weight.

  10. Fort Hood Solar Total Energy Project. Volume II. Preliminary design. Part 1. System criteria and design description. Final report

    Energy Technology Data Exchange (ETDEWEB)

    None,

    1979-01-01

    This volume documents the preliminary design developed for the Solar Total Energy System to be installed at Fort Hood, Texas. Current system, subsystem, and component designs are described and additional studies which support selection among significant design alternatives are presented. Overall system requirements which form the system design basis are presented. These include program objectives; performance and output load requirements; industrial, statutory, and regulatory standards; and site interface requirements. Material in this section will continue to be issued separately in the Systems Requirements Document and maintained current through revision throughout future phases of the project. Overall system design and detailed subsystem design descriptions are provided. Consideration of operation and maintenance is reflected in discussion of each subsystem design as well as in an integrated overall discussion. Included are the solar collector subsystem; the thermal storage subsystem, the power conversion sybsystem (including electrical generation and distribution); the heating/cooling and domestic hot water subsystems; overall instrumentation and control; and the STES building and physical plant. The design of several subsystems has progressed beyond the preliminary stage; descriptions for such subsystems are therefore provided in more detail than others to provide complete documentation of the work performed. In some cases, preliminary design parameters require specific verificaton in the definitive design phase and are identified in the text. Subsystem descriptions will continue to be issued and revised separately to maintain accuracy during future phases of the project. (WHK)

  11. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

    Science.gov (United States)

    Waddell, Bradford S.; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. Case Report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum. PMID:27303232

  12. Feasibility study for evaluating cumulative exposure of downstream migrant juvenile salmonids to total dissolved gas. Final report

    International Nuclear Information System (INIS)

    Abernethy, C.S.; Dauble, D.D.; Johnson, R.L.

    1997-11-01

    A feasibility study was initiated to determine if downstream migrant salmonids could be monitored to determine potential relationships between total dissolved gas (TDG) exposure and signs of gas bubble trauma (GBT). The primary objectives were to: (1) establish logistical requirements for in-river monitoring of TDG exposure, including net pen design, deployment, and navigation constraints; (2) resolve uncertainties associated with effects of the net pen on fish behavior; (3) test the accuracy and precision of in-river monitoring equipment used to measure fish distribution and water quality; and (4) determine the application of hydrologic/flow models to predictions of TDG exposure. In-river measurements included water velocity, boat position, and selected water quality parameters (temperature, dissolved oxygen, pH, depth, conductivity). Fish distribution within the net pen was monitored using scanning sonar, and a split-beam echo sounder was used to evaluate vertical distribution of fish m in the river adjacent to the net pen. Three test drifts were conducted from late July through late August. The studies demonstrated that it was feasible to assemble and deploy a large net pen for mobile monitoring of TDG exposure. Accurate monitoring of vertical and lateral distribution of smolts was performed, and diel differences in behavior were documented. Further, the fish sounded in response to researcher activity on the perimeter platform. Thus, in-transit monitoring for GBT or mortality would affect fish depth distribution and exposure to TDG. Principal recommendations for future studies are directed at improving maneuverability of the net pen in adverse weather conditions and applying new acoustics technology to simultaneously collect fish distribution data from within and outside of the pen. 6 refs., 17 figs., 2 tabs

  13. Side-by-side comparison of techniques for analyzing organic acids, total organic carbon, and anions. Final report

    International Nuclear Information System (INIS)

    Byers, W.A.; Richards, J.; Silva, H.; Miller, M.R.; Palino, G.F.; Wall, P.S.

    1986-09-01

    The objective of this project was to compare the organic acids sampling and analysis methods of Westinghouse and NWT Corporation. Sampling was performed at three sites, chosen to represent units with high, intermediate and low levels of organic contamination. To check the precision of each method, concurrent sampling was employed. To check the accuracy of each method, additions of standard organic solutions were made at one of the sites. Inorganic anions were also analyzed at each site by each contractor. Theoretical values of cation conductivity were calculated from organic and inorganic analytical data and compared to values measured onsite at the time of sampling. Total organic carbon (TOC) analyses were performed to evaluate different instruments and sampling techniques, as well as provide additional information on the relationship between TOC and organic acids concentrations. It was concluded that either of the organic acid sampling/analysis techniques used by the contractors can produce reliable results. TOC samples lose organics content with storage time and should be analyzed no later than one week after they are taken; if at all possible, they should be stored in a refrigerated condition. State-of-the art techniques for TOC sampling and analysis can produce results varying by 20 to 50 ppB for levels in the range of 50 to 120 ppB; any proposed limits for TOC should be reviewed in that light. Results of anion analyses are quite sensitive to sampling and analytical techniques. Reasonable agreement between calculated and measured values of cation conductivity suggests that both contractors had accurately determined all major anionic species

  14. Totally James

    Science.gov (United States)

    Owens, Tom

    2006-01-01

    This article presents an interview with James Howe, author of "The Misfits" and "Totally Joe". In this interview, Howe discusses tolerance, diversity and the parallels between his own life and his literature. Howe's four books in addition to "The Misfits" and "Totally Joe" and his list of recommended books with lesbian, gay, bisexual, transgender,…

  15. Report on achievements of research and development of an automatic sewing system in fiscal 1986. Total system; 1986 nendo jido hosei system no kenkyu kaihatsu seika hokokusho. Total system

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1987-03-01

    The Automatic Sewing System Technology Research Association was commissioned from the Agency of Industrial Science and Technology on the 'development of an automatic sewing system'. The association has performed the research and development by dividing the subject into such component technologies as a total system and sewing preparation and processing technology, a sewing and assembling technology, a cloth handling technology, and a system management and control technology. This paper reports the achievement of the research and development on the total system. Such apparel side researches were performed on setting five kinds of trial wears to be said model wears, and on developing the component technologies by wear types. In addition, software research was carried out on automating five kinds of three-dimensional assembling and sewing works as the core works. With regard to codification required for the software, plans were established on apparel configuration codes, sewing specification codes, sewing device codes, and sewing attachment codes. Plans for indication symbols in the sewing works were also established. In the research based on FA and FMS, researches were executed on the facility plan in the system model and on an intermediate evaluation method, with information exchange being made with the apparel side researches. In researching the retrofit technologies, researches were performed to incorporate the principle of achieving the target. (NEDO)

  16. Infrastructure expenditures and costs. Practical guidelines to calculate total infrastructure costs for five modes of transport. Final report

    International Nuclear Information System (INIS)

    2005-11-01

    Transport infrastructures in general, and the Trans European Transport Network (TEN-T) in particular, play an important role in achieving the medium and long-term objectives of the European Union. In view of this, the Commission has recently adopted a revision of the guidelines for the TEN-T. The main consequences of this revision are the need for a better understanding of the investments made by the member states in the TEN-T and the need for ensuring optimal consistency in the reporting by the Members States of such investments. With Regulation number 1108/70 the Council of the European Communities introduced an accounting system for expenditure on infrastructure in respect of transport by rail, road and inland waterways. The purpose of this regulation is to introduce a standard and permanent accounting system for infrastructure expenditures. However maritime and aviation infrastructure were not included. Further, the need for an effective and easy to apply classification for infrastructure investments concerning all five transport modes was still pending. Therefore, DG TREN has commissioned ECORYS Transport and CE Delft to study the expenditures and costs of infrastructure, to propose an adequate classification of expenditures, and to propose a method for translating data on expenditures into data on costs. The objectives of the present study are threefold: To set out a classification of infrastructure expenditures, in order to increase knowledge of expenditures related to transport infrastructures. This classification should support a better understanding of fixed and variable infrastructure costs; To detail the various components of such expenditures for five modes of transportation, which would enable the monitoring of infrastructure expenditures and costs; and to set up a methodology to move from annual series of expenditures to costs, including fixed and variable elements.

  17. Total energy cycle assessment of electric and conventional vehicles: an energy and environmental analysis. Volume 2: appendices A-D to technical report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-01

    This report compares the energy use, oil use and emissions of electric vehicles (EVs) with those of conventional, gasoline- powered vehicles (CVs) over the total life cycle of the vehicles. The various stages included in the vehicles` life cycles include vehicle manufacture, fuel production, and vehicle operation. Disposal is not included. An inventory of the air emissions associated with each stage of the life cycle is estimated. Water pollutants and solid wastes are reported for individual processes, but no comprehensive inventory is developed. Volume II contains additional details on the vehicle, utility, and materials analyses and discusses several details of the methodology.

  18. Metastatic spread from squamous cell carcinoma of the hypopharynx to the totally implantable venous access port insertion site: Case report and review of literature.

    Science.gov (United States)

    Mangla, Ankit; Agarwal, Nikki; Mullane, Michael Russell

    2017-12-01

    The totally implantable venous access port plays a crucial role in delivering chemotherapy in the outpatient setting. Here, we report the first case of a patient with hypopharyngeal tumor who developed chest wall metastasis over the totally implantable venous access port inserted in the internal jugular vein. Our patient, a 58-year-old man with a hypopharyngeal tumor presented with a lump over the totally implantable venous access port site. The port was removed and the lump was biopsied. The CT studies showed that the tumor had spread along the catheter from the hypopharynx to the chest wall. The pathology from the biopsy showed squamous cell carcinoma (SCC). The patient had poor performance status and opted for hospice care. We present a novel case of metastasis over the totally implantable venous access port implanted in a patient with a hypopharyngeal tumor. We also reviewed relevant literature comparing the data from percutaneous endoscopic gastrostomy (PEG) tube site metastasis with our patient and other similar case reports. © 2017 Wiley Periodicals, Inc.

  19. Use of the predictive sugars biomarker to evaluate self-reported total sugars intake in the Observing Protein and Energy Nutrition (OPEN) study.

    Science.gov (United States)

    Tasevska, Natasa; Midthune, Douglas; Potischman, Nancy; Subar, Amy F; Cross, Amanda J; Bingham, Sheila A; Schatzkin, Arthur; Kipnis, Victor

    2011-03-01

    A predictive biomarker for intake of total sugars was recently developed under controlled conditions. We used this biomarker to assess measurement error (ME) structure in self-reported intake of total sugars in free-living individuals. The Observing Protein and Energy Nutrition (OPEN) study involved 484 participants aged 40 to 69 years. Diet was assessed using two administrations of a food frequency questionnaire (FFQ) and two nonconsecutive 24-hour dietary recalls (24HDR). Two 24-hour urine samples checked for completeness were analyzed on sucrose and fructose. We applied the biomarker calibrated in a feeding study to OPEN data to assess the ME structure and the attenuation factors (AF) for intakes of absolute total sugars and sugars density for the FFQ and 24HDR. The AFs for absolute sugars were similar for a single FFQ and 24HDR, but attenuation decreased with repeated 24HDRs. For sugars density, the AFs for FFQ (men: 0.39; women: 0.33) were greater than for single 24HDR (men: 0.30; women: 0.24), and similar to two 24HDRs (men: 0.41; women: 0.35). The attenuation associated with both instruments was greater in women than in men. Both the FFQ and 24HDR were found to be biased; hence, incorporation of the sugars biomarker in calibration studies within the cohorts may be necessary to more reliably estimate associations of sugars and disease. In this article, we propose a new dietary reference instrument based on the recently defined class of predictive biomarkers. Using sugars biomarker, we quantify ME in the FFQ- and 24HDR-reported absolute total sugars and total sugars density. ©2011 AACR.

  20. Fiscal 1998 research report (New Sunshine Project). Research on the total system for development of superconductor power application technology; 1998 nendo seika hokokusho (new sunshine keikaku). Chodendo denryoku oyo gijutsu kaihatsu total system no kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    This report summarizes the fiscal 1998 research promoted as a part of New Sunshine Project 'R and D project on development of superconductor power application technology.' This project is composed of R and D of superconductor power application technology (Rank 1), study on the total system (Rank 2), and study on review of introduction effects (Rank 3). The project is promoting R and D of the prototype superconducting generator model and elementary technologies based on the basic plan mainly by the research association. The combination test of the developed armature and the multi- cylindrical rotor model or slow response excitation rotor model was finished, and the test of the quick response excitation rotor model is in promotion. Together with R and D of hardware, this project is also promoting R and D of software through review of the introduction effects of superconducting power equipment. In fiscal 1998, the pre- final review was carried out by the project review sub- committee. 2 times of the committee, 12 times of the sub- committee, and several times of the working group were held until March, 1999. (NEDO)

  1. Bilateral fracture of L5 pedicles in a patient with total disc replacement of L5-S1: a case report

    Directory of Open Access Journals (Sweden)

    Jorge Alberto De Haro Estrada

    2014-01-01

    Full Text Available Report of a rare complication - fracture of the pedicles - in a patient with total disc replacement of L5-S1, a surgical resolution, and a biomechanical explanation. To the authors' knowledge, there is only one previous report of bilateral fracture of the pedicles in the literature, as a complication in total disc replacement of the lumbar spine. In this case, no direct repair was made to the fracture site; instead intersomatic fusion was performed by the anterior approach. A 40-year-old male, a martial arts practitioner who had undergone L5-S1 (ProDisc(r disc replacement nine months earlier, with complete resolution of the preoperative symptoms and no complications, sudden pain during physical activity, without neurological symptoms. Computed axial tomography showed a fracture of the L5 pedicles and anterior luxation of the polyethylene insert. Surgery was performed by the posterior approach, with direct repair of the fractures and posterolateral fusion of L5-S1 with transpedicular screws (Schanz and USS(r internal fixator. A follow-up axial CT scan at 6 months after surgery showed complete consolidation of the fractures, and the patient was asymptomatic. Due to the alteration in weight transmission through the anterior part of the spine in the total replacement of the lumbar disc, which preserves the movement but not the absorption of forces, the pedicle becomes more susceptible to fracture. It is important to bear this complication in patients submitted to this procedure.

  2. Self-Expandable Metal Stent Placement for Closure of a Leak after Total Gastrectomy for Gastric Cancer: Report on Three Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Dario Raimondo

    2014-01-01

    Full Text Available In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

  3. Assessment of physical function following total hip arthroplasty: Inertial sensor based gait analysis is supplementary to patient-reported outcome measures.

    Science.gov (United States)

    Bolink, S A A N; Lenguerrand, E; Brunton, L R; Wylde, V; Gooberman-Hill, R; Heyligers, I C; Blom, A W; Grimm, B

    2016-02-01

    Functional outcome assessment after total hip arthroplasty often involves subjective patient-reported outcome measures whereas analysis of gait is more objective. The study's aims were to compare subjective and objective functional outcomes after total hip arthroplasty between patients with low and high self-reported levels of pre-operative physical function. Patients undergoing total hip arthroplasty (n=36; m/f=18/18; mean age=63.9; SD=9.8 years; BMI=26.3; SD=3.5) were divided into a low and high function subgroup, and prospective measures of WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function score and gait were compared at baseline and 3 and 12 months post-operatively. WOMAC function scores significantly improved in both low and high function subgroups at 3 months post-operatively whereas gait parameters only improved in patients with a low pre-operative function. Between 3 and 12 months post-operatively, WOMAC function scores had not significantly further improved whereas several gait parameters significantly improved in the low function group. WOMAC function scores and gait parameters were only moderately correlated (Spearman's r=0.33-0.51). In a cohort of patients undergoing total hip arthroplasty, pre-operative differences in mean WOMAC function scores and gait parameters between low and high function subgroups disappeared by 3 months post-operatively. Gait parameters only improved significantly during the first 3 post-operative months in patients with a low pre-operative function, highlighting the importance of investigating relative changes rather than the absolute changes and the need to consider patients with high and low functions separately. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. The innovation of composite core dual coil coronary guide-wire technology: A didactic coronary chronic total occlusion revascularization case report.

    Science.gov (United States)

    Tomasello, Salvatore Davide; Giudice, Pietro; Attisano, Tiziana; Boukhris, Marouane; Galassi, Alfredo R

    2014-10-01

    The treatment of coronary chronic total occlusions (CTO) continues to solicit technical innovations. As success primarily depends on crossing the lesion with a wire, all aspects regarding tip shape retention, torque precision, and penetration ability of the guide-wire have greatly influenced new techniques and strategies. The world of interventional cardiology has to look carefully at these developments, and to use them accordingly to improve the success rate in ordinary percutaneous coronary interventions. We present a didactical case report of a CTO revascularization treated with a new 'dual core' technology guide-wire.

  5. Analysis of Ionospheric Monitoring System (IMS) Total Electron Content (TEC) data and equatorial phase-scintillation data. Scientific report No. 1

    Energy Technology Data Exchange (ETDEWEB)

    Secan, J.A.; Andreasen, C.C.; Fremouw, E.J.; Holland, E.; Mazzella, A.

    1995-07-01

    Many military systems used for communications, command and control, navigation, tracking, and surveillance depend on reliable and relatively noise-free transmission of radiowave signals through the earth`s ionosphere. This report documents the results of the first year of a three-year investigation of various facets of this problem. Two study areas are reported on: (1) an investigation of methods for using signals from Global Positioning System (GPS) satellites to measure ionospheric Total Electron Content (TEC), and (2) a study of the shape and behavior of the phase-scintillation power-density spectrum (PDS) over a scale-size range of 1Os to 1OOs of kilometers. The phase PDS study found that the slope of the phase PDS at these scale sizes is steeper than those found in earlier studies at shorter scales.

  6. Coin pica-induced gastric perforation resulting from ingestion of 1,894 coins, 8 kg in total: case report and review of published works.

    Science.gov (United States)

    Sekiya, Kosuke; Mori, Shusuke; Otomo, Yasuhiro

    2018-04-01

    Pica is common among patients with psychiatric disorders, but only a few cases regarding coin pica have been reported. A 51-year-old man with depression complaining of fatigue was found to have numerous coins in the esophagus and the stomach on X-rays. He had a peritoneal sign and underwent an emergency laparotomy. The surgical findings showed perforation on the anterior wall of the gastric body and coins in the stomach, which were removed manually, followed by an omental patch. Residual coins in the esophagus were removed by endoscopy. The coins totaled 1,894, weighing 8,076 grams. The patient was then diagnosed as schizophrenic. He was asymptomatic for metal toxicity and was finally transferred to a psychiatric hospital. This pica case is the first to show coin pica can lead to gastric perforation, and also reports the largest amounts of coins ingested by a person to date.

  7. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

    Science.gov (United States)

    Copanitsanou, Panagiota; Valkeapää, Kirsi; Cabrera, Esther; Katajisto, Jouko; Leino-Kilpi, Helena; Sigurdardottir, Arun K; Unosson, Mitra; Zabalegui, Adelaida; Lemonidou, Chryssoula

    2017-04-01

    Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research. © 2016 Wiley Periodicals, Inc.

  8. The emergency and delay management in total talus extrusion: Case report and review of literature after 24 months of follow up

    Directory of Open Access Journals (Sweden)

    Luigi Piscitelli

    2016-07-01

    Full Text Available Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octogenarian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months performing contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main complications, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life.

  9. Stent implantation for a totally occluded right coronary artery in a six-year-old boy after Kawasaki disease: a case report

    Directory of Open Access Journals (Sweden)

    Hsu Ya-Chi

    2012-04-01

    Full Text Available Abstract Introduction Coronary stenting has previously been considered to be less feasible in children under 12 years old due to the limitation of vascular access. We report the case of a six-year-old boy who successfully underwent stent implantation for his totally occluded right coronary artery. Case presentation A Taiwanese boy aged six years and nine months old was found to have giant aneurysms after an acute episode of Kawasaki disease. An angiography revealed that his middle right coronary artery was totally occluded. A 0.014-inch guidewire was advanced to cross the totally occluded site. After pre-dilating the middle portion of his right coronary artery with a 1.5 mm balloon, stenting of his right coronary artery was accomplished using a 2.5 × 28 mm and a 2.5 × 18 mm bare metal stent. A final angiography demonstrated no residual stenosis or dissection. Conclusion Coronary stenting could be a therapeutic option for children as young as six years old. Close follow-up is mandatory because the long-term outcome is still unclear, especially in a small child.

  10. Total absorption gamma-ray spectroscopy (TAGS): Current status of measurement programmes for decay heat calculations and other applications. Summary report of consultants' meeting

    International Nuclear Information System (INIS)

    Nichols, A.L.; Nordborg, C.

    2009-02-01

    A Consultants' Meeting on 'Total Absorption Gamma-ray Spectroscopy (TAGS)' was held on 27-28 January 2009 at the IAEA Headquarters, Vienna, Austria. All presentations, discussions and recommendations of this meeting are contained within this report. The purpose of the meeting was to report and discuss progress and plans to measure total gamma-ray spectra in order to derive mean beta and gamma decay data for decay heat calculations and other applications. This form of review had been recommended by contributors to Subgroup 25 of the OECD-NEA Working Party on International Evaluation Cooperation of the Nuclear Science Committee, for implementation in 2008/09. Hence, relevant specialists were invited to discuss their recently performed and planned TAGS studies, along with experimentalists proposing to assemble and operate such dedicated facilities. Knowledge and quantification of antineutrino spectra is believed to be a significant asset in the non-invasive monitoring of reactor operations and possible application in safeguards, as well as fundamental in the study of neutrino oscillations - these data needs were also debated in terms of appropriate TAGS measurements. A re-assessment of the current request list for TAGS studies is merited and was undertaken in the context of decay heat calculations, and agreement was reached to extend these requirements to the derivation of antineutrino spectra. (author)

  11. Total Synthesis of Avrainvilleol.

    Science.gov (United States)

    Wegener, Aaron; Miller, Kenneth A

    2017-11-03

    The first total synthesis of the marine natural product avrainvilleol is reported. The total synthesis features the first application of the transition-metal-free coupling of a tosyl hydrazone and a boronic acid to the preparation of a complex natural product, and the first example of this coupling with a hindered diortho substituted hydrazone substrate.

  12. A Novel Downhill Gait-Training Program Following a Total Knee Arthroplasty: A Case Report Highlighting the Impacts of Self-selected Speed on Gait Symmetry.

    Science.gov (United States)

    Blue, Cody; Coomes, Sara; Yoshida, Yuri

    2018-02-01

    Study Design Case report. Background Walking plays an essential role in activities of daily living and has varied health benefits. Studies report that gait speed and symmetry are impacted in individuals following total knee arthroplasty (TKA). Unfortunately, abnormal gait patterns persist in individuals after TKA. Downhill walking may provide a simple and feasible exercise regimen to improve gait patterns. The purpose of this case report was to describe the application of a downhill treadmill training program and the subsequent changes in gait patterns in an individual following a unilateral TKA. Case Description The participant was a 59-year-old woman following a right TKA. Downhill gait training was initiated 1 month post TKA and completed for 5 weeks. Outcomes were assessed using questionnaires, mobility tests, strength of quadriceps, and gait patterns. The treadmill speed was determined by the participant's self-selected gait speed on a level surface. Outcomes The participant's eccentric quadriceps strength in the operated limb significantly increased after the gait training. Her physical function recovered to a level similar to that of previous reports. Postintervention gait analysis was conducted at 2 self-selected speeds, due to an increase in the participant's self-selected gait speed between sessions. The participant demonstrated a more symmetrical gait pattern when walking slower and a more asymmetrical gait pattern at the faster speed. Discussion After completion of downhill gait training in conjunction with therapeutic exercises, the participant showed an increase in quadriceps strength and improved physical function. This case report describes the utilization and potential feasibility of downhill gait training in conjunction with outpatient physical therapy for an individual following unilateral TKA. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(2):104-110. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7374.

  13. Total Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Lopez Moris E

    2016-06-01

    Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.

  14. Acute hypotension in a patient undergoing posttraumatic cervical spine fusion with somatosensory and motor-evoked potential monitoring while under total intravenous anesthesia: a case report.

    Science.gov (United States)

    Cann, David F

    2009-02-01

    Hypotension should be vigilantly prevented in patients with spinal cord injury. Recent advances in neurological, intraoperative monitoring techniques have allowed Certified Registered Nurse Anesthetists to assess the effects of spinal cord ischemia and compression as they occur. This case report describes a young, healthy man who sustained a cervical spine fracture and was scheduled for anterior spinal fusion with somatosensory and motor-evoked potential (MEP) monitoring while under total intravenous anesthesia. This patient experienced a brief period of intraoperative hypotension with evidence of abnormal MEPs. A wake-up test was performed, which showed normal functioning, and the case resumed an uneventful course. Although this scenario resulted in no neurological sequelae, the effects of spinal cord ischemia due to hypotension can lead to permanent, devastating motor and sensory damage.

  15. Clinical and radiological evolution of Intervened patients of total arthroplasty of hip with prostheses of resuperficialization metal-metal - Preliminary report

    International Nuclear Information System (INIS)

    Galvan Villamarin, Fernando; Bernal Torres, Fabio A; Paez, Jose Mauricio and others

    2006-01-01

    The articular degeneration of the hip in young patients requires including therapeutical alternatives for the management of this population. The resurfacing prostheses with metal-metal surfaces is an alternative for this type of patients. Reports with short and medium follow up are very promising, besides the different studies of laboratory that bear, the theoretical bases for their success. In this descriptive study, observational cases series type is described the radiological and clinical evolution of patients intervened of total arthroplasty of hip with resurfacing prostheses metal-metal in the hospital el Tunal of Bogota. The results of 31 hips are presented (27 patients) with an age average of 50 years old and a medium follow up of 16 months, with a good post surgical functional result with a median of 96 in the Harris Scores. The complications presented in the patient series are described and their relation with the different factors analyzed

  16. The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Broeng, Leif; Jensen, Carsten

    2014-01-01

    is a prospective, double blinded, parallel-group controlled trial with balanced randomisation [1: 1]. Patients with hip osteoarthritis scheduled for hip replacement surgery, aged 45-70 years, will be consecutively recruited and randomised into two groups. Group A will receive hip replacement using the posterior......BACKGROUND: Total hip replacement provides pain relief and improves physical function and quality of life in patients with end-stage hip osteoarthritis. The incidence of hip replacement operations is expected to increase due to the growing elderly population. Overall, the posterior approach...... and lateral approach are the two most commonly used approaches for hip replacement operations. The posterior approach is associated with an increased risk of revision due to dislocations, and some studies have shown that the lateral approach is associated with reduced patient-reported outcomes, including...

  17. Fabella Syndrome as an Uncommon Cause of Posterolateral Knee Pain after Total Knee Arthroplasty: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Eriko Okano

    2016-01-01

    Full Text Available The fabella is a sesamoid bone that is located in the lateral head of the gastrocnemius muscle and has been identified on magnetic resonance imaging in 31% of Japanese people. In the present case, a 65-year-old woman experienced posterolateral knee pain, accompanied by a clicking “sound” during active knee flexion, after undergoing total knee arthroplasty for knee osteoarthritis. Eight months of conservative therapy failed to produce an improvement, with progressive osteoarthritic change of the fabella identified on plain radiography. Based on this evidence, a diagnosis of fabella syndrome was made and the patient underwent a fabellectomy. Fabellectomy provided immediate resolution of posterolateral knee pain and the clicking sound with knee flexion, with the patient remaining symptom-free 18 months after fabellectomy and with no limitations in knee function. Fabellectomy eliminated symptoms in all of five case reports that have been previously published and is regarded as an effective first choice for treating fabella syndrome after total knee arthroplasty.

  18. Reconstruction with Composite Cement-Autoclaved Autograft after a Near-Total Excision of the Humerus for Osteosarcoma: A Case Report

    Directory of Open Access Journals (Sweden)

    KL Pan

    2009-11-01

    Full Text Available Osteosarcoma occurring in the humerus is often confined to the proximal part, in which case, reconstruction after excision is less daunting. When the tumour spreads down the medullary cavity distally, a total humeral replacement is often required. This is costly and beyond the means of the average patient in a developing country. An amputation is often the procedure of first resort. We report a 13-year-old boy with osteosarcoma originating from the left proximal humerus, with involvement of the marrow reaching down to the distal diaphyseal-metaphyseal junction, leaving only 6 cm of the distal humerus intact after wide resection. Reconstruction of the defect was done with a composite cement-autoclaved autograft fixed to the remaining humerus with a plate. At 40 months of follow-up, the patient is well with normal function of the elbow, wrist and hand. Salvaging the limb despite near total involvement of the humerus by high grade osteosarcoma is possible using material available in the average orthopaedic operating room.

  19. Visual recovery in a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision: a case report

    Directory of Open Access Journals (Sweden)

    Liebmann Jeffrey M

    2011-06-01

    Full Text Available Abstract Introduction We report the case of a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision, who regained counting fingers vision with complete regression of neovascularization following anterior chamber washout, intravitreal bevacizumab, pars plana vitrectomy, and silicone oil placement. This represents a rare case in which a patient with no light perception vision was able to regain functional vision. Case presentation A 63-year-old Caucasian man with a 55-year history of long-standing retinal detachment after trauma presented to our facility with pain and redness, a total hyphema, no light perception vision and an intraocular pressure of 60 mmHg (right eye. He had a history of diabetes mellitus and coronary artery disease. Following anterior chamber washout, he was found to have neovascular glaucoma, for which intravitreal bevacizumab was administered. After washout and intraocular pressure control, his visual acuity improved to light perception. He subsequently underwent vitrectomy, membrane peeling, endolaser and silicone oil placement to reattach his retina, and then a second retinal reattachment procedure. Following these procedures, he had visual recovery to counting fingers vision in his right eye at five metres, complete regression of neovascularization, and intraocular pressure of 10 to 12 mmHg on one antiglaucoma medication. Conclusion Functional vision can be regained despite long-standing retinal detachment.

  20. Eradication of multidrug-resistant Acinetobacter baumannii in a female patient with total hip arthroplasty, with debridement and retention: a case report

    Directory of Open Access Journals (Sweden)

    Beieler Alison M

    2009-02-01

    Full Text Available Abstract Introduction Multidrug-resistant Acinetobacter baumannii has become a significant cause of healthcare-associated infections, but few reports have addressed Acinetobacter baumannii infections associated with orthopedic devices. The current recommended treatment for complicated infections due to orthopedic devices, including resistant gram-negative rods, consists of antimicrobial therapy with debridement and removal of implants. Case presentation The patient, a 47-year-old woman, had previously had a prior total hip arthroplasty at 16 years of age for a complex femoral neck fracture, and multiple subsequent revisions. This time, she underwent a fifth revision secondary to pain. Surgery was complicated by hypotension resulting in transfer to the intensive care unit and prolonged respiratory failure. She received peri-operative cefazolin but postoperatively developed surgical wound drainage requiring debridement of a hematoma. Cultures of this grew ampicillin-sensitive Enterococcus and Acinetobacter baumannii (sensitive only to amikacin and imipenem. The patient was started on imipenem. Removal of the total hip arthroplasty was not recommended because of the recent surgical complications, and the patient was eventually discharged home. She was seen weekly for laboratory tests and examinations and, after 4 months of therapy, the imipenem was discontinued. She did well clinically for 7 months before recurrent pain led to removal of the total hip arthroplasty. Intra-operative cultures grew ampicillin-sensitive Enterococcus and coagulase-negative Staphylococcus but no multidrug-resistant Acinetobacter baumannii. The patient received ampicillin for 8 weeks and had not had recurrent infection at the time of writing, 37 months after discontinuing imipenem. Conclusion We describe the successful treatment of an acute infection from multidrug-resistant Acinetobacter baumannii with debridement and retention of the total hip arthroplasty, using

  1. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report.

    Science.gov (United States)

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Local tissue reaction and necrosis-induced femoral nerve palsy in a patient with a metal-on-metal total hip arthroplasty: a case report.

    Science.gov (United States)

    Wodowski, Andrew J; Rider, Carson M; Mihalko, William M

    2014-01-01

    This case report describes a 54-year-old Hispanic male who developed femoral nerve palsy approximately 1 year after metal-on-metal total hip arthroplasty (MOM THA). Cobalt and chromium levels were 4.8 ppb and undetectable, respectively. MRI demonstrated a well-encapsulated pseudotumor that communicated with the anterior portion of the right hip, and EMG showed neuropraxic femoral nerve injury. As a result, the patient experienced motor and sensory loss in the femoral and proximal saphenous nerve distributions. Surgical revision to ceramic-on-poly THA with debridement and decompression of the pseudotumor improved the patient's neurological status. Similar acute local tissue reactions have been described but the serum levels of cobalt and chrome associated with these reactions have been variable. Wear particles and products produced from corrosion at the head taper junction from MOM THA can potentially lead to cellular dysfunction with subsequent pseudotumer formation, but these reactions and fluid collections have also been found. In this patient, serum cobalt levels were elevated, while serum chromium levels remained undetectable. The purpose of this case report is to describe one patient's response and to review the recent literature regarding potential complications of MOM THA.

  3. Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

    Directory of Open Access Journals (Sweden)

    Pua Yong-Hao

    2013-01-01

    Full Text Available Abstract Background Knee extensor strength and knee extension range of motion (ROM are important predictors of physical function in patients with a total knee arthroplasty (TKA. However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function. Methods Data from 441 patients with a TKA were collected preoperatively and 6 months postoperatively. Self-report measure of physical function was assessed by the Short Form 36 (SF-36 questionnaire. Knee extensor strength was measured by handheld dynamometry and knee extension ROM by goniometry. A bootstrapped cross product of coefficients approach was used to evaluate mediation effects. Results Mediation analyses, adjusted for clinicodemographic measures, revealed that the association between changes in knee extension ROM and SF-36 physical function was mediated by changes in knee extensor strength. Conclusions In patients with TKA, knee extensor strength mediated the influence of knee extension ROM on physical function. These results suggest that interventions to improve the range of knee extension may be useful in improving knee extensor performance.

  4. ATU/Fort Hood Solar Total Energy Military Large-Scale Experiment (LSE-1): system design and support activities. Final report, November 23, 1976-November 30, 1977

    Energy Technology Data Exchange (ETDEWEB)

    1977-01-01

    The ATU/Fort Hood Solar Total Energy System will include a concentrating solar collector field of several acres. During periods of direct insolation, a heat-transfer fluid will be circulated through the collector field and thus heated to 500 to 600/sup 0/F. Some of the fluid will be circulated through a steam generator to drive a turbine-generator set; additional fluid will be stored in insulated tanks for use when solar energy is not available. The electrical output will satisfy a portion of the electrical load at Fort Hood's 87,000 Troop Housing Complex. Heat extracted from the turbine exhaust in the form of hot water will be used for space heating, absorption air conditioning, and domestic water heating at the 87,000 Complex. Storage tanks for the hot water are also included. The systems analysis and program support activities include studies of solar availability and energy requirements at Fort Hood, investigation of interfacing LSE-1 with existing energy systems at the 87,000 Complex, and preliminary studies of environmental, health, and safety considerations. An extensive survey of available concentrating solar collectors and modifications to a computerized system simulation model for LSE-1 use are also reported. Important program support activities are military liaison and information dissemination. The engineering test program reported involved completion of the Solar Engineering Test Module (SETM) and extensive performance testing of a single module of the linear-focusing collector.

  5. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia venosa total (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

    Directory of Open Access Journals (Sweden)

    Luis Otavio Esteves

    2010-10-01

    ías. Tal vez, ese paciente tenga más de 12 meses y entonces la definición de lactante sería inadecuada. El segundo y el más importante de mis cuestionamientos, versa sobre la técnica usada y sobre el título del artículo. En el título, se usó la expresión "anestesia venosa total", pero en el relato se dijo que, además del propofol y del remifentanil, la anestesia se mantuvo con oxígeno y N2O. Si fue usado un gas con propiedades anestésicas (N2O, no sería correcto clasificar esa técnica como venosa total. Además, él cita el artículo de Crawford y col. ², que definió dosis de remifentanil para la intubación en niños. Ese estudio fue realizado utilizando la oxigenación en la concentración de 100%, porque los autores probablemente entienden que la adición de los gases con propiedades anestésicas interferiría en los resultados obtenidosI read the article "Total Intravenous Anesthesia (TIA in a Patient with Werdnig-Hoffman Disease. Case Report", of Resende et al.1, published in this journal with great interest. First, I would like to congratulate the authors for their initiative. However, two points called my attention. The first one refers to the definition of infant, which comprehends the period from 1 to 12 months of age. From 12 months on, it defines preschooler or just child. In the article, the author states the age of the patient as 1 year old, but he does not specify months or days. Probably, this patient has more than 12 months of age and, therefore, calling him an infant is inappropriate. The second and most important point refers to the technique used and to the title of the article. In the title, the expression "total intravenous anesthesia" was used, but in the report it was stated that besides propofol and remifentanil anesthesia was maintained with oxygen and N2O. If a gas with anesthetic properties (N2O was used, it would not be correct to call this technique total intravenous anesthesia. Besides, he mentioned the article of Crawford et

  6. Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report

    Directory of Open Access Journals (Sweden)

    Korfer Reiner

    2010-03-01

    Full Text Available Abstract Introduction The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall. Case presentation We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 × 37.7 × 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months. Conclusion Chest wall resection has become a critical component of the thoracic surgeon's armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis or malignant diseases. There are, however, very few reports on the

  7. Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report.

    Science.gov (United States)

    Daliakopoulos, Stavros I; Klimatsidas, Michael N; Korfer, Reiner

    2010-03-01

    The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall. We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 x 37.7 x 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months. Chest wall resection has become a critical component of the thoracic surgeon's armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis) or malignant diseases. There are, however, very few reports on the results of full-thickness complete chest wall resections for locally

  8. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Kaplan Mehmet

    2012-07-01

    Full Text Available Abstract Background This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD. Case report A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma. After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7. Conclusion In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.

  9. Patient-Reported Outcomes, Quality of Life, and Satisfaction Rates in Young Patients Aged 50 Years or Younger After Total Knee Arthroplasty.

    Science.gov (United States)

    Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Bin Abd Razak, Hamid Rahmatullah; Tay, Darren Keng-Jin; Lo, Ngai-Nung; Yeo, Seng-Jin

    2017-02-01

    Recent studies have shown a discrepancy between traditional functional outcomes and patient satisfaction, with some reporting less than 85% satisfaction in older patients undergoing total knee arthroplasty (TKA). As native knee biomechanics are not completely replicated, the resulting functional limitations may cause dissatisfaction in higher-demand individuals. Few studies have recorded patient-reported outcomes, health-related quality of life scores, and patient satisfaction in a young population undergoing TKA. One hundred thirty-six primary TKAs were performed in 114 patients aged 50 years or younger (mean age, 47.0 years; range, 30-50 years) at a single institution. The main diagnoses were osteoarthritis (85%) and rheumatoid arthritis (10%). The range of motion, Knee Society Score, Oxford Knee Score, and Physical and Mental Component Scores of Short Form-36 increased significantly (P patients had good/excellent knee scores, 71.3% had good/excellent function scores, 94.9% met the minimal clinically important difference for the Oxford Knee Score, and 84.6% met the minimal clinically important difference for the Physical Component Score. We found that 88.8% of patients were satisfied with their surgeries, whereas 86.8% had their expectations fulfilled. Survivorship using revision as an end point was 97.8% at a mean of 7 years (range, 3-16 years). Patients aged 50 years or younger undergoing TKA can experience significant improvements in their quality of life, have their expectations met, and be satisfied with their surgeries, at rates similar to those of non-age-restricted populations. Surgeons should inform them of these benefits and the potential risk of revision surgery in the future, albeit increasingly shown to be low. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. FY 1987 report on the result of the R and D of an automatic sewing system. Total system; 1987 nendo jido hosei system no kenkyu kaihatsu seika hokokusho. Total system

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1988-03-01

    The paper summarized the R and D of a total system which is an element technology of an automatic sewing system by the Automatic Sewing System Technology Research Association. As to the research on the apparel side, the following were studied: A. To clarify the effective field of element technology by dress type. B. To clarify the method of applying the system to small-/medium-size plants. C. To make study for automation so that it can be the basic data for experimental plants. To proceed with the study concretely, they asked 6 companies developing element technology to have the field study meeting. To study conditions for experimental plants from viewpoints of FA and FMS, the following studies were conducted concretely using a system model, based on the plant design law: A. Layout plan of the system model. B. Handling plan of the system model. C. Communication plan of the system model. D. Utility plan of the system model. E. Building plan. F. Study of the medium-term evaluation method. G. Study on the model plant. The above-mentioned study of the total system was proceeded with under the consideration of supporting the smooth progress of the developmental schedule of the automatic sewing system. (NEDO)

  11. Fiscal 2000 report on result of R and D of nonmetallic material recycling promotion technology (demonstration test and research, total system technology); 2000 nendo hitetsu kinzokukei sozai recycle sokushin gijutsu kenkyu kaihatsu seika hokokusho. Jissho shiken kenkyu, total system gijutsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    R and D was conducted on advanced recycling technology for aluminum and base metal/rare metal based materials, with fiscal 2000 results compiled. In the research of aluminum recycling technology, on a continuous fractional crystallization process and a purification by zinc removal process, the existing facilities for each demonstrated that they could simulate an aluminum scrap melting process capacity of 1,000 t/month, with a series of initial conditions determined. In the research of total system technology, combined test facilities were completed in which a purification process and a melt cleaning process were integrated. In the research of the recycling technology for base metal/rare metal based materials, a test was carried out by demonstrative facilities, with the aim of establishing copper regeneration technology in which high grade copper is produced using metal/resin based scraps such as shredder dust of automobiles as the materials. In structuring the total system technology, a preliminary survey and environmental load measures were carried out toward the practicability of a comprehensive copper metal collection recycling system. (NEDO)

  12. Research report of fiscal 1997. Study on total energy and material control (feasibility study on circulating society); 1997 nendo chosa hokokusho. Total energy and material control ni kansuru chosa (junkangata shakai kochiku kanosei chosa) chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    In order to construct real sustainable global environment and human society in the 21st century called the century of environment, not only the innovation of manufacturing processes technically supporting such the construction but also the conception including the innovation of the whole society from a wide viewpoint are essential. As a total energy and material control system (TEMCOS) concept, the view of an energy-saving circulating society is attempted which minimizes a total energy and material flow in Japan, and the role and issue of manufacturing industry, in particular, material industry are extracted. As one of the targets of such a concept, the conception of an eco-town is also described. Paying attention on some important material industries including a mass material flow and consuming a large amount of energy such as metal, plastics and automobile industries, the study result on a material flow for every industry is arranged, and some effective issues contributing to minimize a material flow and control energy consumption and CO2 emission are extracted. 80 refs., 67 figs., 30 tabs.

  13. Total body irradiation in a patient with fragile X syndrome for acute lymphoblastic leukemia in preparation for stem cell transplantation: A case report and literature review.

    Science.gov (United States)

    Collins, D T; Mannina, E M; Mendonca, M

    2015-10-01

    Fragile X syndrome (FXS) is a congenital disorder caused by expansion of CGG trinucleotide repeat at the 5' end of the fragile X mental retardation gene 1 (FMR1) on the X chromosome that leads to chromosomal instability and diminished serum levels of fragile X mental retardation protein (FMRP). Afflicted individuals often have elongated features, marfanoid habitus, macroorchidism and intellectual impairment. Evolving literature suggests the condition may actually protect from malignancy while chromosomal instability would presumably elevate the risk. Increased sensitivity to ionizing radiation should also be predicted by unstable sites within the DNA. Interestingly, in this report, we detail a patient with FXS diagnosed with acute lymphoblastic leukemia treated with induction followed by subsequent cycles of hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) with a complete response who then was recommended to undergo peripheral stem cell transplantation. The patient underwent total body irradiation (TBI) as a component of his conditioning regimen and despite the concern of his clinicians, developed minimal acute toxicity and successful engraftment. The pertinent literature regarding irradiation of patients with FXS is also reviewed. © 2015 Wiley Periodicals, Inc.

  14. The Effect of Prior Hip Arthroscopy on Patient-Reported Outcomes After Total Hip Arthroplasty: An Institutional Registry-Based, Matched Cohort Study.

    Science.gov (United States)

    Konopka, Joseph F; Buly, Robert L; Kelly, Bryan T; Su, Edwin P; McLawhorn, Alexander S

    2018-02-02

    A significant number of patients who undergo hip arthroscopy will subsequently undergo total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA), although limited evidence exists regarding effects of prior hip arthroscopy on the outcomes of these procedures. Of 5091 patients who underwent hip arthroscopy, we identified 69 patients who underwent subsequent THA (46) or HRA (23). Patients were matched to patients with no history of hip arthroscopy. Preoperative and 2-year postoperative Hip disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12, Lower Extremity Activity Scale score, and satisfaction surveys were compared. Patients who underwent THA with history of arthroscopy had lower postoperative Hip disability and Osteoarthritis Outcome Score Pain (82 ± 16 vs 93 ± 9, P = .003), Stiffness (85 ± 16 vs 93 ± 15, P = .01), Sports and Recreation (71 ± 22 vs 88 ± 18, P = .003), Quality-of-Life (65 ± 22 vs 86 ± 11, P Hip arthroscopy before hip arthroplasty is associated with slightly lower results in several patient-reported outcomes. These results are relevant when assessing patients for hip arthroscopy and when counseling prospective arthroplasty patients with history of arthroscopy. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Manuseio de grave diminuição de hemoglobina em paciente jovem, testemunha de Jeová, submetido à proctocolectomia total: relato de caso Manoseo de grave disminución de hemoglobina en paciente joven, testigo de Jehová, sometido a la proctocolectomia total: relato de caso Extreme intraoperative hemodilution in Jehovah’s witness patient submitted total proctocolectomy: case report

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2005-10-01

    un caso de proctocolectomia total en un paciente Testigo de Jehová donde el nivel de hemoglobina fue de 4 g/dL. RELATO DEL CASO: Paciente masculino, 17 años, historia de poliposis intestinal familiar. Iniciada a los ocho años, caracterizada por sangramiento. A los 13 años colectomia total. A los 17 años proctocolectomia total. Preparado con eritropoietina, ácido fólico, infusión de hierro y vitamina B12. El hemograma reveló: hematíes 4.200.000/mm3, hemoglobina 10,5 g/dL y hematócrito del 37%. Plaquetas 273.000/mm3, tiempo de protrombina normal. Monitorización con PANI, oximetría de muñeca (pulso capnografia y ECG continuamente. Anestesia con propofol, sufentanil, pancuronio y enflurano en circuito cerrado. Infusión de 7.000 mL de solución de Ringer con lactato y 150 mL de albúmina humana a 20%. Diuresis de 2.900 mL. Duración de 10 horas y 30 minutos. En la UTI Ht del 20%, hematíes 2.300.000/mm3, Hb de 4,2 g/dL y mantenido con propofol y atracúrio. En examen al día siguiente reveló: Ht del 18%, hematíes de 2.050.000/mm3, Hb de 4 g/dL. Extubado 18 horas después del término de la cirugía. Al segundo día fue encaminado para el cuarto. Al cuarto día iniciada con alimentación por vía oral. Alta hospitalario al décimo día de PO. En el 30º PO Ht del 35%, hematíes de 4.000.000/mm3 y Hb de 9,5 g/dL. Seis meses después, encerramiento de la ileostomia. Sometido a 12 cirugías sin transfusión sanguínea. CONCLUSIONES: Una planificación de todo el equipo (clínico, cirujano, anestesista y médicos de terapia intensiva permite realizar procedimientos quirúrgicos asociados con importantes pierdas sanguíneas, sin administración de sangre.BACKGROUND AND OBJECTIVES: Homologous blood transfusion risks are well known and some patients may refuse blood transfusions on religious grounds. This report aimed at describing a case of total proctocolectomy in Jehovah’s Witness patient with 4 g/dL hemoglobin. CASE REPORT: Male patient, 17 years old, with

  16. Multi-EM27/SUN Total Carbon Column Observing Network (TCCON) Comparison at the Southern Great Plains Site Field Campaign Report

    Energy Technology Data Exchange (ETDEWEB)

    Parker, H. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hedelius, J. [California Inst. of Technology (CalTech), Pasadena, CA (United States)

    2016-04-01

    During the summer of 2015, a field campaign took place to help characterize off-the-shelf portable solar-viewing Fourier Transform Spectrometer (FTS) instruments (EM27/SUN). These instruments retrieve greenhouse gas (GHG) abundances from direct solar spectra. A focus of this campaign was to test possible dependence on different atmospheric conditions. Along with the U.S. Department of Energy’s Atmospheric Radiation Measurement (ARM) Climate Research Facility Southern Great Plains (SGP) site in Oklahoma, experiments were conducted in Pasadena, California; Park Falls, Wisconsin; and the Armstrong Flight Research Center (AFRC), California. These locations are home to instruments in the Total Column Carbon Observing Network (TCCON). TCCON measurements were used as standards for the portable (EM27/SUN) measurements. Comparisons between the two types of instruments are crucial in the attempt to use the portable instruments to broaden the capabilities of GHG measurements for monitoring, reporting, and verification of carbon in the atmosphere. This campaign was aimed at testing the response of the portable FTS to different atmospheric conditions both local and regional. Measurements made at ARM SGP provided data in an agricultural environment with a relatively clean atmosphere with respect to pollution. Due to the homogeneity of the region surrounding Lamont, Oklahoma, portable FTS measurements were less effected by large changes in column GHG abundances from air mass movement between regions. These conditions aided in characterizing potential artificial solar zenith angle dependence of the retrievals. Data collected under atmospheric conditions at ARM SGP also provide for the analysis of cloud interference on solar spectra. In situ measurements were also made using a Picarro isotopic methane analyzer to determine surface-level in situ GHG concentrations and possible influences due to local agriculture and nearby towns. Data collected in this campaign have been presented

  17. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  18. Raquianestesia total após bloqueio do plexo lombar por via posterior: relato de caso Raquianestesia total después del bloqueo del plexo lumbar por vía posterior: relato de caso Total spinal block after posterior lumbar plexus blockade: case report

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2006-10-01

    que continua hasta los espacios peridural y subaracnoideo, para donde la solución anestésica puede se dispersar. A pesar de ofrecer un extenso margen de seguridad, el bloqueo del plexo lumbar demanda del anestesiólogo un conocimiento minucioso de la anatomía, una capacitación en la técnica y una vigilancia constante.BACKGROUND AND OBJECTIVES: Lumbar plexus blockade can be very useful in surgical procedures of the hip, thigh, and knee, but it should be performed by an experienced anesthesiologist due to potential complications. The current report presents a case of total spinal block after posterior lumbar plexus blockade and discusses the possible pathophysiological mechanisms. CASE REPORT: Male patient, 34 years old, 97 kg, physical status ASA I, scheduled for total hip arthroplasty. After general anesthesia, a right posterior lumbar plexus blockade was performed with the adjunct of a peripheral nerve stimulator. The needle was introduced to a depth of 8 cm, perpendicular to the skin, 4 cm from the mid line, on a line perpendicular to the spinal process of L4. After identification of a motor response from the quadriceps, the intensity of the current was reduced to 0.35 mA and 0.5% ropivacaine (39 mL was administered. During the injection, there were intermittent contractions of the quadriceps. After the block, the patient presented apnea, hypotension, and both pupils were dilated. At the end of the surgery, the patient presented motor block of the lower extremities, which reversed only nine hours after the block. In the postoperative period, the patient complained of severe pain; he was discharged 12 days after the surgery without motor or sensitive deficits. CONCLUSIONS: To identify the psoas compartment, where the lumbar plexus blockade is located, the intensity of the current must be between 0.5 and 1 mA. Motor response with low current indicates that the needle may be inside the sheath that surrounds the nervous root and extends to the epidural and

  19. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

    Directory of Open Access Journals (Sweden)

    José Costa

    2005-04-01

    dolor y hemodinámicamente estable siendo entonces encaminada a la sala de recuperación pos-anestésica. CONCLUSIONES: La anestesia venosa total con propofol y remifentanil proporcionó estabilidad hemodinámica para la madre y el feto, con un suave y precoz despertar.BACKGROUND AND OBJECTIVES: Anesthesia for pregnant patients is a challenge to the anesthesiologist because of the risks for mother and fetus. There are many complications described by the literature, such as fetal malformations, premature birth, maternal hemodynamic instability and even fetal death. The objective here is to show a 28 weeks pregnant patient submitted to partial laryngectomy under total intravenous general anesthesia with propofol, remifentanil and cisatracurium. CASE REPORT: Patient 29 years, 59 kg, primigravida of 28 weeks with previous diagnosis of epidermoid carcinoma close to the right vocal chord, scheduled for laryngectomy. Initial monitoring consisted of noninvasive and invasive blood pressure, cardioscopy, oxicapnography and continuous cardiotocography accomplished by the obstetrician. Venous puncture in right and left arm with 16G and 18G catheter, respectively. Patient received intravenous midazolam (1 mg, cefazolin (1 g, metoclopramide (10 mg and dipirone (1 g. Patient was oxygenated with 100% O2 under mask for 3 minutes and intravenous anesthesia was induced with propofol in controlled target infusion (3 µg.mL-1 and continuous remifentanil (1 µg.kg-1 in bolus and 0.2 µg.kg-1.min-1 for maintenance. Cisatracurium (13 mg was administered for muscle relaxation and tracheal intubation was achieved with 6.5 mm spiral-reinforced cuffed tube. Anesthesia was maintained with propofol and remifentanil in infusion pump, in addition to cisatracurium complementation. Fetus was continuously monitored with cardiotocography accomplished and analyzed by the obstetrician. Propofol and remifentanil infusion pumps were turned off at the end of completion and patient woke up 10 minutes later

  20. Estrogenic and androgenic activities in total plasma measured with reporter-gene bioassays: relevant exposure measures for endocrine disruptors in epidemiologic studies?

    NARCIS (Netherlands)

    Brouwers, M.M.; Besselink, H.; Bretveld, R.W.; Anzion, R.B.M.; Scheepers, P.T.J.; Brouwer, A.; Roeleveld, N.

    2011-01-01

    Measurements of estrogenic and androgenic activities in total plasma with Chemically Activated LUciferase gene eXpression (CALUX(R)) bioassays could provide biologically relevant measures for exposure to endocrine disruptors in epidemiologic studies. The objective of this study was to explore the

  1. Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report

    Directory of Open Access Journals (Sweden)

    V. Amorese

    2017-01-01

    Conclusion: The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.

  2. Immunohistochemically determined total epidermal growth factor receptor levels not of prognostic value in newly diagnosed glioblastoma multiforme: Report from the Radiation Therapy Oncology Group

    International Nuclear Information System (INIS)

    Chakravarti, Arnab; Seiferheld, Wendy; Tu Xiaoyu; Wang Huijun; Zhang Huazhong; Ang, K. Kian; Hammond, Elizabeth; Curran, Walter; Mehta, Minesh

    2005-01-01

    Purpose: The Radiation Therapy Oncology Group (RTOG) performed an analysis of patterns of immunohistochemically detected total epidermal growth factor receptor (EGFR) protein expression levels and their prognostic significance on archival tissue in newly diagnosed glioblastoma multiforme (GBM) patients from prior prospective RTOG clinical trials. Methods and materials: Patients in this study had been treated on previous RTOG GBM trials (RTOG 7401, 7918, 8302, 8409, 9006, 9305, 9602, and 9806). Tissue microarrays were prepared from 155 patients enrolled in these trials. These specimens were stained using a mouse monoclonal antibody specific for the extracellular binding domain of EGFR to detect total EGFR (including both wild-type phosphorylated and wild-type unphosphorylated isoforms with some cross-reactivity with EGFRvIII). The intensity of total EGFR protein expression was measured by computerized quantitative image analysis using the SAMBA 4000 Cell Image Analysis System. The parameters measured were the mean optical densities over the labeled areas and the staining index, which represents the proportion of stained area relative to the mean stain concentration. Both parameters were correlated with the clinical outcome. Results: No differences in either overall or progression-free survival could be demonstrated by the mean optical density class or mean optical density quartile or the staining index of total EGFR immunostaining among the representative RTOG GBM cases. Conclusion: Total EGFR protein expression levels, as measured immunohistochemically, do not appear to be of prognostic value in newly diagnosed GBM patients. Given the accumulating clinical evidence of the activity of anti-EGFR agents in GBM and the preclinical data suggesting the important role of downstream mediators as effectors of EGFR signaling, the RTOG is conducting additional investigations into the prognostic value of activation patterns of EGFR signaling, both at the level of the receptor

  3. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  4. Therapeutic limited bronchoalveolar lavage with fiberoptic bronchoscopy as a bridging procedure prior to total lung lavage in a patient with pulmonary alveolar proteinosis: a case report.

    Science.gov (United States)

    Rodrigo, Damith; Rathnapala, Amila; Senaratne, Wijitha

    2015-04-29

    Therapeutic total lung lavage under general anesthesia is the current mainstay of treatment for pulmonary alveolar proteinosis, which is a rare lung disease characterized by alveolar accumulation of surfactant. Therapeutic limited bronchoalveolar lavage is considered an alternative treatment to conventional total lung lavage. A 61-year-old, previously healthy, Sri Lankan Moor woman presented to our facility with progressively worsening difficulty in breathing and persistent dry cough for one year. Her respiratory examination revealed bibasal fine end-inspiratory crepitations. A chest radiograph showed bilateral mid and lower zone alveolar interstitial shadows and a high-resolution computed tomography scan of her chest revealed septal thickening with ground-glass shadows more on mid and lower zones bilaterally. A diagnostic bronchoalveolar lavage fluid analysis revealed diastase-resistant protein clumps in periodic acid Schiff stain. The diagnosis was made as pulmonary alveolar proteinosis. An arterial blood gas analysis performed prior to intervention revealed a significant hypoxia (partial pressure of oxygen - 64 mmHg) with alveolar-arterial gradient was 35.4 mmHg. Therapeutic limited bronchoalveolar lavage was arranged and her right and her left lung were lavaged separately in two sessions done two weeks apart under local anesthesia. Our patient had significant clinical improvement and resolution of the bilateral septal thickening with minimal resolution of the ground-glass opacities in a repeat high-resolution computed tomography scan done two weeks later. Subsequently, a total lung lavage under general anesthesia was also done, which improved her dyspnea and arterial hypoxemia. Therapeutic limited bronchoalveolar lavage can be successfully performed as an interval bridging procedure, as a 'prewash', prior to conventional total lung lavage for pulmonary alveolar proteinosis.

  5. Report on a Total Diet Study carried out by the Food Safety Authority of Ireland in the period 2012 – 2014

    OpenAIRE

    Food Safety Authority of Ireland

    2016-01-01

    As part of its statutory responsibility to ensure the safety of food consumed, distributed, produced and sold on the Irish market, the Food Safety Authority of Ireland (FSAI) periodically carries out Total Diet Studies (TDS) to measure the dietary exposure of the population to particular chemicals that may pose a risk to health if taken into the body in excessive amounts. In carrying out a TDS, the most commonly consumed foods in Ireland, based on food consumption data, are analysed for parti...

  6. Iris reconstruction using autologous iris preserved in cold balanced salt solution for 8 hours in iatrogenic total iridodialysis during cataract surgery: a case report.

    Science.gov (United States)

    Bang, Seung Pil; Jun, Jong Hwa

    2017-04-04

    A large iris defect or extensive iridodialysis can be an intractable cause of visual disturbance, photophobia, glare, monocular diplopia, or cosmetic deformity. The implantation of an artificial iris substitute could be an effective option, but this can cause a reduction in endothelial cell density. We succeeded in the anatomical restoration of iris tissue that was totally dialyzed out of the eye, and was preserved in cold balanced salt solution for 8 h. Engrafted iris tissue was maintained within the aqueous humor. A 71-year-old man was referred to our clinic for management of an iatrogenic total iridodialysis. The totally dialyzed iris tissue was immediately preserved in sterile cold balanced salt solution and packed in a sterile biopsy bottle that was surrounded with ice cubes. Under general anesthesia, a pars plana vitrectomy was performed to remove the remaining lens cortex and vitreous fiber anterior to the equator. A sulcus-positioned intraocular lens (IOL) was repositioned and fixed by ab externo scleral sutures. Preserved iris tissue was inserted and ironed using both iris spatula and ocular viscoelastic devices. Five-point ab interno scleral sutures were made 1.0 mm posterior to the limbus. The engrafted iris was successfully maintained for 6 months and did not undergo any atrophic change or depigmentation, which may be caused by primary implantation failure due to a blocked blood supply.

  7. Patient-reported Outcomes and Revision Rates at a Mean Follow-up of 10 Years After Lumbar Total Disc Replacement

    DEFF Research Database (Denmark)

    Laugesen, Line A.; Tendal Paulsen, Rune; Carreon, Leah

    2017-01-01

    STUDY DESIGN.: Prospective observational cohort study. OBJECTIVE.: To determine the long-term clinical results and prosthesis survival in patients treated with lumbar total disc replacement (TDR). SUMMARY OF BACKGROUND DATA.: Fusion has become the current standard surgical treatment for lumbar...... and statistically significant worse outcome scores at last follow-up compared to patients who had no revision. Thirty patients (52.6%) would choose the same treatment again if they were faced with the same problem. CONCLUSION.: This study demonstrated significant improvement in long-term clinical outcomes, similar...

  8. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  9. Total Synthesis of Hyperforin.

    Science.gov (United States)

    Ting, Chi P; Maimone, Thomas J

    2015-08-26

    A 10-step total synthesis of the polycyclic polyprenylated acylphloroglucinol (PPAP) natural product hyperforin from 2-methylcyclopent-2-en-1-one is reported. This route was enabled by a diketene annulation reaction and an oxidative ring expansion strategy designed to complement the presumed biosynthesis of this complex meroterpene. The described work enables the preparation of a highly substituted bicyclo[3.3.1]nonane-1,3,5-trione motif in only six steps and thus serves as a platform for the construction of easily synthesized, highly diverse PPAPs modifiable at every position.

  10. Total 2004 fact book

    International Nuclear Information System (INIS)

    2004-01-01

    This report presents the activities and results of the Group Total-Fina-Elf for the year 2004. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)

  11. Total Factbook 2003

    International Nuclear Information System (INIS)

    2003-01-01

    This report presents the activities and results of the Group Total-Fina-Elf for the year 2003. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)

  12. Analysis of Total Food Intake and Composition of Individual's Diet Based on the U.S. Department of Agriculture's 1994-96, 1998 Continuing Survey of Food Intakes by Individuals (CSFII) (2005, Final Report)

    Science.gov (United States)

    EPA released the final report, Analysis of Total Food Intake and Composition of Individual’s Diet Based on USDA’s 1994-1996, 98 Continuing Survey of Food Intakes by Individuals (CSFII). The consumption of food by the general population is a significant route of potential ...

  13. Changes in total and differential white cell counts, total lymphocyte ...

    African Journals Online (AJOL)

    Background: Published reports on the possible changes in the various immune cell populations, especially the total lymphocyte and CD4 cell counts, during the menstrual cycle in Nigerian female subjects are relatively scarce. Aim: To determine possible changes in the total and differential white blood cell [WBC] counts, ...

  14. Final report on the proficiency test on the determination of total arsenic concentration in water TC Project BGD/08/018

    International Nuclear Information System (INIS)

    Shakhashiro, A.; Trinkl, A.; Rossbach, M.; Benesch, T.; Campbell, M.; Sansone, U.; Will, K.; Schorn, R.; Toervenyi, A.

    2005-02-01

    A proficiency test on the determination of arsenic in drinking water was organised within the frame of the TC project BGD/8/018 to evaluate the analytical performance of laboratories in Bangladesh. This report summarises the performance evaluation of the participating laboratories. Analytical data evaluation showed that 61% of data obtained a 'Passed' final score for both the accuracy and precision criteria applied to this exercise. (author)

  15. An auto-SCT-based total therapy resulted in encouraging outcomes in adolescents and young adults with acute lymphoblastic leukemia: report from a single center of China.

    Science.gov (United States)

    Huang, J; Zou, D-H; Li, Z-J; Fu, M-W; Xu, Y; Zhao, Y-Z; Qi, J-Y; Feng, S-Z; Liu, B-C; Lin, D; Mi, Y-C; Han, M-Z; Wang, J-X; Qiu, L-G

    2012-08-01

    Application of auto-SCT in the post-remission therapy for adolescents and young adults (AYAs) with ALL is controversial. We analyzed the outcomes of 79 AYAs (15-24 years) with ALL who received our designed total therapy protocol with auto-SCT in first CR from 1990 to 2009. The estimated OS and EFS at 5 years for the cohort were 62.8±5.9 and 61.5±5.7%. The cumulative non-relapse mortality and relapse rate at 5 years for the cohort were 7.2±3.1 and 33.6±5.8%. Time to CR >4 weeks was the only independent unfavorable factor associated with OS, EFS and relapse in multivariate analysis. Patients in standard risk (SR) group and high risk (HR) group had better OS (78.3±7.4, 63.8±10.2 vs 38.1±11.6%) and EFS (78.0±7.4, 63.4±9.4 vs 32.4±11.3%), and lower relapse rate (15.9±6.5, 31.5±9.5 vs 65.7±11.8%) compared with patients in very high risk (VHR) group. Our data confirmed that auto-SCT-based total therapy might be an optional treatment strategy for AYAs with ALL in SR. Patients in HR also could get benefit from such schedule. But for those in VHR, allogenetic SCT is still the prior recommendation for the frequent recurrence after auto-SCT.

  16. Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report.

    Science.gov (United States)

    Amorese, V; Corda, M; Donadu, M; Usai, D; Pisanu, F; Milia, F; Marras, F; Sanna, A; Delogu, D; Mazzarello, V; Manzoni, G; Conti, M; Meloni, G B; Zanetti, S; Doria, C

    2017-01-01

    The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%. A 76year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016. The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Total half-body systemic irradiation for occult metastases in non-small cell lung cancer: an Eastern Cooperative Oncology group pilot report

    International Nuclear Information System (INIS)

    Salazar, O.M.; Scarantino, C.W.; Rubin, P.; Feldstein, M.L.; Keller, B.E.

    1980-01-01

    There is a high probability for patients with locally advanced, unresectable, nonmetastatic, nonsmall-cell bronchogenic carcinoma (NSCBC) to harbor subclinical distant metastases at diagnosis. Approximately 30% will disseminate in the first three months and an additional 50% will disseminate before a year has elapsed. Twenty advanced nonmetastatic patients wtith NSCBC were treated with localized split-course chest irradiation (LCI) plus total body (upper and lower half-body) irradiation for occult metastases. Thirty equally advanced, nonmetastatic patients, who were treated with only localized split-course chest irradiation, were matched and served as a retrospective control group. Apparently, the median recurrence free survival, metastatic free interval, and median survival were significantly prolonged, and there was a decrease in the incidence of liver metastases in patients receiving HBI for occult metastases over the patients of the control group. Although elective HBI seems to delay the appearance of distant metastases, it did not prevent their occurrence, alter patterns of first relapse, or significantly improve the overall survival. Nevertheless, a therapeutic gain may have been achieved and is discussed. The incidence of radiation pneumonitis with 800 rad of UHBI corrected for lung transmission was 9%. A hypothesis and a rationale for a more effective combined modality therapy in these patients is given

  18. Long-term survival following total pancreatectomy and superior mesenteric-portal vein resection for pancreatic ductal adenocarcinoma: A case report.

    Science.gov (United States)

    Tong, Han-Xing; Zhang, Lei; Rong, Ye-Fei; Wang, Dan-Song; Kuang, Tian Tao; Xu, Xue-Feng; Lou, Wen-Hui; Jin, DA-Yong

    2015-01-01

    Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with few therapeutic options. At present, surgical resection remains the only potential curative treatment for PDAC. However, only 15-20% of patients with PDAC are eligible for lesion resection. Total pancreatectomy (TP) and superior mesenteric-portal vein resection (SMPVR) may increase the rate of resection of PDCA, but the effect of this approach on improving long-term patient outcomes remains controversial. The present study investigated a case of PDAC in the pancreatic neck of a male patient. The patient underwent a TP, combined with SMPVR, for a margin-negative resection. Following an uneventful post-operative recovery, the patient received adjuvant chemoradiotherapy. The patient is currently alive at six years post-surgery, with a high quality of life. Given the clinical outcome of this patient, TP combined with SMPVR may provide PDAC patients with an opportunity for long-term survival. Therefore, patients with PDAC that is believed to be unresectable based on pre-operative assessment, may benefit from TP and SMPVR.

  19. Hexavalent and total chromium at low reporting concentrations in source-water aquifers and surface waters used for public supply in Illinois, 2013

    Science.gov (United States)

    Mills, Patrick C.; Cobb, Richard P.

    2015-01-01

    On the basis of their recent review of the human health effects of hexavalent chromium [Cr(VI)] in public drinking water, the U.S. Environmental Protection Agency is considering the need for Federal regulation of Cr(VI). Presently, only total chromium is regulated, at a Maximum Contaminant Level (MCL) of 100 micrograms per liter (µg/L). The occurrence of Cr(VI) in groundwater and surface waters generally is attributed to industrial sources, but can be of natural origin. California’s recently established MCL for Cr(VI) of 10 µg/L illustrates the drinking-water concerns associated with Cr(VI). To improve understanding of the possible impact of a Cr(VI)-specific standard that approximates the California level on the management of Illinois’ public drinking water, the U.S. Geological Survey, in cooperation with the Illinois Environmental Protection Agency, assessed the occurrence and distribution of Cr(VI) in the State’s public-water supplies.

  20. A real time biofeedback using Kinect and Wii to improve gait for post-total knee replacement rehabilitation: a case study report.

    Science.gov (United States)

    Levinger, Pazit; Zeina, Daniel; Teshome, Assefa K; Skinner, Elizabeth; Begg, Rezaul; Abbott, John Haxby

    2016-01-01

    This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group. The biofeedback system consisted of Microsoft Kinect(TM) and Nintendo Wii balance board with a dedicated software. A six-week inpatient rehabilitation program was augmented by biofeedback and tested in a single patient following TKR. Three patients underwent a six weeks standard rehabilitation with no biofeedback and served as a control group. Gait, function and pain were assessed and compared before and after the rehabilitation. The biofeedback software incorporated real time visual feedback to correct limb alignment, movement pattern and weight distribution. Improvements in pain, function and quality of life were observed in both groups. The strong improvement in the knee moment pattern demonstrated in the case study indicates feasibility of the biofeedback-augmented intervention. This novel biofeedback software has used simple commercially accessible equipment that can be feasibly incorporated to augment a post-TKR rehabilitation program. Our preliminary results indicate the potential of this biofeedback-assisted rehabilitation to improve knee function during gait. Research is required to test this hypothesis. Implications for Rehabilitation The real-time biofeedback system developed integrated custom-made software and simple low-cost commercially accessible equipment such as Kinect and Wii board to provide augmented information during rehabilitation following TKR. The software incorporated key rehabilitation principles and visual feedback to correct alignment of the lower legs, pelvic and trunk as well as providing feedback on limbs weight distribution. The case study patient demonstrated greater improvement in their knee function where a more normal biphasic knee moment was achieved following the six

  1. Revision Total Hip Arthroplasty Using an Acetabular Reinforcement Ring With a Hook: A Precise Follow-Up, at Average 11.4 Years, of a Previous Report.

    Science.gov (United States)

    Park, Kyung-Soon; Seon, Jong-Keun; Lee, Keun-Bae; Kim, Sung-Kyu; Chan, Chee-Ken; Yoon, Taek-Rim

    2017-02-01

    This study aims at determining the average long-term result of revision total hip arthroplasty (THA) using the acetabular reinforcement ring with a hook (ARRH) and bone grafting in severe acetabular bony defect. Expected 15-year survival of ARRH in revision THA is included in the study. Retrospective review of 48 patients (48 hips) with follow-up duration of average 11.4 years (range, 6.1-21.4 years) was conducted. At each follow-up, Harris hip score was used to assess functional outcome, and radiographic acetabular component osteolysis was measured by DeLee and Charnley classification. Bone defects were assessed preoperatively and intraoperatively using American academy of orthopedic surgeons and Paprosky classification. The common modes of ARRH failures were evaluated. Bone consolidation, presence of heterotopic ossification, and complications such as infection and dislocation were recorded. The bone defects were varied and included cavitary, segmental, and combined defects without any pelvic discontinuity. Mean Harris hip score improved from 52.6 points preoperatively to 82.0 points postoperatively. Nine acetabular revisions and 3 stem revisions (2 concurrent with acetabular revisions and 1 isolated stem revision) were performed. There were 5 infected cases and 1 patient with recurrent dislocation. The 11.4-year survival of revision THA with ARRH was 71% as the end point for acetabular revision surgery for any reason. The expected 15-year survival of revision THA with ARRH was 60%. The most common failure mode of ARRH was superomedial migration followed by lateral migration. ARRH combined with bone grafting produces relatively good average long-term clinical results. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Patient-reported Outcomes and Revision Rates at a Mean Follow-up of 10 Years After Lumbar Total Disc Replacement.

    Science.gov (United States)

    Laugesen, Line A; Paulsen, Rune T; Carreon, Leah; Ernst, Carsten; Andersen, Mikkel Ø

    2017-11-01

    Prospective observational cohort study. The aim of this study was to determine the long-term clinical results and prosthesis survival in patients treated with lumbar total disc replacement (TDR). Fusion has become the current standard surgical treatment for lumbar degenerative disease. TDR is an alternative treatment that seeks to avoid fusion-related adverse events, specifically adjacent segment disease. Sixty-eight consecutive patients treated with TDR from 2003 to 2008 were invited to follow-up and complete a Visual Analog Scale (VAS) for back and leg pain, the Dallas Pain Questionnaire (DPQ), and the Short Form-36. These surveys were also administered to the subjects before their index TDRs. Data on reoperation were collected from the patients' medical records. Fifty-seven (84%) patients were available for follow-up at a mean 10.6 years post-operatively (range 8.1-12.6 years). There was a significant improvement from preop to latest follow-up in VAS (6.8 vs. 3.2, P fusion surgery after their index TDR. Patients who had revision surgery had statistically significant worse outcome scores at last follow-up than patients who had no revision. Thirty patients (52.6%) would choose the same treatment again if they were faced with the same problem. This study demonstrated significant improvement in long-term clinical outcomes, similar to previously published studies, and two-thirds of the discus prostheses were still functioning at follow-up. However, there is still a lack of well-designed long-term studies, thus requiring further investigation. 3.

  3. Is cementing technique the cause of early aseptic loosening of the tibial component in total knee arthroplasty? A report of 22 failed tibial components

    Directory of Open Access Journals (Sweden)

    Stefan Endres

    2011-05-01

    Full Text Available Despite excellent results of bicondylar knee resurfacing when both the tibial and femoral components are cemented, loosening of the cemented tibial component (surface cementing occurs in approximately 10% of the implants within a 4-year interval after the procedure. Based on our own experience, we want to report of early failed tibial components in 22 patients after a mean follow up of 51 months, necessitating a revision procedure. We analysed retrospectively 22 cases of failed tibial components in patients after a mean follow up of 51 months, necessitating a revision procedure. This raised the question of whether the cementing technique was implicated in the loosening. Every correlation between early loosening and clinically relevant covariates were investigated. All patients were evaluated for radiolucency and osteolytic lesions at the bone–cement interfaces by radiographic assessment according to Rossi et al. (a.p. view and lateral view divided into two zones. The mean radiographic cement penetration in anterior-posterior view was 1.2 mm (SD 0.8 in zone 1 and 1.6 mm (SD 0.9 in zone 2. The mean radiographic cement penetration in lateral view was 1.1 mm (SD 0.4 in zone 1 and 1.3 mm (SD 0.3 in zone 2. Osteolytic lesions were seen in all cases around the implant after a mean of 51 months. In all cases a revision procedure was done. Based on clinical presentation, haematological screening, joint aspiration (synovial fluid diagnostic, microbiological analyses and histological evaluation of intraoperative samples an infection was excluded. The authors have a critical attitude toward a loosening rate of almost 10% as stated by the recent literature within the first 4 to 5 years and consider that a reduction of the loosening rate when using the full cementation technique /cementing the stem will mean a greater benefit for patients than the possible advantage of a better bone stock in case of revision surgery. Apart from this aspect, the question of

  4. No associations between self-reported knee joint instability and radiographic features in knee osteoarthritis patients prior to Total Knee Arthroplasty: A cross-sectional analysis of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis study (LOAS) data.

    Science.gov (United States)

    Leichtenberg, Claudia S; Meesters, Jorit J L; Kroon, Herman M; Verdegaal, Suzan H M; Tilbury, Claire; Dekker, Joost; Nelissen, Rob G H H; Vliet Vlieland, Thea P M; van der Esch, Martin

    2017-08-01

    To describe the prevalence of self-reported knee joint instability in patients with pre-surgery knee osteoarthritis (OA) and to explore the associations between self-reported knee joint instability and radiological features. A cross-sectional study including patients scheduled for primary Total Knee Arthroplasty (TKA). Self-reported knee instability was examined by questionnaire. Radiological features consisted of osteophyte formation and joint space narrowing (JSN), both scored on a 0 to three scale. Scores >1 are defined as substantial JSN or osteophyte formation. Regression analyses were provided to identify associations of radiological features with self-reported knee joint instability. Two hundred and sixty-five patients (mean age 69years and 170 females) were included. Knee instability was reported by 192 patients (72%). Substantial osteophyte formation was present in 78 patients (41%) reporting and 33 patients (46%) not reporting knee joint instability. Substantial JSN was present in 137 (71%) and 53 patients (73%), respectively. Self-reported knee instability was not associated with JSN (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.87 (0.30-2.54), 0.98 (0.38-2.52), 0.68 (0.25-1.86), respectively) or osteophyte formation (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.77 (0.36-1.64), 0.69 (0.23-1.45), 0.89 (0.16-4.93), respectively). Stratified analysis for pain, age and BMI showed no associations between self-reported knee joint instability and radiological features. Self-reported knee joint instability is not associated with JSN or osteophyte formation. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Total iron binding capacity

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003489.htm Total iron binding capacity To use the sharing features on this page, please enable JavaScript. Total iron binding capacity (TIBC) is a blood test to ...

  6. Technique of total thyroidectomy

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    It is essential to define the various surgical procedures that are carried out for carcinoma of the thyroid gland. They are thyroid gland, subtotal lobectomy, total thyroidectomy and near total thyroidectomy

  7. Total parenteral nutrition

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000177.htm Total parenteral nutrition To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  8. Total parenteral nutrition - infants

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007239.htm Total parenteral nutrition - infants To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  9. On total disc replacement.

    Science.gov (United States)

    Berg, Svante

    2011-02-01

    Low back pain consumes a large part of the community's resources dedicated to health care and sick leave. Back disorders also negatively affect the individual leading to pain suffering, decreased quality-of-life and disability. Chronic low back pain (CLBP) due to degenerative disc disease (DDD) is today often treated with fusion when conservative treatment has failed and symptoms are severe. This treatment is as successful as arthroplasty is for hip arthritis in restoring the patient's quality of life and reducing disability. Even so, there are some problems with this treatment, one of these being recurrent CLBP from an adjacent segment (ASD) after primarily successful surgery. This has led to the development of alternative surgical treatments and devices that maintain or restore mobility, in order to reduce the risk for ASD. Of these new devices, the most frequently used are the disc prostheses used in Total Disc Replacement (TDR). This thesis is based on four studies comparing total disc replacement with posterior fusion. The studies are all based on a material of 152 patients with DDD in one or two segments, aged 20-55 years that were randomly treated with either posterior fusion or TDR. The first study concerned clinical outcome and complications. Follow-up was 100% at both one and two years. It revealed that both treatment groups had a clear benefit from treatment and that patients with TDR were better in almost all outcome scores at one-year follow-up. Fusion patients continued to improve during the second year. At two-year follow-up there was a remaining difference in favour of TDR for back pain. 73% in the TDR group and 63% in the fusion group were much better or totally pain-free (n.s.), while twice as many patients in the TDR group were totally pain free (30%) compared to the fusion group (15%). Time of surgery and total time in hospital were shorter in the TDR group. There was no difference in complications and reoperations, except that seventeen of the

  10. Total well dominated trees

    DEFF Research Database (Denmark)

    Finbow, Arthur; Frendrup, Allan; Vestergaard, Preben D.

    cardinality then G is a total well dominated graph. In this paper we study composition and decomposition of total well dominated trees. By a reversible process we prove that any total well dominated tree can both be reduced to and constructed from a family of three small trees....

  11. Reemplazo total de cadera

    OpenAIRE

    Sánchez Vergel, Alfredo; Fundación Valle de Lili

    2002-01-01

    Definición/Tipos de prótesis/ ¿Qué pacientes se podrían beneficiar de un reemplazo total de cadera?/Artrosis de cadera/Tipos de artrosis de cadera/Alternativas al reemplazo total de cadera/Preguntas frecuentes sobre el reemplazo total de cadera.

  12. Total synthesis of proposed auranthine.

    Science.gov (United States)

    Kshirsagar, Umesh A; Puranik, Vedavati G; Argade, Narshinha P

    2010-04-16

    Starting from CBz-protected glutamic anhydride and Boc-protected o-aminobenzyl amine, the first total synthesis of proposed structure of auranthine has been reported. An intramolecular aza-Wittig reaction involving a lactam carbonyl group that delivered the diazepine core unit was the key step in the synthesis.

  13. Self-Reported Snoring Is Associated with Dyslipidemia, High Total Cholesterol, and High Low-Density Lipoprotein Cholesterol in Obesity: A Cross-Sectional Study from a Rural Area of China.

    Science.gov (United States)

    Zhang, Naijin; Chen, Yintao; Chen, Shuang; Jia, Pengyu; Guo, Xiaofan; Sun, Guozhe; Sun, Yingxian

    2017-01-17

    Studies to explore the relationship between self-reported snoring and dyslipidemia, especially high total cholesterol (TC) and high low-density lipoprotein cholesterol (LDL-C), in the general population are still lacking. Our study was designed to examine whether self-reported snoring is significantly associated with dyslipidemia and ascertain the effects of different snoring intensities on dyslipidemia. There were 10,139 participants in our study. After adjustment for all confounding factors, self-reported snoring (OR = 1.207; p = 0.003), moderate (OR = 1.229; p = 0.015), strong (OR = 1.222; p = 0.033), and very strong (OR = 1.467; p = 0.012) snoring intensity, but not low (OR = 1.110; p = 0.224) snoring intensity, were significantly associated with dyslipidemia among adults with BMI (body mass index) ≥ 25 kg/m². In addition, self-reported snoring was significantly associated with high TC (OR = 1.167; p = 0.048) and high LDL-C (OR = 1.228; p = 0.044), rather than low HDL-C (OR = 1.171; p = 0.057) and high triglyceride (TG) (OR = 1.110; p = 0.141). In conclusion, adults with BMI ≥ 25 kg/m² and who experience snoring, especially moderate, strong, and very strong intensity levels of snoring, should be on the alert regarding the possibility of dyslipidemia, especially high LDL-C and high TC.

  14. Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007

    Directory of Open Access Journals (Sweden)

    Olav Lutro

    2014-01-01

    Full Text Available We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA. The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007. Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records. A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS (41%, 113/278 and Staphylococcus aureus (19%, 53/278. The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28 in the first period, 1993–1997, to 84% (52/62 in the last period, 2003–2007 (P = 0.003. There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.

  15. Aloenxerto circunferencial de femur proximal em cirurgia de revisäo de artroplastia total de quadril: relato de casos com seguimento mínimo de 20 anos Circumferential proximal femoral allografts in revision surgery on total hip arthroplasty: case reports with a minimum follow-up of 20 years

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    2012-01-01

    Full Text Available Dentre as opções para reconstrução femoral em cirurgias de revisão de artroplastia total do quadril (RATQ em defeitos circunferenciais extensos está a utilização de aloenxerto de fêmur proximal. O seu uso permite a correção do mecanismo abdutor do quadril e da discrepância de comprimento dos membros inferiores, além de apresentar potencial osteocondutivo. Os autores relatam os achados clínicos e radiográficos de dois casos de RATQ com uso desta técnica, em seguimento mínimo de 20 anos.Among the options for femoral reconstruction in total hip arthroplasty (THA revision procedures, in cases of extensive circumferential defects, is the use of proximal femoral allografts. This technique makes it possible to correct the hip abductor mechanism and the leg length discrepancy, as well as presenting osteoconductive potential. The authors report the clinical and radiographic results from two cases of THA revision using this technique, with a minimum follow-up of 20 years.

  16. Totalization Data Exchange (TDEX)

    Data.gov (United States)

    Social Security Administration — The Totalization Data Exchange (TDEX) process is an exchange between SSA and its foreign country partners to identify deaths of beneficiaries residing abroad. The...

  17. Bilateral Staged Total Hip Replacement and the Natural Progress of an Untreated Case of Developmental Dysplasia (Dislocation of the Hip: A Clinical Case Report by the Surgeon and the Patient

    Directory of Open Access Journals (Sweden)

    Hamid Honarpisheh

    2015-07-01

    Full Text Available The natural history of an untreated case of a Developmental Dysplasia (Dislocation of the Hip (DDH associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient’s complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices.

  18. Perioperative management of a patient with Dandy Walker malformation with tetralogy of Fallot undergoing total correction and fresh homologous pericardial pulmonary valve conduit implantation: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Vishnu Datt

    2015-01-01

    Full Text Available Perioperative management of a patient with Dandy-Walker malformation (DWM with tetralogy of Fallot (TOF, patent ductus arteriosus, and pulmonary artery stenosis is a great challenge to the anesthesiologist. Anesthetic management in such patients can trigger tet spells that might rapidly increase intracranial pressure (ICP, conning and even death. The increase in ICP can precipitate tet spells and further brain hypoxia. To avoid an increase in ICP during TOF corrective surgery ventriculo-peritoneal (VP shunt should be performed before cardiac surgery. We present the first case report of a 11-month-old male baby afflicted with DWM and TOF who underwent successful TOF total corrective surgery and fresh autologous pericardial pulmonary valve conduit implantation under cardiopulmonary bypass after 1 week of VP shunt insertion.

  19. Incapacidad laboral total

    Directory of Open Access Journals (Sweden)

    Orlando Díaz Tabares

    1997-04-01

    Full Text Available Se realizó un estudio longitudinal, descriptivo y retrospectivo con el objetivo de conocer el comportamiento de la incapacidad permanente para el trabajo en el municipio "San Cristóbal" durante el decenio 1982-1991, y se aplicó el método de encuesta por el que se recogieron datos que fueron extraídos del modelo oficial de peritaje médico laboral y de la entrevista con el peritado. Los resultados fueron plasmados en tablas de contingencias donde se relacionan las variables por cada año estudiado, y se aplicó la prueba estadística de chi cuadrado. El número de individuos dictaminados con incapacidad laboral total fue de 693; predominó en reportes el año 1988 con 114 casos y muy discretamente el sexo femenino sobre el masculino, el grupo etáreo de 45 a 54 años con 360 casos y la artrosis como entidad valorada por ortopedia, con análisis estadísticos significativos. No resultó estadísticamente significativo, el predominio de la hipertensión arterial sistémica entre las entidades valoradas por la especialidad de medicina interna como causas de incapacidad laboral. Fue muy significativa la variación del número de dictaminados por la comisión en cada uno de los años estudiados y que el porcentaje de ellos que se encontraban realizando trabajos que demandan esfuerzo físico de moderado a intenso al momento de aplicar la encuesta, ascendió al 64,9.A longitudinal, descriptive and retrospective study was conducted in order to know the behavior of permanent labor disability at the municipality of San Cristóbal during 1982-1991. A survey was done to collect data taken from the official model of medical inspections and from the interview with the disabled worker. The results were shown in contingency tables where the variables are related by every year studied. The chi square statistical test was applied. The number of individuals with labor disability was 693. As for reports, the year 1988 predominated with 114. There was a discreet

  20. Total synthesis of ciguatoxin.

    Science.gov (United States)

    Hamajima, Akinari; Isobe, Minoru

    2009-01-01

    Something fishy: Ciguatoxin (see structure) is one of the principal toxins involved in ciguatera poisoning and the target of a total synthesis involving the coupling of three segments. The key transformations in this synthesis feature acetylene-dicobalthexacarbonyl complexation.

  1. Total 2004 results

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-02-01

    This document presents the 2004 results of Total Group: consolidated account, special items, number of shares, market environment, adjustment for amortization of Sanofi-Aventis merger-related intangibles, 4. quarter 2004 results (operating and net incomes, cash flow), upstream (results, production, reserves, recent highlights), downstream (results, refinery throughput, recent highlights), chemicals (results, recent highlights), Total's full year 2004 results (operating and net income, cash flow), 2005 sensitivities, Total SA parent company accounts and proposed dividend, adoption of IFRS accounting, summary and outlook, main operating information by segment for the 4. quarter and full year 2004: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refined product sales by region, chemicals), Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)

  2. Total 2004 results

    International Nuclear Information System (INIS)

    2005-02-01

    This document presents the 2004 results of Total Group: consolidated account, special items, number of shares, market environment, adjustment for amortization of Sanofi-Aventis merger-related intangibles, 4. quarter 2004 results (operating and net incomes, cash flow), upstream (results, production, reserves, recent highlights), downstream (results, refinery throughput, recent highlights), chemicals (results, recent highlights), Total's full year 2004 results (operating and net income, cash flow), 2005 sensitivities, Total SA parent company accounts and proposed dividend, adoption of IFRS accounting, summary and outlook, main operating information by segment for the 4. quarter and full year 2004: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refined product sales by region, chemicals), Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)

  3. Genoptraening efter total knaealloplastik

    DEFF Research Database (Denmark)

    Holm, Bente; Kehlet, Henrik

    2009-01-01

    The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty....

  4. Genoptraening efter total knaealloplastik

    DEFF Research Database (Denmark)

    Holm, Bente; Kehlet, Henrik

    2009-01-01

    The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty. Udgivelsesdato: 2009-Feb-23...

  5. Total lymphoid irradiation

    International Nuclear Information System (INIS)

    Sutherland, D.E.; Ferguson, R.M.; Simmons, R.L.; Kim, T.H.; Slavin, S.; Najarian, J.S.

    1983-01-01

    Total lymphoid irradiation by itself can produce sufficient immunosuppression to prolong the survival of a variety of organ allografts in experimental animals. The degree of prolongation is dose-dependent and is limited by the toxicity that occurs with higher doses. Total lymphoid irradiation is more effective before transplantation than after, but when used after transplantation can be combined with pharmacologic immunosuppression to achieve a positive effect. In some animal models, total lymphoid irradiation induces an environment in which fully allogeneic bone marrow will engraft and induce permanent chimerism in the recipients who are then tolerant to organ allografts from the donor strain. If total lymphoid irradiation is ever to have clinical applicability on a large scale, it would seem that it would have to be under circumstances in which tolerance can be induced. However, in some animal models graft-versus-host disease occurs following bone marrow transplantation, and methods to obviate its occurrence probably will be needed if this approach is to be applied clinically. In recent years, patient and graft survival rates in renal allograft recipients treated with conventional immunosuppression have improved considerably, and thus the impetus to utilize total lymphoid irradiation for its immunosuppressive effect alone is less compelling. The future of total lymphoid irradiation probably lies in devising protocols in which maintenance immunosuppression can be eliminated, or nearly eliminated, altogether. Such protocols are effective in rodents. Whether they can be applied to clinical transplantation remains to be seen

  6. Totally optimal decision rules

    KAUST Repository

    Amin, Talha

    2017-11-22

    Optimality of decision rules (patterns) can be measured in many ways. One of these is referred to as length. Length signifies the number of terms in a decision rule and is optimally minimized. Another, coverage represents the width of a rule’s applicability and generality. As such, it is desirable to maximize coverage. A totally optimal decision rule is a decision rule that has the minimum possible length and the maximum possible coverage. This paper presents a method for determining the presence of totally optimal decision rules for “complete” decision tables (representations of total functions in which different variables can have domains of differing values). Depending on the cardinalities of the domains, we can either guarantee for each tuple of values of the function that totally optimal rules exist for each row of the table (as in the case of total Boolean functions where the cardinalities are equal to 2) or, for each row, we can find a tuple of values of the function for which totally optimal rules do not exist for this row.

  7. Totally Nonnegative Matrices

    CERN Document Server

    Fallat, Shaun M

    2011-01-01

    Totally nonnegative matrices arise in a remarkable variety of mathematical applications. This book is a comprehensive and self-contained study of the essential theory of totally nonnegative matrices, defined by the nonnegativity of all subdeterminants. It explores methodological background, historical highlights of key ideas, and specialized topics.The book uses classical and ad hoc tools, but a unifying theme is the elementary bidiagonal factorization, which has emerged as the single most important tool for this particular class of matrices. Recent work has shown that bidiagonal factorization

  8. Qualità totale e mobilità totale Total Quality and Total Mobility

    Directory of Open Access Journals (Sweden)

    Giuseppe Trieste

    2010-05-01

    Full Text Available FIABA ONLUS (Italian Fund for Elimination of Architectural Barriers was founded in 2000 with the aim of promoting a culture of equal opportunities and, above all, it has as its main goal to involve public and private institutions to create a really accessible and usable environment for everyone. Total accessibility, Total usability and Total mobility are key indicators to define quality of life within cities. A supportive environment that is free of architectural, cultural and psychological barriers allows everyone to live with ease and universality. In fact, people who access to goods and services in the urban context can use to their advantage time and space, so they can do their activities and can maintain relationships that are deemed significant for their social life. The main aim of urban accessibility is to raise the comfort of space for citizens, eliminating all barriers that discriminate people, and prevent from an equality of opportunity. “FIABA FUND - City of ... for the removal of architectural barriers” is an idea of FIABA that has already affected many regions of Italy as Lazio, Lombardy, Campania, Abruzzi and Calabria. It is a National project which provides for opening a bank account in the cities of referring, in which for the first time, all together, individuals and private and public institutions can make a donation to fund initiatives for the removal of architectural barriers within its own territory for a real and effective total accessibility. Last February the fund was launched in Rome with the aim of achieving a Capital without barriers and a Town European model of accessibility and usability. Urban mobility is a prerequisite to access to goods and services, and to organize activities related to daily life. FIABA promotes the concept of sustainable mobility for all, supported by the European Commission’s White Paper. We need a cultural change in management and organization of public means, which might focus on

  9. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient

    OpenAIRE

    Kane, Patrick M.; Stull, Justin D.; Culp, Randall W.

    2015-01-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty.

  10. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...

  11. Total versus subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe

    2005-01-01

    The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty...

  12. Total Quality Management Seminar.

    Science.gov (United States)

    Massachusetts Career Development Inst., Springfield.

    This booklet is one of six texts from a workplace literacy curriculum designed to assist learners in facing the increased demands of the workplace. The booklet contains seven sections that cover the following topics: (1) meaning of total quality management (TQM); (2) the customer; (3) the organization's culture; (4) comparison of management…

  13. Total Quality Management Simplified.

    Science.gov (United States)

    Arias, Pam

    1995-01-01

    Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…

  14. Total synthesis of aquatolide

    NARCIS (Netherlands)

    Saya, J.M.; Vos, K.; Klein Nijenhuis, R.A.; van Maarseveen, J.H.; Ingemann, S.; Hiemstra, H.

    2015-01-01

    A total synthesis of the sesquiterpene lactone aquatolide has been accomplished. The central step is an intramolecular [2 + 2]-photocycloaddition of an allene onto an alpha,beta-unsaturated delta-lactone. Other key steps are an intramolecular Horner-Wadsworth-Emmons reaction to close the lactone and

  15. CSF total protein

    Science.gov (United States)

    CSF total protein is a test to determine the amount of protein in your spinal fluid, also called cerebrospinal fluid (CSF). ... The normal protein range varies from lab to lab, but is typically about 15 to 60 milligrams per deciliter (mg/dL) ...

  16. Total Cost of Ownership

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2007-01-01

    Total Cost of Ownership (TCO), som giver et bud på, hvordan virksomheder kan opnå en bedre indsigt i, hvilke leverandører der forårsager hvilke omkostninger og dermed danne et forbedret beslutningsgrundlag for besparelser i leverandørleddet. I artiklen argumenteres først og fremmest for, hvorfor TCO er...

  17. Scenarios for total utilisation of hydrogen as an energy carrier in the future Danish energy system. Final report; Scenarier for samlet udnyttelse af brint som energibaerer i Danmarks fremtidige energisystem. Slutrapport

    Energy Technology Data Exchange (ETDEWEB)

    Hauge Petersen, A.; Engberg Pedersen, T.; Joergensen, K. (and others)

    2001-04-01

    This is the final report from a project performed for the Danish Energy Agency under its Hydrogen Programme. The project, which within the project group goes by the abbreviated title 'Hydrogen as an energy carrier', constructs and analyses different total energy scenarios for introducing hydrogen as an energy carrier, as energy storage medium and as a fuel in the future Danish energy system. The primary aim of the project is to study ways of handling the large deficits and surpluses of electricity from wind energy expected in the future Danish energy system. System-wide aspects of the choice of hydrogen production technologies, distribution methods, infrastructure requirements and conversion technologies are studied. Particularly, the possibility of using in the future the existing Danish natural gas distribution grid for carrying hydrogen will be assessed. For the year 2030, two scenarios are constructed: One using hydrogen primarily in the transportation sector, the other using it as a storage option for the centralised power plants still in operation by this year. For the year 2050, where the existing fossil power plants are expected to have been phased out completely, the scenarios for two possible developments are investigated: Either, there is a complete decentralisation of the use of hydrogen, converting and storing electricity surpluses into hydrogen in individual buildings, for later use in vehicles or regeneration of power and heat. Or, some centralised infrastructure is retained, such as hydrogen cavern stores and a network of vehicle hydrogen filling stations. The analysis is used to identify the components in an implementation strategy, for the most interesting scenarios, including a time sequence of necessary decisions and technology readiness. The report is in Danish, because it is part of the dissemination effort of the Hydrogen Committee, directed at the Danish population in general and the Danish professional community in particular. (au)

  18. Endoscopic Transaxillary Near Total Thyroidectomy

    Science.gov (United States)

    Ejeh, Ijeoma Acholonu; Speights, Fredne; Rashid, Qammar N.; Ideis, Mustafa

    2006-01-01

    Background: Since first reported in 1996, endoscopic minimally invasive surgery of the cervical region has been shown to be safe and effective in the treatment of benign thyroid and parathyroid disease. The endoscopic transaxillary technique uses a remote lateral approach to the thyroid gland. Because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, this technique has typically been reserved for patients with unilateral disease. Objectives: The present study examines the safety and feasibility of the transaxillary technique in dissecting and assessment of both thyroid lobes in performing near total thyroidectomy. Methods: Prior to this study we successfully performed endoscopic transaxillary thyroid lobectomy in 32 patients between August 2003 and August 2005. Technical feasibility in performing total thyroidectomy using this approach was accomplished first utilizing a porcine model followed by three human cadaver models prior to proceeding to human surgery. After IRB approval three female patients with histories of enlarging multinodular goiter were selected to undergo endoscopic near total thyroidectomy. Results: The average operative time for all models was 142 minutes (range 57–327 min). The three patients in this study had clinically enlarging multinodular goiters with an average size of 4 cm. The contralateral recurrent laryngeal nerve and parathyroid glands were identified in all cases. There was no post-operative bleeding, hoarseness or subcutaneous emphysema. Conclusion: Endoscopic transaxillary near total thyroidectomy is feasible and can be performed safely in human patients with bilateral thyroid disease. PMID:16882421

  19. Total design of participation

    DEFF Research Database (Denmark)

    Munch, Anders V.

    2016-01-01

    The idea of design as an art made not only for the people, but also by the people is an old dream going back at least to William Morris. It is, however, reappearing vigoriously in many kinds of design activism and grows out of the visions of a Total Design of society. The ideas of participation b...... for? To which degree should everyone be educated in ’design literacy’ to participate? Total design of participation is an artistic intervention in society and must be discussed in this utopian tradition....... by Tim Brown can be compared to considerations by László Moholy-Nagy and Walter Gropuis on the training and education of active and capable citizens. This opens, though, some dilemmas to discuss: To what extend is the capability of creativity then a (pre)condition to be a citizen of the society wished...

  20. TOTAL PERFORMANCE SCORECARD

    Directory of Open Access Journals (Sweden)

    Anca ȘERBAN

    2013-06-01

    Full Text Available The purpose of this paper is to present the evolution of the Balanced Scorecard from a measurement instrument to a strategic performance management tool and to highlight the advantages of implementing the Total Performance Scorecard, especially for Human Resource Management. The study has been accomplished using the methodology of bibliographic study and various secondary sources. Implementing the classical Balanced Scorecard indicated over the years, repeatedly failure. It can be indicated that the crucial level is determined by the learning and growth perspective. It has been developed from a human perspective, which focused on staff satisfaction, innovation perspective with focus on future developments. Integrating the Total Performance Scorecard in an overall framework assures the company’s success, by keeping track of the individual goals, the company’s objectives and strategic directions. Like this, individual identity can be linked to corporate brand, individual aspirations to business goals and individual learning objectives to needed organizational capabilities.

  1. Total 2003 Results

    International Nuclear Information System (INIS)

    2003-01-01

    This document presents the 2003 results of Total Group: consolidated account, special items, number of shares, market environment, 4. quarter 2003 results, full year 2003 results, upstream (key figures, proved reserves), downstream key figures, chemicals key figures, parent company accounts and proposed dividends, 2004 sensitivities, summary and outlook, operating information by segment for the 4. quarter and full year 2003: upstream (combined liquids and gas production by region, liquids production by region, gas production by region), downstream (refinery throughput by region, refined product sales by region, chemicals), impact of allocating contribution of Cepsa to net operating income by business segment: equity in income (loss) and affiliates and other items, Total financial statements: consolidated statement of income, consolidated balance sheet (assets, liabilities and shareholder's equity), consolidated statements of cash flows, business segments information. (J.S.)

  2. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  3. Totally parallel multilevel algorithms

    Science.gov (United States)

    Frederickson, Paul O.

    1988-01-01

    Four totally parallel algorithms for the solution of a sparse linear system have common characteristics which become quite apparent when they are implemented on a highly parallel hypercube such as the CM2. These four algorithms are Parallel Superconvergent Multigrid (PSMG) of Frederickson and McBryan, Robust Multigrid (RMG) of Hackbusch, the FFT based Spectral Algorithm, and Parallel Cyclic Reduction. In fact, all four can be formulated as particular cases of the same totally parallel multilevel algorithm, which are referred to as TPMA. In certain cases the spectral radius of TPMA is zero, and it is recognized to be a direct algorithm. In many other cases the spectral radius, although not zero, is small enough that a single iteration per timestep keeps the local error within the required tolerance.

  4. Total quality accounting

    OpenAIRE

    Andrijašević Maja

    2008-01-01

    The focus of competitive "battle" shifted from the price towards non-price instruments, above all, towards quality that became the key variable for profitability increase and achievement of better comparative position of a company. Under such conditions, management of a company, which, according to the established and certified system of total quality, strives towards achieving of a better market position, faces the problem of quality cost measurement and determination. Management, above all,...

  5. Total aerosol effect

    OpenAIRE

    Lohmann, Ulrike; Rotstayn, Leon; Storelvmo, Trude; Jones, Andrew; Menon, Surabi; Quaas, Johannes; Ekman, Annica M. L.; Koch, Dorothy; Ruedy, Reto A.

    2015-01-01

    Uncertainties in aerosol radiative forcings, especially those associated with clouds, contribute to a large extent to uncertainties in the total anthropogenic forcing. The interaction of aerosols with clouds and radiation introduces feedbacks which can affect the rate of precipitation formation. In former assessments of aerosol radiative forcings, these effects have not been quantified. Also, with global aerosol-climate models simulating interactively aerosols and cloud microphysical prope...

  6. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  7. Total space in resolution

    Czech Academy of Sciences Publication Activity Database

    Bonacina, I.; Galesi, N.; Thapen, Neil

    2016-01-01

    Roč. 45, č. 5 (2016), s. 1894-1909 ISSN 0097-5397 R&D Projects: GA ČR GBP202/12/G061 EU Projects: European Commission(XE) 339691 - FEALORA Institutional support: RVO:67985840 Keywords : total space * resolution random CNFs * proof complexity Subject RIV: BA - General Mathematics Impact factor: 1.433, year: 2016 http://epubs.siam.org/doi/10.1137/15M1023269

  8. Total Absorption Spectroscopy

    International Nuclear Information System (INIS)

    Rubio, B.; Gelletly, W.

    2007-01-01

    The problem of determining the distribution of beta decay strength (B(GT)) as a function of excitation energy in the daughter nucleus is discussed. Total Absorption Spectroscopy is shown to provide a way of determining the B(GT) precisely. A brief history of such measurements and a discussion of the advantages and disadvantages of this technique, is followed by examples of two recent studies using the technique. (authors)

  9. Sobredentadura total superior implantosoportada

    Directory of Open Access Journals (Sweden)

    Luis Orlando Rodríguez García

    2010-06-01

    Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.

  10. Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design.

    Science.gov (United States)

    Sassoon, A A; Barrack, R L

    2016-06-01

    The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40. ©2016 The British Editorial Society of Bone & Joint Surgery.

  11. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

    Directory of Open Access Journals (Sweden)

    Marco Antonio Cardoso de Resende

    2010-04-01

    delivery. Symmetrical muscular weakness, areflexia, and fasciculations of the tongue are characteristic. The majority of the infants die before two years of age as a consequence of respiratory failure. The present report presents a case in which total intravenous anesthesia was used. CASE REPORT: This is a 1 year old white female weighing 10 kg, physical status ASA III, with Werdnig-Hoffmann disease diagnosed at two months of age. The patient was a candidate for open gastrostomy, fundus gastroplication, and tracheostomy. After venoclysis, the patient was monitored with cardioscope, non-invasive blood pressure, pulse oximeter, precordial stethoscope, and rectal temperature. She was oxygenated and, after bolus administration of atropine (0.3 mg, boluses of remifentanil (20 µg and propofol (30 mg were administered for anesthetic induction. After tracheal intubation, she was ventilated with manual controlled system without CO2 absorber, Baraka (Mapleson D system, FGF of 4 L.min-1, and FiO2 0.5 (O2/N2O. Anesthesia was maintained with continuous manual infusion of propofol, 250 µg.kg-1.min-1, and remifentanil, 0.3 µg.kg-1.min-1. The surgery lasted 150 minutes. The patient regained consciousness 8 minutes after the end of the infusion, ventilating spontaneously. Two hours later, she was transferred to the pediatric unit, being discharged from the hospital on the fourth postoperative day. CONCLUSIONS: The choice of anesthetic technique gives priority to the safety associated with the familiarity of handling available drugs. In children with neuromuscular diseases, due to the extremely short duration, total intravenous anesthesia with remifentanil and propofol in infusion systems can have a favorable influence on disease evolution.

  12. Total Synthesis of Calophyline A.

    Science.gov (United States)

    Li, Guang; Xie, Xiaoni; Zu, Liansuo

    2016-08-22

    Reported herein is the total synthesis of calophyline A, an indoline natural product possessing distinct ring connectivity which has not been synthesized previously. The synthetic route features several key transformations, including an aza-pinacol rearrangement to construct the nitrogen-containing bridged [3.2.2] bicycle, a Heck cyclization to assemble the fused 6/5/6/5 ring system, and a challenging late-stage aldol reaction to generate both a neopentyl quaternary stereogenic center and an oxygen-containing bridged [3.2.1] bicycle. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Total Synthesis of Strychnine.

    Science.gov (United States)

    Lee, Geun Seok; Namkoong, Gil; Park, Jisook; Chen, David Y-K

    2017-11-16

    The total synthesis of the flagship Strychnos indole alkaloid, strychnine, has been accomplished. The developed synthetic sequence features a novel vinylogous 1,4-addition, a challenging iodinium salt mediated silyl enol ether arylation, a palladium-catalyzed Heck reaction, and a streamlined late-stage conversion to strychnine. Furthermore, an application of asymmetric counterion-directed catalysis (ACDC) in the context of target-oriented organic synthesis has been rendered access to an optically active material. The synthetic sequence described herein represents the most concise entry to optically active strychnine to date. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Total quality accounting

    Directory of Open Access Journals (Sweden)

    Andrijašević Maja

    2008-01-01

    Full Text Available The focus of competitive "battle" shifted from the price towards non-price instruments, above all, towards quality that became the key variable for profitability increase and achievement of better comparative position of a company. Under such conditions, management of a company, which, according to the established and certified system of total quality, strives towards achieving of a better market position, faces the problem of quality cost measurement and determination. Management, above all, cost accounting can help in solving of this problem, but the question is how much of its potential is being used for that purpose.

  15. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  16. Supravaginal eller total hysterektomi?

    DEFF Research Database (Denmark)

    Edvardsen, L; Madsen, E M

    1994-01-01

    is examined. It is concluded that the risk of developing carcinoma of the cervical stump is low, and no longer a weighty indication for the total in preference to the supravaginal hysterectomy as long as subsequent screening of the cervix is performed. At the same time it is important to inform the women...... carefully after the supravaginal operation in order to secure that subsequent screening actually is taking place. One must have a normal smear and offer a colposcopic examination before the operation. In general the rate of complications after both kind of hysterectomies is low. However, a few new studies...

  17. Total quality is people

    International Nuclear Information System (INIS)

    Vogel, C.E.

    1991-01-01

    Confronted by changing market conditions and increased global competition, in 1983 the Commercial Nuclear Fuel Division (CNFD) of Westinghouse Electric embarked on an ambitious plan to make total quality the centerpiece of its long-term business strategy. Five years later, the division's efforts in making continuous quality improvement a way of life among its more than 2,000 employees gained national recognition when it was named a charter recipient of the Malcolm Baldridge National Quality Award. What CNFD achieved during the 1980s was a cultural transformation, characterized by an empowered work force committed to a common vision. The company's quality program development strategy is described

  18. Total Logistic Plant Solutions

    Directory of Open Access Journals (Sweden)

    Dusan Dorcak

    2016-02-01

    Full Text Available The Total Logistics Plant Solutions, plant logistics system - TLPS, based on the philosophy of advanced control processes enables complex coordination of business processes and flows and the management and scheduling of production in the appropriate production plans and planning periods. Main attributes of TLPS is to create a comprehensive, multi-level, enterprise logistics information system, with a certain degree of intelligence, which accepts the latest science and research results in the field of production technology and logistics. Logistic model of company understands as a system of mutually transforming flows of materials, energy, information, finance, which is realized by chain activities and operations

  19. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Total process surveillance: (TOPS)

    International Nuclear Information System (INIS)

    Millar, J.H.P.

    1992-01-01

    A Total Process Surveillance system is under development which can provide, in real-time, additional process information from a limited number of raw measurement signals. This is achieved by using a robust model based observer to generate estimates of the process' internal states. The observer utilises the analytical reduncancy among a diverse range of transducers and can thus accommodate off-normal conditions which lead to transducer loss or damage. The modular hierarchical structure of the system enables the maximum amount of information to be assimilated from the available instrument signals no matter how diverse. This structure also constitutes a data reduction path thus reducing operator cognitive overload from a large number of varying, and possibly contradictory, raw plant signals. (orig.)

  1. Intrathoracic Hernia after Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Tashiro

    2016-05-01

    Full Text Available Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

  2. Report

    Directory of Open Access Journals (Sweden)

    Akin Aydogan

    2012-01-01

    Full Text Available Introduction. Gossypiboma (GP is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.

  3. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  4. Total disc replacement.

    Science.gov (United States)

    Vital, J-M; Boissière, L

    2014-02-01

    Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Total equipment parts configuration

    International Nuclear Information System (INIS)

    Ferrare, J.

    1989-01-01

    Florida Power ampersand Lights's (FP ampersand L's) Turkey Point units were built prior to the establishment of American Society of Mechanical Engineers' Sec. III requirements. Since that time, FP ampersand L has voluntarily committed to procuring some spare and replacement parts in compliance with the ordering requirements of ASME Sec. III. New subsystems were designed according to ASME Sec. III requirements. In 1978, 10CFR21 of the Code of Federal Regulations was federally mandated. Environmental qualification concerns and the Three Mile Island incident further complicated the stocking and ordering of spare and replacement parts. Turkey Point assembled a team of quality assurance, quality control, and engineering people and obtained permission to directly access the store department computer so that catalog descriptions could be quickly made available for use by the plant. The total equipment parts configuration (TEPC) system was designed and developed under the direction of the procurement document review team at the Turkey Point nuclear plant. The system is a network of related computer data bases that identifies the equipment at the plant. The equipment (or components that make up a piece of equipment) is identified by a tag/component code system. Each component is further broken down by the manufacturer's parts list or bill of material. A description of the data available to the user, the ways these data can be accessed and displayed, and a description of the data bases and their relation to each other are summarized in this paper

  6. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient.

    Science.gov (United States)

    Kane, Patrick M; Stull, Justin D; Culp, Randall W

    2016-05-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty.

  7. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient

    Science.gov (United States)

    Kane, Patrick M.; Stull, Justin D.; Culp, Randall W.

    2015-01-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty. PMID:27104080

  8. Coordinating Council. Ninth Meeting: Total Quality Management

    Science.gov (United States)

    1992-01-01

    This report summarizes the 9th meeting of the STI Coordinating Council. The council listened to the speakers' understanding of Total Quality Management (TQM) principles and heard stories of successful applications of these principles. Definitions of quality stated were focused on customer satisfaction. Reports presented by the speakers are also included.

  9. [The total shoulder prosthesis].

    Science.gov (United States)

    Mazas, F; Gagey, O

    1990-04-11

    Prosthetic shoulder replacement is impeded by two main obstacles: the articular cavity is very shallow, and the small glenoid surface rests on a narrow neck to which prosthetic pieces are difficult to attach. The principal, currently used prostheses are non-retentive models which reproduce the anatomy of the joint. They differ from each other mainly in the glenoid piece pattern which may be sealed only to the glenoid cavity or also fixed onto the acromion. On the whole, the clinical results reported are encouraging, particularly as regards the absence of pain, but the radiological course of the glenoidal sealing is a source of concern. Obvious unsealing is rare, but cracks between bone and cement are very frequent and some of them become wider as time goes by. In addition, there is still no satisfactory solution to the problem of big rotator cuff tears. This type of prosthesis must be envisaged with caution and should be reserved to very painful shoulders, but it would be wise not to wait until the rotator cuff is destroyed. The best indications are glenohumeral osteoarthritis, rheumatoid arthritis and necrosis of the tumoral head.

  10. Gemella haemolysans Infection in Total Hip Arthroplasty.

    Science.gov (United States)

    Rose, Barry; Jeer, Parminder J S; Spriggins, Anthony J

    2012-01-01

    Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  11. The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement

    DEFF Research Database (Denmark)

    Gossec, L; Paternotte, S; Maillefert, J F

    2011-01-01

    : In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55......OBJECTIVE: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). METHODS: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA...... attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome...

  12. Fractionation and determination of total antioxidant capacity, total ...

    African Journals Online (AJOL)

    There was a strong relationship (R2 = 0.77) between total antioxidant activity and total flavonoid contents and (R2 = 0.6517) for total phenolic content of the fractions. The present study demonstrated that V. doniana leaves extracts contain high amounts of flavonoids and phenolic compounds so that these compounds are ...

  13. Achievement report for fiscal 1996 on the research and development of superconductor technology to power generation. Pt. 1. Research and development of superconducting wire, generator, total system, and refrigeration system; and verification test; 1996 nendo chodendo denryoku oyo gijutsu kaihatsu seika hokokusho. 1. Chodendo senzai no kenkyu kaihatsu, chodendo hatsudenki no kenkyu kaihatsu, total system no kenkyu, reito system no kenkyu kaihatsu, jissho shiken

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-01

    In the research and development of superconducting wires, studies are conducted to increase the current capacity of NbTi and Nb{sub 3}Sn metal wires and to improve their properties, and to increase the current capacity of oxide materials and improve their performance making full use of the features of each manufacturing method. In the development of superconducting generators, a slow excitation response type is tested for verification, and a good result is attained; and a quick excitation response type is tested for field winding static excitation, and good performance is exhibited. Using the results so far achieved, the 200,000kW class pilot machine concept design is reviewed. In the study of total systems, feasibility is studied of a quench test for the 70,000kW class machine through simulation analyses, etc. In the development of refrigeration systems, efforts are exerted to improve on the conventional type in terms of reliability and to further improve on the improved version in terms of performance and space-saving feature. One of the endeavors involves the development of a He Brayton cycle turbine driven compressor. A multilayer cylindrical rotor is verified in terms of functions, characteristics, reliability and durability, and various data are collected toward the development of a pilot machine. (NEDO)

  14. Report on achievements in fiscal 1998. Research and development of a technology to promote non-ferrous metal based material recycling. (Research on component technologies and a total system); 1998 nendo hitetsu kinzokukei sozai recycle sokushin gijutsu seika hokokusho. Kenkyu kaihatsu yoso gijutsu kenkyu, total system kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-03-01

    This project is intended to research and develop a high level aluminum recycling technology to realize the 'product to product' philosophy to return different aluminum scraps into the original materials, while attempting to develop and unify the aluminum recycling technologies and promote utilization of LNG. This fiscal year has studied the following methods as the component technology research: (1) an inclusion removing method, (2) a crystal sorting method, (3) a vacuum distillation method, and (4) a semi-melting method. The studies on (1), (2) and (3) were performed on identification of basic data and systematization to determine the life and facility specifications, with the full-swing demonstration tests being waited to start in fiscal 1999. The research and development on the item (4) was determined technologically feasible although additional discussions are required on the engineering aspect for practical application. The component technology study thereon will be finished with the current fiscal year. For the demonstration tests among the studies on total system technologies, the crystal sorting method and the vacuum distillation method had the achievements obtained in the research of the component technologies reflected directly to the facility design and fabrication. There has been no large-scale facility fabrication for the inclusion removing method and effective utilization of ash remaining in dross, and the researches were performed as scheduled. (NEDO)

  15. The Exosome Total Isolation Chip.

    Science.gov (United States)

    Liu, Fei; Vermesh, Ophir; Mani, Vigneshwaran; Ge, Tianjia J; Madsen, Steven J; Sabour, Andrew; Hsu, En-Chi; Gowrishankar, Gayatri; Kanada, Masamitsu; Jokerst, Jesse V; Sierra, Raymond G; Chang, Edwin; Lau, Kenneth; Sridhar, Kaushik; Bermudez, Abel; Pitteri, Sharon J; Stoyanova, Tanya; Sinclair, Robert; Nair, Viswam S; Gambhir, Sanjiv S; Demirci, Utkan

    2017-11-28

    Circulating tumor-derived extracellular vesicles (EVs) have emerged as a promising source for identifying cancer biomarkers for early cancer detection. However, the clinical utility of EVs has thus far been limited by the fact that most EV isolation methods are tedious, nonstandardized, and require bulky instrumentation such as ultracentrifugation (UC). Here, we report a size-based EV isolation tool called ExoTIC (exosome total isolation chip), which is simple, easy-to-use, modular, and facilitates high-yield and high-purity EV isolation from biofluids. ExoTIC achieves an EV yield ∼4-1000-fold higher than that with UC, and EV-derived protein and microRNA levels are well-correlated between the two methods. Moreover, we demonstrate that ExoTIC is a modular platform that can sort a heterogeneous population of cancer cell line EVs based on size. Further, we utilize ExoTIC to isolate EVs from cancer patient clinical samples, including plasma, urine, and lavage, demonstrating the device's broad applicability to cancers and other diseases. Finally, the ability of ExoTIC to efficiently isolate EVs from small sample volumes opens up avenues for preclinical studies in small animal tumor models and for point-of-care EV-based clinical testing from fingerprick quantities (10-100 μL) of blood.

  16. Technical pearls in total hip arthroplasty

    NARCIS (Netherlands)

    Mulier, M.; Raaijmaakers, M.; van den Bekerom, M.

    2010-01-01

    Total hip arthroplasty (THA) has had a big impact on the quality of life of millions of patients. Primary THA has a very high success rate and implant survival time of more than 30 years have been reported. However, because of the high number of procedures performed, the small percentage of patients

  17. Total Body Opacification 'Technique Neonatal Adrenal Haemorrhage

    African Journals Online (AJOL)

    1971-12-11

    Dec 11, 1971 ... A case is reported illustrating the possible usefulness of total body opacification in the diagnosis of neonatal adrenal haemorrhage. To derive maximum benefit from this principle, the routine use of an early film coupled with high dosage is urged whenever an intravenous pyelogram is performed for ...

  18. Comparison of Serum Concentrations of Total Cholesterol and Total ...

    African Journals Online (AJOL)

    Tuberculosis (TB) is one of the most dangerous tropical diseases that complicates HIV infection in Nigeria to date. Over two million Nigerians are known to be infected with TB and many more are at risk of the infection. Serum concentrations of total cholesterol and total lipid of 117 female TB patients attending chest clinic at ...

  19. Investigation Of Total Phenolic, Total Flavonoid, Antioxidantand Allyl ...

    African Journals Online (AJOL)

    Background: This study was carried out to investigate the total polyphenol (TP), total flavonoid (TF), antioxidative effect and allyl isothyocyanate (ITC) content in different organs of wasabi plant grown in an organic system. Materials and Methods: Invitro study of methanol and boiled water extracts of wasabi were conducted ...

  20. Total body irradiation: current indications

    International Nuclear Information System (INIS)

    Giraud, P.; Danhier, S.; Dubray, B.; Cosset, J.M.

    1998-01-01

    The choice of dose and fractionation for total body irradiation is made difficult by the large number of considerations to be taken into account. The outcome of bone marrow transplantation after total body irradiation can be understood in terms of tumor cell killing, engraftment, and normal tissue damage, each of these endpoints being influenced by irradiation-, disease-, transplant-, and patient- related factors. Interpretation of clinical data is further hampered by the overwhelming influence of logistic constraints, the small numbers of randomized studies, and the concomitant variations in total dose and fraction size or dose rate. So far, three cautious conclusions can be drawn in order to tentatively adapt the total body irradiation schedule to clinically-relevant situations. Firstly, the organs at risk for normal tissue damage (lung, liver, lens, kidney) are protected by delivering small doses per fraction at low dose rate. This suggests that, when toxicity is at stake (e.g. in children), fractionated irradiation should be preferred, provided that inter-fraction intervals are long enough. Secondly, fractionated irradiation should be avoided in case of T-cell depleted transplant, given the high risk of graft rejection in this setting. An alternative would be to increase total (or fractional) dose of fractionated total body irradiation, but this approach is likely to induce more normal tissue toxicity. Thirdly, clinical data have shown higher relapse rates in chronic myeloid leukemia after fractionated or low dose rate total body irradiation, suggesting that fractionated irradiation should not be recommended, unless total (or fractional) dose is increased. Total body irradiation-containing regimens, primarily cyclophosphamide / total body irradiation, are either equivalent to or better than the chemotherapy-only regimens, primarily busulfan / cyclophosphamide. Busulfan / cyclophosphamide certainly represents a reasonable alternative, especially in patients who

  1. Retinal Atherosclerosis, Ophthalmologically Reported and Documented with OSA in 1987, is now Totally Reversed, and Recorded, Photographically. The Supposition then was that Equivalent Cortical Damage could Respond to the same Healing Protocol.

    Science.gov (United States)

    Niemi, Paul N.; O., D.; Mc Leod, David M.; Mc Leod, Roger D.

    2007-10-01

    Documented retinal atherosclerosis, ``silver streaking'' of retinal capillaries, was reported and documented with OSA, in October 1987. That retinal damage, despite claims it usually progresses and is nonreversible, is now completely cleared. The original OSA presentation proposed that equivalent cortical damage was probably present throughout the brain at that time, as attested by failing short-term memory performance and transient ischemic attacks, TIAs, brief vision strokes. The supposition then was that ophthalmologic access to the retina, by some accounts the progenitor of all brain evolution, could provide a means of monitoring the actual circulatory state of inaccessible parts of the brain. To the extent that retinal health was naturopathically restored, and memory performance seems also to have significantly kept pace, is it a tenable premise that such protocols have rather general importance? Can applied optics help establish more appropriate diagnoses, and evaluate treatments for dementia and Alzheimer's disease?

  2. Stereoselective total synthesis of sphingolipids

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Chemical Sciences; Volume 128; Issue 11. Stereoselective total synthesis of sphingolipids. PARAMESH JANGILI PERLA ... Keywords. 1,2-Diacetyl D-erythro-sphinganine; 1,2-diacetyl L-threo-sphinganine; D-erythro-sphinganine triacetate; sphingolipids; total synthesis; Garner aldehyde.

  3. Total hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....

  4. Fractionation and determination of total antioxidant capacity, total ...

    African Journals Online (AJOL)

    DEYAKS PLC

    2014-01-29

    ) and total flavonoids content (TFC) of aqueous, ethanol, n-. Hexane extract as well as ethanol extract fractions of Vitex doniana leaves were determined. Ethanol extract showed the highest 1,1-diphenyl-2-picrylhydrazyl ...

  5. Gemella haemolysans Infection in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Barry Rose

    2012-01-01

    Full Text Available Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  6. Totality eclipses of the Sun

    CERN Document Server

    Littmann, Mark; Willcox, Ken

    2008-01-01

    A total eclipse of the Sun is the most awesome sight in the heavens. Totality: Eclipses of the Sun takes you to eclipses of the past, present, and future, and lets you see - and feel - why people travel to the ends of the Earth to observe them. - ;A total eclipse of the Sun is the most awesome sight in the heavens. Totality: Eclipses of the Sun takes you to eclipses of the past, present, and future, and lets you see - and feel - why people travel to the ends of the Earth to observe them. Totality: Eclipses of the Sun is the best guide and reference book on solar eclipses ever written. It explains: how to observe them; how to photograph and videotape them; why they occur; their history and mythology; and future eclipses - when and where to see them. Totality also tells the remarkable story of how eclipses shocked scientists, revealed the workings of the Sun, and made Einstein famous. And the book shares the experiences and advice of many veteran eclipse observers. Totality: Eclipses of the Sun is profusely ill...

  7. Total Product Life Cycle (TPLC)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Total Product Life Cycle (TPLC) database integrates premarket and postmarket data about medical devices. It includes information pulled from CDRH databases...

  8. Leadership and Total Quality Management

    Science.gov (United States)

    1992-04-15

    leadership and management skills yields increased productivity. This paper will focus on the skills required of senior level leaders (leaders at the...publication until it has been cleared by the appropriate mii..-, service or government agency. Leadership and Total Quality Management An Individual Study...llty Codes fAvti1 and/or DltISpecial Abstract AUTHOR: Harry D. Gatanas, LTC, USA TITLE: Leadership and Total Quality Management FORMAT- Individual

  9. Total spina bifida occulta of the sacrum

    OpenAIRE

    Senoglu N; Senoglu M; Gumusalan Y

    2008-01-01

    Spina bifida occulta results from abnormal neurulation, characterized by incomplete dorsal midline closure of the osseous tissues; thus leaving the spinal cord relatively unprotected. Spina bifida occulta of the sacrum is the most common type of spinal abnormality. We report a case of total spina bifida occulta, in a dried sacrum specimen. This developmental defect must be considered for the sake of patient safety before undertaking caudal epidural block. If not, serious complications such as...

  10. Total syntheses of (-)-haemanthidine, (+)-pretazettine, and (+)-tazettine.

    Science.gov (United States)

    Baldwin, S W; Debenham, J S

    2000-01-27

    [structures: see text] The total syntheses of the amaryllidaceae alkaloids haemanthidine, pretazettine, and tazettine as optically pure enantiomers are reported. Using D-mannose as the starting material, the critical relative stereochemical relationships are established with an intramolecular nitrone-alkene cycloaddition reaction. The synthetic route leads successively to (-)-haemanthidine and then to (+)-pretazettine and (+)-tazettine, taking advantage of the well-established complex relationships among these three alkaloids.

  11. Total body water and total body potassium in anorexia nervosa

    Energy Technology Data Exchange (ETDEWEB)

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-08-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

  12. Total body water and total body potassium in anorexia nervosa

    International Nuclear Information System (INIS)

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-01-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation

  13. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  14. Total Ozone Prediction: Stratospheric Dynamics

    Science.gov (United States)

    Jackman, Charles H.; Kawa, S. Ramdy; Douglass, Anne R.

    2003-01-01

    The correct prediction of total ozone as a function of latitude and season is extremely important for global models. This exercise tests the ability of a particular model to simulate ozone. The ozone production (P) and loss (L) will be specified from a well- established global model and will be used in all GCMs for subsequent prediction of ozone. This is the "B-3 Constrained Run" from M&MII. The exercise mostly tests a model stratospheric dynamics in the prediction of total ozone. The GCM predictions will be compared and contrasted with TOMS measurements.

  15. Sobredentadura total superior implantosoportada Superior total overdenture on implants

    Directory of Open Access Journals (Sweden)

    Luis Orlando Rodríguez García

    2010-06-01

    Full Text Available Se presenta un caso de un paciente desdentado total superior, rehabilitado en la consulta de implantología de la Clínica "Pedro Ortiz" del municipio Habana del Este en Ciudad de La Habana, Cuba, en el año 2009, mediante prótesis sobre implantes osteointegrados, técnica que se ha incorporado a la práctica estomatológica en Cuba como alternativa al tratamiento convencional en los pacientes desdentados totales. Se siguió un protocolo que comprendió una fase quirúrgica, procedimiento con o sin realización de colgajo y carga precoz o inmediata. Se presenta un paciente masculino de 56 años de edad, que acudió a la consulta multidisciplinaria, preocupado, porque se le habían elaborado tres prótesis en los últimos dos años y ninguna reunía los requisitos de retención que él necesitaba para sentirse seguro y cómodo con las mismas. El resultado final fue la satisfacción total del paciente, con el mejoramiento de la calidad estética y funcional.This is the case of a total maxilla edentulous patient seen in consultation of the "Pedro Ortíz" Clinic Implant of Habana del Este municipality in 2009 and con rehabilitation by prosthesis over osteointegration implants added to stomatology practice in Cuba as an alternative to conventional treatment in patients totally edentulous. We follow a protocol including a surgery or surgical phase, technique without or with flap creation and early or immediate load. This is a male patient aged 56 came to our multidisciplinary consultation worried because he had three prostheses in last two years and any fulfilled the requirements of retention to feel safe and comfortable with prostheses. The final result was the total satisfaction of rehabilitated patient improving its aesthetic and functional quality.

  16. [Risk factors of hypoparathyroidism following total or near total thyroidectomy].

    Science.gov (United States)

    Wang, T X; Yu, W B; Ma, X; Song, Y T; Zhang, N S

    2016-03-01

    To study the risk factors for postoperative hypoparathyroidism or hypocalcemia. Totally 414 patients with thyroid diseases who underwent total or near total thyroidectomy at Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute from June 2007 to June 2014 were studied retrospectively. There were 119 male and 295 female patients with a median age of 47 years. The clinical and pathological features that related to post-operative hypoparathyroidism were studied by χ(2) test and multivariate Logistic regression analysis. Of the 414 patients, 36.2% developed transient hypocalcemia, 36.5% developed transient hypoparathyroidism, 2.2% developed permanent hypoparathyroidism. In regression analysis, unilateral or bilateral center lymph node dissection were associated with mild transient hypocalcemia after surgery (OR=2.366, P=0.022; OR=5.216, P=0.000); unilateral or bilateral center lymph node dissection as well as surgical options were significant risk factors for severe transient hypocalcemia (OR=4.029, P=0.001; OR=8.384, P=0.000; OR=2.073, P=0.017) and hypoparathyroidism (OR=1.755, P=0.040; OR=4.144, P=0.000; OR=2.287, P=0.000). The parathyroid hormone concentration on postoperative day 1 was an independent risk factor for permanent hypoparathyroidism (OR=2.011, P=0.014). The concentration of parathyroid hormone threshold hypoparathyroidism with accuracy of 95.0%. Bilateral center lymph node dissection is a risk factor of permanent hypoparathyroidism in patients received total thyroidectomy should be taken thoughtfully. The parathyroid hormone concentration on postoperative day 1 provides better prediction for persistent hypoparathyroidism.

  17. Subtotal versus total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael

    2015-01-01

    , randomized clinical trial without blinding. Eleven gynecological departments in Denmark contributed participants to the trial. Women referred for benign uterine diseases who did not have contraindications to subtotal abdominal hysterectomy were randomized to subtotal (n = 161) vs total (n = 158) abdominal...

  18. Total Synthesis of a Gene

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 17; Issue 12. Total Synthesis of a Gene. H G Khorana. Classics Volume 17 Issue 12 December 2012 pp 1174-1197 ... Author Affiliations. H G Khorana1. Professor of Biology and Chemestry, Massachusetts Institute of Technology, Cambridge 02139.

  19. What is Total Quality Management?

    Science.gov (United States)

    Bryan, William A.

    1996-01-01

    Provides a general overview of Total Quality Management (TQM) and explains why there is pressure for change in higher education institutions. Defines TQM and the various themes, tools, and beliefs that make it different from other management approaches. Presents 14 principles and how they might be applied to student affairs. (RJM)

  20. The Total Synthesis of Chlorophyll

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 7. The Total Synthesis of Chlorophyll. Setty Mallikarjuna Babu Subramania Ranganathan. General Article Volume 19 Issue 7 July 2014 pp 645-648. Fulltext. Click here to view fulltext PDF. Permanent link:

  1. First total synthesis of Boehmenan

    Indian Academy of Sciences (India)

    The first total synthesis of dilignan Boehmenan has been achieved. A biomimetic oxidative coupling of the ferulic acid methyl ester in the presence of silver oxide is the crucial step in the synthesis sequence, generating the dihydrobenzofuran skeleton. Hydroxyl group was protected with DHP and reducted with LiAlH4 to ...

  2. Total Quality Management for Schools.

    Science.gov (United States)

    Greenwood, Malcolm S.; Gaunt, Helen J.

    Education in the United Kingdom has been shaped by the advent of local school management and the rapid growth of grant-maintained schools. Total Quality Management (TQM) offers a new way of looking at management principles and structures by identifying the needs of both internal and external customers. This book applies principles of TQM…

  3. First total synthesis of Boehmenan

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Chemical Sciences; Volume 126; Issue 3 ... The first total synthesis of dilignan Boehmenan has been achieved. A biomimetic oxidative coupling of the ferulic acid methyl ester in the presence of silver oxide is the crucial step in the synthesis sequence, generating the dihydrobenzofuran skeleton.

  4. The Total Synthesis of Strychnine

    Indian Academy of Sciences (India)

    IAS Admin

    The Total Synthesis of Strychnine. Edited by Setty Mallikarjuna Babu and Subramania Ranganathan. Keywords. Strychnine. N. N. O. H. H. H. H. O. H. Strychnine! No other molecule has captured the popular imagina- tion as strychnine, perhaps because thousands of writers of fiction have used it to dispatch the recipient and ...

  5. Total Hip Replacement in Sickle Cell Disorder: A Preliminary report ...

    African Journals Online (AJOL)

    2018-04-04

    Apr 4, 2018 ... Ituku Ozalla, Enugu, Nigeria. E‑mail: uchekatchy@yahoo.com. Original Article. Introduction. Avascular necrosis of the head of femur is one of the major complications seen in sickle cell disorder (SCD) patients. In terms of pain, level of activity, and function, the hip is one of the most limiting factors in their life.

  6. Septic Loosening of a Total Hip Replacement: Case Report ...

    African Journals Online (AJOL)

    It can be difficult to differentiate septic from aseptic loosening of prosthesis and especially those due to delayed and late prosthetic-joint infection. In delayed and late prosthetic-joint infection, the acute signs and symptoms of infection such as fever, swelling, erythema and warmth are usually absent and the only ...

  7. MODIFIED TECHNIQUE OF TOTAL LARYNGECTOMY

    Directory of Open Access Journals (Sweden)

    Predrag Spirić

    2010-12-01

    Full Text Available Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF. Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and pharyngocutanous fistula formation. In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16% (p=0,0334. Also, the average hospital stay was shortened from 14,96 to 10,63 days (t =-2.9850; p=0.0358.The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay.

  8. An Operational Perspective of Total Lightning Information

    Science.gov (United States)

    Nadler, David J.; Darden, Christopher B.; Stano, Geoffrey; Buechler, Dennis E.

    2009-01-01

    The close and productive collaborations between the NWS Warning and Forecast Office, the Short Term Prediction and Research Transition Center at NASA Marshall Space Flight Center and the University of Alabama in Huntsville have provided a unique opportunity for science sharing and technology transfer. One significant technology transfer that has provided immediate benefits to NWS forecast and warning operations is the use of data from the North Alabama Lightning Mapping Array. This network consists of ten VHF receivers deployed across northern Alabama and a base station located at the National Space Science and Technology Center. Preliminary investigations done at WFO Huntsville, along with other similar total lightning networks across the country, have shown distinct correlations between the time rate-of-change of total lightning and trends in intensity/severity of the parent convective cell. Since May 2003 when WFO HUN began receiving these data - in conjunction with other more traditional remotely sensed data (radar, satellite, and surface observations) -- have improved the situational awareness of the WFO staff. The use of total lightning information, either from current ground based systems or future space borne instrumentation, may substantially contribute to the NWS mission, by enhancing severe weather warning and decision-making processes. Operational use of the data has been maximized at WFO Huntsville through a process that includes forecaster training, product implementation, and post event analysis and assessments. Since receiving these data, over 50 surveys have been completed highlighting the use of total lightning information during significant events across the Tennessee Valley. In addition, around 150 specific cases of interest have been archived for collaborative post storm analysis. From these datasets, detailed trending information from radar and total lightning can be compared to corresponding damage reports. This presentation will emphasize

  9. Failure of aseptic revision total knee arthroplasties.

    Science.gov (United States)

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-02-01

    In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

  10. Total Nitrogen in Surface Water

    Data.gov (United States)

    U.S. Environmental Protection Agency — Excess nitrogen in surface water can result in eutrophication. TOTALN is reported in kilograms/hectare/year. More information about these resources, including the...

  11. Total Phosphorus in Surface Water

    Data.gov (United States)

    U.S. Environmental Protection Agency — Excess phosphorus in surface water can result in eutrophication. TOTALP is reported in kilograms/hectare/year. More information about these resources, including the...

  12. Total generating costs: coal and nuclear plants

    International Nuclear Information System (INIS)

    1979-02-01

    The study was confined to single and multi-unit coal- and nuclear-fueled electric-generating stations. The stations are composed of 1200-MWe PWRs; 1200-MWe BWRs; 800-and 1200-MWe High-Sulfur Coal units, and 800- and 1200-MWe Low-Sulfur Coal units. The total generating cost estimates were developed for commercial operation dates of 1985 and 1990; for 5 and 8% escalation rates, for 10 and 12% discount rates; and, for capacity factors of 50, 60, 70, and 80%. The report describes the methodology for obtaining annualized capital costs, levelized coal and nuclear fuel costs, levelized operation and maintenance costs, and the resulting total generating costs for each type of station. The costs are applicable to a hypothetical Middletwon site in the Northeastern United States. Plant descriptions with general design parameters are included. The report also reprints for convenience, summaries of capital cost by account type developed in the previous commercial electric-power cost studies. Appropriate references are given for additional detailed information. Sufficient detail is given to allow the reader to develop total generating costs for other cases or conditions

  13. Edge colouring by total labellings

    DEFF Research Database (Denmark)

    Brandt, Stephan; Rautenbach, D.; Stiebitz, M.

    2010-01-01

    We introduce the concept of an edge-colouring total k-labelling. This is a labelling of the vertices and the edges of a graph G with labels 1, 2, ..., k such that the weights of the edges define a proper edge colouring of G. Here the weight of an edge is the sum of its label and the labels of its...... two endvertices. We define χ (G) to be the smallest integer k for which G has an edge-colouring total k-labelling. This parameter has natural upper and lower bounds in terms of the maximum degree Δ of G : ⌈ (Δ + 1) / 2 ⌉ ≤ χ (G) ≤ Δ + 1. We improve the upper bound by 1 for every graph and prove χ (G...

  14. CYPRINIDS TOTAL BLOOD PROTEINS DETERMINATION

    Directory of Open Access Journals (Sweden)

    TANŢI PATRICHE

    2009-10-01

    Full Text Available In aquaculture to get a high production is conditioned by awareness and keeping of an unaltered health condition of the biological material. To be aware of the health condition of the biological material in a fish farm allows us to establish the preventive measures required to prevent spreading of a disease and the treatment to be applied in case that a mass disease occurs. The level of the total protein in serum is, first of all, a synthetically indicator of the nutritional condition of the organism, presenting, at the same time, ample qualitative and quantitative variations depending on species, age, sex, stage of sexual maturity, water temperature and especially in correlation with the health condition of fish. Modification in value of the total protein point out some metabolic perturbations in fish body.

  15. Asymptotic Behaviour of Total Generalised Variation

    KAUST Repository

    Papafitsoros, Konstantinos

    2015-01-01

    © Springer International Publishing Switzerland 2015. The recently introduced second order total generalised variation functional TGV2 β,α has been a successful regulariser for image processing purposes. Its definition involves two positive parameters α and β whose values determine the amount and the quality of the regularisation. In this paper we report on the behaviour of TGV2 β,α in the cases where the parameters α, β as well as their ratio β/α becomes very large or very small. Among others, we prove that for sufficiently symmetric two dimensional data and large ratio β/α, TGV2 β,α regularisation coincides with total variation (TV) regularization

  16. Hyperphosphatemic Tumoral Calcinosis after Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Takeshi Mochizuki

    2017-01-01

    Full Text Available We report a case of hyperphosphatemic tumoral calcinosis (TC that occurred after total knee arthroplasty. A 64-year-old Japanese man presented with painful swellings in both shoulders, the left elbow, and the right hip that developed after he underwent total knee arthroplasty (TKA. The pathology of the patient’s bone at the time of TKA included a thick osteoid seam with calcareous deposition at the margin of the trabecular bone, which is not generally seen in osteoarthritis. Computed tomography scans of the swollen joints demonstrated leaflet and amorphous calcification masses around the joints. We diagnosed the patient with TC. The present case highlights that TC lesions are rare but should be considered in the differential diagnosis of subcutaneous soft and hard masses around the joint.

  17. Transanal total mesorectal excision - a systematic review

    DEFF Research Database (Denmark)

    Bjørn, Maya Xania; Perdawood, Sharaf Karim

    2015-01-01

    of the dissection. We aimed to evaluate the literature on TaTME. METHODS: We performed a systematic search of the literature in the PubMed and Embase databases. Both authors assessed the studies. All publications on TaTME were included with the exception of review articles. RESULTS: A total of 29 studies (336...... patients) were included. Only low-quality evidence is available, and the literature consists of case reports and case series. Studies represent the initial experience of surgeons/centres. No precise indication for TaTME is yet specified other than the presence of mid and low rectal tumours, although...

  18. Prosthetic rehabilitation of a total laryngectomy patient

    Directory of Open Access Journals (Sweden)

    Pulkit Jain

    2015-01-01

    Full Text Available The fundamental objective in restoring a defect created after total laryngectomy with a custom made silicone prosthesis is to enable the patient to cope better with the difficult process of rehabilitation after a major surgery has been performed. A cosmetically acceptable prosthesis that reproduces the color and form and allows the patient to return to his/her accustomed lifestyle. A sequence of steps for construction of custom-made laryngeal prosthesis is outlined in this case report using the readily available materials and method which any prosthodontist can readily understand and deliver.

  19. TotalFinaElf Factbook 2002

    International Nuclear Information System (INIS)

    2002-01-01

    This report presents the activities and results of the Group Total-Fina-Elf for the year 2002. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)

  20. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  1. Total filmless digital radiology service

    International Nuclear Information System (INIS)

    Mun, S.K.; Goeringer, F.; Benson, H.; Horii, S.C.

    1989-01-01

    The completion of a comprehensive picture archiving and communication system (PACS) at Georgetown University Hospital has allowed us to identify a number of technical, administrative, personnel, and operational issues that will affect a total digital radiology service. With a hospital-wide digital imaging network system, computer simulation of communications and storage options, and economic modeling, we have developed a feasibility study and implementation strategy for the smooth transition to a nearly filmless radiology service over the next several years. This paper describes the technical and operational requirements for various database operations, workstations (used in diagnosis, review, and education), and communications. Site and installation planning, personnel training, and transition operations are discussed

  2. Diverticulosis in total colonic aganglionosis

    International Nuclear Information System (INIS)

    Ivancev, K.; Fork, T.; Haegerstrand, I.; Ivarsson, S.; Kullendorff, C.M.; Lund Univ.; Lund Univ.; Malmoe Allmaenna Sjukhus; Malmoe Allmaenna Sjukhus

    1985-01-01

    Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction. (orig.)

  3. Diverticulosis in total colonic aganglionosis

    Energy Technology Data Exchange (ETDEWEB)

    Ivancev, K.; Fork, T.; Haegerstrand, I.; Ivarsson, S.; Kullendorff, C.M.

    Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction. (orig.).

  4. Total eclipses of the sun

    CERN Document Server

    Zirker, Jack B

    2014-01-01

    Eclipses have captured attention and sparked curiosity about the cosmos since the first appearance of humankind. Having been blamed for everything from natural disasters to the fall of kings, they are now invaluable tools for understanding many celestial as well as terrestrial phenomena. This clear, easy-to-understand guide explains what causes total eclipses and how they can be used in experiments to examine everything from the dust between the planets to general relativity. A new chapter has been added on the eclipse of July 11, 1991 (the great Hawaiian eclipse). Originally published in 19

  5. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier......Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007...

  6. Changes in total body water during spaceflight

    Science.gov (United States)

    Leach, Carolyn S.; Inners, L. D.; Charles, John B.

    1991-01-01

    Total body water (TBW) changes occurring in humans as a consequence of prolonged exposure to microgravity were measured in five male crewmembers of Space Shuttle missions STS-61C and STS-26. It was found that the inflight mean TBW values were significantly different from the preflight and postflight values, while the preflight TBW values were not significantly different from the postflight values. It was also found that individuals may differ in the rate at which they respond to weightlessness. Of the three crewmen who reported experiencing no symptoms of space motion sickness (SMS), two had not exhibited a decrease of TBW at the time of measurements (24 hrs after launch), while the two crewmen who reported SMS of intermediate severity showed a decrease of several kg by 24 hrs, suggesting that dehydration might be an important factor affecting the rate of TBW decrease.

  7. Total Value of Phosphorus Recovery.

    Science.gov (United States)

    Mayer, Brooke K; Baker, Lawrence A; Boyer, Treavor H; Drechsel, Pay; Gifford, Mac; Hanjra, Munir A; Parameswaran, Prathap; Stoltzfus, Jared; Westerhoff, Paul; Rittmann, Bruce E

    2016-07-05

    Phosphorus (P) is a critical, geographically concentrated, nonrenewable resource necessary to support global food production. In excess (e.g., due to runoff or wastewater discharges), P is also a primary cause of eutrophication. To reconcile the simultaneous shortage and overabundance of P, lost P flows must be recovered and reused, alongside improvements in P-use efficiency. While this motivation is increasingly being recognized, little P recovery is practiced today, as recovered P generally cannot compete with the relatively low cost of mined P. Therefore, P is often captured to prevent its release into the environment without beneficial recovery and reuse. However, additional incentives for P recovery emerge when accounting for the total value of P recovery. This article provides a comprehensive overview of the range of benefits of recovering P from waste streams, i.e., the total value of recovering P. This approach accounts for P products, as well as other assets that are associated with P and can be recovered in parallel, such as energy, nitrogen, metals and minerals, and water. Additionally, P recovery provides valuable services to society and the environment by protecting and improving environmental quality, enhancing efficiency of waste treatment facilities, and improving food security and social equity. The needs to make P recovery a reality are also discussed, including business models, bottlenecks, and policy and education strategies.

  8. Testing EDM of Total Stations

    Directory of Open Access Journals (Sweden)

    Cirbus Ján

    2001-03-01

    Full Text Available The paper is devoted to testing electrooptical distance measuring devices (EDM built in total stations, than can be used for various tasks in the contemporary geodetic works. A rich market offer and availability of these universal measuring systems with satisfying distance range, excellent accuracy and other parameters, make total stations as dominant terrestrial geodetic instruments.For succesfully applying these instruments, above all for relliable distance measurements, the stability of the modulation frequency is the most important pre-condition. In the article, therefore, there are given some methods to verify the modulation frequency stability. In addition, some ways for determining the EDM distance constant and periodical corrections of the phase measuring unit are introduced for 4 types of EDM : LEICA 1700L, TOPCON GTS6A, TOPCON GTS2, C.ZEISS ELTA50. It were also investigated their possibilities for precise distance survey. Values of the determined constants and periodical corrections are presented in Tab. 2.Based on the investigation results of the 4 EDM types and using the values m obtained for different distances S, equations of the a posteriori standard deviations in form : m = (a+b.S were derived too.

  9. Qualidade total: Um novo paradigma?

    Directory of Open Access Journals (Sweden)

    Suzana da Rosa Tolfo

    1999-01-01

    Full Text Available Nos últimos anos, o movimento para a implantação da Gestão da Qualidade Total vem crescendo ao redor do mundo. Em razão disso, há uma diversidade de ações realizadas com o nome de "Qualidade Total'. Uma revisão da teoria é complexa, porque existem muitos autores que tratam da questão. Eles escolhem diferentes perspectivas de análises (teóricas e empíricas e há dificuldades em se identificar um corpo conceitual. Há uma ampla difusão de modelos, ferramentas, técnicas, mercado e consultores. Essa popularidade, muitas vezes, faz com que determinadas organizações adotem essa forma de gestão do trabalho sem o conhecimento necessário das implicações que um modelo dessa ordem representa; especialmente no caso brasileiro, suscetível a proposições importadas. O presente artigo propõe um exame daquilo que os fundadores têm articulado sobre TQM, as principais críticas nesta direção e a avaliação de como vem sendo aplicadono nosso país.

  10. Jogging after total hip arthroplasty.

    Science.gov (United States)

    Abe, Hirohito; Sakai, Takashi; Nishii, Takashi; Takao, Masaki; Nakamura, Nobuo; Sugano, Nobuhiko

    2014-01-01

    Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Case-control study; Level of evidence, 3. Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for

  11. Total employment effect of biofuels

    International Nuclear Information System (INIS)

    Stridsberg, S.

    1998-08-01

    The study examined the total employment effect of both direct production of biofuel and energy conversion to heat and electricity, as well as the indirect employment effect arising from investments and other activities in conjunction with the production organization. A secondary effect depending on the increased capital flow is also included in the final result. The scenarios are based on two periods, 1993-2005 and 2005-2020. In the present study, the different fuels and the different applications have been analyzed individually with regard to direct and indirect employment within each separate sector. The greatest employment effect in the production chain is shown for logging residues with 290 full-time jobs/TWh, whereas other biofuels range between 80 and 280 full-time jobs/TWh. In the processing chain, the corresponding range is 200-300 full-time jobs per each additional TWh. Additionally and finally, there are secondary effects that give a total of 650 full-time jobs/TWh. Together with the predicted increase, this suggests that unprocessed fuel will provide an additional 16 000 annual full-time jobs, and that fuel processing will contribute with a further 5 000 full-time jobs. The energy production from the fuels will provide an additional 13 000 full-time jobs. The total figure of 34 000 annual full-time jobs must then be reduced by about 4000 on account of lost jobs, mainly in the oil sector and to some extent in imports of biofuel. In addition, the anticipated increase in capital turnover that occurs within the biofuel sector, will increase full-time jobs up to year 2020. Finally, a discussion is given of the accomplishment of the programmes anticipated by the scenario, where it is noted that processing of biofuel to wafers, pellets or powder places major demands on access to raw material of good quality and that agrarian fuels must be given priority if they are to enter the system sufficiently fast. Straw is already a resource but is still not accepted by

  12. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    Science.gov (United States)

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

  13. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer.

    Science.gov (United States)

    Higgs, Peta; Janda, Monika; Asher, Rebecca; Gebski, Val; Forder, Peta; Obermair, Andreas

    2018-01-02

    Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  14. Total quality management implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  15. Total synthesis of mycalamide A.

    Science.gov (United States)

    Sohn, Jeong-Hun; Waizumi, Nobuaki; Zhong, H Marlon; Rawal, Viresh H

    2005-05-25

    This communication describes a concise and efficient total synthesis of mycalamide A by the convergent coupling of pederic acid unit with the mycalamine unit. The left-half, (+)-7-benzoylpederic acid, was synthesized from (2R,3R)-3-methylpent-4-en-2-ol in seven steps and 34.6% overall yield through a route that features a one-step Pd(II)-catalyzed tandem Wacker/Heck cyclization reaction to prepare the tetrahydropyran ring system. The right-half, the mycalamine unit, was synthesized in 21 steps and 10.5% overall yield from diethyl d-tartrate. Effective, stereoselective methods were developed for the assembly of the two parts to yield either mycalamide A or C(10)-epi-mycalamide A.

  16. A total safety management model

    International Nuclear Information System (INIS)

    Obadia, I.J.; Vidal, M.C.R.; Melo, P.F.F.F.

    2002-01-01

    In nuclear organizations, quality and safety are inextricably linked. Therefore, the search for excellence means reaching excellence in nuclear safety. The International Atomic Energy Agency, IAEA, developed, after the Chernobyl accident, the organizational approach for improving nuclear safety based on the safety culture, which requires a framework necessary to provide modifications in personnel attitudes and behaviors in situations related to safety. This work presents a Total Safety Management Model, based on the Model of Excellence of the Brazilian Quality Award and on the safety culture approach, which represents an alternative to this framework. The Model is currently under validation at the Nuclear Engineering Institute, in Rio de Janeiro, Brazil, and the results of its initial safety culture self assessment are also presented and discussed. (author)

  17. Total quality management program planning

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, P.T.; Spence, K.

    1994-05-01

    As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.

  18. Total upper and lower eyelid reconstruction using deltopectoral flap

    OpenAIRE

    Gujjalanavar, Rajendra Suresh; Girish, A. C

    2013-01-01

    Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the firs...

  19. Implementation of total responsibility management into corporate strategy

    OpenAIRE

    Gorenak, Štefka; Bobek, Vito

    2012-01-01

    This contribution reports about relationship and potential synergies between the total quality management (TQM) and total responsibility management (TRM) as well as corporate citizenship. TRM principles and standards reflect the raising public expectations about corporate social responsibility. Many companies develop TRM as requisitely holistically and hence successfully manage their responsibilities toward their stakeholders and natural environment. The evolution and implementation of TRM in...

  20. Perirectal block for out-patient anorectal surgery: A new technique Bloqueo perirrectal para cirugía anorrectal ambulatoria: una nueva técnica

    Directory of Open Access Journals (Sweden)

    Javier H. Eslava-Schmalbach

    2011-03-01

    Full Text Available Introduction. Perirectal block using four puncture places has been classically described for rectal surgery.
    Objective. This paper was aimed at showing the quality of anesthesia and postoperative analgesia using a new two-puncture-site technique.
    Materials and methods. Patients scheduled for ambulatory rectal surgery between January/2003 and December/2007 were included consecutively. The new two-puncture technique was used. Alternative anesthetic management and level of postoperative pain requirements were evaluated (rated visual analogue scale-VAS. Follow-up was done by telephone between 1st and 10th postoperative day to evaluate complications, pain (yes/no, and satisfaction level (1-5 points score.
    Results. Four hundred and nine subjects were included; 50.61% were female. Mean age was 43 (95%CI: 41-44; range: 17-85, 12.7% were aged over 60. According to the American Society of Anesthesiology (ASA, 72.6% were classified as ASA1 and 26.1% ASA2. External and internal hemorrhoidectomy was performed on 31% of patients; 61.6% had two or more procedures. Lidocaine was used on 406 subjects. Ropivacaine was added for 9.2% of them and levobupivacaine for 89.4%. 394 patients were followed-up. Median follow-up was 4 days. A response was obtained from 346 subjects (84.6%; 105 (30.3% recalled having suffered pain during the post-operative period, being most frequent in the lidocaine+ropivacaine group (17/39, 43.5% than in the lidocaine+bupivacaine group (88/307, 28.6%. Satisfaction was evaluated by 336 subjects (82.1%, 332 of them (98.8% awarding a score of 5. Two subjects (0.6% scored this 2 and 1. Subjects did not mention complications.
    Conclusions. The new peri-rectal two-puncture block technique is easy and also provides analgesia and a high degree of satisfaction.

    Introducción. El bloqueo perirrectal de cuatro punciones ha sido descrito clásicamente para cirugía rectal. El objetivo de este artículo es describir la calidad de la anestesia y la analgesia posoperatoria cuando se utiliza una nueva técnica de dos punciones.
    Materiales y métodos. Se incluyeron, consecutivamente, los pacientes programados para cirugía rectal ambulatoria entre enero de 2003 y diciembre de 2007. Se utilizó la nueva técnica anestésica de dos punciones. Se registraron las necesidades de manejo anestésico alternativo y el nivel de dolor posoperatorio por medio de una escala visual análoga graduada. El seguimiento fue telefónico (1 a 10 días posoperatorios para evaluar complicaciones, dolor (sí/no y nivel de satisfacción (escala, 1 a 5.
    Resultados. Se incluyeron 409 sujetos. El 50,61 % eran mujeres. La edad promedio fue de 43 años, (rango, 17 a 85. El 12,7 % eran mayores de 60 años. De acuerdo con la clasificación de la American Society of Anesthesiology (ASA, el 72,6 % fueron ASA1 y 26,1 % ASA2. Se practicó hemorroidectomía externa e interna en 31 % de los pacientes; 61,6 % tuvo más de dos procedimientos. Se utilizó lidocaína en 406 sujetos. Se adicionó ropivacaína en 9,2 % y levobupivacaína en 89,4 %. La mediana de seguimiento fue de cuatro días. Se obtuvo respuesta de 346 sujetos (84,6 %; 105 (30,3 % refirieron haber sufrido dolor durante el posoperatorio, lo que fue más frecuente en el grupo de lidocaína más ropivacaína (17/39, 43,5 % que en el de lidocaína más bupivacaína (88/307, 28,6 %. La satisfacción se evaluó en 336 sujetos (82,1 %: 332 (98,8 % la calificaron en 5, 2 sujetos (0,6 % la calificaron en 2 y en 1. No hubo complicaciones.
    Conclusiones. El bloqueo perirrectal de dos punciones es una técnica fácil que, además, provee analgesia y un alto grado de satisfacción.

  1. Assessing Operational Total Lightning Visualization Products

    Science.gov (United States)

    Stano, Geoffrey T.; Darden, Christopher B.; Nadler, David J.

    2010-01-01

    In May 2003, NASA's Short-term Prediction Research and Transition (SPoRT) program successfully provided total lightning data from the North Alabama Lightning Mapping Array (NALMA) to the National Weather Service (NWS) office in Huntsville, Alabama. The major accomplishment was providing the observations in real-time to the NWS in the native Advanced Weather Interactive Processing System (AWIPS) decision support system. Within days, the NALMA data were used to issue a tornado warning initiating seven years of ongoing support to the NWS' severe weather and situational awareness operations. With this success, SPoRT now provides real-time NALMA data to five forecast offices as well as working to transition data from total lightning networks at Kennedy Space Center and the White Sands Missile Range to the surrounding NWS offices. The only NALMA product that has been transitioned to SPoRT's partner NWS offices is the source density product, available at a 2 km resolution in 2 min intervals. However, discussions with users of total lightning data from other networks have shown that other products are available, ranging from spatial and temporal variations of the source density product to the creation of a flash extent density. SPoRT and the Huntsville, Alabama NWS are evaluating the utility of these variations as this has not been addressed since the initial transition in 2003. This preliminary analysis will focus on what products will best support the operational warning decision process. Data from 19 April 2009 are analyzed. On this day, severe thunderstorms formed ahead of an approaching cold front. Widespread severe weather was observed, primarily south of the Tennessee River with multiple, weak tornadoes, numerous severe hail reports, and wind. This preliminary analysis is the first step in evaluation which product(s) are best suited for operations. The ultimate goal is selecting a single product for use with all total lightning networks to streamline training and

  2. Total sleep time severely drops during adolescence.

    Directory of Open Access Journals (Sweden)

    Damien Leger

    Full Text Available UNLABELLED: Restricted sleep duration among young adults and adolescents has been shown to increase the risk of morbidities such as obesity, diabetes or accidents. However there are few epidemiological studies on normal total sleep time (TST in representative groups of teen-agers which allow to get normative data. PURPOSE: To explore perceived total sleep time on schooldays (TSTS and non schooldays (TSTN and the prevalence of sleep initiating insomnia among a nationally representative sample of teenagers. METHODS: Data from 9,251 children aged 11 to 15 years-old, 50.7% of which were boys, as part of the cross-national study 2011 HBSC were analyzed. Self-completion questionnaires were administered in classrooms. An estimate of TSTS and TSTN (week-ends and vacations was calculated based on specifically designed sleep habits report. Sleep deprivation was estimated by a TSTN - TSTS difference >2 hours. Sleep initiating nsomnia was assessed according to International classification of sleep disorders (ICSD 2. Children who reported sleeping 7 hours or less per night were considered as short sleepers. RESULTS: A serious drop of TST was observed between 11 yo and 15 yo, both during the schooldays (9 hours 26 minutes vs. 7 h 55 min.; p<0.001 and at a lesser extent during week-ends (10 h 17 min. vs. 9 h 44 min.; p<0.001. Sleep deprivation concerned 16.0% of chidren aged of 11 yo vs. 40.5% of those of 15 yo (p<0.001. Too short sleep was reported by 2.6% of the 11 yo vs. 24.6% of the 15 yo (p<0.001. CONCLUSION: Despite the obvious need for sleep in adolescence, TST drastically decreases with age among children from 11 to 15 yo which creates significant sleep debt increasing with age.

  3. Esophagojejunostomy reconstruction using a robot-sewing technique during totally robotic total gastrectomy for gastric cancer.

    Science.gov (United States)

    Jiang, Zhi-Wei; Liu, Jiang; Wang, Gang; Zhao, Kun; Zhang, Shu; Li, Ning; Li, Jie-Shou

    2015-01-01

    The aim of this study was to report on the feasibility of esophagojejunostomy reconstruction using a robot-sewing technique during a completely robotic total gastrectomy for gastric cancer. Between May 2011 and July 2012, 65 patients in whom gastric adenocarcinoma was diagnosed underwent a completely robotic total gastrectomy, including a robot-sewing esophagojejunal anastomosis. We demonstrated the surgical techniques with analysis of clinicopathologic data and short-term surgical outcomes. All robotic surgeries were successfully performed without conversion. Among the 65 patients, 46 were men and 19 were women. The mean age (± SD) was 57.8 ± 6.5 y. The mean total operative time (± SD), EJ anastomosis time (± SD), and blood loss (± SD) were 245 ± 53 min, 45 ± 26 min, and 75 ± 50 ml, respectively. The mean (± SD) post-operative hospital stay was 5.4 ± 2.5 d. One patient was readmitted for an intestinal obstruction and underwent re-operation 14 d post-operatively; he recovered uneventfully and was discharged 10 d post- operatively. During the follow-up, no patients developed an esophgojejunostomy stricture. A robot-sewing anastomosis for esophagojejunostomy reconstruction during robotic total gastrectomy for gastric cancer is feasible. Indeed, a robot-sewing anastomosis for esophagojejunostomy reconstruction may become a standard surgical technique during completely robotic total gastrectomy for gastric cancer.

  4. Halogen-specific total organic halogen analysis: Assessment by recovery of total bromine.

    Science.gov (United States)

    Langsa, Markus; Allard, Sebastien; Kristiana, Ina; Heitz, Anna; Joll, Cynthia A

    2017-08-01

    Determination of halogen-specific total organic halogen (TOX) is vital for studies of disinfection of waters containing bromide, since total organic bromine (TOBr) is likely to be more problematic than total organic chlorine. Here, we present further halogen-specific TOX method optimisation and validation, focusing on measurement of TOBr. The optimised halogen-specific TOX method was validated based on the recovery of model compounds covering different classes of disinfection by-products (haloacetic acids, haloacetonitriles, halophenols and halogenated benzenes) and the recovery of total bromine (mass balance of TOBr and bromide concentrations) during disinfection of waters containing dissolved organic matter and bromide. The validation of a halogen-specific TOX method based on the mass balance of total bromine has not previously been reported. Very good recoveries of organic halogen from all model compounds were obtained, indicating high or complete conversion of all organic halogen in the model compound solution through to halide in the absorber solution for ion chromatography analysis. The method was also successfully applied to monitor conversion of bromide to TOBr in a groundwater treatment plant. An excellent recovery (101%) of total bromine was observed from the raw water to the post-chlorination stage. Excellent recoveries of total bromine (92%-95%) were also obtained from chlorination of a synthetic water containing dissolved organic matter and bromide, demonstrating the validity of the halogen-specific TOX method for TOBr measurement. The halogen-specific TOX method is an important tool to monitor and better understand the formation of halogenated organic compounds, in particular brominated organic compounds, in drinking water systems. Copyright © 2017. Published by Elsevier B.V.

  5. K+ nucleus total cross sections

    International Nuclear Information System (INIS)

    Sawafta, R.

    1990-01-01

    The scattering of K + mesons from nuclei has attracted considerable interest in the last few years. The K + holds a very special position as the weakest of all strongly interaction probes. The average cross section is not larger than about 10 mb at lab momenta below 800 MeV/c, corresponding to a mean free path in the nucleus larger than 5 fm. Thus the K + is capable of probing the entire volume of the nucleus. Single scattering of the K + with a nucleon in the nucleus dominates the nuclear scattering, and only small and calculable higher order corrections are needed. The nucleon is a dynamical entity and its internal structure can, in principle, be altered by its surrounding nuclear environment. This work reports an experiment in which the K + is used to compare the nucleon in the nucleus with a free nucleon

  6. Total joint replacement preadmission programs.

    Science.gov (United States)

    Messer, B

    1998-01-01

    Patients begin to formulate their expectations of the postoperative hospitalization during the preadmission program. The challenge is to better understand the factors patients consider when formulating judgments about the quality of preadmission education. For example, it may be that perceptions of the preadmission program are influenced by what patients believe about their postoperative pain and functional abilities. Specific attention needs to be given both preoperatively and postoperatively to instructing patients on realistic expectations for recovery. One other method of measuring patient outcomes is with the Health Status Profile (SF-36) (Response Healthcare Information Management, 1995). The SF-36 approach emphasizes the outcome of medical care as the patient sees it, in addition to a clinical evaluation of successful health care. This form is currently initiated in the physician's office and returned for scanning at the preadmission class. The patient then completes another SF-36 at 6 months and every year thereafter to compare measurable outcomes. Patients intending to have elective total joint replacements experience anxiety and require much support and education. An effective preadmission program is a major investment in a patient's recovery, as well as a unique marketing tool to customers. Preadmission programs can be viewed as an opportunity to enhance customer satisfaction. Preadmission clinics are an excellent means for nurses to improve the quality of patient care through patient education. the overall goal of preadmission testing programs is to ensure patient preparedness while increasing quality health care and overall customer satisfaction. To enhance program effectiveness, health care providers must lead collaborative efforts to improve the efficiency of systems.

  7. Total cross sections for positron and electron scattering from pyrimidine

    International Nuclear Information System (INIS)

    Zecca, A; Chiari, L; Trainotti, E; GarcIa, G; Blanco, F; Brunger, M J

    2010-01-01

    In this paper we report original measurements of total cross sections for positron scattering from the important biomolecule pyrimidine. The energy range of these measurements was 0.3-45 eV, while the energy resolution was ∼260 meV. In addition, we report theoretical results, calculated within the independent atom-screened additivity rule (IAM-SCAR) formalism, for the corresponding electron impact total cross sections. In that case the energy range is 1-10 000 eV. Total cross sections are very important input data for codes that seek to simulate charged-particle tracks in matter, as they define the mean-free path between collisions. As the present data and computations are to the best of our knowledge the first total cross sections to be reported for either positron or electron scattering from pyrimidine, they fill an important void in our available knowledge in the literature.

  8. Reverse hybrid total hip arthroplasty

    Science.gov (United States)

    Wangen, Helge; Havelin, Leif I; Fenstad, Anne M; Hallan, Geir; Furnes, Ove; Pedersen, Alma B; Overgaard, Søren; Kärrholm, Johan; Garellick, Göran; Mäkelä, Keijo; Eskelinen, Antti; Nordsletten, Lars

    2017-01-01

    Background and purpose The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs. PMID:28095724

  9. Trunnionosis in total hip arthroplasty: a review.

    Science.gov (United States)

    Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Diedrich, Aloise; Le, Sidney; Thomas, Melbin; Mont, Michael A

    2016-03-01

    Trunnionosis is defined as wear of the femoral head-neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication.

  10. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were......, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls...

  11. Antibiotic impregnated total femur spacers: a technical tip

    Directory of Open Access Journals (Sweden)

    Colin D. Canham, MD

    2018-03-01

    Full Text Available Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss. Keywords: total femur spacer, revision arthroplasty, total hip arthroplasty, total knee arthroplasty, prosthetic joint infection

  12. Effectiveness of total worker health interventions.

    Science.gov (United States)

    Anger, W Kent; Elliot, Diane L; Bodner, Todd; Olson, Ryan; Rohlman, Diane S; Truxillo, Donald M; Kuehl, Kerry S; Hammer, Leslie B; Montgomery, Dede

    2015-04-01

    Total Worker Health (TWH) was introduced and the term was trademarked in 2011 by the National Institute for Occupational Safety and Health (NIOSH) to formally signal the expansion of traditional occupational safety and health (OSH) to include wellness and well-being. We searched PubMed, PsycINFO, and other databases using keywords TWH, health promotion, health protection, and variants for articles meeting the criteria of (a) employing both occupational safety and/or health (OSH, or health protection) and wellness and/or well-being (health promotion, or HP) in the same intervention study, and (b) reporting both OSH and HP outcomes. Only 17 published studies met these criteria. All but 1 of the 17 TWH interventions improved risk factors for injuries and/or chronic illnesses, and 4 improved 10 or more risk factors. Several TWH interventions reported sustained improvements for over a year, although only 1 is readily available for dissemination. These results suggest that TWH interventions that address both injuries and chronic diseases can improve workforce health effectively and more rapidly than the alternative of separately employing more narrowly focused programs to change the same outcomes in serial fashion. These 17 articles provide useful examples of how TWH interventions can be structured. The promise of simultaneous improvements in safety, health, and well-being leads to the call to pursue TWH research to identify and disseminate best practices. (c) 2015 APA, all rights reserved).

  13. Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

    OpenAIRE

    Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom

    2012-01-01

    Purpose Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. Materials and Methods From March 20...

  14. Amputation Totale de La Verge: A Propos de Trois Observations ...

    African Journals Online (AJOL)

    Conclusion: qu'elle soit d'origine criminelle ou psychogène, l'amputation totale du pénis est rarissime. Les conséquences sont urinaires, sexuelles et psychogènes. La prise en charge doit être multidisciplinaire. Mots Clés: Verge; amputation; méat; sténose. English Title: Total penile amputation: a report on three cases.

  15. Total hip arthroplasty at the rothman institute.

    Science.gov (United States)

    Austin, Matthew S; Higuera, Carlos A; Rothman, Richard H

    2012-07-01

    Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

  16. Total sleep time as a predictor of suicidal behaviour.

    Science.gov (United States)

    Michaels, Matthew S; Balthrop, Tia; Nadorff, Michael R; Joiner, Thomas E

    2017-12-01

    Insomnia symptoms are a known predictor of suicide; however, less is known about the relationship between hypersomnia and suicide, and how total sleep time may better account for suicidal ideation compared with subjective reports of insomnia symptoms. In the present secondary data analysis, a squared term confirmed the importance of both short and long total sleep time on suicidal behaviour. Total sleep time had a significant positive direct effect on suicidal behaviour (b = 0.20, SE = 0.08, P sleep time and suicidal behaviour, but insomnia symptoms did not. Total sleep time squared had a significant positive relationship with suicidal behaviour (b = 0.02, SE = 0.01, P sleep time and suicidal behaviour. These results suggest the importance of assessing for total sleep time in clinical settings with regard to suicide risk. © 2017 European Sleep Research Society.

  17. Correlation of total, diffuse, and direct solar radiation

    Science.gov (United States)

    Buyco, E. H.; Namkoong, D.

    1977-01-01

    Present requirements for realistic solar energy system evaluations necessitate a comprehensive body of solar-radition data. The data should include both diffuse and direct solar radiation as well as their total on an hourly (or shorter) basis. In general, however, only the total solar radiation values were recorded. This report presents a correlation that relates the diffuse component of an hourly total solar radiation value to the total radiation ratio of the maximum value attainable. The data used were taken at the Blue Hill Observatory in Milton, Massachusetts, for the period 1952. The relation - in the form of the data plots - can be used in situations in which only the hourly total radiation data are available but the diffuse component is desired.

  18. Achievement report for fiscal 1998 on the development of superconductor power application technology. 2. Research and development of superconducting wire and superconductive power generator, research of total system, research and development of refrigeration system, and verification test; 1998 nendo chodendo denryoku oyo gijutsu kaihatsu seika hokokusho. 2. Chodendo senzai no kenkyu kaihatsu, chodendo hatsudenki no kenkyu kaihatsu, total sytsem no kenkyu, reito system no kenkyu kaihatsu, jissho shiken

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-03-01

    The slow excitation response type power generator is studied when the rotor and stator of a 70,000kW-class model are combinedly subjected to an on-site verification test, when a good result is obtained. The rotor is disassembled for inspection, and its members are found to be sound without any problem in terms of mechanical strength. The quick excitation response type is studied when a 70,000kW model is experimentally built and subjected to an on-site verification test after a rotation and excitation test in the factory, when the pilot machine concept design is reviewed. In the study of a total system, efforts continue for the review of the model machine test method, improvement on generator design and analytical methods, development of operating methods, and the effect of its introduction into the power system. Since a He-refrigerated system is requested to exhibit high reliability for application to power equipment and to be capable of continuous long-period operation, a system having constituents with their reliability enhanced and an appropriate redundant system is developed, and a verification study is under way which will continue for more than 10,000 hours. Described also is an oil-free low-temperature turbo refrigerator. The latest quick excitation response type rotor is also tested for verification. (NEDO)

  19. Global Drought Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Drought Total Economic Loss Risk Deciles is a 2.5 minute grid of global drought total economic loss risks. A process of spatially allocating Gross Domestic...

  20. Chinese National Strategy of Total War

    National Research Council Canada - National Science Library

    Good, Michael J

    2008-01-01

    ... concept of total warfare. This research seeks to determine if China is currently engaged in a total war with the United States across nontraditional forms of conflict including economic, political, information, financial...

  1. Global Drought Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Drought Total Economic Loss Risk Deciles is a 2.5 by 2.5 minute grid of global drought total economic loss risks. A process of spatially allocating Gross...

  2. Global Earthquake Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Earthquake Total Economic Loss Risk Deciles is a 2.5 minute grid of global earthquake total economic loss risks. A process of spatially allocating Gross...

  3. Global Landslide Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Landslide Total Economic Loss Risk Deciles is a 2.5 minute grid of global landslide total economic loss risks. A process of spatially allocating Gross...

  4. Global Multihazard Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Multihazard Total Economic Loss Risk Deciles is a 2.5 minute grid of global multihazard total economic loss risks. First, for each of the considered hazards...

  5. Global Volcano Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Volcano Total Economic Loss Risk Deciles is a 2.5 minute grid of global volcano total economic loss risks. First, subnational distributions of Gross Domestic...

  6. Global Flood Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Flood Total Economic Loss Risk Deciles is a 2.5 minute grid of global flood total economic loss risks. A process of spatially allocating Gross Domestic...

  7. Global Cyclone Total Economic Loss Risk Deciles

    Data.gov (United States)

    National Aeronautics and Space Administration — Global Cyclone Total Economic Loss Risk Deciles is a 2.5 minute grid of global cyclone total economic loss risks. A process of spatially allocating Gross Domestic...

  8. Seasonal total methane depletion in limestone caves.

    Science.gov (United States)

    Waring, Chris L; Hankin, Stuart I; Griffith, David W T; Kertesz, Michael A; Kobylski, Victoria; Wilson, Neil L; Coleman, Nicholas V; Kettlewell, Graham; Zlot, Robert; Bosse, Michael; Bell, Graham

    2017-08-16

    Methane concentration in caves is commonly much lower than the external atmosphere, yet the cave CH 4 depletion causal mechanism is contested and dynamic links to external diurnal and seasonal temperature cycles unknown. Here, we report a continuous 3-year record of cave methane and other trace gases in Jenolan Caves, Australia which shows a seasonal cycle of extreme CH 4 depletion, from ambient ~1,775 ppb to near zero during summer and to ~800 ppb in winter. Methanotrophic bacteria, some newly-discovered, rapidly consume methane on cave surfaces and in external karst soils with lifetimes in the cave of a few hours. Extreme bacterial selection due to the absence of alternate carbon sources for growth in the cave environment has resulted in an extremely high proportion 2-12% of methanotrophs in the total bacteria present. Unexpected seasonal bias in our cave CH 4 depletion record is explained by a three-step process involving methanotrophy in aerobic karst soil above the cave, summer transport of soil-gas into the cave through epikarst, followed by further cave CH 4 depletion. Disentangling cause and effect of cave gas variations by tracing sources and sinks has identified seasonal speleothem growth bias, with implied palaeo-climate record bias.

  9. Alumina-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty

    OpenAIRE

    Jung, Yup Lee; Kim, Shin-Yoon

    2010-01-01

    The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of th...

  10. Report on results for fiscal 1997 on development of superconducting electric power application technology. Pt. 2. R and D of superconducting wire, R and D of superconducting generator, studies on total system, R and D of refrigeration system, and verification test; 1997 nendo chodendo denryoku oyo gijutsu kaihatsu seika hokokusho. Chodendo senzai no kenkyu kaihatsu, chodendo hatsudenki no kenkyu kaihatsu, total system no kenkyu, reito system no kenkyu kaihatsu, jissho shiken

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-09-01

    This report refers, continuously to the Part 1, to the in-situ verification test of the slow-response type model machine rotor and to the review of the conceptual design of the pilot machine. On the basis of the R and D results of various element technology/partial models obtained before the previous fiscal year, the design, manufacturing and factory test had been conducted for a 70,000kW class slow-response type model machine rotor. This year, an in-situ verification test was performed to complete the test of all planned test items. Using the technological results obtained in the design, manufacturing and test of the 70,000kW class model machine, the conceptual design is being reviewed of the 200,000kW class pilot machine. In the aspect of the functional design, accurate grasping of the thermal load is essential for the purpose of attaining a large capacity for a superconducting generator, as a part of which a thermal load analytical method was planned to be established for a torque tube heat exchanger. The reasonableness of the analysis was verified through a comparison with the factory test result of the 70,000kW class slow-response type rotor, indicating good agreement between the calculation result and the actual measurement, and enabling the result to be obtained that explains dependency of the thermal load on the number of revolution. (NEDO)

  11. Report on results for fiscal 1997 on development of superconducting electric power application technology. Pt. 1. R and D of superconducting wire, R and D of superconducting generator, studies on total system, R and D of refrigeration system, and verification test; 1997 nendo chodendo denryoku oyo gijutsu kaihatsu seika hokokusho. 1. Chodendo senzai no kenkyu kaihatsu, chodendo hatsudenki no kenkyu kaihatsu, total system no kenkyu, reito system no kenkyu kaihatsu, jissho shiken

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-09-01

    This report explains the outline as Part 1. In fiscal 1997, the 10th year of the project, a multi cylindrical rotary model for which an in-situ verification test was finished was brought back to the plant and dismantled for examination, while the in-situ verification test of a slow-response type model machine rotor was conducted in combination with a refrigeration system. In addition, in the research of AC wire materials and oxide based materials, studies were made with a purpose of high characterization and long wire materialization. In the metallic materials, a 10kANbTi conductor was developed while, in oxide-based materials, research was done on performance improvement and wire materialization based on various synthesizing methods. The manufacturing, factory test and in-situ text were conducted for a 70,000kW model machine with the purpose of R and D of a 200,000kW class pilot machine. Examination was made on the test method of the 70,000kW class model machine, operation technology of a superconducting generation system, and the effect of introducing the superconducting generator into a power system. In the conventional refrigeration system, a single unit test was carried out for the liquefaction, liquid storing capacity, etc., of the system. The 70,000kW class model machine was put through a test for confirming the general operation including the refrigeration system. (NEDO)

  12. Defense meteorological satellite measurements of total ozone

    International Nuclear Information System (INIS)

    Lovill, J.E.; Ellis, J.S.; Luther, F.M.; Sullivan, R.J.; Weichel, R.L.

    1992-01-01

    A multichannel filter radiometer (MFR) on Defense Meteorological Satellites (DMS) that measured total ozone on a global-scale from March 1977 - February 1980 is described. The total ozone data measured by the MFR were compared with total ozone data taken by surfaced-based Dobson spectrophotometers. When comparisons were made for five months, the Dobson spectrophotometer measured 2-5% more total ozone than the MFR. Comparisons between the Dobson spectrophotometer and the MFR showed a reduced RMS difference as the comparisons were made at closer proximity. A Northern Hemisphere total ozone distribution obtained from MFR data is presented

  13. VERTEX ANTIMAGIC TOTAL LABELING PADA GRAPHMULTICYCLE

    Directory of Open Access Journals (Sweden)

    Dominikus Arif Budi Prasetyo pythagors

    2015-01-01

    Full Text Available Pelabelan graf merupakan bagian dari graf yang berkembang saat ini. Jenis pelabelan pada graf bergantungpada domainnya, yakni pelabelan sisi ajaib, pelabelan titik ajaib, dan pelabelan total ajaib. Pelabelan totalajaib pada graf dibedakan lagi berdasarkan komponen graf yang dievaluasi, yakni pelabelan total sisi ajaibdan pelabelan total titik ajaib. Pada pelabelan ajaib, bobot dari komponen graf yang dievaluasi adalah sama,jika bobotnya tidak sama maka dinamakan pelabelan tak-ajaib (antimagic. Misalkan G adalah graf denganbanyak titik p dan sisi q. Suatu pemetaan bijektif dari komponen-komponen graf ke bilangan bulat positif {1,2, …, (p+q} disebut called (a, d vertex antimagic total labelling (pelabelan total titik ajaib dari graf G jikabobot setiap titik (vertex merupakan barisan aritmetika naik. Pada artikel ini membahas bahwa grafmulticycle mCp memenuhi (a, d vertex antimagic total labelling dan beberapa bentuk pelabelannya.Kata kunci : graph multicycle, vertex antimagic total labeling

  14. Preliminary Results form the Japanese Total Lightning Network

    Science.gov (United States)

    Hobara, Y.; Ishii, H.; Kumagai, Y.; Liu, C.; Heckman, S.; Price, C. G.; Williams, E. R.

    2015-12-01

    We report on the initial observational results from the first Japanese Total Lightning Detection Network (JTLN) in relation to severe weather phenomena. The University of Electro-Communications (UEC) has deployed the Earth Networks (EN) Total Lightning System over Japan to carry out research on the relationship between thunderstorm activity and severe weather phenomena since 2013. In this paper we first demonstrate the current status of our new network followed by the initial scientific results. The lightning jump algorithm was applied to our total lightning data to study the relationship between total lighting activity and hazardous weather events such as gust fronts and tornadoes over land reported by the JMA (Japanese Meteorological Agency) in 2014. As a result, a clear increase in total lighting flash rate as well as lightning jumps are observed prior to most hazardous weather events (~20 min) indicating potential usefulness for early warning in Japan. Furthermore we are going to demonstrate the relationship of total lightning activities with meteorological radar data focusing particularly on Japanese Tornadic storms.

  15. Total synthesis based on the originally claimed structure of mucosin.

    Science.gov (United States)

    Gallantree-Smith, Harrison C; Antonsen, Simen G; Görbitz, Carl H; Hansen, Trond V; Nolsøe, Jens M J; Stenstrøm, Yngve H

    2016-09-28

    The first total synthesis aimed at the naturally occurring eicosanoid bicycle mucosin is reported. A practical route has been devised allowing the issues relating to the previous assignment of stereochemistry to be examined. X-ray crystallography was performed on a late stage intermediate to pinpoint the topological relationship displayed by the featured bicyclo[4.3.0]non-3-ene scaffold.

  16. Total Quality Management Practices and Their Effects on Organizational Performance

    Science.gov (United States)

    Hung, Richard Yu-Yuan; Lien, Bella Ya-Hui

    2004-01-01

    This paper reports a study designed to examine the key concepts of Total Quality Management (TQM) implementation and their effects on organizational performance. Process Alignment and People Involvement are two key concepts for successful implementation of TQM. The purpose of this paper is to discuss how these two constructs affect organizational…

  17. Pancreas-preserving total duodenectomy: a 10-year experience

    DEFF Research Database (Denmark)

    Penninga, Luit; Svendsen, Lars Bo

    2011-01-01

    Traditionally, severe pathology of the duodenum has been treated by a pancreaticoduodenectomy using Whipple's operation. Pancreas-preserving total duodenectomy (PPTD) was introduced in the late 1990s as an alternative to Whipple's operation for selected diseases of the duodenum. We report our 10...

  18. A vascular complication in computer navigated total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Sandesh Gulhane

    2013-01-01

    Full Text Available The use of computer navigation has the potential to improve implant position in total knee arthroplasty (TKA, but pin fixation of reference arrays introduces an additional potential source of complications. We report a case of vascular injury related to the insertion of a femoral pin during navigated TKA.

  19. A vascular complication in computer navigated total knee arthroplasty

    Science.gov (United States)

    Gulhane, Sandesh; Holloway, Ian; Bartlett, Mathew

    2013-01-01

    The use of computer navigation has the potential to improve implant position in total knee arthroplasty (TKA), but pin fixation of reference arrays introduces an additional potential source of complications. We report a case of vascular injury related to the insertion of a femoral pin during navigated TKA. PMID:23531499

  20. Antioxidant activity and total phenolic and flavonoid content of ...

    African Journals Online (AJOL)

    ajl yemi

    2011-12-19

    Dec 19, 2011 ... purposes. Medicinal values of these compounds are well ... The present report describes the total phenolics and flavonoids .... an electron donated by an antioxidant compound, the. DPPH is decolorized, which can be quantitatively mea- sured from the changes in absorbance. The IC50 value of the extract ...

  1. South African dietary total antioxidant capacity based on secondary ...

    African Journals Online (AJOL)

    Objective: In this exploratory study, the average adult South African dietary total antioxidant capacity (TAC) was estimated using secondary data and was evaluated against that determined for dietary intake recommendations. Design: The average adult South African dietary TAC was estimated using a report published by ...

  2. evaluation of total annual costs of heat exchanger networks using

    African Journals Online (AJOL)

    This study presents pinch analysis of some heat exchanger networks (HENs) problems using Hint integration (HINT) software. Three examples reported to have been solved using different approaches by various researchers to obtain the least possible total annual cost (TAC) were solved using the Hint software. In this work ...

  3. Communication, functional disorders and lifestyle changes after total laryngectomy

    NARCIS (Netherlands)

    Ackerstaff, A. H.; Hilgers, F. J.; Aaronson, N. K.; Balm, A. J.

    1994-01-01

    Functional changes after total laryngectomy, including voice quality, hyposmia and dysgeusia, nasal discharge, swallowing and smoking habits were studied by means of a structured interview with 63 laryngectomized patients. Eighty per cent of the patients reported that they were satisfied with the

  4. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    OpenAIRE

    Jeong, Min; Jin, Jin Woo; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.

  5. Determination of Total Petroleum Hydrocarbons (TPH) and Heavy ...

    African Journals Online (AJOL)

    This paper reports the determination of total petroleum hydrocarbons (TPH) and heavy metals in tilapia (Hemichromis spp.) and mackerel (Scomber japonicus) sourced randomly from some Lagos markets. Control samples were harvested from a fish farm in the outskirt of Lagos metropolis. TPH in the samples were ...

  6. Cemented total hip arthroplasty following acetabular fracture.

    Science.gov (United States)

    Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F

    2017-10-01

    To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>// 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 v ersus 40.2, p = 0.026); and final follow-up OHS (33.6 v ersus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399-1408. ©2017 The British Editorial Society of Bone & Joint Surgery.

  7. Total upper and lower eyelid reconstruction using deltopectoral flap

    Science.gov (United States)

    Gujjalanavar, Rajendra Suresh; Girish, A. C

    2013-01-01

    Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results. PMID:24459354

  8. Total upper and lower eyelid reconstruction using deltopectoral flap

    Directory of Open Access Journals (Sweden)

    Rajendra Suresh Gujjalanavar

    2013-01-01

    Full Text Available Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.

  9. Total upper and lower eyelid reconstruction using deltopectoral flap.

    Science.gov (United States)

    Gujjalanavar, Rajendra Suresh; Girish, A C

    2013-09-01

    Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.

  10. Total knee arthroplasty in patients with a previous patellectomy.

    Science.gov (United States)

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.

  11. Total excision of intramedullary epidermoid cyst in one case

    Directory of Open Access Journals (Sweden)

    PU Ke

    2013-12-01

    Full Text Available Clinical experience of total excision in a 14-year-old female with intramedullary epidermoid cyst was reported. The patient with L3-4 intramedullary epidermoid cyst underwent total excision through posterior median approach under microscopy. The patient was admitted for progressive strephexopodia and urinary and fecal incontinence. Preoperative imaging examination showed scoliosis, incontionous L4-S1 and abnormal signal of L3-4. Total excision and spinal remodeling were performed under intraoperative neurophysiological monitoning. Epidermoid cyst and its membrane were totally removed without aseptic meningitis after surgery, and the neurologic symptoms of the patient were gradually improved. Completely removing the membrane of epidermoid cyst is the key point to prevent recurrence and aseptic meningitis postoperatively. Dissection should be strictly in accordance with the boundaries of the membrane and the spinal cord, in order to avoid spinal cord injury.

  12. Total ozone retrieval from satellite multichannel filter radiometer measurements

    International Nuclear Information System (INIS)

    Lovill, J.E.; Sullivan, T.J.; Weichel, R.L.; Ellis, J.S.; Huebel, J.G.; Korver, J.; Weidhaas, P.P.; Phelps, F.A.

    1978-01-01

    A total ozone retrieval model has been developed to process radiance data gathered by a satellite-mounted multichannel filter radiometer (MFR). Extensive effort went into theoretical radiative transfer modeling, a retrieval scheme was developed, and the technique was applied to the MFR radiance measurements. The high quality of the total ozone retrieval results was determined through comparisons with Dobson measurements. Included in the report are global total ozone maps for 20 days between May 12 and July 5, 1977. A comparison of MFR results for 13 days in June 1977 with Dobson spectrophotometer measurements of ozone for the same period showed good agreement: there was a root-mean-square difference of 6.2% (equivalent to 20.2 m.atm.cm). The estimated global total ozone value for June 1977 (296 m.atm.cm) was in good agreement with satellite backscatter ultraviolet data for June 1970 (304 m.atm.cm) and June 1971

  13. Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy.

    Science.gov (United States)

    Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom

    2012-11-01

    Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

  14. Countrywise results of total hip replacement

    Science.gov (United States)

    2014-01-01

    Background and purpose An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995–2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included. Material and methods 438,733 THRs performed during the period 1995–2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint. Results The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7–86.9) in Denmark, 88% (CI: 87.6–88.3) in Sweden, 87% (CI: 86.4–87.4) in Norway, and 84% (CI: 82.9–84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34–0.82), seventh (HR = 0.60, CI: 0.37–0.97), and ninth (HR = 0.59, CI: 0.36–0.98) year of follow-up. Interpretation The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required. PMID:24650019

  15. [Total pancreatectomy: renaissance of a surgical procedure].

    Science.gov (United States)

    Keck, T; Hopt, U T

    2008-12-01

    Permanent reduction of morbidity and death in centers for pancreatic surgery has led to a change in the indication for total pancreatectomy from rescue pancreatectomy for complications of pancreatic surgery increasingly to elective surgery, especially in the management of advanced intraductal papillary mucinous neoplasms. We discuss the indication for oncologic total pancreatectomy, rescue pancreatectomy, and removal of the whole pancreas for chronic pancreatitis. Furthermore we describe technical and metabolic aspects following total pancreatectomy.

  16. Total pollution effect of urban surface runoff.

    Science.gov (United States)

    Luo, Hongbing; Luo, Lin; Huang, Gu; Liu, Ping; Li, Jingxian; Hu, Sheng; Wang, Fuxiang; Xu, Rui; Huang, Xiaoxue

    2009-01-01

    For pollution research with regard to urban surface runoff, most sampling strategies to date have focused on differences in land usage. With single land-use sampling, total surface runoff pollution effect cannot be evaluated unless every land usage spot is monitored. Through a new sampling strategy known as mixed stormwater sampling for a street community at discharge outlet adjacent to river, this study assessed the total urban surface runoff pollution effect caused by a variety of land uses and the pollutants washed off from the rain pipe system in the Futian River watershed in Shenzhen City of China. The water quality monitoring indices were COD (chemical oxygen demand), TSS (total suspend solid), TP (total phosphorus), TN (total nitrogen) and BOD (biochemical oxygen demand). The sums of total pollution loads discharged into the river for the four indices of COD, TSS, TN, and TP over all seven rainfall events were very different. The mathematical model for simulating total pollution loads was established from discharge outlet mixed stormwater sampling of total pollution loads on the basis of four parameters: rainfall intensity, total land area, impervious land area, and pervious land area. In order to treat surface runoff pollution, the values of MFF30 (mass first flush ratio) and FF30 (first 30% of runoff volume) can be considered as split-flow control criteria to obtain more effective and economical design of structural BMPs (best management practices) facilities.

  17. The impact of total laryngectomy: the patient's perspective.

    LENUS (Irish Health Repository)

    Noonan, Brendan J

    2012-02-01

    PURPOSE\\/OBJECTIVES: To describe the experiences of patients who had total laryngectomy from their perspective. RESEARCH APPROACH: Descriptive, qualitative study.Setting: Participants\\' homes or investigator\\'s hospital office. PARTICIPANTS: 10 patients after total laryngectomy. METHODOLOGIC APPROACH: Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach. MAIN RESEARCH VARIABLES: Patients\\' experiences of undergoing total laryngectomy. FINDINGS: Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve. CONCLUSIONS: As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery. INTERPRETATION: Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.

  18. The impact of a total reward system of work engagement

    Directory of Open Access Journals (Sweden)

    Crystal Hoole

    2016-11-01

    Research purpose: The overall purpose of this study was to explore the relationship between total rewards and work engagement in a South African context and to determine which reward categories predict work engagement. The study further endeavoured to determine whether gender and age had a moderating effect on the relationship between total rewards and engagement. Motivation for the study: Statistics report that less than 30% of all working people are optimally engaged in their work. Considering that individuals spend more than a third of their lives at work committing themselves emotionally, physically and psychologically – research indicates that employees are no longer satisfied with traditional reward systems and want to feel valued and appreciated. Research approach, design and method: In this quantitative, cross-sectional research design using a non-probability convenience and purposive sampling strategy, 318 questionnaires were collected and analysed from financial institutions in Gauteng in which opinions were sought on the importance of different types of rewards structures and preferences, and how engaged they are in their workplace. The 17-item UWES and Nienaber total reward preference model were the chosen measuring instruments. Main findings: A small statistically significant correlation (r = 0.25; p < 0.05; small effect was found between total rewards and work engagement, and 12% of the variance of work engagement was explained. Only performance and career management significantly predicted work engagement. Practical/Managerial implications: Although small, the significant correlation between total rewards and work engagement implies that total rewards are important motivators for employees in the workplace. Of the total rewards scales tested, only performance and career management significantly predicted work engagement, suggesting that more research is needed. Organisations seeking to implement total reward strategies should pay specific

  19. A note on totally normal spaces

    International Nuclear Information System (INIS)

    Zougdani, H.K.

    1990-10-01

    In this note we give the necessary and sufficient condition for a topological space X such that the product space X x Y is totally normal for any (non discrete) metric space Y, and we show that a totally normal p-space need not be a perfectly normal in general, which makes Theorem 2 doubtful. (author). 6 refs

  20. Total internal reflection effect on gyrotropic interface

    Science.gov (United States)

    Glushchenko, Alexander G.; Glushchenko, Eugene P.; Zhukov, Sergey V.

    2018-02-01

    This article considers the physical features of total internal reflection at gyrotropic and isotropic interfaces for two cases: electrical gyrotropy (plasma) and magnetic gyrotropy (ferrite). It is shown that the plasma magnetization may lead to the formation of the total internal reflection effect, which does not occur in isotropic plasma. The threshold values of the magnetic field, which are necessary for the total internal reflection effect, are determined. The total internal reflection effect on a ferrite-dielectric interface for waves emanating from different angles is observed in various frequency ranges and magnetization fields. The study points out the possibility of changing the total internal reflection angle value in large limits due to a change in the external magnetic field magnitude. The calculation results of the total internal reflection angle dependence on the external magnetic field magnitude are presented. The formulas are elaborated for calculating the total internal reflection angles of different interfaces for gyrotropic and isotropic media. The generalized formulas are defined for calculating the Doppler effect in the gyrotropic media. The study demonstrates how the velocity of the media interface affects the limiting angle of total internal refection.

  1. Custom total occlusal convergence angle sticker fabrication.

    Science.gov (United States)

    Cho, Seok-Hwan; Nagy, William W

    2015-09-01

    This article describes a method of fabricating a custom total occlusal convergence angle sticker with photo editing software and label stickers. The custom total occlusal convergence angle sticker can help clinicians achieve an accurate degree of taper during axial wall reduction of tooth preparation. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. Total cardiovascular disease risk assessment: a review.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2011-09-01

    The high risk strategy for the prevention of cardiovascular disease (CVD) requires an assessment of an individual\\'s total CVD risk so that the most intensive risk factor management can be directed towards those at highest risk. Here we review developments in the assessment and estimation of total CVD risk.

  3. Total Dose Survivability of Hubble Electronic Components

    Science.gov (United States)

    Xapsos, M. A.; Stauffer, C.; Jordan, T.; Poivey, C.; Haskins, D. N.; Lum, G.; Pergosky, A. M.; Smith, D. C.; LaBel, K. A.

    2017-01-01

    A total dose analysis for exposure of electronic parts at the box level is presented for the Hubble Space Telescope. This was done using solid angle sectoring/3-dimensional ray trace and Monte Carlo radiation transport simulations. Results are discussed in terms of parts that are potential total dose concerns.

  4. Records Management in Organization and Total Quality

    Directory of Open Access Journals (Sweden)

    Fahrettin Özdemirci

    1999-06-01

    Full Text Available In this article the relationship between total quality management and records managemen t are examined. It has also been indicated that the records mana­gement has vita'ly important part for realizing the total quality management approach.

  5. Phytochemical composition, total phenolic content and ferric ...

    African Journals Online (AJOL)

    The increased interest in discovering drugs from natural source led to the investigation of the phytochemical composition, the total phenolic content (TPC) and ferric reducing antioxidant power (FRAP) of leaf, stem and root bark extracts of S. sarmentosus DC. The total phenolic content of the extracts were examined using ...

  6. Timing the total reflection of light

    International Nuclear Information System (INIS)

    Chauvat, Dominique; Bonnet, Christophe; Dunseath, Kevin; Emile, Olivier; Le Floch, Albert

    2005-01-01

    We have identified for the first time the absolute delay at total reflection, envisioned by Newton. We show that there are in fact two divergent Wigner delays, depending on the polarisation of the incident light. These measurements give a new insight on the passage from total reflection to refraction

  7. Total cross section of highly excited strings

    International Nuclear Information System (INIS)

    Lizzi, F.; Senda, I.

    1990-01-01

    The unpolarized total cross section for the joining of two highly excited strings is calculated. The calculation is performed by taking the average overall states in the given excitation levels of the initial strings. We find that the total cross section grows with the energy and momentum of the initial states. (author). 8 refs, 1 fig

  8. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  9. Haematocrit, Haemoglobin, Total Protein And Whole Blood ...

    African Journals Online (AJOL)

    The study was performed on a total of one hundred and nineteen apparently healthy mallards, reared under the traditional extensive management system with the aim of establishing the base-line values of packed cell volume (PCV), haemoglobin (Hb), total protein (TP) and whole blood coagulation time (WBCT) of these ...

  10. Total reflection x-ray fluorescence (TXRF)

    International Nuclear Information System (INIS)

    Hockett, R.S.

    1995-01-01

    Total reflection X-Ray Fluorescence (TXRF) is a glancing x-ray analytical technique which is used primarily to measure surface metal contamination on semiconductor substrates. This is a review of Total reflection X-Ray Fluorescence (TXRF) applications for silicon semiconductor processing. In addition, some comments are made about the future of TXRF, and in particular, synchrotron radiation TXRF (SR-TXRF)

  11. Totally optimal decision trees for Boolean functions

    KAUST Repository

    Chikalov, Igor

    2016-07-28

    We study decision trees which are totally optimal relative to different sets of complexity parameters for Boolean functions. A totally optimal tree is an optimal tree relative to each parameter from the set simultaneously. We consider the parameters characterizing both time (in the worst- and average-case) and space complexity of decision trees, i.e., depth, total path length (average depth), and number of nodes. We have created tools based on extensions of dynamic programming to study totally optimal trees. These tools are applicable to both exact and approximate decision trees, and allow us to make multi-stage optimization of decision trees relative to different parameters and to count the number of optimal trees. Based on the experimental results we have formulated the following hypotheses (and subsequently proved): for almost all Boolean functions there exist totally optimal decision trees (i) relative to the depth and number of nodes, and (ii) relative to the depth and average depth.

  12. Total knee replacement in patients with diffuse villonodular synovitis

    Directory of Open Access Journals (Sweden)

    Lucio Flávio Biondi Pinheiro Júnior

    Full Text Available ABSTRACT This paper reports a case of diffuse pigmented villonodular synovitis (DPVNS, associated with advanced gonarthrosis, submitted to total knee replacement. The patient had progressive pain and swelling. She had two previous surgeries, firstly arthroscopic , synovectomy and subsequently open synovectomy associated with radiotherapy, with recurrence of the disease. Magnetic resonance imaging revealed diffuse synovitis, advanced arthrosis, and bone cysts. The patient was submitted to a total knee replacement and synovectomy. There was a good postoperative clinical course, with improvement of pain, function, and joint edema on examination. The patient will be followed regarding the possibility of disease recurrence and implant survival.,

  13. 38 CFR 3.340 - Total and permanent total ratings and unemployability.

    Science.gov (United States)

    2010-07-01

    ... are met. (3) Ratings of total disability on history. In the case of disabilities which have undergone... disability ratings—(1) General. Total disability will be considered to exist when there is present any... substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be...

  14. Reconstrucción nasal total: a propósito de un caso Total nasal reconstruction: case report

    OpenAIRE

    J. Serracanta Domènech; D. Vázquez Fernández; D. López Munné; B. Gornés Benejam; X. Suñol Sala

    2007-01-01

    Presentamos el caso de una paciente de 90 años de edad afecta de un carcinoma escamoso nasal. Cualquier defecto a nivel nasal debe ser analizado en términos de pérdida anatómica de tejido y como subunidades estéticas, empezando en el defecto interno y progresando hacía afuera, plano por plano. El caso en cuestión muestra el uso de un colgajo septal, injertos óseos obtenidos de olécranon para el dorso, e injertos de cartílago conchal para recrear las dos alas nasales. Se precisaron dos colgajo...

  15. Elbow joint biomechanics for preclinical evaluation of total elbow prostheses.

    Science.gov (United States)

    Kincaid, Brian L; An, Kai-Nan

    2013-09-27

    Total elbow arthroplasty is a clinically successful procedure, yet long-term implant survival rates have historically lagged behind those reported for total hips and knees. Clinical complications associated with implant wear, osteolysis, stem loosening and device fracture have been implicated as reasons for limited long-term survivorship. Unfortunately, there is little published information on the biomechanics and method(s) for preclinical evaluation of total elbow prostheses that could provide insight into the mechanisms of failure. Additionally, there are no consensus testing standards or summaries of loading profiles of the humero-ulnar joint associated with a range of activities of daily living. Such data would facilitate the standardized preclinical assessment of total elbow devices such is commonplace for other large joints. The objective of the work here is therefore to provide a comprehensive review of elbow joint biomechanics as it relates to preclinical evaluation of total elbow implants. This summary includes a review of elbow joint forces, kinematics, the types and frequency of humero-ulnar joint motions associated with activities of daily living and clinical outcomes, as well as proposing a methodology for deriving humero-ulnar joint reaction force magnitudes and vector orientations as a function of a known mass/force at the hand. From these data, a scalable, bi-axial loading profile is proposed as a foundation for the development of clinically relevant, laboratory simulations for assessment of total elbow prostheses performance. © 2013 Elsevier Ltd. All rights reserved.

  16. Total's LNG activities from Algeria to Yemen

    International Nuclear Information System (INIS)

    Vedrenne, J.P.

    1997-01-01

    In March 1995, further to an international tender, Total was awarded the leadership of the first LNG project in Yemen. On January 1997 Total announced the extension of the share-holding of the Yemen LNG Co. to include the companies with interests in the Marib area (Hunt-Exxon-Yukong). The Marib area will supply the gas to the future liquefaction plant. The ratification of these agreements confirms the role of Total as lead shareholder with 36% in the share-holding structure and guarantees gas supply from the Marib licence, operated by Hunt-Exxon. (author)

  17. The total irregularity of a graph

    DEFF Research Database (Denmark)

    Abdo, H.; Brandt, S.; Dimitrov, D.

    2014-01-01

    In this note a new measure of irregularity of a graph G is introduced. It is named the total irregularity of a graph and is defined as irr(t)(G) - 1/2 Sigma(u, v is an element of V(G)) vertical bar d(G)(u) - d(G)(v)vertical bar, where d(G)(u) denotes the degree of a vertex u is an element of V......(G). All graphs with maximal total irregularity are determined. It is also shown that among all trees of the same order the star has the maximal total irregularity....

  18. Need total sulfur content? Use chemiluminescence

    Energy Technology Data Exchange (ETDEWEB)

    Kubala, S.W.; Campbell, D.N. [Fluid Data, Inc., Angleton, TX (United States); DiSanzo, F.P. [Mobil Technology Co., Paulsboro, NJ (United States)

    1996-09-01

    Regulations issued by the United States Environmental Protection Agency require petroleum refineries to reduce or control the amount of total sulfur present in their refined products. These legislative requirements have led many refineries to search for online instrumentation that can produce accurate and repeatable total sulfur measurements within allowed levels. Several analytical methods currently exist to measure total sulfur content. They include X-ray fluorescence (XRF), microcoulometry, lead acetate tape, and pyrofluorescence techniques. Sulfur-specific chemiluminescence detection (SSCD) has recently received much attention due to its linearity, selectivity, sensitivity, and equimolar response. However, its use has been largely confined to the area of gas chromatography. This article focuses on the special design considerations and analytical utility of an SSCD system developed to determine total sulfur content in gasoline. The system exhibits excellent linearity and selectivity, the ability to detect low minimum levels, and an equimolar response to various sulfur compounds. 2 figs., 2 tabs.

  19. Can You Depend Totally on Computers?

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 3; Issue 2. Can You Depend Totally on Computers? Computer Security, Availability and Correctness. H N Mahabala. General Article Volume 3 Issue 2 February 1998 pp 35-44 ...

  20. Establishing a total information management program

    International Nuclear Information System (INIS)

    Hegstrom, K.L.; Fisher, J.

    1982-01-01

    A total information management program manages documents for easy access and identifies data elements commonly found in all documents. The program thus links disparate documents by identifying information they share in common

  1. Pulmonary nodules secondary to total parenteral alimentation

    International Nuclear Information System (INIS)

    Landry, B.A.; Melhem, R.E.

    1989-01-01

    A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.)

  2. TOTAL REWARDS MODEL IN ROMANIAN COMPANIES

    Directory of Open Access Journals (Sweden)

    Elena-Sabina HODOR

    2014-04-01

    Full Text Available Total Rewards Management is a subject of major importance for companies, because, by using models for this, firms can achieve their objectives of high performance. In order to analyse a validated total rewards model in Romanian Accounting and Consulting Companies, it is used The WorldatWork Total Rewards Model, which depict what contributes to applicant attraction and employee motivation and retention. Thus, the methodology of the previous survey is adjusted to the local context. The conclusions for the methodological aspects illustrate that the present research involves three strategic steps in order to achieve the objectives presented: the analysis of organizational environment of the companies from the sample, checking if Total Rewards Model proposed in the previous research is applicable for the same romanian companies from the previous survey, the analysing of the differences between results, and, if necessary, the adaptation of the model for Romania.

  3. Definition of total bootstrap current in tokamaks

    International Nuclear Information System (INIS)

    Ross, D.W.

    1995-01-01

    Alternative definitions of the total bootstrap current are compared. An analogous comparison is given for the ohmic and auxiliary currents. It is argued that different definitions than those usually employed lead to simpler analyses of tokamak operating scenarios

  4. ROE Total Nitrogen Deposition 1989-1991

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset identifies the amount of wet, dry, and total deposition of nitrogen in kilograms per hectare from 1989 to 1991 at a set of point locations across the...

  5. ROE Total Sulfur Deposition 1989-1991

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset identifies the amount of wet, dry, and total deposition of sulfur in kilograms per hectare from 1989 to 1991 at a set of point locations across the...

  6. ROE Total Sulfur Deposition 2011-2013

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset identifies the amount of wet, dry, and total deposition of sulfur in kilograms per hectare from 2011 to 2013 at a set of point locations across the...

  7. ROE Total Nitrogen Deposition 2011-2013

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset identifies the amount of wet, dry, and total deposition of nitrogen in kilograms per hectare from 2011 to 2013 at a set of point locations across the...

  8. The total plasmatic estriol on normal gestation

    International Nuclear Information System (INIS)

    Thiesen, A.L.

    1980-01-01

    The total plasmatic estriol in normal pregnants was determinated by radioimmunological method using estriol labelled with sup(125)I. The obtained results presented similar results in comparison with methods using sup(19)C and sup(3)H. (author)

  9. Total Coliform Rule (TCR) Federal Register Notice

    Science.gov (United States)

    This document provides the FR notice to 40 CFR Parts 141 and 142 Drinking Water: National Primary Drinking Water Regulations; Total Coliforms (Including Fecal Coliforms and E. Coli); Final Rule (26 pp, 5 M).

  10. Revised Total Coliform Rule Lab Sampling Form

    Science.gov (United States)

    This form should be completed when a water system collects any required Revised Total Coliform Rule (RTCR) samples. It should also be used when collecting “Special” non-compliance samples for the RTCR.

  11. Revised Total Coliform Webinar for Primacy Agencies

    Science.gov (United States)

    This webinar was created to assist Primacy Agencies in the implementation of the Revised Total Coliform Rule. It provides an overview of the requirements in the rule and implementation guidance for Primacy Agencies.

  12. US-Total Electron Content Product (USTEC)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The US Total Electron Content (US-TEC) product is designed to specify TEC over the Continental US (CONUS) in near real-time. The product uses a Kalman Filter data...

  13. NESDIS Blended Total Precipitable Water (TPW) Products

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The blended Total Precipitable Water (TPW) product is derived from multiple sensors/satellites. The Percentage of TPW normal (PCT), or TPW anomaly, shows the...

  14. Total lymphoid irradiation in alloimmunity and autoimmunity

    Energy Technology Data Exchange (ETDEWEB)

    Strober, S.

    1987-12-01

    Total lymphoid irradiation has been used as an immunosuppressive regimen in autoimmune disease and organ transplantation. The rationale for its use originated from studies of patients with Hodgkin disease, in whom this radiotherapy regimen was noted to induce profound and long-lasting immune suppression and yet was well tolerated, with few long-term side effects. Total lymphoid irradiation is a unique immunosuppressive regimen that produces a selective (and long-lasting) reduction in the number and function of helper T cells and certain subsets of B cells. Conventional immunosuppressive drugs show little selectivity, and their effects are short-lived. The most important aspect of total lymphoid irradiation is the potential for achieving transplantation tolerance and permanent remissions in autoimmune disease in laboratory animals. Attempts are being made to achieve similar goals in humans given total lymphoid irradiation, so that immunosuppressive drugs can be ultimately withdrawn from transplant recipients and patients with lupus nephritis. 28 references.

  15. Pulmonary nodules secondary to total parenteral alimentation

    Energy Technology Data Exchange (ETDEWEB)

    Landry, B.A.; Melhem, R.E.

    1989-07-01

    A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.).

  16. MONITORING THE TOTAL IRON CONTENT IN FOOD

    OpenAIRE

    Petruta Timis

    2010-01-01

    The aim of the paper is to monitorize the total iron content in some food categories presented in the Romanian peoplediet in order to obtain information about the most indicate food for anaemia. The studied food categories are liver, meat, vegetables, fruits, bread and cereals, chicken egg, nuts and seeds, bees products. Duethe fact that some food are consumed after a thermal treatment, the impact of thermal processing (frying, boiling, roasting) on total iron content comparing with no-proces...

  17. Total factor productivity and Bio Economy effects

    OpenAIRE

    Zuniga Gonzalez, Carlos Alberto

    2012-01-01

    This paper develops a new measure of total factor productivity growth in agricultural Production which incorporates Bio Economic components effects.The new measure is called the Bio Economic-Oriented Total Factor Productivity (BTFP) index, and incorporates components of Bio Economic as liquid biofuels. BTFP measure changes in Bio Economic efficiency and can be decomposed into bio economy efficiency change (BEC), and Bio Economic technological change (BTC) components.An empirical analysis, inv...

  18. A strategic zone for Total's future

    International Nuclear Information System (INIS)

    Legros, E.J.

    1997-01-01

    In 1997, the Total company investments in the Middle East reached 1.2 billions of French Francs. This region is considered as a major growth zone by the French group. This paper summarizes the Total's participations in oil and gas activities and partnerships of Middle East countries (Abu Dhabi, Dubai, Oman, Qatar, Yemen): exploration, production, development, contracts, permits, technical assistance etc.. (J.S.)

  19. Studies on the effects of total nephrectomy in sheep.

    Science.gov (United States)

    Singh, J; Singh, A P; Peshin, P K; Singh, M; Sharma, S K

    1983-04-01

    Effects of total nephrectomy were studied in six sheep. There was no marked deterioration in the clinical condition of the animals except anorexia and reduced water intake. Three sheep survived the period of observation of 120 hours when they were euthanized. One animal suddenly died at each of 76, 80 and 100 hours. Progressive increase of blood urea nitrogen concentration was accompanied by severe metabolic acidosis in the later stages. Plasma creatinine rose significantly but the change was not marked. Plasma inorganic phosphorous and calcium decreased significantly. Unaffected plasma sodium levels were accompanied by hyperkalemia and hypochloremia. Plasma total proteins and albumin decreased significantly in the later stages. Results showed markedly different responses to total nephrectomy in sheep as compared to changes reported in cattle and nonruminants.

  20. Optimized design of total energy systems: The RETE project

    Science.gov (United States)

    Alia, P.; Dallavalle, F.; Denard, C.; Sanson, F.; Veneziani, S.; Spagni, G.

    1980-05-01

    The RETE (Reggio Emilia Total Energy) project is discussed. The total energy system (TES) was developed to achieve the maximum quality matching on the thermal energy side between plant and user and perform an open scheme on the electrical energy side by connection with the Italian electrical network. The most significant qualitative considerations at the basis of the plant economic energy optimization and the selection of the operating criterion most fitting the user consumption characteristics and the external system constraints are reported. The design methodology described results in a TES that: in energy terms achieves a total efficiency evaluated on a yearly basis to be equal to about 78 percent and a fuel saving of about 28 percent and in economic terms allows a recovery of the investment required as to conventional solutions, in about seven years.

  1. Colon pouch syndrome. In the spectrum of the anorectal malformaciotions

    OpenAIRE

    Santos Jasso Karla Alejandra; Palestina Carro Oscar

    2014-01-01

    Congenital colon pouch syndrome, is an infrequent clinical condition in which the colon is totally o partially replaced by a cystic dilatation, and is associated with an anorectal malformation; which may be a urinary tract fistula, a vaginal or vestibule fistula, or a cul-de-sac. We present a rare variant of the anorrectal malformation, with two cases of colon pouch types II and III respectively. The diagnosis was suspected in a plain X-ray and on a distal colostogram. It was confirmed during...

  2. Management of total cancer pain: A case of young adult

    Directory of Open Access Journals (Sweden)

    Aanchal Satija

    2014-01-01

    Full Text Available Pain due to cancer is one of the most distressing symptoms experienced by the patients at some or the other time during the course of treatment or disease progression. The multidimensional nature of cancer pain is characterized by various dimensions including physical, social, psychological, and spiritual; which together constitute the term "total pain". Young cancer patients illustrate their unique psychological and developmental needs. This case report highlights the concept of "total cancer pain" in a young adult and demonstrates his distinctive social, spiritual, and psychological sufferings. The report emphasizes that addressing all these concerns is considerably significant in order to provide optimal pain relief to the patient. In the present scenario, it has been done by a skillful multiprofessional team communicating effectively with both the patient and the carer.

  3. First Results from the August 21, 2017, Total Solar Eclipse

    Science.gov (United States)

    Pasachoff, Jay M.

    2017-08-01

    I report on the observations planned and, weather permitting, made from our site in Salem, Oregon, at the August 21, 2017, total solar eclipse. I also give a first report on collaborators' successes, including Megamovie and simultaneous space observations. We also describe our participation in PBS's NOVA on the eclipse that was to be aired on public television on eclipse night. Our eclipse expedition is supported in large part by grants from the Solar Terrestrial Program of the Atmospheric Sciences Division of NSF and by the Committee for Research and Exploration of the National Geographic Society.

  4. Quality of life and deglutition after total laryngectomy

    Directory of Open Access Journals (Sweden)

    Pernambuco, Leandro de Araújo

    2012-01-01

    Full Text Available Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue. The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains "communication" and "fear" represented severe impact and "eating duration" represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain "eating duration", cough and cough to remove the liquid or food of the mouth when they are stopped (domain "symptom frequency", difficulties in understanding (domain "communication" and fear of choking and having pneumonia (domain "fear". Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in "communication," "fear," and "eating duration" domains.

  5. Quality of life and deglutition after total laryngectomy

    Science.gov (United States)

    Pernambuco, Leandro de Araújo; Oliveira, Jabson Herber Profiro de; Régis, Renata Milena Freitas Lima; Lima, Leilane Maria de; Araújo, Ana Maria Bezerra de; Balata, Patrícia Maria Mendes; Cunha, Daniele Andrade da; Silva, Hilton Justino da

    2012-01-01

    Summary Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains “communication” and “fear” represented severe impact and “eating duration” represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain “eating duration”), cough and cough to remove the liquid or food of the mouth when they are stopped (domain “symptom frequency”), difficulties in understanding (domain “communication”) and fear of choking and having pneumonia (domain “fear”). Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in “communication,” “fear,” and “eating duration” domains. PMID:25991974

  6. Failed total carpometacarpal joint prosthesis of the thumb

    DEFF Research Database (Denmark)

    Hansen, Torben Bæk; Homilius, Morten

    2010-01-01

    Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis. T...... in eight of 10 patients, but the mean Disabilities of the arm, shoulder, and hand (DASH) scores, self-reported pinch-grip-related function, and pain were comparable with our earlier published results with the Elektra carpometacarpal total joint prosthesis.......Total joint prosthesis in carpometacarpal joint arthritis of the thumb often fails. Loosening of the implant is often treated by resection arthroplasty, and we reviewed 10 patients, mean age 54 years (range 47-63) who were treated by resection arthroplasty after a failed total joint prosthesis....... The male:female ratio was 1:4 and the mean duration of observation 32 months (range 6-52). In three patients the revised implant was a MOJE uncemented carpometacarpal joint prosthesis and in seven patients an Elektra uncemented one. At follow-up grip strength was reduced to less than 90% of the other hand...

  7. Total thyroidectomy for multi - nodular goiter

    International Nuclear Information System (INIS)

    Ali, M.A.; Raziq, S.R.; Khan, W.A.; Majeed, S.

    2011-01-01

    Objective: To assess the efficacy and safety of total thyroidectomy for benign multi-nodular goiter. Study design: Descriptive study Place and Duration of Study: The study was conducted in the Department of General Surgery, Combined Military Hospital Kharian from January 2004 to December 2008. Materials and Methods: A total of 66 patients with bilateral benign multi-nodular goiter (61 females and 5 males) underwent total thyroidectomy. Sixty two cases were euthyroid while 4 had hyperthyroidism. Surgical dissection techniques involved identifying both recurrent laryngeal nerves through out their course, securing of parathyroid glands with their intact blood supply and ligation of inferior thyroid artery branches close to the thyroid capsule. All the patients were evaluated post operatively for signs of recurrent laryngeal nerve injury and hypoparathyroidism and other complications. All patients were put on thyroxin replacement therapy post-operatively and were followed for 9 to 12 months. There was no injury to the recurrent laryngeal nerves. One case of injury to external laryngeal nerve was found. Transient hypocalcaemia occurred in 4 patients without permanent hypoparathyroidism. All cases of transient hypocalcaemia recovered fully within 3 months. Four patients had occult malignancy diagnosed post-operatively on histo-pathology. In experienced hands, total thyroidectomy is an effective and relatively safe operation for benign multi-nodular goitre and its complication rate is same as that of a sub-total thyroidectomy. (author)

  8. Total lymphoid irradiation of intractable rheumatoid arthritis

    International Nuclear Information System (INIS)

    Herbst, M.; Fritz, H.; Sauer, R.

    1986-01-01

    Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored. (author)

  9. Renal function after elective total hip replacement

    DEFF Research Database (Denmark)

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

    2016-01-01

    and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...... ). Results - 3,416 patients were included (2,064 females (60%)). AKI (according to KDIGO criteria) was seen in 75 patients (2.2%, 95% CI: 1.7-2.7) in the course of primary total hip replacement. Of these, 26 had pre-existing CKD of class 3-5. Pre-existing CKD of class 3-5, indicating moderately to severely...

  10. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.

    1989-01-01

    the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients......The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....

  11. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  12. KP solitons, total positivity, and cluster algebras

    Science.gov (United States)

    Kodama, Yuji; Williams, Lauren K.

    2011-01-01

    Soliton solutions of the KP equation have been studied since 1970, when Kadomtsev and Petviashvili [Kadomtsev BB, Petviashvili VI (1970) Sov Phys Dokl 15:539–541] proposed a two-dimensional nonlinear dispersive wave equation now known as the KP equation. It is well-known that the Wronskian approach to the KP equation provides a method to construct soliton solutions. The regular soliton solutions that one obtains in this way come from points of the totally nonnegative part of the Grassmannian. In this paper we explain how the theory of total positivity and cluster algebras provides a framework for understanding these soliton solutions to the KP equation. We then use this framework to give an explicit construction of certain soliton contour graphs and solve the inverse problem for soliton solutions coming from the totally positive part of the Grassmannian. PMID:21562211

  13. Mixed total screening for sulfur isotope

    International Nuclear Information System (INIS)

    Cui Bin; Zhao Lei; Zhan Zhaoyang; He Zhijun

    2003-01-01

    The research on modern economic geology indicates that most ore deposits formed with characters of multi-origin, multi-stage and multi-genesis. Quantificational research of Sulfur isotope origin is a difficult problem that puzzles Geochemists all along. So the formation process of an ore deposit can be taken as the mix or the superposition of multi totals, which can be described by the mathematics model of mixed total screening. In the study of mid-down Yangtze River and Dongpo ore field in Hunan province, the authors successfully applied the mathematics model of mixed total screening, quantificationally resolved the problem of Sulfur isotope origin and mineralizing matter origin, and found out the mineralizing mechanism. This is very valuable. (authors)

  14. Total factor productivity - a misleading concept

    Directory of Open Access Journals (Sweden)

    Angelo Reati

    2001-09-01

    Full Text Available The paper criticises the concept of total factor productivity as a measure of technical change and economic performance on two grounds: (i theoretical, because it shares all the weaknesses of the neoclassical production function from which it is derived; (ii its relevance in helping to understand the present technological revolution in computer and information technologies, since it concerns only disembodied technical change. The practical conclusion is that total factor productivity is more a measure of "noise" than a genuine indicator of technical progress. In spite of the above drawbacks, total factor productivity is still widely used in empirical work on technical change. This is all the more surprising since the alternative concept ofproductivity of labour not only avoids the above mentioned criticisms but is theoretically superior to its rival concept because it captures the true nature of present technical change.

  15. Total quality management in orthodontic practice.

    Science.gov (United States)

    Atta, A E

    1999-12-01

    Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

  16. Determination of total solutes in synfuel wastewaters

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, J.R.; Bonomo, F.S.

    1984-03-01

    Efforts to investigate both lyophilization and the measurement of colligative properties as an indication of total solute content are described. The objective of the work described is to develop a method for measuring total dissolved material in retort wastewaters which is simple and rugged enough to be performed in a field laboratory in support of pollution control tests. The analysis should also be rapid enough to provide timely and pertinent data to the pollution control plant operator. To be of most value, the technique developed also should be applicable to other synfuel wastewaters, most of which contain similar major components as oil shale retort waters. 4 references, 1 table.

  17. ANALYSIS AND ACCOUNTING OF TOTAL CASH FLOW

    Directory of Open Access Journals (Sweden)

    MELANIA ELENA MICULEAC

    2012-01-01

    Full Text Available In order to reach the objective of supplying some relevant information regarding the liquidity inflows and outflows during a financial exercise, the total cash flow analysis must include the analysis of result cashable from operation, of payments and receipts related to the investment and of financing decisions of the last exercise, as well as the analysis of treasury variation (of cash items. The management of total cash flows ensures the correlation of current liquidness flows as consequence of receipts with the payments ’flows, in order to provide payment continuity of mature obligations.

  18. ASVCP guidelines: Allowable total error hematology.

    Science.gov (United States)

    Nabity, Mary B; Harr, Kendal E; Camus, Melinda S; Flatland, Bente; Vap, Linda M

    2018-02-11

    The purpose of this document is to provide total allowable error (TE a ) recommendations for commonly analyzed hematology measurands for veterinary personnel. These guidelines define relevant terminology and highlight considerations specific to hematology measurands. They also provide reasons and guidelines for using TE a in instrument performance evaluation, including recommendations for when the total observed error exceeds the recommended TE a . Biological variation-based quality specifications are briefly discussed. The appendix describes the derivation of the hematology TE a recommendations and provides resources for external quality assurance/proficiency testing programs and a worksheet for implementation of the guidelines. © 2018 American Society for Veterinary Clinical Pathology.

  19. Trying and the Arguments from Total Failure

    DEFF Research Database (Denmark)

    Grünbaum, Thor

    2008-01-01

    New Volitionalism is a name for certain widespread conception of the nature of intentional action. Some of the standard arguments for New Volitionalism, the so-called arguments from total failure, have even acquired the status of basic assumptions for many other kinds of philosophers. It is there......New Volitionalism is a name for certain widespread conception of the nature of intentional action. Some of the standard arguments for New Volitionalism, the so-called arguments from total failure, have even acquired the status of basic assumptions for many other kinds of philosophers...

  20. Development of kits for total PSA monitoring

    International Nuclear Information System (INIS)

    Suprarop, P.

    1999-01-01

    The development of kits for Total PSA assay has shown promising results. All essential components of the assay were prepared with reproducibility and used to optimize the assay. By choosing two steps method, we could avoid the hook effect and obtain satisfactory Q.C. parameters of the standard curve i.e. blank = 0.8%, maximum binding = 65%. If reference material for calibration of the standard is agree upon, the validation could then be carried out with total confidence. Our final goal is to reduce the step of incubation to just one step with no interference from hook effect

  1. Employee benefits in a total rewards framework.

    Science.gov (United States)

    Kwon, Jane; Hein, Pam

    2013-01-01

    Benefits represent one of the largest investments a company makes in its talent. However, our tendency can be to design, deliver and communicate benefits programs independently, without fully considering how those programs fit within a bigger picture of total rewards. Sure, we need to manage and execute individual benefit programs--but not at the expense of getting a real return on our more significant investment in talent. This article provides employers with perspectives on the value of managing benefits within the broader framework of total rewards, why it works and, most importantly, how to make it work.

  2. Total volatile organic compounds (TVOC) in indoor air quality investigations

    DEFF Research Database (Denmark)

    Mølhave, L.; Clausen, Geo; Berglund, B.

    1997-01-01

    The amount of volatile organic compounds (VOCs) in indoor air, usually called TVOC (total volatile organic compounds), has been measured using different definitions and techniques which yield different results. This report recommends a definition of TVOC referring to a specified range of VOCs and...... for characterizing indoor pollution and for improving source control as required from the points of view of health, comfort, energy efficiency and sustainability. (C) Indoor Air (1997)....... the TVOC value. The report reviews the TVOC concept with respect to its usefulness for exposure assessment and control and for the prediction of health or comfort effects. Although the report concludes that at present it is not possible to use TVOC as an effect predictor, it affirms the usefulness of TVOC......The amount of volatile organic compounds (VOCs) in indoor air, usually called TVOC (total volatile organic compounds), has been measured using different definitions and techniques which yield different results. This report recommends a definition of TVOC referring to a specified range of VOCs...

  3. Total Laparoscopic Conservative Surgery for an Intramural Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Hiroshi Nabeshima

    2010-01-01

    Full Text Available A 38-year-old woman, gravida 3, para 1 with a history of a left salpingectomy for an ectopic pregnancy was admitted for treatment of a presumed ectopic pregnancy. Transvaginal sonography revealed an ill-defined gestational sac and fetal heart beat within the fundal myometrium adjacent to the left cornua. Laparoscopy was performed for a suspected left cornual pregnancy or intramural pregnancy. A cystic mass 3 cm in diameter was visible within the fundal myometrium. Total laparoscopic removal of the gestational sac was performed, and the uterus was preserved. Pathologic evaluation of the excised mass demonstrated chorionic villi involving the myometrium. In the literature, only one other case describing the laparoscopic removal of an intramural pregnancy has been reported. However, in the prior report, the patient still required hysterectomy after conservative surgery. Therefore, this is the first report of the successful treatment of an intramural pregnancy exclusively with laparoscopy.

  4. Postoperative pain treatment after total knee arthroplasty

    DEFF Research Database (Denmark)

    Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa

    2017-01-01

    INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-b...... of an optimal procedure-specific analgesic regimen after TKA....

  5. Total spectral distributions from Hawking radiation

    Science.gov (United States)

    Broda, Bogusław

    2017-11-01

    Taking into account the time dependence of the Hawking temperature and finite evaporation time of the black hole, the total spectral distributions of the radiant energy and of the number of particles have been explicitly calculated and compared to their temporary (initial) blackbody counterparts (spectral exitances).

  6. Total synthesis of insect antifeedant drimane sesquiterpenes

    NARCIS (Netherlands)

    Jansen, B.J.M.

    1993-01-01

    The investigations described in this thesis deal with the total synthesis of sesquiterpenes of the drimane family, named for their widespread occurrence in the stem bark of South American Drimys species. These compounds contain the bicyclofarnesol nucleus

  7. Applying Total Quality Management to Business Education.

    Science.gov (United States)

    Brown, Daniel J.; Koenig, Harold F.

    1993-01-01

    Responses from 390 business school alumni (60%) show that students want educators to consider their opinions about their overall educational experience and what happens after graduation. A total quality management approach can help discover customer/student needs, establish a focus on improvement, and implement a process orientation. (SK)

  8. Total hip arthroplasty: an editiorial comment.

    Science.gov (United States)

    Peterson, L F

    1977-09-01

    Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.

  9. Crossing Total Occlusions : Navigating Towards Recanalization

    NARCIS (Netherlands)

    Sakes, A.; Regar, E.; Dankelman, J.; Breedveld, P.

    2016-01-01

    Chronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate visualization, and the

  10. Crossing Total Occlusions: Navigating Towards Recanalization

    NARCIS (Netherlands)

    A. Sakes (Aimée); E.S. Regar (Eveline); J. Dankelman (Jenny); P. Breedveld (Paul)

    2016-01-01

    textabstractChronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate

  11. Design improvements in Total Knee Arthroplasty

    NARCIS (Netherlands)

    Barink, M.

    2007-01-01

    The thesis deals with three questions concerning the knee joint and total knee arthroplasty. 1. Are there parameters which can be changed to reduce bone resorption, caused by TKA, without affecting other relevant parameters? A debonded anterior flange of the femoral TKA component reduces bone

  12. Concise total syntheses of (+/-)-strychnine and (+/-)-akuammicine.

    Science.gov (United States)

    Sirasani, Gopal; Paul, Tapas; Dougherty, William; Kassel, Scott; Andrade, Rodrigo B

    2010-05-21

    Concise total syntheses of Strychnos alkaloids strychnine (1) and akuammicine (2) have been realized in 13 and 6 operations, respectively. Key steps include (1) the vinylogous Mannich reaction; (2) a novel, sequential one-pot spirocyclization/intramolecular aza-Baylis-Hillman reaction; and (3) a Heck cyclization. The synthesis of 1 proceeds via the Wieland-Gumlich aldehyde (26).

  13. Application of Total Quality Management in Education

    Science.gov (United States)

    Farooq, M. S.; Akhtar, M. S.; Ullah, S. Zia; Memon, R. A.

    2007-01-01

    The purpose of the paper is to analyzing thoughts of the modern management paradigm "Total Quality Management" (TQM), and its application in the field of education. The basic theme of TQM is participatory approach to address the question(s) of quality in business aswell as in the field of education. Reviewing fresh literature from the internet …

  14. Diagnosing total quality management - part 2

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1993-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides a way in which the basic elements can be made operational in practice. Based on this model a quality diagnostic instrument is

  15. Diagnosing Total Quality Management. Part I

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1992-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides the way in which the basic elements can be made operational in practice. Based on this model a quality-diagnostical instrument is

  16. Diagnosing Total Quality Management - part 2

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1993-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides the way in which the basic elements can be made operational in practice. Based on this model a quality-diagnostical instrument is

  17. Total hip arthroplasty for giant cell tumour.

    Directory of Open Access Journals (Sweden)

    Kulkarni S

    1996-07-01

    Full Text Available A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

  18. Accumulation pattern of total nonstructural carbohydrate in ...

    African Journals Online (AJOL)

    The pattern of total nonstructural carbohydrate (TNC) accumulation in strawberry (Fragaria ananassa Duch.) nursery runner plants, cv. eCamarosaf, was determined for three growing seasons. Plant growth and fruit production patterns were also evaluated. The experiments were carried out on plants propagated in high ...

  19. Diagnosing total quality management - part 1

    NARCIS (Netherlands)

    Bossink, B.A.G.; Gieskes, J.F.B.; Pas, T.N.M.

    1992-01-01

    From extensive literature research a total quality management (TQM) model is developed. This model describes the basic elements of the concept of TQM. It also provides the way in which the basic elements can be made operational in practice. Based on this model a quality-diagnostical instrument is

  20. Accumulation pattern of total nonstructural carbohydrate in ...

    African Journals Online (AJOL)

    Umukoro

    1977-09-09

    Sep 9, 1977 ... 1Instituto Nacional de Tecnología Agropecuaria (INTA), EEA Famaillá, Argentina. 2Department of Plant Sciences, University of California Davis, CA, USA. Accepted 17 October, 2012. The pattern of total nonstructural carbohydrate (TNC) accumulation in strawberry (Fragaria ananassa. Duch.) nursery ...