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Sample records for bleed operating regions

  1. Primary coolant feed and bleed operating regions for the Midland Plant

    International Nuclear Information System (INIS)

    Tsai, M.S.

    1985-01-01

    Operating regions for primary coolant feed and bleed cooling are developed for the Midland Plant using core decay heat, the high-pressure injection (HPI) system capacity, and flow rate relief through the power-operated relief valve (PORV). This mode of cooling is used for accident scenarios in which the normal core cooling means of a nuclear power plant is lost because of loss of water inventory in the steam generators. The HPI flow is based on the capacities of one and two pumps. Saturated steam, saturated water, and subcooled water are considered to be possible states of the fluid being relieved through the PORV. In estimating the PORV relief rate, flow equations are derived from the Electric Power Research Institute test data obtained from the same model and size valve that is used in the Midland Plant. For easy reference by operators, the operating region is displayed on a plane of reactor coolant system pressure and temperature. The technique developed for the Midland Plant provides a convenient method for examining the feed and bleed cooling capability for a nuclear power plant that employs a pressurized water reactor system

  2. [Three methods for controlling presacral massive bleeding during pelvic operations].

    Science.gov (United States)

    Wang, Xiaoxue; Liu, Zhimin; Xie, Shangkui; Ren, Donglin; Wu, Yin'ai

    2017-12-25

    To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the

  3. Predictors of post operative bleeding and blood transfusion in ...

    African Journals Online (AJOL)

    blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, ...

  4. Advanced operation strategy for feed-and-bleed operation in an OPR1000

    International Nuclear Information System (INIS)

    Kim, Bo Gyung; Yoon, Ho Joon; Kim, Jaewhan; Kang, Hyun Gook

    2016-01-01

    Highlights: • Advanced operating strategy covers all necessary conditions for F&B operation. • Advanced operating strategy identifies the urgency of F&B operation. • An advanced operating strategy for F&B operation is developed using a decision tree. • Human error probability is re-estimated based on a thermohydraulic analysis and K-HRA method. • An advanced operation strategy provides indications under various plant situations. - Abstract: When the secondary side is unavailable in a pressurized water reactor (PWR), heat from the core will accumulate in the primary side causing core damage. In this situation a heat removal mechanism called feed-and-bleed operation (F&B operation) must be used, which is a process of directly cooling the primary reactor cooling system (RCS). However, conventional operation strategy in emergency operating procedures (EOPs) does not cover all possible conditions to initiate F&B operation. If the EOP informs on the urgency of F&B operation, operators will be able to more clearly make decisions regarding F&B operation initiation. In order to cover all possible scenarios for F&B operation and systematically inform its urgency, an advanced operating strategy using a decision tree is developed in this study. The plant condition can be classified according to failure of secondary side, RCS pressure condition, injectable inventory to RCS, and remaining core inventory. RCS pressure, core level, and RCS temperature are representative indicators which provide information regarding the initiation of F&B operation. Indicators can be selected based on their detectability and quantification, and a decision tree is developed according to combinations of indicators. To estimate the effects of the advanced operation strategy, human error probability (HEP) of F&B operation is re-estimated based on a thermohydraulic analysis. The available time for operators to initiate F&B operation is also re-estimated to obtain more realistic data. This

  5. A Study on the Operator Decision Support for Feed-and-Bleed Operation

    International Nuclear Information System (INIS)

    Kim, Bo Gyung; Kim, Sang Ho; Kang, Hyun Gook; Yoon, Ho Joon

    2014-01-01

    In the case of a combined accident that includes a failure of the secondary cooling system, it is difficult for operators to recognize the necessity of an feed and bleed (F and B) operation because a lot of parameters and alarms should be checked before a decision, and operators may spend a considerable amount of time arriving at the entry for a proper emergency operating procedure that contains the procedure for an F and B operation. Therefore, a clear identification of the success boundary of an F and B operation would help operators in their decision-making when a combined accident that includes a secondary cooling system failure occurs. This study will provide a useful guideline for the initiation of an F and B operation for operators. Cooling the RCS after a scram is one of the most important safety functions for preventing core damage. To support the operator in decision making whether to initiate the F and B operation, plant conditions requiring the initiation of an F and B operation were identified. Plant conditions are affected by the steam generator inventory, RCS inventory, core inventory, and safety injection availability. The combination of accident types, component availabilities, and the initiation time of an F and B operation affect the success of the F and B operation. Operators need clear information about the RCS condition when the steam generators, the RCS's main residual heat removal mechanism, become unavailable. When this happens, the initiation of an F and B operation becomes necessary. As the number of the state increases, the necessity of an F and B operation increases. Especially, the operator should initiate an F and B operation when the RCS condition enters State 3 for Type 1 incidents or State 3-2 for Type 2 incidents. The results of this study may be useful in providing information regarding the necessity and effects of an F and B operation in a quantitative manner. In particular, in the case of a combined accident including a

  6. Efficacy of endoscopic histoacryl injection in treatment of gastric variceal bleeding caused by regional portal hypertension

    Directory of Open Access Journals (Sweden)

    TANG Shanhong

    2015-08-01

    Full Text Available Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis-related portal hypertension. Between-group comparison of categorical data was made by Fisher′s test. Results In patients with regional portal hypertension, five of them had severe isolated gastric varices (IGV and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis-related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short-term response rate (1/6 vs 6/6, P=0.015 and long-term response rate (0/6 vs 5/6, P=0.015. Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

  7. Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

    Directory of Open Access Journals (Sweden)

    Mohammad Haghighi

    2017-03-01

    Full Text Available Background:Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead topostoperative acute anemia and some other complications.Tranexamic acid (TA is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusionrequirements during some elective surgeries (1-3.The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA on intraoperative blood loss and asubsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.Methods:Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullarynailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. GroupI, the intervention group with eighteen patients received 15 mg/kg (TA via intravenous infusion before surgical incision.Patients in the placebo group received an identical volume of normal saline.Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobinchange as well as transfusion rates and volumes were compared between the two groups.Results:Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,respectively (P=0.570. Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group(5.6% compared to the placebo group (30% (P=0.06. No significant difference in The Allowable Blood Loss during thesurgery was found between the two groups (P=0.894.Conclusion:Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion duringtraumatic femoral fracture operation.

  8. Sensitivity Study for Feed and Bleed Operation for Domestic CANDU Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. S; Kim, B. S.; Yoo, H. K.; Kim, H. J. [Atomic Creative Technology Co., Daejeon (Korea, Republic of); Whang, S. W. [Korea Hydro and Nuclear Power Co., Daejeon (Korea, Republic of)

    2016-05-15

    The purpose of this paper is to evaluate the effects of the feed and bleed operation using DCT(Degassing Condenser Tank) over-pressure protection valves when LOCL4 with LOCL3 occurs during LPSD mid-loop operation. The CDF(Core Damage Frequency) of Level-1 Internal Event for Wolsong NPP Unit 1 during LPSD POS5A/5B accounts for about 89.08%(POS5A: 30.04%, POS5B: 59.04%) of the total CDF. For Wolsong NPP Unit 1 LPSD External Event, seismic analysis is excluded from this study because it is PSA-based SMA(Seismic Margin Assessment based Probabilistic Safety Assessment). For the domestic CANDU NPP, the feed and bleed operation using DCT over-pressure protection valves has been incorporated as an additional measure to mitigate the consequences during LPSD mid-loop operation. Since LOCL4 with LOCL3 is considered to be the event with highest frequency among all initial events, the effect of the feed and bleed operation on the safety of Nuclear Power Plant has been evaluated using PSA methodology.

  9. Bleeding outcome during a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia: a prospective study.

    Science.gov (United States)

    Fariz-Safhan, M N; Tee, H P; Abu Dzarr, G A; Sapari, S; Lee, Y Y

    2014-06-01

    During a dengue outbreak in 2005 in the East-coast region of Peninsular Malaysia, one of the worst hit areas in the country at that time, we undertook a prospective study. We aimed to describe the bleeding outcome and changes in the liver and hematologic profiles that were associated with major bleeding outcome during the outbreak. All suspected cases of dengue admitted into the only referral hospital in the region during the outbreak were screened for WHO 2002 criteria and serology. Liver function, hematologic profile and severity of bleeding outcome were carefully documented. The association between symptoms, liver and hematologic impairments with the type of dengue infection (classical vs. hemorrhagic) and bleeding outcome (major vs. non-major) was tested. Dengue fever was confirmed in 183 cases (12.5/100,000 population) and 144 cases were analysed. 59.7% were dengue hemorrhagic fever, 3.5% were dengue shock syndrome and there were 3 in-hospital deaths. Major bleeding outcome (gastrointestinal bleeding, intracranial bleeding or haemoptysis) was present in 14.6%. Elevated AST, ALT and bilirubin were associated with increasing severity of bleeding outcome (all P profiles was seen in major bleeding outcome.

  10. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  11. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao

    2014-01-01

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications

  12. Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2015-09-01

    Full Text Available Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK, proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.

  13. SEBIM pilot operated tandems. A new solution for Darlington NGS bleed condenser relief valves

    International Nuclear Information System (INIS)

    Paetzold, H.; Hera, V.; Schaumburg, G.

    1996-01-01

    Following incidents at Pickering, Wolsung and Bruce NGS, involving instability of bleed condenser relief valves, Darlington station decided to replace the spring loaded RV's by new pilot operated SEBIM tandem valves. This paper is presenting the approach taken, the design and the testing of the new solution, as well as some of the computer modeling work performed in connection with this project. The SEBIM tandems, following successful testing in France, will be installed in Darlington Unit 2, this spring. The new valves can perform with absence of instability and prevent a LOCA incident due to their design, which includes a protection and a redundant valve in series. (author)

  14. Identification of Success Criteria for Automated Function Using Feed and Bleed Operation

    International Nuclear Information System (INIS)

    Kim, Bo Gyung; Kim, Sang Ho; Kang, Hyun Gook; Yoon, Ho Joon

    2013-01-01

    Since NPP has lots of functions and systems, operated procedure is much complicated and the chance of human error to operate the safety systems is quite high. In the case of large break loss of coolant accident (LBLOCA) and station black out (SBO), the dependency of operator is very low. However, when many mitigation systems are still available, operators have several choices to mitigate the accident and the human error can be increased more. To reduce the operator's workload and perform the operation accurate after the accident, automated function for safe cooldown based on the feed and bleed (F and B) operation was suggested. The automated function can predict whether the plant will be safe after the automated function is initiated, and perform the safety functions automatically. To expect the success of cooldown, success criteria should be identified. To perform the operation accurately after the accident, the automated function for safe cooldown based on the F and B operation is suggested. To expect the success of cooldown, sequence of RCS situation when heat removal by secondary system fails is identified. Based on the sequence of RCS situation, four levels of necessity of F and B operation are classified. To obtain the boundary of levels, the TH analysis will be performed

  15. Sequence Tree Modeling for Combined Accident and Feed-and-Bleed Operation

    International Nuclear Information System (INIS)

    Kim, Bo Gyung; Kang Hyun Gook; Yoon, Ho Joon

    2016-01-01

    In order to address this issue, this study suggests the sequence tree model to analyze accident sequence systematically. Using the sequence tree model, all possible scenarios which need a specific safety action to prevent the core damage can be identified and success conditions of safety action under complicated situation such as combined accident will be also identified. Sequence tree is branch model to divide plant condition considering the plant dynamics. Since sequence tree model can reflect the plant dynamics, arising from interaction of different accident timing and plant condition and from the interaction between the operator action, mitigation system, and the indicators for operation, sequence tree model can be used to develop the dynamic event tree model easily. Target safety action for this study is a feed-and-bleed (F and B) operation. A F and B operation directly cools down the reactor cooling system (RCS) using the primary cooling system when residual heat removal by the secondary cooling system is not available. In this study, a TLOFW accident and a TLOFW accident with LOCA were the target accidents. Based on the conventional PSA model and indicators, the sequence tree model for a TLOFW accident was developed. If sampling analysis is performed, practical accident sequences can be identified based on the sequence analysis. If a realistic distribution for the variables can be obtained for sampling analysis, much more realistic accident sequences can be described. Moreover, if the initiating event frequency under a combined accident can be quantified, the sequence tree model can translate into a dynamic event tree model based on the sampling analysis results

  16. Sequence Tree Modeling for Combined Accident and Feed-and-Bleed Operation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Gyung; Kang Hyun Gook [KAIST, Daejeon (Korea, Republic of); Yoon, Ho Joon [Khalifa University of Science, Abu Dhabi (United Arab Emirates)

    2016-05-15

    In order to address this issue, this study suggests the sequence tree model to analyze accident sequence systematically. Using the sequence tree model, all possible scenarios which need a specific safety action to prevent the core damage can be identified and success conditions of safety action under complicated situation such as combined accident will be also identified. Sequence tree is branch model to divide plant condition considering the plant dynamics. Since sequence tree model can reflect the plant dynamics, arising from interaction of different accident timing and plant condition and from the interaction between the operator action, mitigation system, and the indicators for operation, sequence tree model can be used to develop the dynamic event tree model easily. Target safety action for this study is a feed-and-bleed (F and B) operation. A F and B operation directly cools down the reactor cooling system (RCS) using the primary cooling system when residual heat removal by the secondary cooling system is not available. In this study, a TLOFW accident and a TLOFW accident with LOCA were the target accidents. Based on the conventional PSA model and indicators, the sequence tree model for a TLOFW accident was developed. If sampling analysis is performed, practical accident sequences can be identified based on the sequence analysis. If a realistic distribution for the variables can be obtained for sampling analysis, much more realistic accident sequences can be described. Moreover, if the initiating event frequency under a combined accident can be quantified, the sequence tree model can translate into a dynamic event tree model based on the sampling analysis results.

  17. Regional Test Center Operations Manual

    Energy Technology Data Exchange (ETDEWEB)

    Stein, Joshua [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Burnham, Laurie [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Christian Birk [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-07-01

    The U.S. DOE Regional Test Center for Solar Technologies program was established to validate photovoltaic (PV) technologies installed in a range of different climates. The program is funded by the Energy Department's SunShot Initiative. The initiative seeks to make solar energy cost competitive with other forms of electricity by the end of the decade. Sandia National Laboratory currently manages four different sites across the country. The National Renewable Energy Laboratory manages a fifth site in Colorado. The entire PV portfolio currently includes 20 industry partners and almost 500 kW of installed systems. The program follows a defined process that outlines tasks, milestones, agreements, and deliverables. The process is broken out into four main parts: 1) planning and design, 2) installation, 3) operations, and 4) decommissioning. This operations manual defines the various elements of each part.

  18. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  19. [Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial].

    Science.gov (United States)

    Olmos Rodríguez, M; Ballester Hernández, J A; Arteta Bárcenas, M T; Rodríguez Cerezo, A; Vidarte Ortiz de Artiñano, M A; Veiga Alameda, C

    2015-02-01

    Assess the effectiveness of priming the extracorporeal circulation system with albumin-mannitol combined with ultrafiltration during extracorporeal circulation to reduce post-operative bleeding and transfusion requirements in heart surgery, as well as its impact on the fluid balance, coagulation and hematocrit parameters, re-operation for bleeding, ICU, and hospital length of stay. A total of 134 patients scheduled for heart surgery were randomized to receive Ringer's lactate 1,500mL in the priming reservoir (group C), or mannitol 20% 250mL, albumin 20% 150mL and Ringer's lactate 1,100mL combined with ultrafiltration (group T). Bleeding volume, transfusions, fluid balance, coagulation, and hematology parameters were determined until 48h in the post-operative period. There was a reduction of postoperative bleeding in group T, 1,165±789mL vs 992±662mL (P=.17), and red blood cell concentrate transfusions, 694±843mL vs 413±605mL (P=.03). Intra-operative and post-operative fluid balance was significantly less positive in group T, with an overall balance of 2,292±2,152mL vs 5,388±2,834mL (P<.001). There were higher values of hemoglobin and hematocrit, intraoperative (P<.001), on admission to ICU (P=.001), and at 6h (P=.05) in group T, and lower INR at 6h (P=.01) and 24h (P=.02). Re-operation rate and length of stay in ICU were higher in group C, but not statiscally significant. The priming of extracorporeal reservoir with mannitol, albumin, and Ringer's lactate, combined with ultrafiltration, significantly improves intra- and post-operative fluid balance, resulting in a reduction in blood transfusions, with no significant decrease in post-operative bleeding, re-operation bleeding rate, and length of stay in the ICU. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. How to identify rectal sub-regions likely involved in rectal bleeding in prostate cancer radiotherapy

    Science.gov (United States)

    Dréan, G.; Acosta, O.; Ospina, J. D.; Voisin, C.; Rigaud, B.; Simon, A.; Haigron, P.; de Crevoisier, R.

    2013-11-01

    Nowadays, the de nition of patient-speci c constraints in prostate cancer radiotherapy planning are solely based on dose-volume histogram (DVH) parameters. Nevertheless those DVH models lack of spatial accuracy since they do not use the complete 3D information of the dose distribution. The goal of the study was to propose an automatic work ow to de ne patient-speci c rectal sub-regions (RSR) involved in rectal bleeding (RB) in case of prostate cancer radiotherapy. A multi-atlas database spanning the large rectal shape variability was built from a population of 116 individuals. Non-rigid registration followed by voxel-wise statistical analysis on those templates allowed nding RSR likely correlated with RB (from a learning cohort of 63 patients). To de ne patient-speci c RSR, weighted atlas-based segmentation with a vote was then applied to 30 test patients. Results show the potentiality of the method to be used for patient-speci c planning of intensity modulated radiotherapy (IMRT).

  1. An Estimation of Operator's Diagnostic Time for Feed-And-Bleed Operation under Various Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Gyung; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of); Yoon, Ho Joon [Khalifa University of Science, Abu Dhabi (United Arab Emirates)

    2015-10-15

    In order to assess realistic safety of plant, effects of interactions between components, operator, and plant condition are needed to be considered in the PSA model. One of the important issues to estimate the CDF is the estimation of human error probability (HEP). When an accident occurs, operators follow the emergency operating procedure and check various alarm, parameters, and signals. In the conventional Korean PSA model, the Korean standard HRA (K-HRA) method is used. In this method, the HEP is the sum of diagnosis error probability and execution error probability. A diagnosis error probability is expressed by the available time for diagnosis and adjusting performance shaping factors, and an execution error probability is a function of task type and stress level. Available time for diagnosis is very important factor of HEP. If the available time for diagnosis is short, the HEP becomes high. In order to obtain the realistic risk assessment results, we first focus on the estimation of HEP considering the plant dynamics under various scenarios. Target operation and scenarios are feed-and bleed operation (F and B operation) and total loss of feedwater (TLOFW) accident with/without loss of coolant accident (LOCA). One of the highest HEP is HEP of FnB operation. In additional, Scenarios, which are related to combination secondary heat removal failure and primary heat removal failure, are most critical core damage scenario of the combined accident except scenarios related to station black out (SBO). In these scenarios, the FnB operation is last resort to prevent core damage. To estimate available operator diagnosis time, we identify the relationship between accidents, mitigation function, and plant condition. Distribution of available time of diagnosis was estimated using the MOSAIQUE. The variables are break size, break timing, trip timing of RCP, and availability of high pressure safety injection (HPSI) pump under the TLOFW accident with LOCA. For Type 1 accident

  2. The impact of electrocautery method on post-operative bleeding complications after non-newborn circumcision and revision circumcision.

    Science.gov (United States)

    Harty, Niall J; Nelson, Caleb P; Cendron, Marc; Turner, Shaunna; Borer, Joseph G

    2013-10-01

    We evaluated post-operative bleeding complications in non-newborns following use of monopolar versus bipolar electrocautery for circumcision or revision circumcision. We retrospectively reviewed sequentially performed cases of circumcision and revision circumcision performed by nine pediatric urologists at our institution from 2005 to 2010. In order to incorporate both the monopolar and bipolar electrocautery experience for a single surgeon employing bipolar technique, sequential cases from 2002 to 2010 were reviewed. Variables assessed included age, procedure, method of electrocautery, skin approximation and dressing, and bleeding complications. 1810 patients that underwent either circumcision or revision circumcision were reviewed. Complete data was available for 1617 patients. Age at operation was a mean 3.7 ± 4.9 yrs and median 1.5 yrs. Return for bleeding complication for all surgeons, was 2/336 (0.6%) for bipolar and 28/1281 (2.2%) for monopolar (p = 0.0545). For the single surgeon using bipolar technique, returns were 2/336 (0.6%) for bipolar and 5/309 (1.6%) for monopolar (p = 0.2133). Returns per procedure type were 1/200 (0.5%) bipolar and 24/844 (2.8%) monopolar for primary circumcision (p = 0.0513), and 1/136 (0.7%) bipolar and 4/437 (0.9%) monopolar (p = 0.84) for revision. Four of 1617 (0.2%) patients returned to the operating room [4/1281 (0.3%) monopolar (p = 0.31)]. There was no difference in return to the operating room for circumcision versus revision. Return for bleeding complications after circumcision and revision circumcision occurred more frequently after monopolar electrocautery compared to bipolar. However, there was no significant difference between the two electrocautery methods. Either form of electrocautery appears to be effective for this common pediatric urologic procedure. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  3. Vaginal Bleeding

    Science.gov (United States)

    ... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...

  4. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

    Directory of Open Access Journals (Sweden)

    Garbe Edeltraut

    2011-08-01

    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  5. Changes in intracranial morphology, regional cerebral water content and vital physiological variables during epidural bleeding

    International Nuclear Information System (INIS)

    Ganz, J.C.; Inst. of Surgical Research, National Hospital, Oslo; Thuomas, K.AA.; Inst. of Surgical Research, National Hospital, Oslo; Vlajkovic, S.; Inst. of Surgical Research, National Hospital, Oslo; Nilsson, P.; Inst. of Surgical Research, National Hospital, Oslo; Bergstroem, K.; Inst. of Surgical Research, National Hospital, Oslo; Ponten, U.; Inst. of Surgical Research, National Hospital, Oslo; Zwetnow, N.N.; Inst. of Surgical Research, National Hospital, Oslo

    1993-01-01

    Epidural bleeding was produced in 8 anaesthetised and heparinised dogs by an artificial system. Changes in vital physiological variables were related to intracranial shifts and tissue water content assessed with MR imaging. Six animals survived while 2 succumbed. In the surviving animals intracranial shifts and compressions remained unchanged from an early stage. The cerebral perfusion pressure was reduced from between 80 and 110 mm Hg to between 40 and 60 mm Hg. Some increase in supratentorial white matter tissue water was observed. In the lethal experiments cerebral perfusion pressure fell to less than 40 mm Hg. Moreover, secondary delayed anatomical changes were seen including hydrocephalus. Increase in cerebral tissue water was more intense and widespread than in the survivors. These findings indicate that the outcome of epidural bleeding is related to cerebral perfusion pressure with secondary deterioration resulting from additional volume loading from increased tissue water and hydrocephalus. (orig.)

  6. Advancing regional co-operation in Africa

    International Nuclear Information System (INIS)

    Maksoudi, M.

    1991-01-01

    The IAEA's regional co-operation programme in Africa was initiated in 1983, with two regional projects dealing with hydrology and insect physiology and biochemistry. The paper describes the structure of this Regional Programme, the sources of finance and the projects currently in operation in agriculture and hydrology. 1 fig., 1 tab

  7. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. The use of a co-design model in improving timely bleed reporting by adults with haemophilia living in the Auckland region of New Zealand.

    Science.gov (United States)

    d'Young, A I; Young, L; Ockelford, P A; Brasser, M; Slavin, K; Manson, L; Preston, S

    2014-05-01

    Many adult patients diagnosed with phenotypically moderate and severe haemophilia living in the Auckland region of New Zealand do not report bleeding episodes within a timeframe that allows for optimal assessment and management. This can result in poor clinical outcomes for patients and poor oversight of the use of expensive clotting factor concentrates. Our goal was to improve both the number and speed at which bleeding episodes were reported to our centre, improving access to care and clinical oversight of the use of expensive factor concentrates and aiding the development of a care partnership with patients. We worked with 70 adult PWH living in the Auckland region of New Zealand with moderate and severe haemophilia A and B. Over a 5-month period between March and July 2013 we used a co-design model to develop and implement a range of strategies to improve the timing and frequency of bleed reporting. Mean bleed reporting time was reduced threefold, with a threefold increase in the number of bleeds reported per month. We reduced the number of bleeding episodes reported outside of a prespecified 48-h time limit by 68%. We significantly improved bleed reporting and time to report, indicating improved access to our services, improved clinical oversight and improved accountability to our national funder. We have achieved a care partnership and a reduction in factor consumption for the study population without compromising the quality of care they receive. © 2013 John Wiley & Sons Ltd.

  9. Internal Bleeding

    Science.gov (United States)

    ... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...

  10. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty.

    Science.gov (United States)

    Emara, Walid Mohamed; Moez, Khaled K; Elkhouly, Abeer H

    2014-01-01

    This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]). After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded. There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in "r" and "k" times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A. Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.

  11. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  12. Operational transients: A regional administrator's view

    International Nuclear Information System (INIS)

    Collins, J.T.; Johnson, E.H.

    1984-01-01

    This chapter discusses the response of the regional US NRC to operational transients. Three of the major lessons learned from the Three Mile Island-2 accident are reviewed. The need to consider the more probable events of lesser consequences in addition to the significant events is now realized. The importance of the operator in the course of an operational event has been recognized. Three Mile Island also pointed out the many design and hardware deficiencies. Topics considered include the industry capability to meet the challenge of operational transients, the region's capability, and the capability of the utility. It is recommended that technical drills be developed, that plant-specific technical competence be improved, that operator training and education be improved, and that the attitude changes on the part of utilities and the nuclear industry in general be accelerated

  13. AFRA. African Regional Co-operative Agreement

    International Nuclear Information System (INIS)

    1994-04-01

    This publication provides an outline of the African Regional Co-operation Agreement for research, development and training related to nuclear science and technology (AFRA). The agreement stems from an initiative of several African member states of the IAEA to get the agency to help establish an African regional arrangement which would be similar to arrangements which were already in place in the Asian and Latin American regions. Through this regional approach to development, AFRA seeks to accelerate moves toward self-sufficiency in scientific disciplines and appropriate technologies by coordinating intellectual and physical resources and disseminating innovative methods and practices in a cost-effective manner

  14. TRIUMF: Regional government offers KAON operating costs

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1992-09-15

    After a period of uncertainty, confidence in the major KAON project for the Canadian TRIUMF Laboratory in Vancouver was boosted on 28 May at a rally of about a thousand KAON supporters in downtown Vancouver when the regional government of British Columbia announced its willingness to pay part of KAON's operating costs.

  15. TRIUMF: Regional government offers KAON operating costs

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    After a period of uncertainty, confidence in the major KAON project for the Canadian TRIUMF Laboratory in Vancouver was boosted on 28 May at a rally of about a thousand KAON supporters in downtown Vancouver when the regional government of British Columbia announced its willingness to pay part of KAON's operating costs

  16. [Optimal Operational Definition of Patient with Peptic Ulcer Bleeding for Big Data Analysis Using Combination of Clinical Characteristics in a Secondary General Hospital].

    Science.gov (United States)

    Lee, Jae Won; Kim, Hyun Ki; Woo, Yong Sik; Jahng, Jaehoon; Jin, Young Ran; Park, Jong Heon; Kim, Yong Sung; Jung, Hwoon Yong

    2016-08-25

    Peptic ulcer bleeding (PUB) is the most common cause of upper gastrointestinal bleeding in Korea but there has been no research done using big data. This study evaluates the optimal operational definition (OD) for big data research by analyzing clinical characteristics of PUB. We reviewed the clinical characteristics of 92 patients with PUB confirmed on endoscopy in Wonkwang University Sanbon Hospital (January 2013 to December 2014). We calculated sensitivity and positive predictive value (PPV) to detect confirmed PUB patients using ODs developed by combining clinical features of patients with PUB. The mean patient age was 63 years. Men had higher prevalence of PUB than women. Bleeding gastric ulcer was proportionately common in the age range of 40s to 60s in men, while a significantly higher rate of bleeding occurred in women older than 70s. The rate of drug-induced ulcer was 28.2%, whereas the prevalence of Helicobacter pylori was 47.8%. Among the hospitalized patients with diagnostic code of PUB, we ruled out patients with endoscopic removal of gastric adenoma or peritonitis, and selected patients who had been administered intravenous proton pump inhibitor. The sensitivity in this setting was 82.6%, and PPV was 88.4%. PUB was more common in older patients, and there was a clear gender difference in gastric ulcer bleeding by age. With a proper OD using PUB diagnostic codes, we can identify true patients with sufficiently high sensitivity and PPV.

  17. Development of a feed-and-bleed operation strategy with hybrid-SIT under low pressure condition of PWR

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, In Seop, E-mail: jeoni@rpi.edu [Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY (United States); Han, Sang Hoon, E-mail: shhan2@kaeri.re.kr [Advanced Research Group, Korea Atomic Energy Research Institute, 70 Daedeok-daero 989 Beon-gil, Yuseong-gu, Daejeon 34057 (Korea, Republic of); Kang, Sang Hee, E-mail: sanghee.kang@khnp.co.kr [NSSS Design Group, Korea Hydro & Nuclear Power Co., Ltd., Central Research Institute, 70, 1312-beongil, Yuseongdaero, Yuseong-gu, Daejeon (Korea, Republic of); Kang, Hyun Gook, E-mail: hyungook@kaist.ac.kr [Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY (United States)

    2017-04-01

    Highlights: • The novel F&B operation strategy with H-SIT and LPSI is developed. • The effectiveness of the H-SITs is verified using thermo-hydraulic simulations. • Success criteria considered for the new F&B operation strategy is identified. • A PSA model of APR+ reflecting the new F&B strategy with H-SIT is developed. • A risk analysis of the proposed F&B operation strategy is performed. - Abstract: While safety functions in current nuclear power plants are mainly provided by active safety systems, recently passive safety systems are being combined with the active systems to strengthen accident mitigation capability and therefore enhance overall plant safety. To this end, securing long-term cooling of the core is of particular importance. This study considers the hybrid safety injection tank (H-SIT), a passive injection system, as a target component to develop a long-term cooling strategy using active and passive systems concurrently. In the feed-and-bleed (F&B) operation, one of the important long-term cooling strategies to maintain core safety in pressurized water reactors, low pressure safety injection (LPSI) pumps are typically considered inoperable as depressurization is first required, which leads to core dry-out before reaching LPSI operable pressure. This study investigates whether H-SITs, with the important design feature of passive coolant injection under any pressure condition of the primary coolant system, can make up the core during depressurization thereby allowing LPSI pumps to be used in F&B operation as an additional means of long-term cooling. The effectiveness of the H-SITs is verified using thermal-hydraulic simulations, and based on the results a novel F&B operation strategy with H-SITs and LPSI pumps is developed. A probabilistic safety assessment (PSA) model is then developed in order to assess the risk effect of the suggested strategy. PSA results demonstrate that the proposed strategy lowers core damage frequency in the target

  18. Regional Power Authority urged for TMI operations

    International Nuclear Information System (INIS)

    Anon.

    1981-01-01

    If the Three Mile Island (TMI) unit 1 returns to service, state ownership with a Regional Power Authority to oversee its operation and complete the cleanup of unit 2 would benefit ratepayers and avoid lengthy lawsuits, according to an Arthur Young and Company report to the New Jersey Board of Utilities. The report rejects continued ownership by General Public Utilities (GPU), merger, divestiture, and other options. It also outlines several conditions necessary for a Regional Power Authority: adequate rate relief, restart of TMI-1, congressional tax exemption, and approval by the GPU board and stockholders. The report recommends that Jersey Central divest itself of GPU to avoid financial disaster if GPU should declare bankruptcy, but it advises maintaining the flexibility to exercise long-term options

  19. A comparative simulation of feed and bleed operation during the total loss of feedwater event by RELAP5/MOD3 and CEFLASH-4AS/REM computer codes

    International Nuclear Information System (INIS)

    Kwon, Y.M.; Ro, T.S.; Song, J.H.

    1995-01-01

    The Ulchin 3 and 4 nuclear power plants, which are two-loop 2,825 MW(thermal) pressurized water reactors designed by the Korea Atomic Energy Research Institute, adopted a safety depressurization system (SDS) to mitigate the beyond-design-basis event of a total loss of feedwater (TLOFW). A comparative simulation by the CEFLASH-4AS/REM and RELAP5/MOD3 computer codes for the TLOFW event without operator recovery and the TLOFW event with feed and bleed (F and B) operation is performed for Ulchin 3 and 4. In the analyses, the SDS bleed paths are modeled by orifices located on the top of the pressurizer, where the analytical area of the bleed path is based on the Ulchin 3 and 4 SDS design flow capacity. An additional case, where the SDS piping and valves are modeled explicitly, is considered for the RELAP5 analysis. The predictions by the CEFLASH-4AS/REM of the transient two-phase system behavior show good qualitative and quantitative agreement with those by the RELAP5 simulation. The RELAP5 case with explicit piping results in less repressurization and lower reactor coolant system pressure than that of the case without explicit SDS modeling. However, the two cases of RELAP5 analyses result in essentially the same transient scenarios for TLOFW with F and B operation. The results of the simulation demonstrate the validity of the Ulchin 3 and 4 design approach, which employs CEFLASH-4AS/REM computer code and SDS bleed paths modeled by orifices located on the top of the pressurizer. The results also indicate that the decay heat removal and core inventory makeup function can be successfully accomplished by F and B operation by using the SDS for Ulchin 3 and 4

  20. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

    NARCIS (Netherlands)

    Yamaguchi, Akito; Skolarikos, Andreas; Buchholz, Niels-Peter Noor; Chomón, Gonzalo Bueno; Grasso, Michael; Saba, Pietro; Nakada, Stephen; de la Rosette, Jean

    2011-01-01

    The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November

  1. 9 Office of Regions and Center Operations LANS -

    Data.gov (United States)

    Department of Transportation — The 9 Office of Regions and Center Operations LANS located at regional offices is the backbone that provides connectivity to systems including servers, workstations,...

  2. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...

  3. Etiology and outcome in patients with upper gastrointestinal bleeding: Study on 4747 patients in the central region of Iran.

    Science.gov (United States)

    Minakari, Mohammad; Badihian, Shervin; Jalalpour, Pooyan; Sebghatollahi, Vahid

    2017-04-01

    Upper gastrointestinal bleeding (UGIB) is a threatening condition leading to urgent hospitalization. This study aims to investigate etiology and outcome in UGIB patients in Iran. Medical records of GIB patients admitted to Alzahra referral hospital (in Isfahan) during 2010-2015 were retrospectively reviewed for demographic data, comorbidities, history of smoking and taking non-steroidal anti-inflammatory drugs (NSAIDs), presenting symptoms, endoscopic findings, therapeutic endoscopy, blood products' infusion, surgical intervention, rebleeding, and mortality. A total of 4747 patients were enrolled in the study (69.2% men, mean age = 55.46 ± 21.98 years). Hematemesis was the most frequent presenting symptom (63.5%). Peptic ulcer (duodenal ulcer in most cases) was seen as the main reason for UGIB (42.4%). Rebleeding (present in 16.5% of patients) was found to be more frequent in patients with older age, presenting sign of hematochezia and hypotension, history of taking NSAIDs and smoking, presence of comorbidities, history of bleeding because of UGI tract neoplasm and esophageal varices, history of needing blood products' infusion, and history of therapeutic endoscopy or surgical intervention (P < 0.005). We found that mortality (5.5% in total) was also higher in the same group of patients that were seen to have a higher tendency for rebleeding (P < 0.005). Peptic ulcers are the most common cause of UGIB. Comorbidities, hemodynamic instability, high-risk endoscopic stigmata, history of smoking and taking NSAIDs, gastric and esophageal malignancies, may be important predisposing factors for rebleeding and mortality in patients with UGIB. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  4. Vaginal bleeding in pregnancy

    Science.gov (United States)

    Pregnancy - vaginal bleeding; Maternal blood loss - vaginal ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

  5. Bleeding Disorders in Women

    Science.gov (United States)

    ... might be heavy, print and use a menstrual chart to track your bleeding and talk to your ... you’re “low in iron.” Heavy bleeding after dental surgery, other surgery, or childbirth. Prolonged bleeding episodes ...

  6. ZVS Operating Region of Multiresonant DC/DC Boost Conveter

    Directory of Open Access Journals (Sweden)

    Elzbieta Szychta

    2007-01-01

    Full Text Available Electromagnetic phenomena that occur during stable operation in resonant circuits of multiresonant ZVS boost converter are described, which can be applied in many fields of the needs of DC voltage electricity. The operating region of the converter is defined which assures the circuit’s operation in which semiconductor elements are switched at zero voltage (ZVS. Conditions delimiting the ZVS operating region are provided. Analysis of the circuit’s operation is based on results of simulation testing by means of Simplorer software.

  7. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    Directory of Open Access Journals (Sweden)

    Lash Timothy L

    2010-01-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors (SSRI decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association. Methods We conducted a population-based study of the risk of re-operation due to post-surgical bleeding within two weeks of primary surgery among Danish women with primary breast cancer. Patients were categorised according to their use of SSRI: never users, current users (SSRI prescription within 30 days of initial breast cancer surgery, and former users (SSRI prescription more than 30 days before initial breast cancer surgery. We calculated the risk of re-operation due to post-surgical bleeding within 14 days of initial surgery, and the relative risk (RR of re-operation comparing SSRI users with never users of SSRI adjusting for potential confounders. Results 389 of 14,464 women (2.7% were re-operated. 1592 (11% had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk = 2.3; 95% confidence interval (CI = 1.4, 3.9 compared with never users. There was no increased risk of re-operation associated with former use of SSRI (RR = 0.93, 95% CI = 0.66, 1.3. Conclusions Current use of SSRI is associated with an increased risk of re-operation due to bleeding after surgery for breast cancer.

  8. Fatores preditivos do tratamento operatório na úlcera péptica hemorrágica Predictors of operative treatment in patients sustaining bleeding peptic ulcers

    Directory of Open Access Journals (Sweden)

    JOSÉ GUSTAVO PARREIRA

    2002-12-01

    Full Text Available OBJETIVO: Avaliar os fatores preditivos de tratamento operatório nos doentes com úlceras pépticas hemorrágicas. MÉTODOS: Através de um estudo retrospectivo, foram analisados os prontuários dos doentes com úlceras pépticas hemorrágicas admitidos de 1998 a 2001. Foram avaliados 200 doentes, com idade entre 17 e 97 anos e média etária de 52 + 18 anos, sendo 153 (76,5% do sexo masculino. Dados vitais à admissão, antecedentes mórbidos, achados e tratamento endoscópico, bem como a evolução e tratamento definitivo foram revisados. Empregou-se o teste t de student e qui-quadrado para a análise estatística, considerando-se o valor de pOBJECTIVE: To analyze the predictors of operative treatment in patients sustaining bleeding peptic ulcers. METHODS: Retrospective analysis of the patients admitted owing to bleeding peptic ulcers from 1998 to 2001. Vital signs upon admission, associated diseases, endoscopy data, evolution and definitive care were evaluated. Patients who underwent surgery were compared with the others in order to identify the predictors of the operative treatment. Student's t and chi squared test were employed for statistical analysis, considering p< 0,05 as significant. RESULTS: Two hundred patients were included in the study group. The age ranged between 17 and 97 years (mean 52 + 18, and 153 patients (76.5% were male. Shock upon admission was present in 27 (13.5%. The endoscopic exam performed at admission showed that 101 patients sustained ulcers in the duodenum and 99 in the stomach, which were classified as Forrest Ia in 5 (2.5%, Ib in 20 (10%, IIa in 48 (24% and IIb in 48 (24%. Twenty five (12.5% patients needed operation, and 23 (92% were submitted to gastrectomy with Billroth's II reconstruction. The operative treatment were more frequently performed in patients sustaining chronic alcoholic intake (p=0.002, cigarette smoking (p=0.02, diabetes mellitus (p=0.01, chronic peptic disease (p=0.05, shock upon admission

  9. Data report of ROSA/LSTF experiment TR-LF-07. Loss-of-feedwater transient with primary feed-and-bleed operation

    International Nuclear Information System (INIS)

    Takeda, Takeshi

    2016-07-01

    An experiment TR-LF-07 was conducted on June 23, 1992 using the Large Scale Test Facility (LSTF) in the Rig of Safety Assessment-IV (ROSA-IV) Program. The ROSA/LSTF experiment TR-LF-07 simulated a loss-of-feedwater transient in a pressurized water reactor (PWR) under assumptions of primary feed-and-bleed operation and total failure of auxiliary feedwater system. A safety injection (SI) signal was generated when steam generator (SG) secondary-side collapsed liquid level decreased to 3 m. Primary depressurization was initiated by fully opening a power-operated relief valve (PORV) of pressurizer (PZR) 30 min after the SI signal. High pressure injection (HPI) system was started in loop with PZR 12 s after the SI signal, while it was initiated in loop without PZR when the primary pressure decreased to 10.7 MPa. The primary and SG secondary pressures were kept almost constant because of cycle opening of the PZR PORV and SG relief valves. The PZR liquid level began to drop steeply following the PORV full opening, which caused liquid level formation at the hot leg. The PZR and hot leg liquid levels recovered due to the HPI actuation in both loops. The primary pressure became lower than the SG secondary pressure, which resulted in the actuation of accumulator (ACC) system in both loops. The PZR and hot legs became full of liquid again after the ACC actuation. The primary feed-and-bleed operation by use of the PORV, HPI and ACC systems was effective to core cooling because of no core uncovery. The experiment was terminated when the continuous core cooling was confirmed due to the successive coolant injection from the HPI system even after the ACC termination. The obtained data would be useful to study operator actions and procedures in the PWR multiple fault events which behaviors in the PZR affect. This report summarizes the test procedures, conditions and major observation in the ROSA/LSTF experiment TR-LF-07. (author)

  10. An Analysis of Effect of Break-up Timing on the Necessity of a Feed-and-Bleed Operation in the case of TLOFW with Local

    International Nuclear Information System (INIS)

    Kim, Bo Gyung; Kim, Sang Ho; Kang, Hyun Gook; Yoon, Ho Joon

    2014-01-01

    A Feed-and-bleed (F and B) operation is a process to cool the reactor by the primary side directly. If adequate residual heat removal through the secondary side is not available, the heat can be removed from the RCS by F and B operation. A total loss of feedwater (TLOFW) accident is used to represent an accident involving the failure of cooling by the secondary cooling system. Even if the secondary cooling system fails, the RCS can be cooled by F and B transients when a loss of coolant accident (LOCA) with a TLOFW accident occurs. During an F and B transient, the RCS has a residual heat removal mechanism. If the break size is large, an F and B transient continuously occurs if the SIS is available. If the break size is small to sufficiently decrease the RCS pressure, the SIS cannot inject the coolant, causing the F and B transient to terminate. After the termination of the F and B transient, the residual heat cannot be removed, and the necessity of an F and B operation increases. The operators may hesitate to initiate F and B operation if a clear cue is not provided, since its initiation implies the radioactive coolant releases into the containment. Therefore, the necessity of F and B operation is needed to be identified. The factors affected the necessity of F and B operation are the availability of the safety injection system and safety depressurization system, water inventory in the primary and secondary cooling systems, break size in a loss-of-coolant accident, and time of accident occurrence. The necessity of F and B operation can be changed according to different timing of break-up despite same break size. Moreover, different timing of break-up makes the operators more complicated. To identify effect of timing of break-up, a thermohydraulic analysis was performed using the MARS code. This study is expected to provide a useful guideline to identify the necessity of an F and B operation under combined accident

  11. Regional Approach to Building Operational Level Capacity for ...

    African Journals Online (AJOL)

    In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams.

  12. Operations of the Biblioteca Regional de Medicina (BIREME).

    Science.gov (United States)

    Neghme, A

    1975-04-01

    The operations and accomplishments of the Biblioteca Regional de Medicina (BIREME), the regional medical library of the Pan American Health Organization, are summarized. Aspects of BIREME's program which are described include: strengthening biomedical collections in Latin America, network organization, international cooperation, document and information delivery, bibliographic services, and educational efforts.

  13. Natural gas co-operation in the Baltic region

    International Nuclear Information System (INIS)

    Jensen, J.K.

    1996-01-01

    Co-operation between the gas companies in the Baltic Region has been in place for several years. The overview given in this paper shows that the co-operation has been developed in trade, investments, privatisation and participation in the restructuring process. Finally, through a broad technical co-operation, significant efforts are made to establish common operational practices, codes and standards and the integrity of gas transmission pipelines. The Baltic Region, from a resource and gas interconnection point of view, enjoys a strategic position in the future development of the gas industry in Europe. The Baltic gas sector represents an interesting and growing gas market with the significant gas storage capacity. The region is also located strategically for planned gas interconnections and could serve as a transit corridor for the future gas supplies from western Siberia or the North Sea. This co-operation in the region is being supported by international regulations and agreements such as the Energy Charter between the European Union and the central and east European countries. However, at present the gas industry in the Baltic Region seems to be ahead of these international agreements. It may well be seen that trade arrangements such as Third Party Access are implemented directly by market forces rather than through international agreements. The regional development may thus be a driving force for the implementation of the Internal Energy Market for the gas industry

  14. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... There are many causes of abnormal vaginal bleeding. HORMONES ... Doctors call the problem abnormal uterine bleeding (AUB) . AUB ...

  15. Bleeding esophageal varices

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  16. GI bleeding - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100162.htm GI bleeding - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Gastrointestinal Bleeding A.D.A.M., Inc. is accredited by ...

  17. Bleeding into the skin

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003235.htm Bleeding into the skin To use the sharing features on this page, please enable JavaScript. Bleeding into the skin can occur from broken blood ...

  18. Vaginal bleeding between periods

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003156.htm Vaginal bleeding between periods To use the sharing features ... this page, please enable JavaScript. This article discusses vaginal bleeding that occurs between a woman's monthly menstrual ...

  19. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... Us Information For… Media Policy Makers Blood Disorders Heavy Menstrual Bleeding Recommend on Facebook Tweet Share Compartir ... It can also be bleeding that is very heavy. How do you know if you have heavy ...

  20. Bleeding diathesis in Noonan syndrome

    NARCIS (Netherlands)

    Staudt, Joost M.; van der Horst, Chantal M. A. M.; Peters, Marjolijn; Melis, Paris

    2005-01-01

    An 18-year-old girl with Noonan syndrome was operated on for prominent ears. Subcutaneous haematomas developed on both sides, and coagulation tests reported a bleeding diathesis. This is seldom mentioned in descriptions of the syndrome, but it has been shown that one-third of all patients with the

  1. Bleeding during Pregnancy

    Science.gov (United States)

    ... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

  2. Operational region and sawteeth oscillation in the EAST tokamak

    International Nuclear Information System (INIS)

    Liu, H Q; Gao, X; Zhao, J Y; Hu, L Q; Jie, Y X; Ling, B L; Xu, Q; Ti, A; Ming, T F; Yang, Y; Wu, Z W; Wang, J; Xu, G S; Gao, W; Zhong, G Q; Zang, Q; Shi, Y J; Shen, B; Zhou, Q; Li, Y D; Gong, X Z; Hu, J S; Sun, Y W; Zhao, Y P; Luo, J R; Mao, J S; Weng, P D; Wan, Y X; Zhang, X D; Wan, B N; Li, J

    2007-01-01

    The first plasma discharges were successfully achieved on the experimental advanced superconducting tokamak (EAST) in 2006. The sawteeth behaviours were observed by means of soft x-ray diagnostics and ECE signals in the EAST. The displacement and radius of the q = 1 surface was studied and compared with the result of equilibrium calculation. The density sawtooth oscillation was also observed by the HCN laser interferometer diagnostics. The structure of the EAST operational region was studied in detail. Plasma performance was obviously improved by the boronization and wall conditioning. It was observed that lower q a and a wider stable operating region is extended by the GDC boronization

  3. Gynaecological and obstetric management of women with inherited bleeding disorders.

    Science.gov (United States)

    Demers, Christine; Derzko, Christine; David, Michèle; Douglas, Joanne

    2006-10-01

    , and vWF functional assay) (II-2B). 3. Treatment of menorrhagia in women with inherited bleeding disorders should be individualized (III-B). 4. An inherited bleeding disorder is not a contraindication to hormonal therapy (oral contraceptives [II-1B], depot medroxyprogesterone acetate (DMPA) [II-3B], danazol [II-2B], GnRH analogs [II-3B]) or local treatments (levonorgestrel-releasing IUS [II-1B]) and non-hormonal therapy (antifibrinolytic drug tranexamic acid [II-1B]) as well as desmopressin (II-1B). These therapies represent first line treatment. Blood products should not be used for women with mild bleeding disorders (III-A). 5. In women who no longer want to preserve their fertility, conservative surgical therapy (ablation) and hysterectomy may be options (III-B). Clinicians may consult the "SOGC Clinical Practice Guideline: Guidelines for the Management of Abnormal Uterine Bleeding" for an in-depth discussion of the available therapeutic modalities, both medical and surgical. To minimize the risk of intraoperative and post-operative hemorrhage, coagulation factors should be corrected preoperatively with post-operative monitoring (II-1B). 6. Girls growing up in families with a history of vWD or other inherited bleeding disorders should be tested pre-menarchally to determine whether or not they have inherited the disease to allow both the patient and her family to prepare for her first and subsequent menstrual periods (III-C). 7. In adolescents presenting with menorrhagia, an inherited bleeding disorder should be excluded (III-B). When possible, investigation should be undertaken before oral contraceptive therapy is instituted, as the hormonally induced increase in factor VIII and vWF may mask the diagnosis (II-B). 8. Pregnancy in women with inherited bleeding disorders may require a multidisciplinary approach. A copy of their recommendations should be given to the patient and she should be instructed to present it to the health care provider admitting her to the

  4. Promoting regional energy co-operation in South Asia

    International Nuclear Information System (INIS)

    Srivastava, Leena; Misra, Neha

    2007-01-01

    Energy is a key ingredient of the socio-economic development of any region. South Asia is not only one of the fastest growing regions in the world; it is also one of the poorest, which thus puts energy at the very heart of the development process in the region. This paper looks at the challenges faced by the South Asia sub-region for economic co-operation (SASEC) comprised of Bangladesh, Bhutan, India and Nepal, and also at the role of greater regional energy co-operation therein. The region is characterized by pressures of growing economies and increasing population. While the per capita energy consumption is one of the lowest in the world, energy intensity continues to be very high. A large portion of the population lacks access to modern sources of energy and depends on traditional sources that are not only inefficient but also have severe health and environmental problems associated with them. Increasing oil import dependency and huge investment needs for energy market development pose a further challenge. The region has a good resource potential and tremendous scope for energy co-operation, which can play a key role in addressing many of these energy security concerns and in putting it on the path of sustainable development. It is ironic that the record in the area has been so limited and that too in the most basic form of co-operation, i.e. bilateral arrangements between countries. This paper puts forth a multi-pronged strategy for sub-regional energy co-operation encompassing softer options aimed at confidence building to more substantial and larger scale co-operation efforts. Delays in decision making to ensure stronger and mutually beneficial co-operation efforts are associated with high costs not only to the energy sector but also for the entire development agenda. With the precarious energy situation in the region and unprecedented increases in international oil prices seen in recent times, it is high time for policy makers, financing institutions, NGOs

  5. Sustainability indicators - a tool for regional co-operation

    OpenAIRE

    Koitka, Heike

    2002-01-01

    Sustainability indicators are more than just numbers. Besides their main function of illustrating the complex vision of sustainability they could support some factors for success of regional co-operation through their development. Today the discussion on indicators and co-operation is mainly separated from each other. Sustainability indicators are developed on all spatial levels from neighbourhoods up to the United Nations. In some cases the indicators are developed but remain unused. Regiona...

  6. Nonvariceal upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

    2007-01-01

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  7. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  8. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  9. Operations plan for the Regional Seismic Test Network

    International Nuclear Information System (INIS)

    1981-01-01

    The Regional Seismic Test Network program was established to provide a capability for detection of extremely sensitive earth movements. Seismic signals from both natural and man-made earth motions will be analyzed with the ultimate objective of accurately locating underground nuclear explosions. The Sandia National Laboratories, Albuquerque, has designed an unattended seismic station capable of recording seismic information received at the location of the seismometers installed as part of that specific station. A network of stations is required to increase the capability of determining the source of the seismic signal and the location of the source. Current plans are to establish a five-station seismic network in the United States and Canada. The Department of Energy, Nevada Operations Office, has been assigned the responsibility for deploying, installing, and operating these remote stations. This Operation Plan provides the basic information and tasking to accomplish this assignment

  10. Self-reliance through regional co-operation

    International Nuclear Information System (INIS)

    Glubrecht, H.

    1975-01-01

    Article 52 of the Charter of the United Nations is concerned with the usefulness of Regional Arrangements which 'are appropriate for regional action'. Such arrangements need not be considered only with regard to their political aspects but also as organizational structures which can be helpful in the development of science and technology in less developed countries. The definition of a 'Region' can be difficult, but is easier if scientific rather than political co-operation is intended. The International Atomic Energy Agency has undertaken a first step in this direction through its Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology in South and Southeast Asia, the Pacific and the Far East (RCA) which has been signed by six countries so far. This Agreement leaves it to the Member States to initiate cooperative projects. The IAEA will take steps to establish the project if at least three Member States are willing to participate. The implementation of the project will be defined by negotiations with the Member States and the IAEA will only play the role of a co-ordinator. Annual meetings of representatives of those countries which are parties of the RCA and of others from the region which might be interested in joining the Agreement provide the possibility of a continuing exchange of new ideas. Regional activities are also undertaken by means of 'Co-ordinated Research Programmes', which mostly include some co-operation with LDCs. The RCA has initiated two new ideas, that of carrying out the projects exclusively by the countries of the region and that of taking the step from co-ordination to cooperation by means of continuous and intensive exchange of information as well as of personnel. Its main objective is to aim at a reasonable division of labour between the parties and to use expensive equipment jointly. It is to be hoped that this venture will lead to an increasing degree of self-reliance within the

  11. Severe Bleeding: First Aid

    Science.gov (United States)

    ... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...

  12. Abnormal Uterine Bleeding FAQ

    Science.gov (United States)

    ... acid —This medication treats heavy menstrual bleeding. • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps. • Antibiotics—If you have an infection, you may be ...

  13. Operationalizing safe operating space for regional social-ecological systems.

    Science.gov (United States)

    Hossain, Md Sarwar; Dearing, John A; Eigenbrod, Felix; Johnson, Fiifi Amoako

    2017-04-15

    This study makes a first attempt to operationalize the safe operating space concept at a regional scale by considering the complex dynamics (e.g. non-linearity, feedbacks, and interactions) within a systems dynamic model (SD). We employ the model to explore eight 'what if' scenarios based on well-known challenges (e.g. climate change) and current policy debates (e.g. subsidy withdrawal). The findings show that the social-ecological system in the Bangladesh delta may move beyond a safe operating space when a withdrawal of a 50% subsidy for agriculture is combined with the effects of a 2°C temperature increase and sea level rise. Further reductions in upstream river discharge in the Ganges would push the system towards a dangerous zone once a 3.5°C temperature increase was reached. The social-ecological system in Bangladesh delta may be operated within a safe space by: 1) managing feedback (e.g. by reducing production costs) and the slow biophysical variables (e.g. temperature, rainfall) to increase the long-term resilience, 2) negotiating for transboundary water resources, and 3) revising global policies (e.g. withdrawal of subsidy) that negatively impact at regional scales. This study demonstrates how the concepts of tipping points, limits to adaptations, and boundaries for sustainable development may be defined in real world social-ecological systems. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  14. Upper GI Bleeding in Children

    Science.gov (United States)

    Upper GI Bleeding in Children What is upper GI Bleeding? Irritation and ulcers of the lining of the esophagus, stomach or duodenum can result in upper GI bleeding. When this occurs the child may vomit blood ...

  15. Operation and Monitoring of the CMS Regional Calorimeter Trigger Hardware

    CERN Document Server

    Klabbers, P

    2008-01-01

    The electronics for the Regional Calorimeter Trigger (RCT) of the Compact Muon Solenoid Experiment (CMS) have been produced, tested, and installed. The RCT hardware consists of one clock distribution crate and 18 double-sided crates containing custom boards, ASICs, and backplanes. The RCT receives 8-bit energies and a data quality bit from the HCAL and ECAL Trigger Primitive Generators (TPGs) and sends it to the CMS Global Calorimeter Trigger (GCT) after processing. Integration tests with the TPG and GCT subsystems have been successful. Installation is complete and the RCT is integrated into the Level-1 Trigger chain. Data taking has begun using detector noise, cosmic rays, proton-beam debris, and beamhalo muons. The operation and configuration of the RCT is a completely automated process. The tools to monitor, operate, and debug the RCT are mature and will be described in detail, as well as the results from data taking with the RCT.

  16. RF Regional Technical Centers for MPC and A Sustainability Operations

    International Nuclear Information System (INIS)

    Lambert, L D; Toth, W J; Hendrickson, S

    2004-01-01

    The National Nuclear Security Administration (NNSA) programmatic vision to be a catalyst in Russia's assumption of responsibility for long-term system operation is exemplified in the sustainability cooperation with the RF Ministry of Defense (MOD). An identified goal for the MPC and A Program is to encourage the development of Russian Federation (RF) capabilities and commitments to operate and maintain safeguard improvements. The RF MOD Technical Support Center development fulfills the NNSA mission and MPC and A Program goal. The regional technical center concept involves a systematic approach to aid in the determination of the level of sustainability assistance required to transition operators, maintenance, training, and testing of MPC and A systems to the RF MOD. This paper describes the process used to create the RF MOD Technical support center. First are described the needs analyses conducted to determine the key system sustainability factors requiring support. These sustainability functions are then compiled to influence the form and ultimate physical design of the technical support center. Operational interfaces are described, in detail that show the benefit of the center to the individual sites. Finally, benefits relating to information accessibility and other economies of scale are described that highlight the central center concept's strengths

  17. Crew Factors in Flight Operations XIV: Alertness Management in Regional Flight Operations Education Module

    Science.gov (United States)

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.

    2002-01-01

    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  18. Training of tissue bank operators in Asia Pacific region

    International Nuclear Information System (INIS)

    Aziz Nather

    1999-01-01

    To raise quality standards of Tissue Bank in Asia Pacific Region and to meet training needs of tissue bank operators. Singapore (NUH Tissue Bank) was officially appointed by IAEA on 18 September 1996 in Vienna to be the IAEA/NUS Regional Training Centre for RCA (Regional Co-operative Agreement). Member of States including Bangladesh, China, India, Indonesia, Korea, Malaysia, Myanmar, Pakistan, Philippines, Thailand, Sri Lanka and Vietnam. The Singapore Ministry of Environment gave a grant of $225,500 for setting up of this centre with National Science and Technology Board as funding agency, $100,000 being allocated for production of IAEA Developed Curriculum into Multi-Media. (authors being National Project Co-ordinators, Directors of Tissue Banks in the region). The Modules included Guide to Curriculum, Historical Background (0), Rules and Regulation (1), Organisation (2), Quality Assurance (3), Procurement (4), Processing (5), Distribution and Utilisation (6) and Future Developments (7). The Distance Learning Package included case studies from the region in text, in slides and videotapes. A new purpose-built NUH Tissue Bank with separate Wet and Dry Processing laboratories equipped with hands-on facilities was completed in July 1997. This was inaugurated as; IAEA/NUS Regional Training Centre for RCA; IAEA/NUS Interregional Training Centre; and NUS Diploma Course on Tissue Banking also launched by Deputy vice-chancellor, NUS, in conjunction with the IAEA/RCA Regional Training Course on 3 November 1997. One year NUS Open Distance Learning Diploma Course started with two weeks Intensive Course with Core Lectures on Modules (0-7) in the Curriculum and Practical Hands-on Demonstrations. One theory and two practical assessments were conducted. Nineteen participants registered for the Diploma Course. Production of IAEA Multi-Media Curriculum was completed and the Curriculum was distributed to member States during a 2-week-RCA 'Train the Trainers' Workshop on 27 April

  19. Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

    2015-04-01

    The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  20. Causes of lower gastrointestinal bleeding on colonoscopy

    International Nuclear Information System (INIS)

    Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

    2017-01-01

    Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)

  1. Acquired bleeding disorders

    African Journals Online (AJOL)

    B one marrow aplasia ... Laboratory approach to a suspected acquired bleeding disorder. (LER = leuko- .... lymphocytic leukaemia, and lymphoma). ... cells), a bone marrow aspirate and trephine biopsy (BMAT) is not ..... transplantation.

  2. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  3. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... especially the progestin-only pill (also called the “mini-pill”) can actually cause abnormal bleeding for some ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality ...

  4. Operational flood forecasting system of Umbria Region "Functional Centre

    Science.gov (United States)

    Berni, N.; Pandolfo, C.; Stelluti, M.; Ponziani, F.; Viterbo, A.

    2009-04-01

    The hydrometeorological alert office (called "Decentrate Functional Centre" - CFD) of Umbria Region, in central Italy, is the office that provides technical tools able to support decisions when significant flood/landslide events occur, furnishing 24h support for the whole duration of the emergency period, according to the national directive DPCM 27 February 2004 concerning the "Operating concepts for functional management of national and regional alert system during flooding and landslide events for civil protection activities purposes" that designs, within the Italian Civil Defence Emergency Management System, a network of 21 regional Functional Centres coordinated by a central office at the National Civil Protection Department in Rome. Due to its "linking" role between Civil Protection "real time" activities and environmental/planning "deferred time" ones, the Centre is in charge to acquire and collect both real time and quasi-static data: quantitative data from monitoring networks (hydrometeorological stations, meteo radar, ...), meteorological forecasting models output, Earth Observation data, hydraulic and hydrological simulation models, cartographic and thematic GIS data (vectorial and raster type), planning studies related to flooding areas mapping, dam managing plans during flood events, non instrumental information from direct control of "territorial presidium". A detailed procedure for the management of critical events was planned, also in order to define the different role of various authorities and institutions involved. Tiber River catchment, of which Umbria region represents the main upper-medium portion, includes also regional trans-boundary issues very important to cope with, especially for what concerns large dam behavior and management during heavy rainfall. The alert system is referred to 6 different warning areas in which the territory has been divided into and based on a threshold system of three different increasing critical levels according

  5. The International Bleeding Risk Score

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Laine, L.; Dalton, H.

    2017-01-01

    The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding.......The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding....

  6. Regional Disparities in Romania. Contribution of the Regional Operational Program to Health Infrastructure

    Directory of Open Access Journals (Sweden)

    VICTOR PLATON

    2013-01-01

    Full Text Available Health infrastructure is one of the weaknesses of socio-economic development in Romania and in other European states. In order to get a better picture of the Romanian health system issues, this paper analyzes a number of statistical indicators considered representative for the national and European health infrastructure for a 20 years period, between 1990 and 2010. Our paper has three main objectives: (a to identify the main trends for health infrastructure in some of the European Union countries; (b to describe the evolution of the health system in Romania, the comparative situation at the European level as well as regional level indicators dynamics; (c to overview the Regional Operational Program in Romania, how much does it help the regional health infrastructure in our country. At the European level, there is a constant decrease in the number of hospital beds. For this indicator, Romania has slightly higher values than the European average. We must mention that the hospital beds indicator offers limited information on health infrastructure which also includes medical equipment and specific devices and practices. The number of hospitals in Romania increased with 18.9% during the last 20 years (1990-2010. During the observed timeline, the number of hospitals in Romania had a constant positive evolution at regional level. The number of doctors in hospitals has an increasing trend at the local as well as at the international level. Romania has a number of doctors twice lower than the European average (3.6 doctors for one thousand inhabitants. The Regional Operational Program (ROP has a limited influence in achieving the objectives stated in Applicants Guide for Priority Axis 3. Major Intervention Area 3.1. This happens because supporting infrastructure improvements will not create institutional modernization. The financial contribution through ROP will result in the modernization of 11% of the existing hospitals in Romania.

  7. Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.

    Science.gov (United States)

    Wang, Jiayang; Yu, Wenyuan; Jin, Qi; Li, Yaqiong; Liu, Nan; Hou, Xiaotong; Yu, Yang

    2017-04-01

    In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. Multiple electronic literature databases were searched using predefined criteria, with bleeding defined per Valve Academic Research Consortium-2 criteria. A total of 10 eligible articles with 3602 patients were included in the meta-analysis. The meta-analysis revealed that post-TAVI bleeding was associated with a 323% increase in 30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence interval [CI], 2.80-6.40; P logistic regression analysis revealed that atrial fibrillation (AF) was independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI, 1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers like the Society of Thoracic Surgeons (STS) score, mortality, the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic valve area, mean pressure gradient, left ventricular ejection fraction, preoperative hemoglobin and platelet levels, and study design had no significant effects on the results of the meta-analysis. Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  8. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing ... JavaScript. One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it ...

  9. PBO Operations in Alaska and Cascadia, Combining Regions and Collaborating with our Regional Partners

    Science.gov (United States)

    Austin, K. E.; Boyce, E. S.; Dausz, K.; Feaux, K.; Mattioli, G. S.; Pyatt, C.; Willoughby, H.; Woolace, A. C.

    2015-12-01

    During the last year, the Alaska and the Cascadia regions of the EarthScope Plate Boundary Observatory (PBO) network were combined into a single management unit. While both remain distinct regions with their own challenges and engineering staff, every effort has been made to operate as a single team to improve efficiency and provide the highest possible data quality and uptime. Over the last several years a concerted effort has been made to work collaboratively with other institutions and stakeholders to defray ongoing costs by sharing staff and resources. UNAVCO currently operates four integrated GPS/seismic stations in collaboration with the Alaska Earthquake Center, eight with the Alaska Volcano Observatory, and three with the EarthScope TA. By the end of 2015, PBO and TA plan to install another 3 integrated and/or co-located geodetic and seismic systems. While most of these are designed around existing PBO stations, the 2014 installation at Middleton Island is a new station for both groups, providing PBO with an opportunity to expand geodetic data in Alaska. There were two major joint maintenance efforts in 2015:, the largest was a 5 day mission among PBO, AVO, and TA, which shared boat, helicopter, and staff on and around Augustine Volcano; the second, was a 10 day helicopter mission shared between AVO and PBO on Unimak Island. PBO Pacific Northwest is working closely with University of Washington to co-locate at least 9 Earthquake Early Warning Systems, which include the addition of strong motion sensors and high speed RT telemetry at PBO sites. The project is managed by University of Washington but UNAVCO is providing land contact information and infrastructure support. Summer 2015 upgrades include a complete overhaul of aging radio technology at two major networks and several small radio networks in Cascadia. The upgrades will increase reliability and enhance the speed of existing telemetry infrastructure and will continue through summer 2018.

  10. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  11. Mortalidad asociada a hemorragia digestiva alta por enfermedad ácido péptica en pacientes operados Mortality associated with upper gastrointestinal bleeding due to peptic acid disease in patients operated

    Directory of Open Access Journals (Sweden)

    Lucas García Orozco

    2013-04-01

    Full Text Available Introducción: existen diversos criterios en cuanto a la identificación de los pacientes con sangrado digestivo alto que requieren tratamiento quirúrgico de urgencia, dada la alta tasa de letalidad y mortalidad que presentan. Objetivo: valorar la mortalidad por hemorragia digestiva alta asociada a enfermedad ácido péptica. Métodos: se realizó una investigación descriptiva de 38 pacientes que habían sido operados por hemorragia digestiva asociada a enfermedad ácido péptica, que fallecieron en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" durante el decenio 2002-2011. Resultados: en la casuística se encontró un predominio del sexo masculino y del grupo etario de 60 y más años. Los sangrados masivo y persistente constituyeron las situaciones más comunes para decidir el tratamiento quirúrgico urgente. La vagotomía troncular más piloroplastia fue la técnica más empleada, en tanto la infección respiratoria y el choque séptico resultaron ser las principales complicaciones posoperatorias; este último y la disfunción multiorgánica fueron las causas directas de muerte más representativas. Conclusiones: para seleccionar la técnica quirúrgica en cada paciente debe tenerse en cuenta la causa del sangrado, la localización, el estado clínico y la edad. La vagotomía troncular asociada a algún procedimiento de drenaje resultó la más utilizada porque es menos laboriosa y el efecto antiácido más efectivo.Introduction: there are several criteria regarding the identification of patients with upper gastrointestinal bleeding who require emergency surgical treatment because of their high lethality and mortality rate. Objective: to value the mortality due to high gastrointestinal bleeding associated with acid peptic disease. Methods: a descriptive study was carried out in 38 patients who were operated due to gastrointestinal bleeding associated with acid peptic disease and who died in "Saturnino Lora

  12. Reliability measures in managing GI bleeding.

    Science.gov (United States)

    Sonnenberg, Amnon

    2012-06-01

    Multiple procedures and devices are used in a complex interplay to diagnose and treat GI bleeding. To model how a large variety of diagnostic and therapeutic components interact in the successful management of GI bleeding. The analysis uses the concept of reliability block diagrams from probability theory to model management outcome. Separate components of the management process are arranged in a serial or parallel fashion. If the outcome depends on the function of each component individually, such components are modeled to be arranged in series. If components complement each other and can mutually compensate for each of their failures, such components are arranged in a parallel fashion. General endoscopy practice. Patients with GI bleeding of unknown etiology. All available endoscopic and radiographic means to diagnose and treat GI bleeding. Process reliability in achieving hemostasis. Serial arrangements tend to reduce process reliability, whereas parallel arrangements increase it. Whenever possible, serial components should be bridged and complemented by additional alternative (parallel) routes of operation. Parallel components with low individual reliability can still contribute to overall process reliability as long as they function independently of other pre-existing alternatives. Probability of success associated with individual components is partly unknown. Modeling management of GI bleeding by a reliability block diagram provides a useful tool in assessing the impact of individual endoscopic techniques and administrative structures on the overall outcome. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  13. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J

    2013-01-01

    BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday...... in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB...... pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight...

  14. Pinworms and postmenopausal bleeding.

    OpenAIRE

    al-Rufaie, H K; Rix, G H; Pérez Clemente, M P; al-Shawaf, T

    1998-01-01

    The human pinworm Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate out of their host's anus at night to lay their eggs perianally. As a consequence of this nocturnal migration some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing irritative symptoms such as vulvovaginitis. A case of pinworm infestation of the uterus presented as postmenopausal bleeding.

  15. Scintigraphic evaluation of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

    1988-01-01

    Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.

  16. Nuclear energy in Asia and regional co-operation

    International Nuclear Information System (INIS)

    Ishii, M.

    1997-01-01

    There is increasing concern in East Asia about regional cooperation in the field of nuclear power. At the APEC conference in Osaka in 1995, APEC (Asia Pacific Economic Cooperation) established an Energy Research Center. The center has started to perform joint research forecasts on energy supply and demand for the region. Japan proposed the inauguration of a Conference on Nuclear Safety in Asia at the Moscow Nuclear Energy Summit in 1996. The first conference was held in Tokyo that year. This year, the conference will be held in Seoul. Japan's Atomic Energy Commission sponsors the International Conference for Nuclear Cooperation in Asia every year. This year marks the eighth conference. The outstanding feature of this year's conference was that so many countries stressed regional cooperation. South Korea proposed the installation of a regional online radiation monitoring system. The Philippines asserted the need for a cooperative mechanism on the lines of ASIATOM. Why is so much concern now being focused on nuclear power cooperation in East Asia? What kind of regional cooperation is necessary, and what kind is possible? What are the unique features of nuclear power cooperation in East Asia? These are the points addressed in this paper. (author)

  17. Tribal Geographic Area (RTOC) Polygons with Representative Information, US EPA Region 9, 2015, Regional Tribal Operations Committee

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Regional Tribal Operations Committee (RTOC) is a working committee of EPA and Tribal personnel co-chaired by an EPA representative and a Tribal representative....

  18. Latin American regional co-operative programme on food irradiation

    International Nuclear Information System (INIS)

    1992-06-01

    The ''Latin American Regional Co-ordinated Research Programme on Food Irradiation'' was established in 1986 with the participation of research scientists from countries in the region to investigate the efficacy of food irradiation as a treatment to reduce post-harvest losses and improve the hygienic quality of food, to conduct techno-economic feasibility studies, and to disseminate knowledge about the scientific, health, legal and commercial aspects of food irradiation. This publication contains the final report of the Co-ordinated Research Programme and summaries of individual research reports presented by the participating scientists

  19. New information technologies in operative control of modes in regional electrical power systems

    OpenAIRE

    ANDREY D. TEVJASHEV; TATJANA B. TIMOFEEVA

    2003-01-01

    The problem of development of software for management of modes in electrical power systems in connection with casual character of a load in network is considered. The stochastic mathematical model of a system for operating control of modes in regional electrical power systems is offered. The methods for problem solving of operating control and operating planning of operational modes in regional electrical power systems are developed. The application of the developed models and methods will al...

  20. Precise intraoperative location of gastrointestinal bleeding with a hand-held counter. Work in progress

    International Nuclear Information System (INIS)

    Williamson, M.R.; Boyd, C.M.; McGuire, E.L.

    1986-01-01

    The nuclear medicine bleeding scan is frequently insufficient to locate sites of bleeding precisely, in spite of its great sensitivity. A small, hand-held Geiger-Mueller counter, placed directly on exposed intestine in the operating room, enables precise location of the probable bleeding site. In three patients, the technique allowed a minimal amount of intestine to be resected, distinguished between large- and small-intestinal hemorrhage, and eliminated other foci as sites of bleeding.A

  1. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Gärtner, Rune; Cronin-Fenton, Deirdre; Hundborg, Heidi Holmager

    2010-01-01

    Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association.......Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association....

  2. Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

    Science.gov (United States)

    Liu, Juan; Sun, Xicai; Guo, Limin; Wang, Dehui

    2016-01-01

    Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

  3. Production operation of small petroleum enterprises in Tomsk region

    Science.gov (United States)

    Sharf, I.; Filjushin, V.; Shenderova, I.; Kochetkova, O.

    2015-11-01

    Implementing resource-innovative strategy to develop Russian fuel-and-energy sector implies the promotion of small oil production enterprises developing fields with the reserves of less than 5 mln. tons. However, the efficiency of such enterprises, investigated on the example of Tomsk region (considering the indexes of oil extraction, growth of reserves, amount of capital expenditures and geological surveys), signifies the presence of definite tendencies. Consequently, management decisions concerning economic, organizational, financial and fiscal character should be taken in order to eliminate detrimental factors.

  4. The Kaarstoe gas terminal during operation - regional economic effects

    International Nuclear Information System (INIS)

    Wiig, W.; Kristiansen, F.

    1995-02-01

    In the period 1981-1989 a comprehensive study was made of the impact on society of the establishment of Statoil's gas terminal at Kaarstoe, Norway. Some of this work is updated in the present report. The organization at Kaarstoe is Statoil's transport division for gas (GASS-T) and is described in Chapter 2. A survey is given in Chapter 3 of how the employees are associated with the local community, their distribution in age, sex and type of job. Chapter 4 treats the importance for the Haugesund region of the company's purchasing in the area, in particular from suppliers within the Tysvaer municipality. The development of the structure of industry in Tysvaer and the employment situation are described in Chapter 5. Population trends and housebuilding in Tysvaer are described in Chapter 6 and the impact of GASS-T on the municipal economy is described in Chapter 7. Finally, Chapter 8 discusses whether what is learned from Kaarstoe can be transferred to other regions where gas terminals have been established. 14 refs., 24 figs., 12 tabs

  5. [High risk factors of upper gastrointestinal bleeding after neurosurgical procedures].

    Science.gov (United States)

    Zheng, Kang; Wu, Gang; Cheng, Neng-neng; Yao, Cheng-jun; Zhou, Liang-fu

    2005-12-21

    To analyze high risk factors of postoperative upper gastrointestinal (GI) bleeding after neurosurgery so as to give guidance for prevention of GI bleeding. A questionnaire was developed to investigate the medical records of 1500 patients who were hospitalized and underwent neurosurgical operations in 1997. Logistic regression analysis was made. 1430 valid questionnaires were obtained. Postoperative upper GI bleeding occurred in 75 patients (5.24%). The incidence of upper GI bleeding were 6.64% (54/813) in the male patients and 3.40% (21/617) in the female persons (P = 0.007); 9.88% (41/415) in those aged > 50 and 3.35% in those aged hematoma, intraventricular hemorrhage, subdural hematoma, and extradural hematoma were 15.7%, 10.0%, 6.00%, and 2.94% respectively (P = 0.02). The incidence of upper GI bleeding of the patients with tumors of fourth ventricle of cerebrum, brainstem, cerebral hemisphere, and sellar hypothalamus were 15.79% (3/19), 7.89%, 5.71%, and 3.74% respectively. In the emergent cases, the incidence of upper GI bleeding was higher in those with hypertension. The incidence of upper GI bleeding was 5.46% in the patients undergoing adrenocortical hormone treatment, significantly higher than that in those who did not receive such treatment (2.13%). Patients who are at high risk of developing postoperative upper GI bleeding including that: age greater than 50 years; male; Glasgow Coma Score less than 10 pre and post operation; The lesion was located in brain stem and forth ventricle; Hypertensive cerebral hemorrhage; Intracerebral and intraventricular hemorrhagic brain trauma; Postoperative pneumonia, brain edema, encephalic high pressure, pyogenic infection of the central nervous system and other postoperative complications. The mortality of patients with postoperative upper GI bleeding was evidently higher than that of the patients without postoperative upper GI bleeding.

  6. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    camera fitted with LEAP collimator. Delayed imaging up to 6 hours was optional and was undertaken only when first 90 minutes images did not reveal any site of bleeding. Two nuclear physicians reviewed the sequential static images for 1) First appearance of focus of activity in a particular quadrant/region of abdomen and 2) looking for its migration pattern. Scintigraphic results were prospectively compared with surgical outcome in 10 patients. Results: Tc-99m RBC Scan localized site of bleeding in 10 of 13 patient evaluated (77%). Ten scan positive patients underwent exploratory laprotomy. On surgical exploration, five culprit lesions were identified in jejunum and as many number of lesions were detected in ileum. Etiological lesions were mainly inflammatory or ulcerative (n=5) followed by neoplastic and vascular ectasias in 2 patients each. One patient showed diverticular disease of jejunum as the source of haemorrhage.Tc-99m RBC Scan was able to distinguish between proximal (jejunal) and distal (ileal) small bowel bleeding in 8 of 10 scan positive cases (80%). Scintigraphy correctly localized bleeding in jejunum and ileum in 3 and 5 patients respectively. In majority of patients (7/10, 70%), scan became positive within 3 hours. Six types of scan patterns were noticed in thirteen patients evaluated with Tc-99m RBCs scan. Five scintigraphic patterns were representative of small bowel bleeding. A serpentine appearance of bowel loops in mid abdomen, focal tracer appearance in right iliac region with subsequent outlining of ascending colon on delayed images, and a focus of activity showing distal extension in circular fashion on sequential static images were characteristic of ileal bleeding. Visualization of fixed loop in left flank region corroborated with jejunal lesion (Leiomyoma) in our series. An abnormal blush and early localization of diffuse activity in left upper quadrant followed by its centripetal extension/movement, was seen in patient with jejunitis

  7. Coordinated Optimal Operation Method of the Regional Energy Internet

    Directory of Open Access Journals (Sweden)

    Rishang Long

    2017-05-01

    Full Text Available The development of the energy internet has become one of the key ways to solve the energy crisis. This paper studies the system architecture, energy flow characteristics and coordinated optimization method of the regional energy internet. Considering the heat-to-electric ratio of a combined cooling, heating and power unit, energy storage life and real-time electricity price, a double-layer optimal scheduling model is proposed, which includes economic and environmental benefit in the upper layer and energy efficiency in the lower layer. A particle swarm optimizer–individual variation ant colony optimization algorithm is used to solve the computational efficiency and accuracy. Through the calculation and simulation of the simulated system, the energy savings, level of environmental protection and economic optimal dispatching scheme are realized.

  8. Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: Attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.

    Science.gov (United States)

    Chao, Tze-Fan; Lip, Gregory Y H; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Liao, Jo-Nan; Chung, Fa-Po; Chen, Tzeng-Ji; Chen, Shih-Ann

    2018-03-01

    While modifiable bleeding risks should be addressed in all patients with atrial fibrillation (AF), use of a bleeding risk score enables clinicians to 'flag up' those at risk of bleeding for more regular patient contact reviews. We compared a risk assessment strategy for major bleeding and intracranial hemorrhage (ICH) based on modifiable bleeding risk factors (referred to as a 'MBR factors' score) against established bleeding risk stratification scores (HEMORR 2 HAGES, HAS-BLED, ATRIA, ORBIT). A nationwide cohort study of 40,450 AF patients who received warfarin for stroke prevention was performed. The clinical endpoints included ICH and major bleeding. Bleeding scores were compared using receiver operating characteristic (ROC) curves (areas under the ROC curves [AUCs], or c-index) and the net reclassification index (NRI). During a follow up of 4.60±3.62years, 1581 (3.91%) patients sustained ICH and 6889 (17.03%) patients sustained major bleeding events. All tested bleeding risk scores at baseline were higher in those sustaining major bleeds. When compared to no ICH, patients sustaining ICH had higher baseline HEMORR 2 HAGES (p=0.003), HAS-BLED (pbleeding scores, c-indexes were significantly higher compared to MBR factors (pbleeding. C-indexes for the MBR factors score was significantly lower compared to all other scores (De long test, all pbleeding risk scores for major bleeding (all pbleeding risk scores had modest predictive value for predicting major bleeding but the best predictive value and NRI was found for the HAS-BLED score. Simply depending on modifiable bleeding risk factors had suboptimal predictive value for the prediction of major bleeding in AF patients, when compared to the HAS-BLED score. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. 76 FR 23470 - Version One Regional Reliability Standard for Transmission Operations

    Science.gov (United States)

    2011-04-27

    ...; Order No. 752] Version One Regional Reliability Standard for Transmission Operations AGENCY: Federal... Power Act, the Federal Energy Regulatory Commission approves regional Reliability Standard TOP-007-WECC... purpose of this regional Reliability Standard is to ensure that actual flows and associated scheduled...

  10. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, JH; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  11. Regional Comparative Unit Cost Studies for Maintenance and Operation of Physical Plants in Universities and Colleges in Central States Region and Rocky Mountain Region.

    Science.gov (United States)

    Association of Physical Plant Administrators, Corvallis, OR.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the central states region and the Rocky Mountain region. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and…

  12. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...

  13. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Proper Role of Special Operations Forces in the Pan Sahel Region of Africa

    National Research Council Canada - National Science Library

    Baker, Anthony P

    2006-01-01

    .... As the designated lead on synchronizing the GWOT efforts for DOD, US SOF remain focused on the Middle East, while continuing to operate in other regions where terrorists may seek sanctuary. The main U.S...

  15. The Denver region traffic signal system improvement program : planning for management and operations

    Science.gov (United States)

    2009-04-01

    The Denver Regional Council of Governments (DRCOG) works with over 30 local jurisdictions on the Traffic Signal System Improvement Program (TSSIP), a combination of management and operations strategies designed to time and coordinate traffic signals ...

  16. Bleeding during gonioscopy after deep sclerectomy.

    Science.gov (United States)

    Moreno-Montañés, Javier; Rodríguez-Conde, Rosa

    2003-10-01

    To show a new complication after deep sclerectomy (DS). We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.

  17. Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region.

    Science.gov (United States)

    Bazeyo, W; Mayega, R W; Orach, G C; Kiguli, J; Mamuya, S; Tabu, J S; Sena, L; Rugigana, E; Mapatano, M; Lewy, D; Mock, N; Burnham, G; Keim, M; Killewo, J

    2013-06-01

    The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. To develop a sustainable regional approach to building operational level capacity for disaster planning. This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the

  18. The Regional Special Operations Headquarters: Franchising the NATO Model as a Hedge in Lean Times

    Science.gov (United States)

    2012-04-01

    1 AIR FORCE FELLOWS AIR UNIVERSITY THE REGIONAL SPECIAL OPERATIONS HEADQUARTERS: FRANCHISING THE NATO MODEL AS A HEDGE IN LEAN...Headquarters: Franchising The NATO Model As A Hedge In Lean Times 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...it is not copyrighted, but is the property of the United States government. 3 The Regional Special Operations Headquarters: Franchising the

  19. Regional co-operation in radioactive waste management from an IAEA perspective

    International Nuclear Information System (INIS)

    Bonne, A.

    2000-01-01

    This paper is intended to be a lead in to a Round Table discussion on Regional Co-operation in Radioactive Waste Management at the International Conference on N uclear Option in Countries with Small and Medium Electricity Grids , which will be held from 19 to 22 June 2000 in Dubrovnik, Croatia. The Round Table discussion will focus on international co-operation in the Eastern European region

  20. Connected Operators : A review of region-based morphological image processing techniques

    NARCIS (Netherlands)

    Salembier, Philippe; Wilkinson, Michael H. F.

    2009-01-01

    Connected operators are filtering tools that act by merging elementary regions called flat zones. Connecting operators cannot create new contours nor modify their position. Therefore, they have very good contour preservation properties and are capable of both low-level filtering and higher-level

  1. Connected Operators : A review of region-based morphological image processing techniques

    NARCIS (Netherlands)

    Salembier, Philippe; Wilkinson, Michael H. F.

    Connected operators are filtering tools that act by merging elementary regions called flat zones. Connecting operators cannot create new contours nor modify their position. Therefore, they have very good contour preservation properties and are capable of both low-level filtering and higher-level

  2. Empirical Verification of Fault Models for FPGAs Operating in the Subcritical Voltage Region

    DEFF Research Database (Denmark)

    Birklykke, Alex Aaen; Koch, Peter; Prasad, Ramjee

    2013-01-01

    We present a rigorous empirical study of the bit-level error behavior of field programmable gate arrays operating in the subcricital voltage region. This region is of significant interest as voltage-scaling under normal circumstances is halted by the first occurrence of errors. However, accurate...

  3. Fibrinogen concentrate in bleeding patients

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias

    2013-01-01

    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  4. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...

  5. Side Effects: Bleeding and Bruising

    Science.gov (United States)

    Cancer treatments, such as chemotherapy and targeted therapy, can increase patients’ risk of bleeding and bruising, also called thrombocytopenia. Learn about steps to take if you are at increased risk of a low platelet count.

  6. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Benign ulcer. Mallory-Weiss tear .... pressure and direct thermal coagulation. Alternatively, use ... Forrest classification of peptic ulcer bleeding related to risks of rebleeding. (NBVV - non- .... esomeprazole for prevention of recurrent peptic ulcer ...

  7. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

    Science.gov (United States)

    Singh, Pratibha

    2018-01-01

    Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of

  8. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration

    Directory of Open Access Journals (Sweden)

    Pratibha Singh

    2018-01-01

    Full Text Available Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB, especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41–45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and

  9. The economic and social significance of RCA regional co-operative projects

    International Nuclear Information System (INIS)

    Fowler, E.E.

    1979-01-01

    The regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology (RCA) is an established and valuable instrument between the International Atomic Energy Agency (IAEA) and Member States in South Asia, Southeast Asia and the Pacific or Far East for assisting in the transfer of modern technology to areas having economic and social importance to the region. The purpose of this review is to identify on-going or planned work which is designed to help achieve this goal. Currently approved RCA Regional Co-operative Research Projects are listed

  10. Heavy menstrual bleeding: An update on management.

    Science.gov (United States)

    Davies, Joanna; Kadir, Rezan A

    2017-03-01

    Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) >80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life. Aetiology is due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic. Up to 20% of women with HMB will have an underlying inherited bleeding disorder (IBD). Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations. A pelvic examination and ultrasound scan help to rule out presence of any underlying pathology. Management depends on the underlying cause and the woman's preference and her fertility wishes. Medical therapies include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Ulipristal acetate is an approved preoperative treatment for uterine fibroids, and has demonstrated efficacy in reducing MBL. Haemostatic therapies include tranexamic acid and DDAVP (1-deamino-8-D-arginine). DDAVP is used for HMB associated with certain IBDs. These therapies can be used in isolation or in combination with hormonal treatments. HMB associated with certain severe IBDs may require factor concentrate administration during menses to alleviate symptoms. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable. Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved.

  11. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) ... Print en español Sangrado uterino anormal What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...

  12. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

    Directory of Open Access Journals (Sweden)

    Atsushi Kimura

    Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

  13. Common brain regions underlying different arithmetic operations as revealed by conjunct fMRI-BOLD activation.

    Science.gov (United States)

    Fehr, Thorsten; Code, Chris; Herrmann, Manfred

    2007-10-03

    The issue of how and where arithmetic operations are represented in the brain has been addressed in numerous studies. Lesion studies suggest that a network of different brain areas are involved in mental calculation. Neuroimaging studies have reported inferior parietal and lateral frontal activations during mental arithmetic using tasks of different complexities and using different operators (addition, subtraction, etc.). Indeed, it has been difficult to compare brain activation across studies because of the variety of different operators and different presentation modalities used. The present experiment examined fMRI-BOLD activity in participants during calculation tasks entailing different arithmetic operations -- addition, subtraction, multiplication and division -- of different complexities. Functional imaging data revealed a common activation pattern comprising right precuneus, left and right middle and superior frontal regions during all arithmetic operations. All other regional activations were operation specific and distributed in prominently frontal, parietal and central regions when contrasting complex and simple calculation tasks. The present results largely confirm former studies suggesting that activation patterns due to mental arithmetic appear to reflect a basic anatomical substrate of working memory, numerical knowledge and processing based on finger counting, and derived from a network originally related to finger movement. We emphasize that in mental arithmetic research different arithmetic operations should always be examined and discussed independently of each other in order to avoid invalid generalizations on arithmetics and involved brain areas.

  14. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Uflacker, R.

    1987-01-01

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  15. Regional long-term co-operation in the field of nuclear and radiation emergency preparedness

    International Nuclear Information System (INIS)

    Sladek, V.; Metke, E.; Janko, K.; Hohenberg, J. K.; Hofer, P.

    2004-01-01

    Emergency preparedness is generally covered by methodical and coordinative activities of the International Atomic Energy Agency (IAEA) in Member States of the IAEA and by the European Commission (EC) in EU Member and EU Accession Countries. However, the regional harmonisation of emergency arrangements is an important trend of emergency preparedness. The present paper gives a couple of illustrative examples for a regional co-operation in the field of emergency preparedness in Central Europe and an overview on international exercises in this region. The penultimate section contains an outlook on future activities regarding regional co-operation in Central Europe. The following topics have been suggested inter alia: the harmonisation of intervention criteria and countermeasures, co-ordination in the field of information of the public, comprehensive bi lateral and multilateral exercises, exchange of experts between the national nuclear emergency centres and inter-comparison calculations of the computer codes. (authors)

  16. Operational considerations for implementing regional sediment management plans in the northern Gulf of Mexico

    Science.gov (United States)

    Underwood, Steven G.; Khalil, Syed M.; Byrnes, Mark R.; Steyer, Gregory D.; Raynie, Richard C

    2015-01-01

    Development of a comprehensive and stakeholder-driven Regional Sediment Management plan can provide the basis for long-term sustainable resource use and protection. This paper highlights three operational components that can positively influence sediment management at a regional scale, including (1) integration of an operational sediment budget, (2) development of a monitoring and adaptive management plan, and (3) development of a regional sediment availability and allocation program. These components seek to incorporate science and adaptive management through implementation of an organized and well-documented decision making process. They represent a coordinated framework that could serve as a guide for unifying financial investments in regional sediment management plans. Collectively, they establish an integrated process for addressing uncertainties about future system change in light of shrinking federal and state budgets, competing demands for sediment resources within riverine and marine waters, and policy considerations related to sediment/water use (e.g., navigation and commerce versus environmental management).

  17. Effect of regionalization on the allocation of third-party peace operations

    Directory of Open Access Journals (Sweden)

    Dagmar Zakopalová

    2011-06-01

    Full Text Available The paper “Effect of regionalization on the allocation of third-party peace operations” aims to discuss and then empirically test on large-N data what is the effect of the joint activity of the United Nations, regional organizations and ad hoc coalitions of states on the allocation of peace operations in the world. It is argued that after the end of the Cold War, all the actors have become much more active in organizing peace operations in intrastate armed conflicts, but it remains rather unclear to what extent they actually share the burden of peace operations at the macro level and especially whether the United Nations focuses on the regions that are rather overlooked by the other actors. The analysis shows that there are remarkable differences among various regions as regards the involvement of international actors and in fact, regional organizations as well as the ad hoc coalitions of states tend to follow similar patterns in allocation of peace operations as the United Nations.

  18. Operation performance investigation of ground-coupled heat-pump system for temperate region

    OpenAIRE

    Yi Man; Hongxing Yang; Jinggang Wang; Zhaohong Fang

    2010-01-01

    In order to investigate the operation performance of ground-coupled heat-pump (GCHP) system, an analytical simulation model of GCHP system on short time-step basis and a computer program based on this model to predict system operating parameters are developed in this study. Besides, detailed on-site experiments on GCHP test rig installed in a temperate region of China are carried out. The temperature distributions of borehole as well as ground around borehole at different depths are evaluated...

  19. THE FINANCING OF THE ADMINISTRATIVE TERRITORIAL UNITS IN THE WEST DEVELOPMENT REGION THROUGH THE REGIONAL OPERATIONAL PROGRAMME 2007 - 2013

    Directory of Open Access Journals (Sweden)

    Munteanu Nicolae-Eugen

    2011-07-01

    Full Text Available It is very important to be found methods to increase the competitiveness between the Romanian administrative-territorial units, under the current conditions of the economic crisis, by means of the existing economic levers successfully used within the European Union regions. The development regions of Romania do not have the statute of administrative units, but they represent territorial units large enough to constitute a good basis for the elaboration and implementation of regional development strategies, allowing an efficient use of the financial and human resources. The scope for which these development regions were created had in view the support granted for the larger communities in their action to settle the problems which go beyond the administrative borders and which surpass the financial possibilities of one county. In Romania, the communes, towns, municipalities and counties are defined as administrative-territorial units within which the local autonomy is exercised and the authorities of the local public administration are organized and operate. The local, communal, town, municipality and county councils, as deliberative authorities, and also the mayors and the presidents of county councils as executive authorities have the duties to solve the public matters of the community, acting as authorities of the Romanian public administration. In Romania, the local autonomy is only administrative and financial, having as objective the organization, operation, competencies and tasks, and also the management of the inland resources. The principle of the local financial autonomy implies the fact that the administrative-territorial units have the right to financial resources, which can be used by the authorities of the local public administration when exercising their tasks. According to the Law of the local public finances, the local budget incomes could be made also of the non-reimbursable funds granted by the European Union. Based on the

  20. Regional Understanding and Unity of Effort: Applying the Global SOF Network in Future Operating Environments Communications

    Science.gov (United States)

    2016-12-07

    disrupt terrorist networks COL Christopher Varhola, USAR has a Ph.D. in Cultural Anthropology and is a Joint Special Operations University Senior Fellow...conflict, where building relations and empowering regional states and organizations are logical remedies and are rightly a key ele- ment of U.S. diplomatic...grow- ing regional powers and organizations .6 As a result, U.S. freedom of action is reduced and requires coordination and permission from partner

  1. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon; Cho, Chol Kyoon; Kang, Heoung Keun

    2006-01-01

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the

  2. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  3. Assessment of the impact of nuclear power plant construction and operation on small regions

    International Nuclear Information System (INIS)

    Johnson, M.H. Jr.

    1977-01-01

    This study addresses the problem of the comprehensive, quantitative evaluation of the environmental, economic, and social impacts of the construction and operation of nuclear power plant on a given region. A theoretical model of the regional impacts is constructed employing input-output methods that are extended to include ecologic as well as economic effects. Thus, the regional model explicitly incorporates environmental feedback as a consequence of economic activity. The model is then employed to estimate the impact of the construction and operation of a nuclear power facility on a small region in South Carolina. Measures of economic and environmental effects include estimates of changes in output, income, employment, local government revenue and expenditure, external costs of environmental decay, pollution loads, and common-property resource usage. Results indicate that, in the South Carolina case study, significant gains in social welfare accrued to the region due to the construction and operation of the nuclear power facility. Further, the theoretical method developed herein provides a comprehensive method of objectively assessing various types of impacts on a region as small as several contiguous counties or even a single county

  4. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1961-02-07

    The texts of the Agency's agreements for co-operation with the regional inter-governmental organizations listed below, together with the respective protocols authenticating them, are reproduced in this document in the order in which the agreements entered into force, for the information of all Members of the Agency.

  5. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    International Nuclear Information System (INIS)

    1961-01-01

    The texts of the Agency's agreements for co-operation with the regional inter-governmental organizations listed below, together with the respective protocols authenticating them, are reproduced in this document in the order in which the agreements entered into force, for the information of all Members of the Agency

  6. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    International Nuclear Information System (INIS)

    1961-01-01

    The texts of the Agency's agreements for co-operation with the regional inter-governmental organizations listed below, together with the respective protocols authenticating them, are reproduced in this document in the order in which the agreements entered into force, for the information of all Members of the Agency [es

  7. Improved management of winter operations to limit subsurface contamination with degradable deicing chemicals in cold regions

    NARCIS (Netherlands)

    French, H.K.; Zee, van der S.E.A.T.M.

    2014-01-01

    This paper gives an overview of management considerations required for better control of deicing chemicals in the unsaturated zone at sites with winter maintenance operations in cold regions. Degradable organic deicing chemicals are the main focus. The importance of the heterogeneity of both the

  8. Radiological diagnosis of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

    1990-01-01

    In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de

  9. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

    Science.gov (United States)

    Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

    2015-02-09

    of safety assessments, no fatal adverse events were reported. The second primary outcome of blood loss was assessed after surgery and these trials showed the reduction of blood loss and requirement of post-operative replacement treatment in people receiving antifibrinolytic agents compared with placebo. The remaining primary outcome of need for re-intervention was not reported by either trial.Two trials reported on 53 people with haemophilia A and B with inhibitors treated with different regimens of recombinant activated factor VII (rFVIIa) for haemostatic coverage of 33 major and 20 minor surgical interventions. Neither of the included trials specifically addressed any of the review's primary outcomes (mortality, blood loss and need for re-intervention). In one trial a high-dose rFVIIa regimen (90 μg/kg) was compared with a low-dose regimen (35 μg/kg); the higher dose showed increased haemostatic efficacy, in particular in major surgery, with shorter duration of treatment, similar total dose of rFVIIa administered and similar safety levels. In the second trial, bolus infusion and continuous infusion of rFVIIa were compared, showing similar haemostatic efficacy, duration of treatment and safety. There is insufficient evidence from randomised controlled trials to assess the most effective and safe haemostatic treatment to prevent bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgical procedures. Ideally large, adequately powered, and well-designed randomised controlled trials would be needed, in particular to address the cost-effectiveness of such demanding treatments in the light of the increasing present economic constraints, and to explore the new challenge of ageing patients with haemophilia or other congenital bleeding disorders. However, performing such trials is always a complex task in this setting and presently does not appear to be a clinical and research priority. Indeed, major and minor surgeries are effectively

  10. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...

  11. Postpolypectomy lower GI bleeding: descriptive analysis

    NARCIS (Netherlands)

    Sorbi, D.; Norton, I.; Conio, M.; Balm, R.; Zinsmeister, A.; Gostout, C. J.

    2000-01-01

    BACKGROUND: Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS: Patients with postpolypectomy bleeding between April 1989 and

  12. Optimal Operation System of the Integrated District Heating System with Multiple Regional Branches

    Science.gov (United States)

    Kim, Ui Sik; Park, Tae Chang; Kim, Lae-Hyun; Yeo, Yeong Koo

    This paper presents an optimal production and distribution management for structural and operational optimization of the integrated district heating system (DHS) with multiple regional branches. A DHS consists of energy suppliers and consumers, district heating pipelines network and heat storage facilities in the covered region. In the optimal management system, production of heat and electric power, regional heat demand, electric power bidding and sales, transport and storage of heat at each regional DHS are taken into account. The optimal management system is formulated as a mixed integer linear programming (MILP) where the objectives is to minimize the overall cost of the integrated DHS while satisfying the operation constraints of heat units and networks as well as fulfilling heating demands from consumers. Piecewise linear formulation of the production cost function and stairwise formulation of the start-up cost function are used to compute nonlinear cost function approximately. Evaluation of the total overall cost is based on weekly operations at each district heat branches. Numerical simulations show the increase of energy efficiency due to the introduction of the present optimal management system.

  13. Extending the Operational Envelope of a Turbofan Engine Simulation into the Sub-Idle Region

    Science.gov (United States)

    Chapman, Jeffryes Walter; Hamley, Andrew J.; Guo, Ten-Huei; Litt, Jonathan S.

    2016-01-01

    In many non-linear gas turbine simulations, operation in the sub-idle region can lead to model instability. This paper lays out a method for extending the operational envelope of a map based gas turbine simulation to include the sub-idle region. This method develops a multi-simulation solution where the baseline component maps are extrapolated below the idle level and an alternate model is developed to serve as a safety net when the baseline model becomes unstable or unreliable. Sub-idle model development takes place in two distinct operational areas, windmilling/shutdown and purge/cranking/startup. These models are based on derived steady state operating points with transient values extrapolated between initial (known) and final (assumed) states. Model transitioning logic is developed to predict baseline model sub-idle instability, and transition smoothly and stably to the backup sub-idle model. Results from the simulation show a realistic approximation of sub-idle behavior as compared to generic sub-idle engine performance that allows the engine to operate continuously and stably from shutdown to full power.

  14. Stable tokamak access to, and operation in, the second stability region

    International Nuclear Information System (INIS)

    Todd, A.M.M.; Phillips, M.; Chance, M.; Manickam, J.; Pomphrey, N.

    1987-01-01

    Tokamak operation in the second region of stability to ballooning modes holds promise for economic fusion reactor operation. A second region of stability is confirmed to exist in circular tokamaks with a nearby conducting shell for εβθ>1. In addition to ballooning instabilities with high toroidal mode number n, the presence of low n internal pressure driven modes in low shear regions can pose serious problems for access to the second region. These modes can be present even when ballooning modes with infinite n are stable. Stable access to the second region for all ideal modes is demonstrated with current profile programming that raises the safety factor on axis above unity. Present calculations for stable access using this technique indicate that a conducting wall must be located close to the plasma edge (∼ 0.1 plasma minor radius) to stabilize external modes. Pressure and shear profile optimization could be used to increase this value. As εβθ is raised above unity, the stabilizing wall can be moved to progressively larger major radii. This behaviour is attributed to restabilization of the pressure driven component in low n kink modes. Finally, it is shown that poloidally discontinuous conducting structures are effective in stabilizing low n external kink modes. (author)

  15. The capsule endoscopy "suspected blood indicator" (SBI) for detection of active small bowel bleeding: no active bleeding in case of negative SBI.

    Science.gov (United States)

    Tal, Andrea Oliver; Filmann, Natalie; Makhlin, Konstantin; Hausmann, Johannes; Friedrich-Rust, Mireen; Herrmann, Eva; Zeuzem, Stefan; Albert, Jörg G

    2014-09-01

    Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The "suspected blood indicator" (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.

  16. Obliteration of gastric bleeding varices with NBCA

    International Nuclear Information System (INIS)

    Jiang Zaibo; Li Zhengran; Qian Jiesheng; Zhu Kangshun; Huang Mingsheng; Zhao Dabing; Pang Pengfei; Guan Shouhai; Shan Hong

    2007-01-01

    Objective: To study the feasibility of obliteration with NBCA(N-Butyl-2-Cyanoacrylate)for the treatment of gastric bleeding varices in terminal stage of portal hypertension. Methods: All 17 cases of upper gastrointestinal hemorrhage with portal hypertension, mean age 54 years, including 11 cases of advanced hepatocellular carcinoma with portal venous tumor emboli, 6 eases of cirrhosis and 3 cases with moderate to severe ascites; were selected for this study. According to the Child-Pugh classification, 3 cases were in class B and 14 cases in class C at admission. Left gastric, posterior and short gastric varices were shown in all patients on CT or MRI enhancement scannings, together with splenorenal and gastrorenal shunts in 3 and 3 cases respectively. Seven cases were approached through right midaxillary line transhepatic route, 4 cases through infra-cartilago ensiformis transhepatic route, and 6 cases through transsplenic approach. Nine eases took scheduled operation, and 8 cases under emergency operation. According to blood flow rate and variceal internal diameter, the proportion 1:4 of NBCA and lipiodol was selected for the embolization. The survival and symptom relief of the patients were followed up. Results: All cases were successfully engaged in embolization with NBCA, with all varices disappeared on post-operation angiography and CT enhancement scanning during follow-up. Pressure of portal vein rised 3 cmH 2 O after operation with one case having with transient irritable cough. The average survival time was over 5 months during 3-12 months follow-up. Four cases died postoperatively because of hepatic function exhaustion. Conclusion: Utilization of NBCA in obliteration for gastric bleeding varices is effective, feasible and reliable; with less complication, Keeping strict indications would surely raise the long-term efficacy. (authors)

  17. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. Technical background and guidance for deployment in EU regions

    Energy Technology Data Exchange (ETDEWEB)

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Le Pierres, S. [Energies Demain, Montreuil Sous Bois (France); Del Ciello, R. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Harnych, J. [ENVIROS, Prague (Czech Republic)

    2013-03-15

    The CO2MPARE model enables national and regional authorities to assess the carbon impacts of Operational Programmes co-financed through the European Regional Development Fund (ERDF). This document provides technical background information and guidance for deploying the model in additional EU regions.

  18. A Systematic Multi-Time Scale Solution for Regional Power Grid Operation

    Science.gov (United States)

    Zhu, W. J.; Liu, Z. G.; Cheng, T.; Hu, B. Q.; Liu, X. Z.; Zhou, Y. F.

    2017-10-01

    Many aspects need to be taken into consideration in a regional grid while making schedule plans. In this paper, a systematic multi-time scale solution for regional power grid operation considering large scale renewable energy integration and Ultra High Voltage (UHV) power transmission is proposed. In the time scale aspect, we discuss the problem from month, week, day-ahead, within-day to day-behind, and the system also contains multiple generator types including thermal units, hydro-plants, wind turbines and pumped storage stations. The 9 subsystems of the scheduling system are described, and their functions and relationships are elaborated. The proposed system has been constructed in a provincial power grid in Central China, and the operation results further verified the effectiveness of the system.

  19. EMMA model: an advanced operational mesoscale air quality model for urban and regional environments

    International Nuclear Information System (INIS)

    Jose, R.S.; Rodriguez, M.A.; Cortes, E.; Gonzalez, R.M.

    1999-01-01

    Mesoscale air quality models are an important tool to forecast and analyse the air quality in regional and urban areas. In recent years an increased interest has been shown by decision makers in these types of software tools. The complexity of such a model has grown exponentially with the increase of computer power. Nowadays, medium workstations can run operational versions of these modelling systems successfully. Presents a complex mesoscale air quality model which has been installed in the Environmental Office of the Madrid community (Spain) in order to forecast accurately the ozone, nitrogen dioxide and sulphur dioxide air concentrations in a 3D domain centred on Madrid city. Describes the challenging scientific matters to be solved in order to develop an operational version of the atmospheric mesoscale numerical pollution model for urban and regional areas (ANA). Some encouraging results have been achieved in the attempts to improve the accuracy of the predictions made by the version already installed. (Author)

  20. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

    Directory of Open Access Journals (Sweden)

    Kolhe S

    2018-03-01

    Full Text Available Shilpa Kolhe Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK Abstract: The rapid evolution in ambulatory hysteroscopy (AH has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB. The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting. Keywords: abnormal uterine bleeding, ambulatory hysteroscopy, endometrial polyps, one-stop clinic, vaginoscopic approach

  1. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Chua, A. E.; Ridley, L. J.

    2008-01-01

    Full text: The aim of the study was to carry out a systematic review determining the accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding. A search of published work in Medline and manual searching of reference lists of articles was conducted. Studies were included if they compared CT angiography to a reference standard of upper gastrointestinal endoscopy, colonoscopy, angiography or surgery in the diagnosis of acute gastrointestinal bleeding. Eight published studies evaluating 129 patients were included. Data were used to form 2 x2 tables. Computed tomography angiography showed pooled sensitivity of 86% (95% confidence interval 78-92%) and specificity of 95% (95% confidence interval 76-100%), without showing significant heterogeneity (x 2 = 3.5, P=0.6) and (x 2 - 5.4, P = 0.6), respectively. Summary receiver operating characteristic analysis showed an area under the curve of 0.93. Computed tomography angiography is accurate in the diagnosis of acute gastrointestinal bleeding and can show the precise location and aetiology of bleeding, thereby directing further management. Strong recommendations for use of CT cannot be made from this review because of the methodological limitations and further large prospective studies are needed to define the role of CT in acute gastrointestinal bleeding.

  2. DSA diagnosis and interventional management of postoperative bleeding

    International Nuclear Information System (INIS)

    Li Yuwei; Zhang Fuqiang; Li Yunhui; Yuan Liang; Si Guangyan; Liu Lili

    2009-01-01

    Objective: To discuss the clinical application of DSA and interventional management in diagnosing and treating the bleeding after surgery. Methods: The clinical data and the interventional management of 14 patients with DSA-proved postoperative bleeding, encountered during the period of Aug. 2005-Jan. 2008, were retrospectively analyzed. The surgeries included subtotal gastrectomy (n=4), pancreatoduodenectomy (n=3), cesarean section (n=2), nephrolithotomy (n=3), heminephrectomy (n=1), internal hemorrhoidectomy (n=1). Results: Seventeen arterial bleeding sites were demonstrated, including gastroduodenal (n=2), left gastric (n=4), phrenic (n=1), short gastric (n=1), superior mesenteric (n=2), renal (n=4), uterine (n=2) and internal pudendal (n=1) artery. The diagnosis was confirmed with DSA in all 14 patients, of which embolization was successfully carried out in 13 in one session (92.8%). The remaining one case had to be operated again to stop the bleeding because of the failure of the superselective catheterization. No serious complications, such as organ necrosis or visceral dysfunction, occurred. Conclusion: As a safe, minimally-invasive and effective technique, DSA and interventional management are very helpful in diagnosing and treating the bleeding after surgery. (authors)

  3. Asian regional co-operative project on food irradiation: Technology transfer

    International Nuclear Information System (INIS)

    1992-01-01

    These Proceedings include the final reports of work performed by different institutions under the scope of Phase II of the Asian Regional Co-operative Project on Food Irradiation. The topics covered include the disinfestation and decontamination of stored products; improvements in the hygiene of processed seafood; insect disinfestation of fruits; and sprout inhibition of root crops. The individual presentations are indexed separately. Refs, figs and tabs

  4. The Santos Basin Ocean Observing System: From R&D to Operational Regional Forecasts

    Science.gov (United States)

    Da Rocha Fragoso, M.; Moore, A. M.; dos Santos, F. A.; Marques Da Cruz, L.; Carvalho, G. V.; Soares, F.

    2016-02-01

    Santos Basin is located on the Southwestern Brazilian Ocean Basin and comprises the main offshore oil reserves of Brazil. The exploration and production activities on its ocean are growing in accelerated pace, which means that oil spill contingency and search & rescue operations are likely to be more frequent. Therefore, ocean current reliable nowcasts and forecasts has become even more important for this region. The Santos Basin Ocean Observing System was designed as an R&D project and its main objective was to establish and maintain a systematic oceanographic data collection for this region in order to study its ocean dynamics and improve regional ocean forecast through data assimilation. In the first three years of the project surface drifters, profiling floats and gliders were deployed to measure and monitor mainly the Brazil Current Western Boundary System, a highly unstable baroclinic current system, that present several meanders and mesoscale eddies activities. Throughout the development of the project, the team involved was able to learn how to operate the equipment, treat the collected data and use it to assimilate on the Regional Ocean Modeling System (ROMS). After performing a one-year 4DVAR assimilation cycle (Fragoso et al., 2015) in which the forecasting skill was assessed, the system was considered mature enough to start producing ocean circulation forecasts for Santos Basin. It is the first time in Brazil that a regional ocean model using a 4DVAR data assimilation scheme was used to produce high resolution operational ocean current forecasts. This paper describes all the components of this forecasting system, its main results and discoveries with special focus on the Brazil Current System Transport and mesocale eddies dynamics and statistics.

  5. Adaptive Control of a Utility-Scale Wind Turbine Operating in Region 3

    Science.gov (United States)

    Frost, Susan A.; Balas, Mark J.; Wright, Alan D.

    2009-01-01

    Adaptive control techniques are well suited to nonlinear applications, such as wind turbines, which are difficult to accurately model and which have effects from poorly known operating environments. The turbulent and unpredictable conditions in which wind turbines operate create many challenges for their operation. In this paper, we design an adaptive collective pitch controller for a high-fidelity simulation of a utility scale, variable-speed horizontal axis wind turbine. The objective of the adaptive pitch controller in Region 3 is to regulate generator speed and reject step disturbances. The control objective is accomplished by collectively pitching the turbine blades. We use an extension of the Direct Model Reference Adaptive Control (DMRAC) approach to track a reference point and to reject persistent disturbances. The turbine simulation models the Controls Advanced Research Turbine (CART) of the National Renewable Energy Laboratory in Golden, Colorado. The CART is a utility-scale wind turbine which has a well-developed and extensively verified simulator. The adaptive collective pitch controller for Region 3 was compared in simulations with a bas celliansesical Proportional Integrator (PI) collective pitch controller. In the simulations, the adaptive pitch controller showed improved speed regulation in Region 3 when compared with the baseline PI pitch controller and it demonstrated robustness to modeling errors.

  6. Modified Adaptive Control for Region 3 Operation in the Presence of Wind Turbine Structural Modes

    Science.gov (United States)

    Frost, Susan Alane; Balas, Mark J.; Wright, Alan D.

    2010-01-01

    Many challenges exist for the operation of wind turbines in an efficient manner that is reliable and avoids component fatigue and failure. Turbines operate in highly turbulent environments resulting in aerodynamic loads that can easily excite turbine structural modes, possibly causing component fatigue and failure. Wind turbine manufacturers are highly motivated to reduce component fatigue and failure that can lead to loss of revenue due to turbine down time and maintenance costs. The trend in wind turbine design is toward larger, more flexible turbines that are ideally suited to adaptive control methods due to the complexity and expense required to create accurate models of their dynamic characteristics. In this paper, we design an adaptive collective pitch controller for a high-fidelity simulation of a utility-scale, variable-speed horizontal axis wind turbine operating in Region 3. The objective of the adaptive pitch controller is to regulate generator speed, accommodate wind gusts, and reduce the excitation of structural modes in the wind turbine. The control objective is accomplished by collectively pitching the turbine blades. The adaptive collective pitch controller for Region 3 was compared in simulations with a baseline classical Proportional Integrator (PI) collective pitch controller. The adaptive controller will demonstrate the ability to regulate generator speed in Region 3, while accommodating gusts, and reducing the excitation of certain structural modes in the wind turbine.

  7. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the D......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......) again as soon as cardiovascular risks outweigh gastrointestinal risks. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75mg ASA and PPI should be preferred to monotherapy...

  8. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  9. A Coupled Snow Operations-Skier Demand Model for the Ontario (Canada) Ski Region

    Science.gov (United States)

    Pons, Marc; Scott, Daniel; Steiger, Robert; Rutty, Michelle; Johnson, Peter; Vilella, Marc

    2016-04-01

    The multi-billion dollar global ski industry is one of the tourism subsectors most directly impacted by climate variability and change. In the decades ahead, the scholarly literature consistently projects decreased reliability of natural snow cover, shortened and more variable ski seasons, as well as increased reliance on snowmaking with associated increases in operational costs. In order to develop the coupled snow, ski operations and demand model for the Ontario ski region (which represents approximately 18% of Canada's ski market), the research utilized multiple methods, including: a in situ survey of over 2400 skiers, daily operations data from ski resorts over the last 10 years, climate station data (1981-2013), climate change scenario ensemble (AR5 - RCP 8.5), an updated SkiSim model (building on Scott et al. 2003; Steiger 2010), and an agent-based model (building on Pons et al. 2014). Daily snow and ski operations for all ski areas in southern Ontario were modeled with the updated SkiSim model, which utilized current differential snowmaking capacity of individual resorts, as determined from daily ski area operations data. Snowmaking capacities and decision rules were informed by interviews with ski area managers and daily operations data. Model outputs were validated with local climate station and ski operations data. The coupled SkiSim-ABM model was run with historical weather data for seasons representative of an average winter for the 1981-2010 period, as well as an anomalously cold winter (2012-13) and the record warm winter in the region (2011-12). The impact on total skier visits and revenues, and the geographic and temporal distribution of skier visits were compared. The implications of further climate adaptation (i.e., improving the snowmaking capacity of all ski areas to the level of leading resorts in the region) were also explored. This research advances system modelling, especially improving the integration of snow and ski operations models with

  10. Post-tonsillectomy hemorrhagic outcomes in children with bleeding disorders at a single institution.

    Science.gov (United States)

    Patel, Priyesh N; Arambula, Alexandra M; Wheeler, Allison P; Penn, Edward B

    2017-09-01

    To report on the post-tonsillectomy bleeding outcomes and factors associated with hemorrhage among children with pre- or post-operatively diagnosed bleeding disorders treated with an institutional protocol. Retrospective cohort study of patients with hematologic disorders who underwent tonsillectomy between 2003 and 2016 and were treated with perioperative desmopressin or factor replacement and/or aminocaproic acid. Postoperative outcomes were compared to controls matched for age, sex, and indication for surgery. Analysis of factors associated with hemorrhage was performed in patients with bleeding disorders using Mann-Whitney U or chi-squared tests. 45 patients with hematologic disorders met inclusion criteria. Platelet dysfunction, including von Willebrand Disease (vWD), was the most common diagnosis (77.8%). Most patients had a preoperative diagnosis of a bleeding disorder and received perioperative hematologic medications (86.7%). Compared to matched controls, patients with hematologic disorders experienced more postoperative bleeding (15.5%; 12 bleeds, 7 patients vs. 1.7%; 1 bleed, 1 patient, p = 0.05) and had longer postoperative stays (1.3 days vs. 0.4 days, p bleed were significantly more likely to have a factor deficiency (e.g. Hemophilia over vWD) and have a postoperative diagnosis (compared to preoperative diagnosis) for which they did not receive perioperative hematologic medication. Of patients with a postoperative bleed, all those diagnosed postoperatively required at least one surgical intervention to control bleeding compared to 33% of patients with a preoperative diagnosis. A history of post-surgical bleeding, male sex, age at surgery, and pharyngitis as surgical indication were not associated with higher hemorrhage rates in this group. This study suggests a clinically important magnitude of increased bleeding risk in patients with hematologic disease. This risk appears to decrease with the use of an institutional protocol consisting of

  11. Automated registration of tail bleeding in rats.

    Science.gov (United States)

    Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

    2008-05-01

    An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.

  12. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

  13. Bleeding

    Science.gov (United States)

    ... gov/pubmed/24641269 . Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52. ...

  14. Detection of acute gastrointestinal bleeding by means of technetium-99m in vivo labelled red blood cells

    International Nuclear Information System (INIS)

    Dolezal, J.; Vizd'a, J.; Bures, J.

    2002-01-01

    Prognosis of gastrointestinal (GI) bleeding depends on the timely and accurate detection of the source of bleeding and sequential surgical or endoscopy therapy. Scintigraphy with red blood cells (RBCs) in vivo labelled by means of technetium-99m hastened detection of source of GI bleeding and improved management of the particular disease. Gastrointestinal endoscopy is the method of choice for the diagnostics of bleeding from upper tract and large bowel. For diagnostics of bleeding from the small bowel we can use scintigraphy with in vivo labelled autological red blood cells if pushenteroscopy, intra-operative enteroscopy or angiography are not available. 31 patients (13 men, 18 women, aged 20-91, mean 56 years) underwent this investigation from 1998 till 2001 at the Department of Nuclear Medicine. All patients had melaena or enterorrhagia associated with acute anaemia. Gastroscopy, colonoscopy, enteroclysis or X-ray angiography did not detect the source of bleeding. Twenty-one patients had positive scintigraphy with in vivo labelled RBCs - 9 patients were already positive on dynamic scintigraphy, and 12 patients were positive on static images. Scintigraphy with in vivo labelled RBCs was negative in 10 patients. GI bleeding stopped spontaneously in these 10 patients with negative scintigraphy. These patients did not undergo intra-operative enteroscopy or surgery. The final diagnosis of the 21 patients with positive scintigraphy was determined in 16 patients by push-enteroscopy (6 patients), intra-operative enteroscopy (6 patients) or by surgery (4 patients). Of these 16 patients the correct place of bleeding was determined by scintigraphy with labelled RBCs in 11 (69%) patients. Final diagnoses of our 16 patients with positive scintigraphy with autological labelled RBCs were: bleeding small bowel arteriovenous malformation (6 patients), uraemic enteritis with bleeding erosions in ileum and jejunum (2 patients), Osler-Rendu- Weber disease (1 patient), pseudocyst of

  15. Pandemic planning : oilsands operators and the regional municipality constantly refine strategy

    Energy Technology Data Exchange (ETDEWEB)

    Ball, C.G.

    2008-06-15

    The Alberta government anticipates that between 17 to 43 per cent of the province's population will be affected during a potential influenza pandemic. It is expected that between 3 and 12,000 Albertans will be hospitalized and up to 3000 will die. This article discussed emergency plans made by the oil and gas industry for future pandemics. Oil sands operators in the Wood Buffalo municipality prepared plans based on guidelines made by the World Health Organization (WHO) and various government bodies. The transient nature of the region's population and its limited health resources may increase the level of risk associated with a pandemic. The planning process adopted by the region has been designed to provide staff with the ability to deal with increased numbers of people visiting the hospital. The planning process includes training exercises that range from desktop drills to the setting up of triage areas. Other plans include the identification of operations and processes that would be at risk in the event of a pandemic, as well the identification of key operations and roles. Plans are constantly being refined in order to identify new areas of risk. 1 fig.

  16. A Novel Operant-based Behavioral Assay of Mechanical Allodynia in the Orofacial Region of Rats

    Science.gov (United States)

    Rohrs, Eric L.; Kloefkorn, Heidi E.; Lakes, Emily H.; Jacobs, Brittany Y.; Neubert, John K.; Caudle, Robert M.; Allen, Kyle D.

    2015-01-01

    Background Detecting behaviors related to orofacial pain in rodent models often relies on subjective investigator grades or methods that place the animal in a stressful environment. In this study, an operant-based behavioral assay is presented for the assessment of orofacial tactile sensitivity in the rat. New Methods In the testing chamber, rats are provided access to a sweetened condensed milk bottle; however, a 360° array of stainless steel wire loops impedes access. To receive the reward, an animal must engage the wires across the orofacial region. Contact with the bottle triggers a motor, requiring the animal to accept increasing pressure on the face during the test. To evaluate this approach, tolerated bottle distance was measured for 10 hairless Sprague-Dawley rats at baseline and 30 minutes after application of capsaicin cream (0.1%) to the face. The experiment was repeated to evaluate the ability of morphine to reverse this effect. Results The application of capsaicin cream reduced tolerated bottle distance measures relative to baseline (porofacial sensitivity is presented using an operant system. Conclusions This operant device allows for consistent measurement of heightened tactile sensitivity in the orofacial regions of the rat. PMID:25823368

  17. LPV Control for the Full Region Operation of a Wind Turbine Integrated with Synchronous Generator

    Science.gov (United States)

    Grigoriadis, Karolos M.; Nyanteh, Yaw D.

    2015-01-01

    Wind turbine conversion systems require feedback control to achieve reliable wind turbine operation and stable current supply. A robust linear parameter varying (LPV) controller is proposed to reduce the structural loads and improve the power extraction of a horizontal axis wind turbine operating in both the partial load and the full load regions. The LPV model is derived from the wind turbine state space models extracted by FAST (fatigue, aerodynamics, structural, and turbulence) code linearization at different operating points. In order to assure a smooth transition between the two regions, appropriate frequency-dependent varying scaling parametric weighting functions are designed in the LPV control structure. The solution of a set of linear matrix inequalities (LMIs) leads to the LPV controller. A synchronous generator model is connected with the closed LPV control loop for examining the electrical subsystem performance obtained by an inner speed control loop. Simulation results of a 1.5 MW horizontal axis wind turbine model on the FAST platform illustrates the benefit of the LPV control and demonstrates the advantages of this proposed LPV controller, when compared with a traditional gain scheduling PI control and prior LPV control configurations. Enhanced structural load mitigation, improved power extraction, and good current performance were obtained from the proposed LPV control. PMID:25884036

  18. LPV Control for the Full Region Operation of a Wind Turbine Integrated with Synchronous Generator

    Directory of Open Access Journals (Sweden)

    Guoyan Cao

    2015-01-01

    Full Text Available Wind turbine conversion systems require feedback control to achieve reliable wind turbine operation and stable current supply. A robust linear parameter varying (LPV controller is proposed to reduce the structural loads and improve the power extraction of a horizontal axis wind turbine operating in both the partial load and the full load regions. The LPV model is derived from the wind turbine state space models extracted by FAST (fatigue, aerodynamics, structural, and turbulence code linearization at different operating points. In order to assure a smooth transition between the two regions, appropriate frequency-dependent varying scaling parametric weighting functions are designed in the LPV control structure. The solution of a set of linear matrix inequalities (LMIs leads to the LPV controller. A synchronous generator model is connected with the closed LPV control loop for examining the electrical subsystem performance obtained by an inner speed control loop. Simulation results of a 1.5 MW horizontal axis wind turbine model on the FAST platform illustrates the benefit of the LPV control and demonstrates the advantages of this proposed LPV controller, when compared with a traditional gain scheduling PI control and prior LPV control configurations. Enhanced structural load mitigation, improved power extraction, and good current performance were obtained from the proposed LPV control.

  19. Genomic region operation kit for flexible processing of deep sequencing data.

    Science.gov (United States)

    Ovaska, Kristian; Lyly, Lauri; Sahu, Biswajyoti; Jänne, Olli A; Hautaniemi, Sampsa

    2013-01-01

    Computational analysis of data produced in deep sequencing (DS) experiments is challenging due to large data volumes and requirements for flexible analysis approaches. Here, we present a mathematical formalism based on set algebra for frequently performed operations in DS data analysis to facilitate translation of biomedical research questions to language amenable for computational analysis. With the help of this formalism, we implemented the Genomic Region Operation Kit (GROK), which supports various DS-related operations such as preprocessing, filtering, file conversion, and sample comparison. GROK provides high-level interfaces for R, Python, Lua, and command line, as well as an extension C++ API. It supports major genomic file formats and allows storing custom genomic regions in efficient data structures such as red-black trees and SQL databases. To demonstrate the utility of GROK, we have characterized the roles of two major transcription factors (TFs) in prostate cancer using data from 10 DS experiments. GROK is freely available with a user guide from >http://csbi.ltdk.helsinki.fi/grok/.

  20. Tennessee Valley region study: potential year 2000 radiological dose to population resulting from nuclear facility operations

    International Nuclear Information System (INIS)

    1978-06-01

    A companion report, DOE/ET-0064/1, presents a geographic, cultural, and demographic profile of the Tennessee Valley Region study area. This report describes the calculations of radionuclide release and transport and of the resultant dose to the regional population, assuming a projected installed capacity of 220,000 MW in the year 2000, of which 144,000 MW would be nuclear. All elements of the fuel cycle were assumed to be in operation. The radiological dose was calculated as a one-year dose based on ingestion of 35 different food types as well as for nine non-food pathways, and was reported as dose to the total body and for six specific organs for each of four age groups (infant, child, teen, and adult). Results indicate that the average individual would receive an incremental dose of 7 x 10 -4 millirems in the year 2000 from the operation of nuclear facilities within and adjacent to the region, five orders of magnitude smaller than the dose from naturally occurring radiation in the area. The major contributor to dose was found to be tritium, and the most significant pathways were immersion in air, inhalation of air, transpiration of tritium (absorption through the skin), and exposure radionuclide-containing soil. 60 references

  1. A feasibility study on feed and bleed for pressurized water reactors

    International Nuclear Information System (INIS)

    Yi-Shung Chen; Shimeck, D.J.; Sullivan, L.H.

    1983-01-01

    By injecting coolant with a high pressure emergency core cooling system, and removing the heated/ vaporized fluid by way of the pressurizer power operated relief valve, primary feed and bleed cooling denotes an operation whereby reactor core cooling is maintained. This paper presents the results from an experimental and analytical study that includes a simplified analysis of mass and energy balances associated with the feed and bleed, examination of test data from the Semiscale system, RELAP5 code analyses of both Semiscale and a four-loop Westinghouse plant, and the primary coolant system behavior for a transient that leads to the need for feed and bleed. Examination of the parameters that govern a stable feed and bleed operation identifies four key parameters such as: core decay heat, cooling water injection capacity, power operated relief valve (PORV) energy removal rate, and PORV mass removal rate. A simplified analytical approach to determining if stable feed and bleed is feasible, has been developed and corroborated by experimental data and computer code calculations. The Semiscale tests have not only provided test data for code assessment, but also have identified the factors influencing the PORV discharge, which is the most variable of the boundary conditions influencing feed and bleed. The RELAP5 computer code has demonstrated the capability of predicting the Semiscale experiments, and when applied to a four-loop Westinghouse plant has indicated that primary feed and bleed is a viable cooling mechanism. This has also been shown by using the simplified analytical method

  2. Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

    Science.gov (United States)

    Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Crimmins, Darach; Caird, John

    2018-01-01

    OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.

  3. Columbia River System Operation Review final environmental impact statement. Appendix Q: Regional forum

    International Nuclear Information System (INIS)

    1995-11-01

    The System Operation Review (SOR) is a study and environmental compliance process being used by the three Federal agencies to analyze future operations of the system and river use issues. The goal of the SOR is to achieve a coordinated system operation strategy for the river that better meets the needs of all river users. This technical appendix addresses only the effects of alternative system operating strategies for managing the Columbia River system. The SOR is currently developing a System Operating Strategy (SOS) that will guide the physical operations of the Columbia River system. The SOR is also addressing the institutional arrangements that must be in place to make needed changes to the SOS in the future, or make interpretations of the strategy in the light of changing water conditions or river needs. For convenience, this future institutional arrangement is referred to as ''The Columbia River Regional Forum,'' or simply ''the Forum,'' even though the nature of this institution is still to be determined. This appendix and the Final Environmental Impact Statement (EIS) identify the Forum as an administrative process that will not result in impacts to the environment and will not require analysis in a NEPA context. The composition of and procedures followed by a decision making body cannot--in and of themselves--be used to predict a particular decision with definable impacts on the environment. Nevertheless, because of the relationship to the other SOR actions, the SOR lead agencies have prepared this Technical Appendix to provide opportunities for review and comment on the Forum alternatives

  4. Facing operational problems in a biodigester in Yuvientsa - Amazonian region of Ecuador

    Energy Technology Data Exchange (ETDEWEB)

    Aragundy, J.

    2007-07-01

    Yuvientsa is a Shuar indigenous community located in the Morona Santiago Province in the southwestern part of the Amazonian region of Ecuador. Two types of alternative energies have being implemented in Yuvientsa to satisfy people's needs. Solar panels provide electricity to the community. A biodigester to treat the school lavatories' brown-water (fecal water) and to provide gas for cooking to the communal kitchen was built as well. During the operational phase the biodigester faced some difficulties as: being perforated by people of the community as started inflating, being fumigated against malaria, and not having enough organic matter to produce biogas. As a result in this time the biodigester did not operate satisfactorily and the community did not believe that it could work and produce biogas. A biodigester should not be built without an awareness campaign or showing a direct benefit to the community that ensures its adequate operation and maintenance. Before constructing the reactor the organic matter source to operate the biodigester should be clearly identified and its amount should be enough. (orig.)

  5. Estimated Impact of the Regional Operational Programme 2007-2013 in Romania

    Directory of Open Access Journals (Sweden)

    Daniela Antonescu

    2013-08-01

    Full Text Available The evaluation process is a basic element of modern public sector management practice. If this process is well conducted, it can contribute to improved public interventions, increased transparency, accountability and cost-effectiveness. In the European Union, old Member States have a relatively long record of conducting evaluations and acting on their results, especially regarding Structural Funds. For Romania and other new Member States, this process is being introduced increasingly, in particular, after integration. The study analyses the estimated impact of Regional Operational Programme 2007-2013 in Romania.

  6. Carcinoma of the pancreas and periampullary region: palliation versus cure

    NARCIS (Netherlands)

    Klinkenbijl, J. H.; Jeekel, J.; Schmitz, P. I.; Rombout, P. A.; Nix, G. A.; Bruining, H. A.; van Blankenstein, M.

    1993-01-01

    A retrospective study of 310 patients with carcinoma of the head of the pancreas or periampullary region was performed. Preoperative bile drainage by placement of a stent reduced the number of postoperative complications, especially bleeding (P = 0.03). The operative mortality rate was nil in

  7. PRESSCA: A regional operative Early Warning System for landslides risk scenario assessment

    Science.gov (United States)

    Ponziani, Francesco; Stelluti, Marco; Berni, Nicola; Brocca, Luca; Moramarco, Tommaso

    2013-04-01

    The Italian national alert system for the hydraulic and hydrogeological risk is ensured by the National Civil Protection Department, through the "Functional Centres" Network, together with scientific/technical Support Centres, named "Competence Centres". The role of the Functional Centres is to alert regional/national civil protection network, to manage the prediction and the monitoring phases, thus ensuring the flow of data for the management of the emergency. The Umbria regional alerting procedure is based on three increasing warning levels of criticality for 6 sub-areas (~1200 km²). Specifically, for each duration (from 1 to 48 hours), three criticality levels are assigned to the rainfall values corresponding to a recurrence interval of 2, 5, and 10 years. In order to improve confidence on the daily work for hydrogeological risk assessment and management, a simple and operational early warning system for the prediction of shallow landslide triggering on regional scale was implemented. The system is primarily based on rainfall thresholds, which represent the main element of evaluation for the early-warning procedures of the Italian Civil Protection system. Following previous studies highlighting that soil moisture conditions play a key role on landslide triggering, a continuous physically-based soil water balance model was implemented for the estimation of soil moisture conditions over the whole regional territory. In fact, a decreasing trend between the cumulated rainfall values over 24, 36 and 48 hours and the soil moisture conditions prior to past landslide events was observed. This trend provides an easy-to-use tool to dynamically adjust the operational rainfall thresholds with the soil moisture conditions simulated by the soil water balance model prior to rainfall events. The application of this procedure allowed decreasing the uncertainties tied to the application of the rainfall thresholds only. The system is actually operational in real-time and it was

  8. Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

    Directory of Open Access Journals (Sweden)

    V. V. Izbitsky

    2013-06-01

    Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

  9. [Gastrointestinal bleeding--concepts of surgical therapy in the upper gastrointestinal tract].

    Science.gov (United States)

    Knoefel, W T; Rehders, A

    2006-02-01

    Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.

  10. High Cooling Water Temperature Effects on Design and Operational Safety of NPPs in the Gulf Region

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Koo [Khalifa Univ., Abu Dhabi (United Arab Emirates); Jeong, Yong Hoon [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    2013-12-15

    The Arabian Gulf region has one of the highest ocean temperatures, reaching above 35 degrees and ambient temperatures over 50 degrees in the summer. Two nuclear power plants (NPP) are being introduced in the region for the first time, one at Bushehr (1,000 MWe PWR plant from Russia), and a much larger one at Barakah (4Χ1,400 MWe PWR from Korea). Both plants take seawater from the Gulf for condenser cooling, having to modify the secondary/tertiary side cooling systems design by increasing the heat transfer surface area from the country of origin. This paper analyses the secondary side of a typical PWR plant operating under the Rankine cycle with a simplified thermal-hydraulic model. Parametric study of ocean cooling temperatures is conducted to estimate thermal efficiency variations and its associated design changes for the secondary side. Operational safety is reviewed to deliver rated power output with acceptable safety margins in line with technical specifications, mainly in the auxiliary systems together with the cooling water temperature. Impact on the Gulf seawater as the ultimate heat sink is considered negligible, affecting only the adjacent water near the NPP site, when compared to the solar radiation on the sea surface.

  11. HIGH COOLING WATER TEMPERATURE EFFECTS ON DESIGN AND OPERATIONAL SAFETY OF NPPS IN THE GULF REGION

    Directory of Open Access Journals (Sweden)

    BYUNG KOO KIM

    2013-12-01

    Full Text Available The Arabian Gulf region has one of the highest ocean temperatures, reaching above 35 degrees and ambient temperatures over 50 degrees in the summer. Two nuclear power plants (NPP are being introduced in the region for the first time, one at Bushehr (1,000 MWe PWR plant from Russia, and a much larger one at Barakah (4X1,400 MWe PWR from Korea. Both plants take seawater from the Gulf for condenser cooling, having to modify the secondary/tertiary side cooling systems design by increasing the heat transfer surface area from the country of origin. This paper analyses the secondary side of a typical PWR plant operating under the Rankine cycle with a simplified thermal-hydraulic model. Parametric study of ocean cooling temperatures is conducted to estimate thermal efficiency variations and its associated design changes for the secondary side. Operational safety is reviewed to deliver rated power output with acceptable safety margins in line with technical specifications, mainly in the auxiliary systems together with the cooling water temperature. Impact on the Gulf seawater as the ultimate heat sink is considered negligible, affecting only the adjacent water near the NPP site, when compared to the solar radiation on the sea surface.

  12. Gastric ulcer bleeding: diagnosis by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-06-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.

  13. Gastric ulcer bleeding: diagnosis by computed tomography

    International Nuclear Information System (INIS)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-01-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas

  14. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  15. Operational forecasting of daily temperatures in the Valencia Region. Part II: minimum temperatures in winter.

    Science.gov (United States)

    Gómez, I.; Estrela, M.

    2009-09-01

    Extreme temperature events have a great impact on human society. Knowledge of minimum temperatures during winter is very useful for both the general public and organisations whose workers have to operate in the open, e.g. railways, roadways, tourism, etc. Moreover, winter minimum temperatures are considered a parameter of interest and concern since persistent cold-waves can affect areas as diverse as public health, energy consumption, etc. Thus, an accurate forecasting of these temperatures could help to predict cold-wave conditions and permit the implementation of strategies aimed at minimizing the negative effects that low temperatures have on human health. The aim of this work is to evaluate the skill of the RAMS model in determining daily minimum temperatures during winter over the Valencia Region. For this, we have used the real-time configuration of this model currently running at the CEAM Foundation. To carry out the model verification process, we have analysed not only the global behaviour of the model for the whole Valencia Region, but also its behaviour for the individual stations distributed within this area. The study has been performed for the winter forecast period from 1 December 2007 - 31 March 2008. The results obtained are encouraging and indicate a good agreement between the observed and simulated minimum temperatures. Moreover, the model captures quite well the temperatures in the extreme cold episodes. Acknowledgement. This work was supported by "GRACCIE" (CSD2007-00067, Programa Consolider-Ingenio 2010), by the Spanish Ministerio de Educación y Ciencia, contract number CGL2005-03386/CLI, and by the Regional Government of Valencia Conselleria de Sanitat, contract "Simulación de las olas de calor e invasiones de frío y su regionalización en la Comunidad Valenciana" ("Heat wave and cold invasion simulation and their regionalization at Valencia Region"). The CEAM Foundation is supported by the Generalitat Valenciana and BANCAIXA (Valencia

  16. Operational forecasting of daily temperatures in the Valencia Region. Part I: maximum temperatures in summer.

    Science.gov (United States)

    Gómez, I.; Estrela, M.

    2009-09-01

    Extreme temperature events have a great impact on human society. Knowledge of summer maximum temperatures is very useful for both the general public and organisations whose workers have to operate in the open, e.g. railways, roadways, tourism, etc. Moreover, summer maximum daily temperatures are considered a parameter of interest and concern since persistent heat-waves can affect areas as diverse as public health, energy consumption, etc. Thus, an accurate forecasting of these temperatures could help to predict heat-wave conditions and permit the implementation of strategies aimed at minimizing the negative effects that high temperatures have on human health. The aim of this work is to evaluate the skill of the RAMS model in determining daily maximum temperatures during summer over the Valencia Region. For this, we have used the real-time configuration of this model currently running at the CEAM Foundation. To carry out the model verification process, we have analysed not only the global behaviour of the model for the whole Valencia Region, but also its behaviour for the individual stations distributed within this area. The study has been performed for the summer forecast period of 1 June - 30 September, 2007. The results obtained are encouraging and indicate a good agreement between the observed and simulated maximum temperatures. Moreover, the model captures quite well the temperatures in the extreme heat episodes. Acknowledgement. This work was supported by "GRACCIE" (CSD2007-00067, Programa Consolider-Ingenio 2010), by the Spanish Ministerio de Educación y Ciencia, contract number CGL2005-03386/CLI, and by the Regional Government of Valencia Conselleria de Sanitat, contract "Simulación de las olas de calor e invasiones de frío y su regionalización en la Comunidad Valenciana" ("Heat wave and cold invasion simulation and their regionalization at Valencia Region"). The CEAM Foundation is supported by the Generalitat Valenciana and BANCAIXA (Valencia, Spain).

  17. Management of acute gastric varices bleeding

    Directory of Open Access Journals (Sweden)

    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  18. Serendipity in scintigraphic gastrointestinal bleeding studies

    International Nuclear Information System (INIS)

    Goergen, T.G.

    1983-01-01

    A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value

  19. The operative treatment of pressure sores in the pelvic region: A 10-year period overview.

    Science.gov (United States)

    Jósvay, János; Klauber, András; Both, Béla; Kelemen, Péter B; Varga, Zsombor Z; Pesthy, Pál Cs

    2015-07-01

    Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

  20. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. Improved carbon management with EU Regional Policy. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Schram, J. [Energies Demain, Montreuil Sous Bois (France); Amerighi, O. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Ten Donkelaar, M. [ENVIROS, Prague (Czech Republic)

    2013-03-15

    The CO2MPARE model supports national and regional authorities in making balanced decisions for their investment portfolio under their regional development programmes, in particular under their Operational Programmes of EU Regional Policy. The EU's climate objectives require that investments across the EU are channeled towards low-carbon development. The carbon impacts of investments should therefore be seriously considered in the decision making process of regional development programmes. The CO2MPARE model informs national and regional authorities on the impacts that the investments under various Operational Programmes can have in terms of CO2 emissions. Knowing which investments lead either to additional emissions or rather to emission reductions, and what the overall impact of a programme is, represents the first step towards investment decisions that have decarbonisation co-benefits. CO2MPARE estimates the combined carbon impact of all activities that take place under a programme, and provides insights into the relative contributions of the different themes. Through its high aggregation level, it allows comparison of investment scenarios rather than individual projects. As such, it aims to support informed decisions on investment strategies rather than project investment decisions. In doing so, it also helps to build and develop a 'carbon culture' within the authorities directly or indirectly in charge of managing Regional Policy Operational Programmes. The model is primarily aimed at Operational Programmes co-financed by the European Regional Development Fund (ERDF)

  1. Minor Bleeds Alert for Subsequent Major Bleeding in Patients Using Vitamin K Antagonists.

    OpenAIRE

    Veeger , Nic J.G.M.; Piersma-Wichers , Margriet; Meijer , Karina; Hillege , Hans L.

    2011-01-01

    Abstract Vitamin K antagonists (VKA) have shown to be effective in primary and secondary prevention of thromboembolism, but the associated risk of bleeding is an important limitation. The majority of the bleeds are clinically mild. In this study, we assessed whether these minor bleeds are associated with major bleeding, when controlling for other important risk indicators, including the achieved quality of anticoagulation. For this, 5898 patients of a specialised anticoagulation cl...

  2. Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

    Science.gov (United States)

    Kamo, Minobu; Fuwa, Sokun; Fukuda, Katsuyuki; Fujita, Yoshiyuki; Kurihara, Yasuyuki

    2016-07-01

    This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  3. Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

    Science.gov (United States)

    Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

    2015-12-01

    To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  4. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.

    Science.gov (United States)

    Lewis, B S; Wenger, J S; Waye, J D

    1991-02-01

    Intraoperative endoscopy (IOE) is accepted as the ultimate diagnostic procedure for completely evaluating the small bowel in patients with obscure gastrointestinal (GI) bleeding. Small bowel enteroscopy (SBE) has been reported useful in the nonsurgical evaluation of the small intestine in these patients, but findings may be limited because of incomplete small bowel intubation and a lack of tip deflection. Twenty-three patients underwent 25 SBE exams and subsequently had 25 IOE exams during surgical exploration for continued bleeding. Patients' bleeding histories averaged 2 yr, with an average transfusion requirement of 27 units. Findings on IOE were the same as with SBE in 17/22 (77%) of examinations. We conclude that SBE and IOE are comparable in depth of insertion and ability to detect small vascular ectasias. Both procedures missed pathology due to limited visibility and the evanescent nature of ectasias. Long-term success in abolishing bleeding with these combined techniques can be expected in 55% of these patients. SBE should precede surgery, since the finding of diffuse ectasias precludes any benefit from operative intervention.

  5. Is non-operative approach applicable for penetrating injuries of the left thoraco-abdominal region?

    Directory of Open Access Journals (Sweden)

    Osman Kones

    2016-03-01

    Full Text Available Objectives: Currently, diagnostic laparoscopy (DL is recommended for the left thoraco-abdominal region penetrating injuries (LTARP. However, organ and diaphragmatic injury may not be detected in all of these patients. Our aim is to focus on this LTARP patient group without any operative findings and to highlight the evaluation of diagnostic tools in the high-tech era for a possible selected conservative treatment. Material and methods: The patients who were admitted to ED due to LTARP, and who underwent routine DL were evaluated retrospectively in terms of demographic, clinical, radiological, and operative findings of the patients. Results: The current study included 79 patients with LTARP. In 44 of 79 patients, abdominal injury was not detected. In 30 patients an isolated diaphragmatic injury was revealed and in 4 patients a visceral injury was accompanying to diaphragmatic injury. Surgical findings revealed that the diaphragm was the organ most likely to sustain injury. In patients with more than one positive diagnostic findings need for surgery rate was 61.5%, however; in patients with one positive diagnostic finding (n = 53, positive surgical finding rate was only 35.8%, (p = 0.03. Regarding the combined use of all diagnostic tools in these patients; such as physical examination, plain chest X-ray, and computed tomography, when this method was used for pre-operative diagnosis, sensitivity was measured as 82.7%, specificity 84.1%, PPV 77.4% and NPV 88.1%. Conclusion: Although DL is reliable for diagnosis of diaphragmatic and visceral injury in patients with LTARP. However, individual decision making for laparoscopic intervention is needed to prevent morbidity of an unnecessary operation under emergent setting due to high rates of negative intraabdominal findings. Keywords: Wounds penetrating, Physical examination, Diagnostic imaging, Treatment outcome

  6. Comparative study of vaginal danazol vs diphereline (a synthetic GnRH agonist) in the control of bleeding during hysteroscopic myomectomy in women with abnormal uterine bleeding: a randomized controlled clinical trial.

    Science.gov (United States)

    Sayyah-Melli, M; Bidadi, S; Taghavi, S; Ouladsahebmadarek, E; Jafari-Shobeiri, M; Ghojazadeh, M; Rahmani, V

    2016-01-01

    To compare the usefulness of vaginal danazol and diphereline in the management of intra-operative bleeding during hysteroscopy. Randomized controlled clinical trial. University hospital. One hundred and ninety participants of reproductive age were enrolled for operative hysteroscopy. Thirty women were excluded from the study. One hundred and sixty participants with submucous myomas were allocated at random to receive either vaginal danazol (200mg BID, 30 days before surgery) or intramuscular diphereline (twice with a 28-day interval). Severity of intra-operative bleeding, clarity of the visual field, volume of media, operative time, success rate for completion of operation and postoperative complications. Overall, 145 patients completed the study. In the danazol group, 78.1% of patients experienced no intra-operative uterine bleeding, and 21.9% experienced mild bleeding. In the diphereline group, 19.4% of patients experienced no intra-operative uterine bleeding, but mild, moderate and severe bleeding was observed in 31.9%, 45.8% and 2.8% of patients, respectively. The difference between the groups was significant (puterine bleeding during operative hysteroscopy. However, vaginal danazol provided a clearer visual field. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Environmental and economic assessment of discharges from Gulf of Mexico Region Oil and Gas Operations

    International Nuclear Information System (INIS)

    Gettleson, D.A.

    1997-01-01

    Task 3 (Environmental Field Sampling and Analysis of NORM, Heavy Metals, and Organics) and 4 (Monitoring of the Recovery of Impacted Wetland and Open Bay Produced Water Discharge Sites in Coastal Louisiana and Texas) activities involved continued data analysis and report writing. Task 5 (Assessment of Economic Impacts of Offshore and Coastal Discharge Requirements on Present and Future Operations in the Gulf of Mexico Region) was issued as a final report during the previous reporting period. Task 6 (Synthesis of Gulf of Mexico Seafood Consumption and Use Patterns) activities included the preparation of the final report. There were no Task 7 (Technology Transfer Plan) activities to report. Task 8 (Project Management and Deliverables) activities involved the submission of the necessary reports and routine management

  8. The Increased Role of Regional Organizations in Peacekeeping and Effects on the United Nations Preeminence in Future Peace Operations

    National Research Council Canada - National Science Library

    Dhanoa, Birender

    2003-01-01

    .... The UN, drawn into a plethora of peacekeeping operations in the 1990s, has relied increasingly on regional organizations and alliances to take the lead in conflict resolution, especially for peace enforcement...

  9. Regional transportation operations collaboration and coordination : a primer for working together to improve transportation safety, reliability, and security

    Science.gov (United States)

    2002-01-01

    This primer was written for transportation professionals and public safety officials from cities, counties, and States who are responsible for day-to-day management and operations within a metropolitan region. It is intended to help agencies and orga...

  10. Experimental and clinical application of laser doppler flowmetry in gastric and duodenal ulcerative bleedings

    Directory of Open Access Journals (Sweden)

    Afanasieva G.A.

    2011-12-01

    Full Text Available The research goal is to develop a new objective diagnostic method of prerecurrence syndrome that will prognose bleeding recurrence from gastroduodenal ulcers. Materials and methods. Method of laser Doppler flowmetry (LDF of the regional perfusion of tissue has been used. The experimental part has been done on 30 white laboratory rats. Characteristics of regional tissue perfusion in the simulation and laser hemostasis of bleeding have been studied. Gastroduodenal endoscopy has been performed with laser Doppler flowmetry (ELDF in clinical conditions to predict the recurrence of ulcerative bleeding. The prognostic method of gastroduodenal ulcerative bleeding was used in 58 patients hospitalized with such pathology and activity of bleeding Forrest II. Results. The study of microcirculation parameters and experimental hemostasis has showed the possibility of using LDF to measure its performance. Effective hemostasis has been accompanied by a significant decrease in perfusion. On the basis of microcirculation parameters in ulcerative bleeding, medical adrenaline test has been proposed for an objective verification pre-recurrence syndrome. To evaluate the effectiveness of endoscopic hemostasis perfusion has been measured before and after its implementation. Conclusion. ELDF has objectified the prognosis of ulcerative bleeding recurrence, verified pre-recurrence syndrome and evaluated the efficacy of endoscopic hemostasis

  11. Helical CT in acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine; Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  12. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  13. Rectal bleeding in children: endoscopic evaluation revisited

    NARCIS (Netherlands)

    de Ridder, Lissy; van Lingen, Anna V.; Taminiau, Jan A. J. M.; Benninga, Marc A.

    2007-01-01

    Objectives Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. Study

  14. RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

    African Journals Online (AJOL)

    Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...

  15. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

    Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

  16. Embolization of a Hemorrhoid Following 18 Hours of Life-Threatening Bleeding

    International Nuclear Information System (INIS)

    Berczi, Viktor; Gopalan, Deepa; Cleveland, Trevor J

    2008-01-01

    Hemorrhoids usually do not pose diagnostic difficulties and they rarely cause massive bleeding. We report a case of massive rectal bleeding over 18 h needing 22 U blood transfusion treated by superselective transcatheter coil embolization 12 h following operative treatment performed in a different hospital. Diagnostic angiography with a view to superselective embolization, following failure of sigmoidoscopy to localize and treat the cause of hemorrhage, might act as a life-saving treatment in massive rectal bleeding, obviating the need for repeated endoscopy or emergency surgery

  17. TREATMENT OF ULCER GASTRODUODENAL BLEEDINGS: CURRENT STATE OF THE PROBLEM (A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    O. N. Antonov

    2014-01-01

    Full Text Available ABSTRACT. The problem of ulcer gastro-duodenal bleeding therapy is one of the most essential in urgent surgery. The bleeding is the most serious complication of peptic ulcer desease. It is observed in 15– 20% cases when patients have peptic ulcer diagnosis determined. In general the issues of bleeding therapy in gastroduodenal sphere are surveyed imperfectly. Some patulous endoscopic hemostasis methods don’t fully meet safety and confidence reqirements that preserves high level of general and post-operational lethality in our country and in the rest of the world. 

  18. A review of operational, regional-scale, chemical weather forecasting models in Europe

    Directory of Open Access Journals (Sweden)

    J. Kukkonen

    2012-01-01

    Full Text Available Numerical models that combine weather forecasting and atmospheric chemistry are here referred to as chemical weather forecasting models. Eighteen operational chemical weather forecasting models on regional and continental scales in Europe are described and compared in this article. Topics discussed in this article include how weather forecasting and atmospheric chemistry models are integrated into chemical weather forecasting systems, how physical processes are incorporated into the models through parameterization schemes, how the model architecture affects the predicted variables, and how air chemistry and aerosol processes are formulated. In addition, we discuss sensitivity analysis and evaluation of the models, user operational requirements, such as model availability and documentation, and output availability and dissemination. In this manner, this article allows for the evaluation of the relative strengths and weaknesses of the various modelling systems and modelling approaches. Finally, this article highlights the most prominent gaps of knowledge for chemical weather forecasting models and suggests potential priorities for future research directions, for the following selected focus areas: emission inventories, the integration of numerical weather prediction and atmospheric chemical transport models, boundary conditions and nesting of models, data assimilation of the various chemical species, improved understanding and parameterization of physical processes, better evaluation of models against data and the construction of model ensembles.

  19. Outcomes from the regional Co-operation in the Area of the Safety Analysis Methodology

    International Nuclear Information System (INIS)

    D'Auria, F.; Mavko, B.; Prosek, A.; Debrecin, N.; Bajs, T.

    2000-01-01

    International Atomic Energy Agency (IAEA) carried out the Co-ordinated Research Program (CRP) ON V alidation of Accident and Safety Analysis Methodology'' in the period between 1995 and 1998. Three areas of interest identified by the participants referred to the pressurised water reactors of Western and Eastern type (PWR and WWER type). The specific areas of attention were: system behaviour of the primary and secondary loops (PS area), the containment response (CO area) and the severe accidents (SA area). During the CRP it became clear that the technology advancements, the available tools (i.e. codes) and the experimental databases in the above areas are quite different. At the conclusion of the CRP, all objectives of the program have been reached. This paper presents the summary of the regional co-operation in this framework. The CRP activities focused on the codes and expertise available at the participating organisations. This overview therefore summarises their experience related to the state-of-the-art in the field of computational accident analysis. In addition, the paper proposes the recommendations for future activities related to the code usage, the user effects and code development. In pursuing of these goals special attention is given to the importance of the international co-operation. (author)

  20. Semi-Automatic Operational Service for Drought Monitoring and Forecasting in the Tuscany Region

    Directory of Open Access Journals (Sweden)

    Ramona Magno

    2018-02-01

    Full Text Available A drought-monitoring and forecasting system developed for the Tuscany region was improved in order to provide a semi-automatic, more detailed, timely and comprehensive operational service for decision making, water authorities, researchers and general stakeholders. Ground-based and satellite data from different sources (regional meteorological stations network, MODIS Terra satellite and CHIRPS/CRU precipitation datasets are integrated through an open-source, interoperable SDI (spatial data infrastructure based on PostgreSQL/PostGIS to produce vegetation and precipitation indices that allow following of the occurrence and evolution of a drought event. The SDI allows the dissemination of comprehensive, up-to-date and customizable information suitable for different end-users through different channels, from a web page and monthly bulletins, to interoperable web services, and a comprehensive climate service. The web services allow geospatial elaborations on the fly, and the geo-database can be increased with new input/output data to respond to specific requests or to increase the spatial resolution.

  1. Improved management of winter operations to limit subsurface contamination with degradable deicing chemicals in cold regions.

    Science.gov (United States)

    French, Helen K; van der Zee, Sjoerd E A T M

    2014-01-01

    This paper gives an overview of management considerations required for better control of deicing chemicals in the unsaturated zone at sites with winter maintenance operations in cold regions. Degradable organic deicing chemicals are the main focus. The importance of the heterogeneity of both the infiltration process, due to frozen ground and snow melt including the contact between the melting snow cover and the soil, and unsaturated flow is emphasised. In this paper, the applicability of geophysical methods for characterising soil heterogeneity is considered, aimed at modelling and monitoring changes in contamination. To deal with heterogeneity, a stochastic modelling framework may be appropriate, emphasizing the more robust spatial and temporal moments. Examples of a combination of different field techniques for measuring subsoil properties and monitoring contaminants and integration through transport modelling are provided by the SoilCAM project and previous work. Commonly, the results of flow and contaminant fate modelling are quite detailed and complex and require post-processing before communication and advising stakeholders. The managers' perspectives with respect to monitoring strategies and challenges still unresolved have been analysed with basis in experience with research collaboration with one of the case study sites, Oslo airport, Gardermoen, Norway. Both scientific challenges of monitoring subsoil contaminants in cold regions and the effective interaction between investigators and management are illustrated.

  2. Clopidogrel is not associated with major bleeding complications during peripheral arterial surgery.

    Science.gov (United States)

    Stone, David H; Goodney, Philip P; Schanzer, Andres; Nolan, Brian W; Adams, Julie E; Powell, Richard J; Walsh, Daniel B; Cronenwett, Jack L

    2011-09-01

    Persistent variation in practice surrounds preoperative clopidogrel management at the time of vascular surgery. While some surgeons preferentially discontinue clopidogrel citing a perceived risk of perioperative bleeding, others will proceed with surgery in patients taking clopidogrel for an appropriate indication. The purpose of this study was to determine whether preoperative clopidogrel use was associated with significant bleeding complications during peripheral arterial surgery. We reviewed a prospective regional vascular surgery registry recorded by 66 surgeons from 15 centers in New England from 2003 to 2009. Preoperative clopidogrel use within 48 hours of surgery was analyzed among patients undergoing carotid endarterectomy (CEA), lower extremity bypass (LEB), endovascular abdominal aortic aneurysm repair (EVAR), and open abdominal aortic aneurysm repair (oAAA). Ruptured AAAs were excluded. Endpoints included postoperative bleeding requiring reoperation, as well as the incidence and volume of blood transfusion. Statistical analysis was performed using analysis of variance, Fisher exact, χ(2), and Wilcoxon rank-sum tests. Over the study interval, a total of 10,406 patients underwent surgery, including 5264 CEA, 2883 LEB, 1125 EVAR, and 1134 oAAA repair. Antiplatelet use among all patients varied, with 19% (n = 2010) taking no antiplatelet agents, 69% (n = 7132) taking aspirin (ASA) alone, 2.2% (n = 229) taking clopidogrel alone, and 9.7% (n = 1017) taking both ASA and clopidogrel. Clopidogrel alone or as dual antiplatelet therapy was most frequently used prior to CEA and least frequently prior to oAAA group (CEA 16.1%, LEB 9.0%, EVAR 6.5%, oAAA 5%). Reoperation for bleeding was not significantly different among patients based on antiplatelet regimen (none 1.5%, ASA 1.3%, clopidogrel 0.9%, ASA/clopidogrel 1.5%, P = .74). When analyzed by operation type, no difference in reoperation for bleeding was seen across antiplatelet regimens. There was also no

  3. Modeling the wind-fields of accidental releases with an operational regional forecast model

    International Nuclear Information System (INIS)

    Albritton, J.R.; Lee, R.L.; Sugiyama, G.

    1995-01-01

    The Atmospheric Release Advisory Capability (ARAC) is an operational emergency preparedness and response organization supported primarily by the Departments of Energy and Defense. ARAC can provide real-time assessments of atmospheric releases of radioactive materials at any location in the world. ARAC uses robust three-dimensional atmospheric transport and dispersion models, extensive geophysical and dose-factor databases, meteorological data-acquisition systems, and an experienced staff. Although it was originally conceived and developed as an emergency response and assessment service for nuclear accidents, the ARAC system has been adapted to also simulate non-radiological hazardous releases. For example, in 1991 ARAC responded to three major events: the oil fires in Kuwait, the eruption of Mt. Pinatubo in the Philippines, and the herbicide spill into the upper Sacramento River in California. ARAC's operational simulation system, includes two three-dimensional finite-difference models: a diagnostic wind-field scheme, and a Lagrangian particle-in-cell transport and dispersion scheme. The meteorological component of ARAC's real-time response system employs models using real-time data from all available stations near the accident site to generate a wind-field for input to the transport and dispersion model. Here we report on simulation studies of past and potential release sites to show that even in the absence of local meteorological observational data, readily available gridded analysis and forecast data and a prognostic model, the Navy Operational Regional Atmospheric Prediction System, applied at an appropriate grid resolution can successfully simulate complex local flows

  4. Use of tranexamic acid for controlling bleeding in thoracolumbar scoliosis surgery with posterior instrumentation

    Directory of Open Access Journals (Sweden)

    Vinícius Magno da Rocha

    2015-04-01

    Full Text Available OBJECTIVE: Scoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients' bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis.METHODS: This was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups.RESULTS: The group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion.CONCLUSIONS: Tranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss.

  5. Numerical simulations of heat transfer distribution of a two-pass square channel with V-rib turbulator and bleed holes

    Science.gov (United States)

    Kumar, Sourabh; Amano, R. S.; Lucci, Jose Martinez

    2013-08-01

    The blade tip region in gas turbine encounters high thermal loads due to temperature difference and hence efforts for high durability and safe operations are essential. Improved and robust methods of cooling are required to downgrade heat transfer rate to turbine blades. The blade tip regions, which are exposed to high gas flow, suffers high local thermal load which are due to external tip leakage. Jet impingement, pin cooling etc. are techniques used for cooling blades. A more usual way is to use serpentine passage with 180-degree turn. In this study, numerical simulation of heat transfer distribution of a two-pass square channel with rib turbulators and bleed holes were done. Periodical rib turbulators and bleed holes were used in the channel. The ribs arrangement were 60 degree V rib, 60 degree inverted V ribs, combination of 60 degree V rib at inlet and 60 inverted V rib at outlet section and combination of Inverted V at inlet and V rib at the outlet. The results were numerically computed using Fluent with Reynolds number of 12,500 and 28,500. Turbulence models used for computations were k-ω-SST and RSM. Temperature based and shear stress based techniques were used for heat transfer distribution prediction. The results for 60 degree V rib, 60 degree inverted V ribs were compared with the experimental results for validation of the results obtained. Detailed distribution shows distinctive peaks in heat transfer around bleed holes and rib turbulator. Comparisons of the overall performance of the models with different orientation of rib turbulator are presented. It is found that due to the combination of 60 degree inverted V rib in inlet and 60 V rib in outlet with bleed holes provides better heat treatment. It is suggested that the use of rib turbulator with bleed holes provides suitable for augmenting blade cooling to achieve an optimal balance between thermal and mechanical design requirements.

  6. AROME-Arctic: New operational NWP model for the Arctic region

    Science.gov (United States)

    Süld, Jakob; Dale, Knut S.; Myrland, Espen; Batrak, Yurii; Homleid, Mariken; Valkonen, Teresa; Seierstad, Ivar A.; Randriamampianina, Roger

    2016-04-01

    substitute our actual operational Arctic mesoscale HIRLAM (High Resolution Limited Area Model) NWP model. This presentation will discuss in detail the operational implementation of the AROME-Arctic model together with post-processing methods. Aimed services in the Arctic region covered by the model, such as online weather forecasting (yr.no) and tracking of polar lows (barentswatch.no), is also included.

  7. 78 FR 19879 - Final Order in Response to a Petition From Certain Independent System Operators and Regional...

    Science.gov (United States)

    2013-04-02

    ...'') \\1\\ from certain regional transmission organizations (``RTOs'') and independent system operators... include three RTOs (Midwest Independent Transmission System Operator, Inc. (``MISO''); ISO New England..., responsibilities and services of ISOs and RTOs are substantially similar.\\29\\ As described in the Proposed Order...

  8. Whipple's operation for carcinoma of the pancreatic head and the ampullary region. Short-and long-term results

    DEFF Research Database (Denmark)

    Sørensen, M B; Banner, Jytte; Rokkjaer, M

    1998-01-01

    In this retrospective review short- and long-term perspectives have been evaluated for 108 patients who, during 1982 through 1992, had Whipple's operation performed for carcinoma of the pancreatic head (PC, n=63) or the ampullary region (AC, n=45). In 24 patients the operation was not radical (21...

  9. Experience with WASP and MAED among IAEA Member States participating in the Regional Co-operative Agreement (RCA) in Asia and the Pacific Region

    International Nuclear Information System (INIS)

    1989-10-01

    The report includes the proceedings and papers presented during the workshop on the experience with WASP/MAED computer programs among IAEA Member States participating in the regional co-operative agreement (RCA) in Asia and the Pacific Region, organized by the IAEA and held in Kuala Lumpur (Malaysia) between 5-9 December 1988. A separate abstract was prepared for each of the 14 papers presented. Refs, figs and tabs

  10. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations; Teksty Soglashenij o Sotrudnichestve Mezhdu Agentstvom i Regional 'Nymi Mezhpravitel' Stvennymi Organizacijami

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1961-02-07

    The texts of the Agency's agreements for co-operation with the regional inter-governmental organizations listed below, together with the respective protocols authenticating them, are reproduced in this document in the order in which the agreements entered into force, for the information of all Members of the Agency [Russian] Teksty soglashenii Agentstva o sotrudnichestve s perechislennymi nizhe regional'nymi mezhpravitel'stvennymi organizacijami vmeste s sootvetstvujushhimi protokolami, udostoverjajushhimi ih autentichnost'; soglashenija perechisleny v porjadke vstuplenija ih v silu.

  11. Mortality and need of surgical treatment in acute upper gastrointestinal bleeding: a one year study in a tertiary center with a 24 hours / day-7 days / week endoscopy call. Has anything changed?

    Science.gov (United States)

    Botianu, Am; Matei, D; Tantau, M; Acalovschi, M

    2013-01-01

    Acute upper gastrointestinal bleeding, previously often a surgical problem, is now the most common gastroenterological emergency. To evaluate the current situation in terms of mortality and need of surgery. Retrospective non-randomised clinical study performed between 1st January-31st December 2011, at "Professor Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology in Cluj Napoca. 757 patients with upper gastrointestinal bleeding were endoscopically examined within 24 hours from presentation in the emergency unit. Data were collected from admission charts and Hospital Manager programme. Statistical analysis was performed with GraphPad 2004, using the following tests: chi square, Spearman, Kruskall-Wallis, Mann-Whitney, area under receiver operating curve. Non-variceal etiology was predominant, the main cause was bleeding being peptic ulcer. In hospital global mortality was of 10.43%, global rebleeding rate was 12.02%, surgery was performed in 7.66% of patients. Urgent haemostatic surgery was needed in 3.68% of patients with nonvariceal bleeding. The need for surgery correlated with the postendoscopic Rockall score (p=0.0425). In peptic ulcer, the need for surgery was not influenced by time to endoscopy or type of treatment (p=0.1452). Weekend (p=0.996) or night (p=0.5414) admission were not correlated with a higher need for surgery. Over the last decade, the need for urgent surgery in upper gastrointestinal bleeding has decreased by half, but mortality has remained unchanged. Celsius.

  12. CO{sub 2}MPARE. CO2 Model for Operational Programme Assessment in EU Regions. User Tutorial

    Energy Technology Data Exchange (ETDEWEB)

    Hekkenberg, M. [ECN Policy Studies, Amsterdam (Netherlands); Vincent-Genod, C. [Energies Demain, Montreuil Sous Bois (France); Regina, P. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Keppo, I. [University College London UCL, London (United Kingdom); Papagianni, S. [Centre for Renewable Energy Sources and Saving CRES, Pikermi Attiki (Greece); Harnych, J. [ENVIROS, Prague (Czech Republic)

    2013-03-15

    The CO2MPARE model supports national and regional authorities in making balanced decisions for their investment portfolio under their regional development programmes, in particular under their Operational Programmes of EU Regional Policy. This document is a tutorial for users of the CO2MPARE model and provides step by step guidance on the different functionalities of the model for both basic and expert users.

  13. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  14. Assessment of a water hydraulics joint for RH operations in the divertor region

    International Nuclear Information System (INIS)

    Dubus, G.; David, O.; Measson, Y.; Friconneau, J.P.

    2007-01-01

    Due to the high level of radiations, all the nominal maintenance in the divertor region of ITER will be carried out with help of robotic means. In reduced volumes, hydraulic applications can provide powerful actuators. They become an interesting technology to build a heavy duty manipulator for operations in space constrained areas. Oil hydraulics can not ensure the cleanliness level required for all maintenance operations in the vacuum vessel. Therefore, pure water hydraulics proposes a good alternative to oil and developments are today focusing on that direction. Although basic hydraulic elements like pumps, on-off valves, filters running with pure water are already available on the market, actuators are not so many and generally limited to linear motions. Fine control of the joint is achieved with help of servovalves. Today's off the shelf products are only adaptations from standard oil servovalves and are not specifically designed for water use. Operational experience for these products shows short lifetime expectancy and could not last a complete shutdown. Starting from the oil hydraulic version CEA with help of Cybernetix redesigned for water applications the elbow vane actuator of a Maestro arm, a six-degrees-of-freedom hydraulic manipulator used in decommissioning activities. In parallel with help of In-LHC, CEA developed a servovalve for water hydraulic applications that fits the space constraints of a Maestro manipulator. This prototype is a pressure-control valve. To a current input this servovalve supplies a very accurate pressure difference output instead of a flow rate in the case of flow control servovalve that are generally used in that kind of applications. The advantage is the improvement of the performances and stability of the force control loop. This paper presents the performances of the modified vane actuator and its servovalve. Both static and dynamic responses of the servovalve prototype with and without actuator are presented. Position and

  15. Assessment of a water hydraulics joint for RH operations in the divertor region

    Energy Technology Data Exchange (ETDEWEB)

    Dubus, G.; David, O.; Measson, Y.; Friconneau, J.P. [CEA LIST, Interactive Robotics Unit (France)

    2007-07-01

    Due to the high level of radiations, all the nominal maintenance in the divertor region of ITER will be carried out with help of robotic means. In reduced volumes, hydraulic applications can provide powerful actuators. They become an interesting technology to build a heavy duty manipulator for operations in space constrained areas. Oil hydraulics can not ensure the cleanliness level required for all maintenance operations in the vacuum vessel. Therefore, pure water hydraulics proposes a good alternative to oil and developments are today focusing on that direction. Although basic hydraulic elements like pumps, on-off valves, filters running with pure water are already available on the market, actuators are not so many and generally limited to linear motions. Fine control of the joint is achieved with help of servovalves. Today's off the shelf products are only adaptations from standard oil servovalves and are not specifically designed for water use. Operational experience for these products shows short lifetime expectancy and could not last a complete shutdown. Starting from the oil hydraulic version CEA with help of Cybernetix redesigned for water applications the elbow vane actuator of a Maestro arm, a six-degrees-of-freedom hydraulic manipulator used in decommissioning activities. In parallel with help of In-LHC, CEA developed a servovalve for water hydraulic applications that fits the space constraints of a Maestro manipulator. This prototype is a pressure-control valve. To a current input this servovalve supplies a very accurate pressure difference output instead of a flow rate in the case of flow control servovalve that are generally used in that kind of applications. The advantage is the improvement of the performances and stability of the force control loop. This paper presents the performances of the modified vane actuator and its servovalve. Both static and dynamic responses of the servovalve prototype with and without actuator are presented. Position

  16. Fatiguing effect of multiple take-offs and landings in regional airline operations.

    Science.gov (United States)

    Honn, Kimberly A; Satterfield, Brieann C; McCauley, Peter; Caldwell, J Lynn; Van Dongen, Hans P A

    2016-01-01

    Fatigue is a risk factor for flight performance and safety in commercial aviation. In US commercial aviation, to help to curb fatigue, the maximum duration of flight duty periods is regulated based on the scheduled start time and the number of flight segments to be flown. There is scientific support for regulating maximum duty duration based on scheduled start time; fatigue is well established to be modulated by circadian rhythms. However, it has not been established scientifically whether the number of flight segments, per se, affects fatigue. To address this science gap, we conducted a randomized, counterbalanced, cross-over study with 24 active-duty regional airline pilots. Objective and subjective fatigue was compared between a 9-hour duty day with multiple take-offs and landings versus a duty day of equal duration with a single take-off and landing. To standardize experimental conditions and isolate the fatiguing effect of the number of segments flown, the entire duty schedules were carried out in a high-fidelity, moving-base, full-flight, regional jet flight simulator. Steps were taken to maintain operational realism, including simulated airplane inspections and acceptance checks, use of realistic dispatch releases and airport charts, real-world air traffic control interactions, etc. During each of the two duty days, 10 fatigue test bouts were administered, which included a 10-minute Psychomotor Vigilance Test (PVT) assessment of objective fatigue and Samn-Perelli (SP) and Karolinska Sleepiness Scale (KSS) assessments of subjective sleepiness/fatigue. Results showed a greater build-up of objective and subjective fatigue in the multi-segment duty day than in the single-segment duty day. With duty start time and duration and other variables that could impact fatigue levels held constant, the greater build-up of fatigue in the multi-segment duty day was attributable specifically to the difference in the number of flight segments flown. Compared to findings in

  17. Postpartum bleeding: efficacy of endovascular management

    International Nuclear Information System (INIS)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

    2003-01-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding

  18. Postpartum bleeding: efficacy of endovascular management

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

    2003-06-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

  19. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  20. THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

    Science.gov (United States)

    Brummel-Ziedins, Kathleen E.; Whelihan, Matthew F.; Gissel, Matthew; Mann, Kenneth G.; Rivard, Georges E.

    2012-01-01

    Introduction Hemophilia A displays phenotypic heterogeneity with respect to clinical severity. Aim To determine if tissue factor (TF)-initiated thrombin generation profiles in whole blood in the presence of corn trypsin inhibitor (CTI) are predictive of bleeding risk in hemophilia A. Methods We studied factor(F) VIII deficient individuals (11 mild, 4 moderate and 12 severe) with a well-characterized five-year bleeding history that included hemarthrosis, soft tissue hematoma and annual FVIII concentrate usage. This clinical information was used to generate a bleeding score. The bleeding scores (range 0–32) were separated into three groups (bleeding score groupings: 0, 0 and ≤9.6, >9.6), with the higher bleeding tendency having a higher score. Whole blood collected by phlebotomy and contact pathway suppressed by 100μg/mL CTI was stimulated to react by the addition of 5pM TF. Reactions were quenched at 20min by inhibitors. Thrombin generation, determined by ELISA for thrombin – antithrombin was evaluated in terms of clot time (CT), maximum level (MaxL) and maximum rate (MaxR) and compared to the bleeding score. Results Data are shown as the mean±SD. MaxL was significantly different (phemophilia A. PMID:19563500

  1. Predictors of postoperative bleeding after vitrectomy for vitreous hemorrhage in patients with diabetic retinopathy.

    Science.gov (United States)

    Motoda, Saori; Shiraki, Nobuhiko; Ishihara, Takuma; Sakaguchi, Hirokazu; Kabata, Daijiro; Takahara, Mitsuyoshi; Kimura, Takekazu; Kozawa, Junji; Imagawa, Akihisa; Nishida, Kohji; Shintani, Ayumi; Iwahashi, Hiromi; Shimomura, Iichiro

    2017-12-19

    To clarify the association between perioperative variables and postoperative bleeding in pars plana vitrectomy for vitreous hemorrhage in diabetic retinopathy. The present retrospective study enrolled 72 eyes of 64 patients who were admitted to Osaka University Hospital between April 2010 and March 2014, and underwent vitrectomy for vitreous hemorrhage as a result of diabetic retinopathy. Postoperative bleeding developed in 12 eyes. Using binomial logistic regression analysis, we found that the duration of operation was the only significant variable associated with postoperative bleeding within 12 weeks after vitrectomy. Furthermore, Poisson regression analysis identified fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs, as well as duration of operation, to be significantly associated with the frequency of bleeding within 52 weeks after vitrectomy. Long duration of operation can be used to predict bleeding within both 12 and 52 weeks after vitrectomy. In addition, fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs might be risk factors for postoperative bleeding up to 1 year after vitrectomy. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

  2. Processing covariance data for the resonance region - International Evaluation Co-operation, V. 20

    International Nuclear Information System (INIS)

    Dunn, M.; Leal, L.C.; Wiarda, D.; Jacqmin, R.; Kodeli, I.; ); Chiba, G.; Shibata, K.; Ishikawa, M.; Oh, S.; Nikolaev, M.; Kahler, A.C. Jr.; Kawano, T.; Arcilla, R.

    2014-01-01

    A Working Party on International Evaluation Co-operation (WPEC) was established under the sponsorship of the OECD/NEA Nuclear Science Committee (NSC) to promote the exchange of information on nuclear data evaluations, validation, and related topics. Its aim is also to provide a framework for co-operative activities between members of the major nuclear data evaluation projects. Requirements for experimental data resulting from this activity are compiled. The working party determines common criteria for evaluated nuclear data files with a view to assessing and improving the quality and completeness of evaluated data. The parties to the project are ENDF (United States), JEF/EFF (NEA Data Bank member countries), and JENDL (Japan). Cooperation with evaluation projects of non- OECD countries is organized through the Nuclear Data Section of the International Atomic Energy Agency (IAEA). This report summarizes the work performed by WPEC Subgroup 28 (SG28) on issues pertinent to the methodology used to process covariance data in the resonance region. Specifically, SG28 has developed the requisite processing methods needed to process resonance parameter covariance data, generate cross-section covariance data files and demonstrate the use of covariance data in radiation transport analyses. The work performed by SG28 and documented in this report addresses the following tasks: - Produce resonance parameter covariance evaluation for 235 U; - Develop resonance parameter covariance processing methods in widely used processing systems (e.g., NJOY, AMPX, etc.); - Use the updated cross-section processing systems to generate covariance data files for use in radiation transport analyses. In addition, use sensitivity/uncertainty (S/U) analyses to demonstrate the propagation of the covariance data in specific radiation transport applications

  3. The Korean Peninsula Energy Development Organization : implications for Northeast Asian regional security co-operation?

    International Nuclear Information System (INIS)

    Snyder, S.

    2000-01-01

    This paper identifies opportunities for co-operation on regional development and security in the North Pacific region. The Korean Peninsula Energy Development Organization (KEDO) was created in 1993 during bilateral negotiations between the United States and the Democratic People's Republic of Korea (US-DPRK) over North Korea's alleged nuclear weapons program. The negotiations resulted in an agreement to freeze North Korea's known nuclear weapons program in return for the construction of two proliferation-resistant 100 MWe light water reactors (LWR) in North Korea, and the provision of 500,000 tons of heavy fuel oil per year until the completion of the LWR construction as compensation for lost energy production capacity resulting from the shutting down of North Korea's nuclear reactors. The author described the activities of KEDO and examined its internal dynamics. The unique circumstances that produced the Agreed Framework and KEDO in response to a major international crisis of the nuclear program in the DPRK were also highlighted along with the US-DPRK bilateral agreement and the multilateral institution involving the United States, South Korea, Japan and the European Union. Financial support from Australia and Canada was discussed along with the mechanism for engaging North Korea in regularized interaction and technical cooperation. It was concluded that KEDO's record of successes and failures is mixed. The energy security issue has been identified as an area that could result in conflict among Northeast Asian countries which are increasingly dependent on oil supplies from the Middle East. In response, numerous multilateral financing mechanisms have been developed to promote joint business opportunities that exploit natural gas resources in the Russian Far East to address Japanese, Korean and Chinese energy needs. 35 refs

  4. Applying micro scales of horizontal axis wind turbines for operation in low wind speed regions

    International Nuclear Information System (INIS)

    Pourrajabian, Abolfazl; Ebrahimi, Reza; Mirzaei, Masoud

    2014-01-01

    Highlights: • Three micro-turbines with output power less than 1 kW were designed for operation in low wind speed regions. • In addition to the output power, starting time was considered as a key parameter during the design. • The effects of generator resistive torque and number of blades on the performance of the turbines were investigated. - Abstract: Utilizing the micro scales of wind turbines could noticeably supply the demand for the electricity in low wind speed regions. Aerodynamic design and optimization of the blade, as a main part of a wind turbine, were addressed in the study. Three micro scales of horizontal axis wind turbines with output power of 0.5, 0.75 and 1 kW were considered and the geometric optimization of the blades in terms of the two involved parameters, chord and twist, was undertaken. In order to improve the performance of the turbines at low wind speeds, starting time was included in an objective function in addition to the output power – the main and desirable goal of the wind turbine blade design. A purpose-built genetic algorithm was employed to maximize both the output power and the starting performance which were calculated by the blade-element momentum theory. The results emphasize that the larger values of the chord and twist at the root part of the blades are indispensable for the better performance when the wind speed is low. However, the noticeable value of the generator resistive torque could largely delay the starting of the micro-turbines especially for the considered smaller size, 0.5 kW, where the starting aerodynamic torque could not overcome the generator resistive torque. For that size, an increase in the number of blades improved both the starting performance and also output power

  5. [The causes of recurrent ulcerative gastroduodenal bleeding].

    Science.gov (United States)

    Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

    To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

  6. Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2015-05-28

    To distinguish upper from lower gastrointestinal (GI) bleeding. Patient records between April 2011 and March 2014 were analyzed retrospectively (3296 upper endoscopy, and 1520 colonoscopy). Seventy-six patients had upper GI bleeding (Upper group) and 65 had lower GI bleeding (Lower group). Variables were compared between the groups using one-way analysis of variance. Logistic regression was performed to identify variables significantly associated with the diagnosis of upper vs lower GI bleeding. Receiver-operator characteristic (ROC) analysis was performed to determine the threshold value that could distinguish upper from lower GI bleeding. Hemoglobin (P = 0.023), total protein (P = 0.0002), and lactate dehydrogenase (P = 0.009) were significantly lower in the Upper group than in the Lower group. Blood urea nitrogen (BUN) was higher in the Upper group than in the Lower group (P = 0.0065). Logistic regression analysis revealed that BUN was most strongly associated with the diagnosis of upper vs lower GI bleeding. ROC analysis revealed a threshold BUN value of 21.0 mg/dL, with a specificity of 93.0%. The threshold BUN value for distinguishing upper from lower GI bleeding was 21.0 mg/dL.

  7. IMPACT ANALYSIS OF LEGISLATIVE AND INSTITUTIONAL FRAMEWORK ON THE POLICY FOR REGIONAL DEVELOPMENT IN THE LIGHT OF THE REGIONAL OPERATIONAL PROGRAMME

    Directory of Open Access Journals (Sweden)

    Popescu (Stîngaciu Ana-Maria

    2012-12-01

    Full Text Available The analysis of the administrative capacity of institutions in the regional development starts from the analysis of the existing framework for the implementation of regional politics in Romania and studies the extent to what the structures and competencies were regionally enlarged as to contribute in the regional development. The basic hypothesis considered for such analysis had in view the fact that the differences recorded with respect to the implementation capacity of the regional development policy are caused by the various levels of the administrative capacity of the national, regional and local institutions existent in Romania. Although the regional development activity is, both centrally and regionally, dominated by the Regional Operational Programmme 2007-2013 (ROP implementation, significant activity also exists outside the ROP, but only regionally. The regional strategies incorporate to a great extent the strategic objectives established nationally, being coordinated with the national financing instruments for economic, social and territorial development. The undertaking degree of responsibilities regarding the objectives fulfillment of the regional development policy is relatively low both regionally and locally, and the main indicator which contributes in sustaining this conclusion is the absence of an adequate level regarding the property holding on certain strategies and also the methodological lack of strategies. Nationally, the current activity of Ministry of Regional Development and Tourism in the field of regional development totally overlaps the management activity of ROP. The management of structural funds 2007-2013 granted through ROP deals with various situations in which, due to the fact that the Law of regional development remained behind the legislation for the structural instruments implementation in Romania, additional resources are necessary to be granted in order to be found solutions through other types of

  8. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  9. Scintigraphic demonstration of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Alavi, A.

    1980-01-01

    Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

  10. 75 FR 81157 - Version One Regional Reliability Standard for Transmission Operations

    Science.gov (United States)

    2010-12-27

    ... not exceed the path's system operating limits, when the transmission operator implements its real-time... return the actual power flow to within [system operating limits] such that at no time shall the power... return the transmission system to within [system operating limits] within a time certain, only a...

  11. Operation Sadbhavana: winning hearts and minds in the Ladakh Himalayan region.

    Science.gov (United States)

    Cariappa, Mudera P; Bonventre, Eugene V; Mohanti, Bikash K

    2008-08-01

    "Sadbhavana" literally means "goodwill among people." The Indian Army has evolved a military strategy of winning hearts and minds, with this being just a phase in the broader war on terror. We have focused on actions to address the border regions of Ladakh in the Himalayas. The government of India strives against difficult conditions to provide essential services (including health care) to its population in an equitable manner; in remote areas with fragile security and hamstrung provincial government systems, the Indian Army fills this role. The Army's medical units have played a pivotal role in providing comprehensive health care as a keystone of the strategy. The endeavors of the doctors in uniform have succeeded in winning over an alienated population. A total of 163 medical camps were held in 2004, with attendance of 14,050 patients seeking medical attention and 264 patients seeking dental attention; in 2005, 87 camps were conducted, with attendance totals of 7,562 and 559, respectively. The Operation Sadbhavana military strategy has paid rich dividends in the form of changes in the perspective of the denizens of the remote and exotic locales of Ladakh. Planners must carefully analyze the target audiences and the messages delivered to those audiences at the onset of such projects. Future efforts would be enhanced by attempts to quantify the effects of medical missions on the health of the population and on population attitudes toward the Indian Army and the central government.

  12. Receiver operating characteristic analysis of regional cerebral blood flow in Alzheimer's disease

    International Nuclear Information System (INIS)

    Zemcov, A.; Barclay, L.L.; Sansone, J.; Metz, C.E.

    1985-01-01

    Receiver operating characteristic (ROC) curves were used to quantitatively assess the ability of individual detectors in a 32-detector 133 Xe inhalation system to discriminate between two populations over the range of regional cerebral blood flow (rCBF) values. These populations were clinically evaluated as normal (age 63.1 +/- 13.1, n = 23) and presumed Alzheimer's disease (age 72.7 +/- 7.0, n = 82). Summary statistics showed that for homologous detectors the average value of blood flow in the normal group was greater than the flow value in the group of subjects with Alzheimer's disease. Conclusions drawn from single values of flow or mean hemispheric flow can lead to erroneous conclusions about hemisphere asymmetries. However, the dynamic relationship between the correct identifications (true positives) compared with incorrect identifications (false positives) of Alzheimer's disease at each detector varies over the range of blood flow values, and quantitative characterization of this relationship in terms of an ROC curve provides more insight into the structure of the data. Detectors approximating the speech, auditory and association cortex were most effective in discriminating between groups. Frontal detectors were marginally useful diagnostically

  13. Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery.

    Science.gov (United States)

    Nielsen, Alexander W; Helm, Melissa C; Kindel, Tammy; Higgins, Rana; Lak, Kathleen; Helmen, Zachary M; Gould, Jon C

    2018-05-01

    Morbidly obese patients are at increased risk for venous thromboembolism (VTE) after bariatric surgery. Perioperative chemoprophylaxis is used routinely with bariatric surgery to decrease the risk of VTE. When bleeding occurs, routine chemoprophylaxis is often withheld due to concerns about inciting another bleeding event. We sought to evaluate the relationship between perioperative bleeding and postoperative VTE in bariatric surgery. The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) dataset between 2012 and 2014 was queried to identify patients who underwent bariatric surgery. Gastric bypass (n = 28,145), sleeve gastrectomy (n = 30,080), bariatric revision (n = 324), and biliopancreatic diversion procedures (n = 492) were included. Univariate and multivariate regressions were used to determine perioperative factors predictive of postoperative VTE within 30 days in patients who experience a bleeding complication necessitating transfusion. The rate of bleeding necessitating transfusion was 1.3%. Bleeding was significantly more likely to occur in gastric bypass compared to sleeve gastrectomy (1.6 vs. 1.0%) (p surgeries, increased age, length of stay, operative time, and comorbidities including hypertension, dyspnea with moderate exertion, partially dependent functional status, bleeding disorder, transfusion prior to surgery, ASA class III/IV, and metabolic syndrome increased the perioperative bleeding risk (p Bariatric surgery patients who receive postoperative blood transfusion are at a significantly increased risk for VTE. The etiology of VTE in those who are transfused is likely multifactorial and possibly related to withholding chemoprophylaxis and the potential of a hypercoagulable state induced by the transfusion. In those who bleed, consideration should be given to reinitiating chemoprophylaxis when safe, extending treatment after discharge, and screening ultrasound.

  14. Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

    Science.gov (United States)

    Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

    2014-01-01

    Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  15. Pelvic artery embolization in gynecological bleeding

    International Nuclear Information System (INIS)

    Hausegger, K.A.; Schreyer, H.; Bodhal, H.

    2002-01-01

    The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [de

  16. AL Amyloidosis Complicated by Persistent Oral Bleeding

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Liarte Marconcini

    2015-01-01

    Full Text Available A case of amyloid light chain (AL amyloidosis is presented here with uncontrolled bleeding after a nonsurgical dental procedure, most likely multifactorial in nature, and consequently treated with a multidisciplinary approach.

  17. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... are many possible causes of GI bleeding, including hemorrhoids , peptic ulcers , tears or inflammation in the esophagus, ... blood Show More Show Less Related Health Topics Hemorrhoids Peptic Ulcer National Institutes of Health The primary ...

  18. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding

    Directory of Open Access Journals (Sweden)

    Shakhawan H.A. Said

    2017-03-01

    Conclusion: According to our present results stone complexity (GSS grade 3 and 4, history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

  19. Intrathoracic Gastric Volvulus presenting with GIT Bleed

    OpenAIRE

    Rahul Kadam; VSV Prasad

    2017-01-01

    Intrathoracic gastric volvulus in neonatal period is a life-threatening surgical emergency. We report a case of neonate with respiratory distress and GI bleeding who was diagnosed to have congenital diaphragmatic eventration with Intrathoracic gastric volvulus.

  20. Transfusion strategy for acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Handel, James; Lang, Eddy

    2015-09-01

    Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

  1. Upper gastrointestinal bleeding in irbid, jordan

    International Nuclear Information System (INIS)

    Banisalamah, A.A.; Mraiat, Z.M.

    2007-01-01

    To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

  2. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...

  3. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.

  4. Development of optimal management of upper gastrointestinal bleeding secondary to pancreatic sinistral portal hypertension

    Directory of Open Access Journals (Sweden)

    SONG Yang

    2014-08-01

    Full Text Available The pathogenesis of pancreatic sinistral portal hypertension (PSPH is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension. Gastric variceal bleeding is a less common manifestation of PSPH; however, it probably exacerbates the patient’s condition and leads to critical illness, and inappropriate management would result in death. Therefore, it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients. Splenectomy is considered as a definitive procedure, together with surgical procedures to treat underlying pancreatic diseases. For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second-stage operation. The therapeutic decision should be made individually, and the further multi-center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.

  5. Comparative efficiency of endoscopic hemostasis methods in bleeding undercomplicated peptic ulcer in children

    Directory of Open Access Journals (Sweden)

    Сергій Олександрович Сокольник

    2015-05-01

    Full Text Available Aim. To compare the effectiveness of endoscopic hemostasis in complex treatment of gastrointestinal bleeding in children of Chernovtsy region with peptic ulcer disease.Methods. 43 cases of bleeding in peptic ulcer disease in children are analyzed. Argon plasma coagulation is undergone in order to stop the bleeding for 11 patients, for others – aminocaproic acid irrigation.Results. Using argon plasma coagulation, in contrast to the aminocaproic acid irrigation reduces the risk of rebleeding 0.59 times when the number of patients who must be treated – 2.99.Conclusions. The most effective method of endoscopic hemostasis of bleeding in peptic ulcer disease in children is argon plasma coagulation, which allows you to achieve a stable hemostasis and reduce the risk of rebleeding

  6. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.

    Science.gov (United States)

    Loor, Gabriel; Vivacqua, Alessandro; Sabik, Joseph F; Li, Liang; Hixson, Eric D; Blackstone, Eugene H; Koch, Colleen G

    2013-11-01

    High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding. From January 1, 2011, through June 30, 2012, 5812 cardiac surgical procedures were performed at Cleveland Clinic (Cleveland, OH). A multidisciplinary team developed a simple, easy-to-perform hemostasis checklist based on the most common sites of bleeding. An extensive educational in-service was performed before limited, then universal, checklist implementation. Geometric charts were used to track the number of cases between consecutive reoperations for bleeding. We compared these before (phase 0) and after the first limited implementation phase (phase 1) and the universal implementation phase (phase 2) of the checklist. The average number of cases between consecutive reoperations for bleeding increased from 32 in phase 0 to 53 in both phase 1 (P = .002) and phase 2 (P = .01). A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. Angiographic diagnosis and treatment of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung

    1986-01-01

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  8. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  9. Transcatheter arterial embolization for traumatic bleeding control

    International Nuclear Information System (INIS)

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

    1989-01-01

    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

  10. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  11. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  12. Co-operation and Competition in Regional Economic Development Associated with Radioactive Waste Management

    International Nuclear Information System (INIS)

    Webler, Thomas

    2009-01-01

    Competition and co-operation appear in many different social venues. The author gives a variety of examples of co-operative behaviour in economics, politics, research, and everyday life activities such as sports. These four diverse examples illustrate the variety of forms that co-operation may take such as tacit co-operation, incremental co-operation, deep co-operation, etc. The links with the form of democracy (adversary democracy or consensual democracy) are also pointed. However, as with so many other things in life, the key is to the question of co-operation or competition is balance. Co-operation and competition are dialectical opposites. They create and maintain and define each other; they each are incomplete without the other

  13. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

    Directory of Open Access Journals (Sweden)

    Lärfars Gerd

    2010-09-01

    Full Text Available Abstract Background Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS. This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.

  14. Features of harvesting machinery operation on weak soils in the Far East Region

    Directory of Open Access Journals (Sweden)

    A. N. Panasyuk

    2017-01-01

    Full Text Available The authors based on own researches established actual problems of harvesting in the Amur region: ensuring passability of machines on the waterlogged soil, need of machines adaptivising to technologies of soybean harvesting, transfer of a part of the combine fleet to a caterpillar track, implementation of reloading reducing impact on the soil technologies of harvesting, increase in cost efficiency of mashines use and postharvest drying of grain and corn.Perspective solutions of problems are shown: design development of caterpillar end trucks of combines with the rubber-reinforced tracks (RRT; engineering and production of the soybean-grain harvester with RRT or a set of devices for the grain harvester with RRT as the option transferring it to the category the soybean-grain ones; process development to provide harvesting of soybean heap by the machine with RRT which crush and spread straw across the field simultaneous, to deliver soybean heap to stationary point of postharvest handling for the subsequent separation into seeds, marketable soybean and a soy chaff as valuable protein feed for livestock production, ready for feeding and storage; engineering of the forage harvester with RRT on a block and modular basis, that is based on the multipurpose power mean on RRT with the 4-machine scheme of a hydrostatic power drive of a undercarriager; development of a design of caterpillar blocks with triangular shape of contour; implementation of reloading technologies of harvest operations on system VIMLIFT.Production of harvest transport vehicles should be performed on a block and modular basis - in the form of a complex of self-propelled agricultural machines based on the released multipurpose power module with a set of the replaceable technological adapters providing its loading within a year. The agroterm of corn on grain harvesting should be delayed to later time when grain reaches standard humidity naturally.

  15. Prostate segmentation by feature enhancement using domain knowledge and adaptive region based operations

    International Nuclear Information System (INIS)

    Nanayakkara, Nuwan D; Samarabandu, Jagath; Fenster, Aaron

    2006-01-01

    Estimation of prostate location and volume is essential in determining a dose plan for ultrasound-guided brachytherapy, a common prostate cancer treatment. However, manual segmentation is difficult, time consuming and prone to variability. In this paper, we present a semi-automatic discrete dynamic contour (DDC) model based image segmentation algorithm, which effectively combines a multi-resolution model refinement procedure together with the domain knowledge of the image class. The segmentation begins on a low-resolution image by defining a closed DDC model by the user. This contour model is then deformed progressively towards higher resolution images. We use a combination of a domain knowledge based fuzzy inference system (FIS) and a set of adaptive region based operators to enhance the edges of interest and to govern the model refinement using a DDC model. The automatic vertex relocation process, embedded into the algorithm, relocates deviated contour points back onto the actual prostate boundary, eliminating the need of user interaction after initialization. The accuracy of the prostate boundary produced by the proposed algorithm was evaluated by comparing it with a manually outlined contour by an expert observer. We used this algorithm to segment the prostate boundary in 114 2D transrectal ultrasound (TRUS) images of six patients scheduled for brachytherapy. The mean distance between the contours produced by the proposed algorithm and the manual outlines was 2.70 ± 0.51 pixels (0.54 ± 0.10 mm). We also showed that the algorithm is insensitive to variations of the initial model and parameter values, thus increasing the accuracy and reproducibility of the resulting boundaries in the presence of noise and artefacts

  16. OPERATIONAL COSTS OF CANAL COMPANIES AND IRRIGATION DISTRICTS IN THE INTERMOUNTAIN REGION

    OpenAIRE

    Wilkins-Wells, John; Lagae, Hubert J.; Anderson, Raymond L.; Anwer, Muhammad Sarfraz

    1999-01-01

    This study reports on the trends of operational costs of farmer owned and operated irrigation enterprises (irrigation districts and canal companies) in five intermountain states. Administrative costs have risen faster then operation and maintenance costs. While salaries of employees have not risen significantly over time, legal costs have greatly escalated.

  17. Duration of increased bleeding tendency after cessation of aspirin therapy.

    LENUS (Irish Health Repository)

    Cahill, Ronan A

    2012-02-03

    BACKGROUND: Aspirin has a significant effect on hemostasis, so it is often recommended that patients taking aspirin discontinue treatment before elective surgery. While off aspirin, these patients may be at risk of thrombosis. The optimum period of time that aspirin should be withheld is controversial. The aim of this study was to establish the duration of the antihemostatic effect of prolonged aspirin therapy. STUDY DESIGN: In a prospective study, 51 healthy volunteers were randomly assigned into 3 groups, each receiving an identical tablet for 14 days. One group received a placebo tablet; individuals in the other two groups received either 75 mg or 300 mg of aspirin once a day. Template bleeding times and specific platelet function testing (using the PFA-100; Dade Behring) were carried out on subjects before therapy and again after its completion until they returned to baseline. RESULTS: Thirty-eight volunteers complied sufficiently with the protocol to provide useful results. All bleeding times normalized within 96 hours and all platelet function tests within 144 hours after stopping aspirin. There was no demonstrable hemostatic defect in any volunteer persisting by or beyond the sixth day after treatment cessation. There was no apparent difference in duration of effect between those taking either 75 mg or 300 mg of aspirin. CONCLUSIONS: This study uses sensitive measures of platelet function to demonstrate the duration of increased bleeding tendency after withdrawal of aspirin therapy. It supports discontinuation of aspirin therapy 5 days before elective surgery (with the operation being performed on the sixth day).

  18. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Directory of Open Access Journals (Sweden)

    Mohammad U. Malik

    2015-12-01

    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  19. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

    Bryant-Smith, Alison C; Lethaby, Anne; Farquhar, Cindy; Hickey, Martha

    2018-04-15

    Heavy menstrual bleeding (HMB) is an important physical and social problem for women. Oral treatment for HMB includes antifibrinolytic drugs, which are designed to reduce bleeding by inhibiting clot-dissolving enzymes in the endometrium.Historically, there has been some concern that using the antifibrinolytic tranexamic acid (TXA) for HMB may increase the risk of venous thromboembolic disease. This is an umbrella term for deep venous thrombosis (blood clots in the blood vessels in the legs) and pulmonary emboli (blood clots in the blood vessels in the lungs). To determine the effectiveness and safety of antifibrinolytic medications as a treatment for heavy menstrual bleeding. We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registers in November 2017, together with reference checking and contact with study authors and experts in the field. We included randomized controlled trials (RCTs) comparing antifibrinolytic agents versus placebo, no treatment or other medical treatment in women of reproductive age with HMB. Twelve studies utilised TXA and one utilised a prodrug of TXA (Kabi). We used standard methodological procedures expected by Cochrane. The primary review outcomes were menstrual blood loss (MBL), improvement in HMB, and thromboembolic events. We included 13 RCTs (1312 participants analysed). The evidence was very low to moderate quality: the main limitations were risk of bias (associated with lack of blinding, and poor reporting of study methods), imprecision and inconsistency.Antifibrinolytics (TXA or Kabi) versus no treatment or placeboWhen compared with a placebo, antifibrinolytics were associated with reduced mean blood loss (MD -53.20 mL per cycle, 95% CI -62.70 to -43.70; I² = 8%; 4 RCTs, participants = 565; moderate-quality evidence) and higher rates of improvement (RR 3.34, 95% CI 1.84 to 6.09; 3 RCTS, participants = 271; moderate-quality evidence). This suggests that

  20. Monitoring and treatment of acute gastrointestinal bleeding.

    Science.gov (United States)

    Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

    2012-01-01

    Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

  1. A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mostafa Sadeghi

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative bleeding has a great clinical importance and can contribute to increased mortality and morbidity in patients undergoing coronary artery bypass graft surgery. In this prospective, randomized, double-blind study, we evaluated the effect of prophylactic administration of fibrinogen concentrate on post-coronary artery bypass graft surgery bleeding. METHODS: A total of 60 patients undergoing coronary artery bypass surgery were randomly divided into two groups. Patients in the fibrinogen group received 1 g of fibrinogen concentrate 30 min prior to the operation, while patients in the control group received placebo. Post-operative bleeding volumes, prothrombin time, partial thromboplastin time, INR, hemoglobin and transfused blood products in both groups were recorded. A strict red blood cell transfusion protocol was used in all patients. RESULTS: There were no significant differences between intra-operative packed red blood cells infusion in the studied groups (1.0 ± 1.4 in fibrinogen group, and 1.3 ± 1.1 in control group. Less postoperative bleeding was observed in the fibrinogen group (477 ± 143 versus 703 ± 179, p = 0.0001. Fifteen patients in the fibrinogen group and 21 in the control group required post-op packed red blood cells infusion (p = 0.094. No thrombotic event was observed through 72 h after surgery. CONCLUSION: Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft.

  2. From cities and towns to urban networks in Germany – intra regional competition versus regional co-operation and inter regional competitiveness

    Directory of Open Access Journals (Sweden)

    Bernhard Mueller

    2000-01-01

    Full Text Available For many decades of the 20th century particular cities and towns were understood as integral parts of national and international urban systems. For many years the theory on central places and hierarchy of central places, first developed by Christaller and amended by Loesch, had a decisive influence on spatial research and regional development policies with guiding principles for urbanisation and the development of settlement patterns. However it is becoming ever more evident, that the planned effects of concepts for harmonising intra- and inter-regional differences were not reached. Moreover, inter-regional competition between neighbouring municipalities, as well as modern life styles and residential choices have caused the emergence of new settlement structures with dispersed spatial patterns and string functional ties. It is also true, that urban networking isn’t an easy task and that it inherently carries numerous obstacles.

  3. Development of a Remotely Operated NDE System for Inspection of Hanford's Double Shell Waste Tank Knuckle Regions

    International Nuclear Information System (INIS)

    Pardini, Allan F; Alzheimer, James M; Crawford, Susan L; Diaz, Aaron A; Gervais, Kevin L; Harris, Robert V; Riechers, Douglas M; Samuel, Todd J; Schuster, George J; Tucker, Joseph C

    2001-01-01

    This report documents work performed at the PNNL in FY01 to support development of a Remotely Operated NDE (RONDE) system capable of inspecting the knuckle region of Hanford's DSTs. The development effort utilized commercial off-the-shelf (COTS) technology wherever possible and provided a transport and scanning device for implementing the SAFT and T-SAFT techniques

  4. [Application of TB type thermal balloon endometrial ablation for the treatment of abnormal uterine bleeding].

    Science.gov (United States)

    Wang, W; Zhai, Y; Zhang, Z H; Li, Y; Zhang, Z Y

    2016-11-08

    Objective: To investigate the clinical efficacy, safety and promotion value of TB type thermal balloon endometrial ablation in the treatment of abnormal uterine bleeding. Methods: Fourty three patients who had received TB type endometrial ablation system for treatment of abnormal uterine bleeding from January, 2015 to January, 2016 in theDepartment of gynecology, Beijing Chaoyang Hospital were enrolled in this study. The intra-operative and post-operative complications and improvement of abnormal uterine bleeding and dysmenorrhea were observed. Results: There were nointra-operative complication occurred, such as uterine perforation, massive hemorrhage or surrounding organ damage. At 6 months after operation, 32 patients developed amenorrhea, 6 developed menstrual spotting, 3 developed menstruation with a small volume and 1 had a normal menstruation. No menstruation with an increased volume occurred. The occurrence of amenorrhea was 76.19% and the response rate was 97.62%.At 6 months after operation, 1 case had no response, 2 cases had partial response and 11 cases had complete response among the 14 cases of pre-operative dysmenorrhea; only 3 cases still had anemia among the 23 cases of pre-operative anemia. Compared with before treatment, patients with dysmenorrhea and anemia both significantly reduced with a statistically significant difference( P abnormal uterine bleeding, which could have clinical promotion practice.

  5. A RESEARCH REPORT ON OPERATIONAL PLANS FOR DEVELOPING REGIONAL EDUCATIONAL MEDIA RESEARCH CENTERS.

    Science.gov (United States)

    CARPENTER, C.R.; AND OTHERS

    THE NEED AND FEASIBILITY OF ESTABLISHING A NUMBER OF "REGIONAL EDUCATIONAL MEDIA RESEARCH CENTERS WITH A PROGRAMMATIC ORIENTATION" WERE INVESTIGATED. A PLANNING GROUP WAS ESTABLISHED TO SERVE AS A STEERING COMMITTEE. CONFERENCES IN WHICH GROUPS IN RESEARCH AND EDUCATION IN WIDELY DISTRIBUTED REGIONS OF THE COUNTRY PARTICIPATED WERE HELD…

  6. Establishing the Information System: An Operational Handbook. MOREL Regional Information System for Educators.

    Science.gov (United States)

    Kromer, Charles; Doyle, James

    This document is one of a series describing the background, functions, and utilization of the Regional Information System (RIS), developed by the Michigan-Ohio Regional Educational Laboratory (MOREL). RIS, which was developed to improve the accessibility of information for the educational practitioner, is described in this handbook. The handbook…

  7. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

    NARCIS (Netherlands)

    Cooper, Natalie A. M.; Barton, Pelham M.; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W. J.; Khan, Khalid S.; Clark, T. Justin

    2014-01-01

    Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity

  8. Intracranial hemorrhage in congenital bleeding disorders.

    Science.gov (United States)

    Tabibian, Shadi; Motlagh, Hoda; Naderi, Majid; Dorgalaleh, Akbar

    2018-01-01

    : Intracranial hemorrhage (ICH), as a life-threatening bleeding among all kinds of congenital bleeding disorders (CBDs), is a rare manifestation except in factor XIII (FXIII) deficiency, which is accompanied by ICH, early in life, in about one-third of patients. Most inherited platelet function disorders (IPFDs) are mild to moderate bleeding disorders that can never experience a severe bleeding as in ICH; however, Glanzmann's thrombasthenia, a common and severe inherited platelet function disorder, can lead to ICH and occasional death. This bleeding feature can also be observed in grey platelet syndrome, though less frequently than in Glanzmann's thrombasthenia. In hemophilia, intracerebral hemorrhage is affected by various risk factors one of which is the severity of the disease. The precise prevalence of ICH in these patients is not clear but an estimated incidence of 3.5-4% among newborns with hemophilia is largely ascertained. Although ICH is a rare phenomenon in CBDs, it can be experienced by every patient with severe hemophilia A and B, FXIII deficiency (FXIIID), FVIID, FXD, FVD, FIID, and afibrinogenemia. Upon observing the general signs and symptoms of ICH such as vomiting, seizure, unconsciousness, and headache, appropriate replacement therapies and cranial ultrasound scans must be done to decrease ICH-related morbidity and mortality.

  9. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    International Nuclear Information System (INIS)

    Asgher, S.; Saleem, M.K.

    2015-01-01

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  10. 'ReRegions' project - contribution of Usti region to co-operation of public administration in regions impacted by open-cast brown coal mining; Sbornik, Vyzkumny ustav pro hnede uhli

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

    Usti Region is the Lead partner of the ReRegions project. In this project we co-operate with six partners from five European countries: Greece, Spain, Germany, Poland and Great Britain. The project's main objective is to find solutions to joint environmental and socio-economic issues. One of Usti Region's targets is to help to the change the image of the Region both in the eyes of outside subjects (professionals and general public abroad and in other regions of the Czech Republic) as well as inhabitants and representatives of public administration of Usti Region. The project is financed by the EU INTERREG IIIC East initiative. 9 figs.

  11. From cities and towns to urban networks in Germany – intra regional competition versus regional co-operation and inter regional competitiveness

    OpenAIRE

    Bernhard Mueller

    2000-01-01

    For many decades of the 20th century particular cities and towns were understood as integral parts of national and international urban systems. For many years the theory on central places and hierarchy of central places, first developed by Christaller and amended by Loesch, had a decisive influence on spatial research and regional development policies with guiding principles for urbanisation and the development of settlement patterns. However it is becoming ever more evident, that the planned...

  12. Gas Bearing Control for Safe Operation in Critical Speed Regions - Experimental Verification

    DEFF Research Database (Denmark)

    Theisen, Lukas R. S.; Niemann, Hans H.; Galeazzi, Roberto

    2015-01-01

    supported by gas bearings to extend their operating range. Using H∞-design methods, active lubrication techniques are proposed to enhance the damping, which in turn reduces the vibrations to a desired safe level. The control design is validated experimentally on a laboratory test rig, and shown to allow...... and deceleration patterns and avoidance of operation near the critical speeds, which is a limiting factor during operation, specially during run-downs. An approach for reducing the vibrations is by feedback controlled lubrication. This paper addresses the challenge of reducing vibrations in rotating machines...

  13. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...

  14. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  15. Bleeding stomal varices in portal hypertension

    Directory of Open Access Journals (Sweden)

    Karen Tran-Harding, MD

    2018-04-01

    Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA

  16. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  17. The Texts of the Agency's Co-operation Agreements with Regional Intergovernmental Organizations

    International Nuclear Information System (INIS)

    1969-01-01

    The text of the Agency's agreement for co-operation with the Organization of African Unity (OAU) is reproduced in this document for the information of all Members. The agreement entered into force on 26 March 1969

  18. The Remotely Operated Nondestructive Examination System for Examining the Knuckle Region of Hanford's Double Shell Waste Tanks

    International Nuclear Information System (INIS)

    Crawford, Susan L.; Pardini, Allan F.; Donald Thompson and Dale Chimenti

    2005-01-01

    The Pacific Northwest National Laboratory has developed a technology to address the examination requirements associated with the knuckle region of Hanford's double shell waste tanks. This examination poses a significant technical challenge because the area that requires examination is in a confined space, high radiation region and is not accessible using conventional measurement techniques. This paper describes the development, deployment, and modification of the remotely operated nondestructive examination (RONDE) system that utilizes a technique known as Synthetic Aperture Focusing (SAFT). The system detects stress corrosion cracking in the high stress region of the knuckle and characterizes the crack with tandem SAFT. PNNL has qualified the system to perform inspections on the entire knuckle region of Hanford's double shell waste tanks

  19. State and business co-operation in settling socio-economic issues: forward to sustainable development of ecologically unfavorable regions

    Science.gov (United States)

    Bashkirova, N. N.; Lessovaia, S. N.

    2018-01-01

    The complexity of socio-economic issues of mono-cities located in the ecologically unfavorable regions of Eurasia was disclosed. The economically strategic role of city-forming mining enterprises and their impact on ecological situation was revealed. The general conception of settling the socio-economic problems of mono-cities located in ecologically unfavorable regions was worked out. Various approached to the concentration of financial resources for economic and ecological sustainable development of the regions located on the north of Eurasia holding nature protection actions were submitted. Based on performed critical analysis of the positive international experience of ecological taxation some approaches to reforming current Russian system of ecological taxation were suggested. It was revealed that increasing the social responsibilities of business in the field of waste recycling, environmental protection and monitoring of ecological conditions of territories and state and business co-operation are the most efficient opportunities in settling socio-economic issues of ecologically unfavorable regions.

  20. Illicit Trafficking in the Western Hemisphere: Developing an Operational Approach to Defeat Smuggling within the Region

    Science.gov (United States)

    2017-03-31

    chain. Therefore, much like any transregional super store franchise , criminals leverage local, regional, and global experts to navigate the complex...this phenomenon influences the region, as well as global security. Transnational organized crime signifies a substantial, complex, and asymmetric...of global Gross Domestic Product (GDP). Illicit trafficking is pervasive and impacts everyone in the U.S., regardless of financial status or station

  1. Endoscopic management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Successful Management of Neobladder Variceal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

    2016-10-15

    Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

  3. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  4. Does topical tranexamic acid reduce postcoronary artery bypass graft bleeding?

    Directory of Open Access Journals (Sweden)

    Amir Mirmohammadsadeghi

    2018-01-01

    Full Text Available Background: Postoperative bleeding is a common problem in cardiac surgery. We tried to evaluate the effect of topical tranexamic acid (TA on reducing postoperative bleeding of patients undergoing on-pump coronary artery bypass graft (CABG surgery. Materials and Methods: One hundred and twenty-six isolated primary CABG patients were included in this clinical trial. They were divided blindly into two groups; Group 1, patients receiving 1 g TA diluted in 100 ml normal saline poured into mediastinal cavity before closing the chest and Group 2, patients receiving 100 ml normal saline at the end of operation. First 24 and 48 h chest tube drainage, hemoglobin decrease and packed RBC transfusion needs were compared. Results: Both groups were the same in baseline characteristics including gender, age, body mass index, ejection fraction, clamp time, bypass time, and operation length. During the first 24 h postoperatively, mean chest tube drainage in intervention group was 567 ml compared to 564 ml in control group (P = 0.89. Mean total chest tube drainage was 780 ml in intervention group and 715 ml in control group (P = 0.27. There was no significant difference in both mean hemoglobin decrease (P = 0.26 and packed RBC transfusion (P = 0.7. Topical application of 1 g TA diluted in 100 ml normal saline does not reduce postoperative bleeding of isolated on-pump CABG surgery. Conclusion: We do not recommend topical usage of 1 g TA diluted in 100 ml normal saline for decreasing blood loss in on-pump CABG patients.

  5. Prospective analysis of delayed colorectal post-polypectomy bleeding.

    Science.gov (United States)

    Park, Soo-Kyung; Seo, Jeong Yeon; Lee, Min-Gu; Yang, Hyo-Joon; Jung, Yoon Suk; Choi, Kyu Yong; Kim, Hungdai; Kim, Hyung Ook; Jung, Kyung Uk; Chun, Ho-Kyung; Park, Dong Il

    2018-01-17

    Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age ( 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding. Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

  6. [Effects of heavy machinery operation on the structural characters of cultivated soils in black soil region of Northeast China].

    Science.gov (United States)

    Wang, En-Heng; Chai, Ya-Fan; Chen, Xiang-Wei

    2008-02-01

    With the cultivated soils in black soil region of Northeast China as test objects, this paper measured their structural characters such as soil strength, bulk density, and non-capillary porosity/capillary porosity (NCP/CP) ratio before and after heavy and medium-sized machinery operation, aimed to study the effects of machinery operation on the physical properties of test soils. The results showed that after machinery operation, there existed three distinct layers from top to bottom in the soil profiles, i.e., plowed layer, cumulative compacted layer, and non-affected layer, according to the changes of soil strength. Under medium-sized machinery operation, these three layers were shallower, and there was a new plow pan at the depth between 17.5 and 30 cm. Heavy machinery operation had significant positive effects on the improvement of topsoil structure (P heavy machinery, the bulk density of topsoil decreased by 7.2% and 3.5%, respectively, and NCP/CP increased by 556.6% after subsoiling, which would benefit water infiltration, reinforce water storage, and weaken the threat of soil erosion. The main action of heavy machinery operation was soil loosening, while that of medium-sized machinery operation was soil compacting.

  7. Regional co-operation in the nuclear field: The Nordic experience

    International Nuclear Information System (INIS)

    Marcus, F.R.

    1983-01-01

    Experience from 25 years of co-operation in the nuclear field between the Nordic countries is described. A pragmatic approach with a minimum of formalism is used. The co-operation takes place mainly through ''horizontal'' channels between corresponding bodies in the different countries - safety authorities, research institutions, electricity producers, etc. In addition, a ''vertical'' co-ordination between these different circles is accomplished through a Nordic Liaison Committee. The experience shows that valuable results can be obtained, mainly through rationalization and improved use of resources. Difficulties, which are inherent in international co-operation, can be reduced, provided that there is a strong political will, an efficient system to promote contacts, and a flexible financing scheme. Apart from the benefits obtained in each of the countries - whether or not it has its own nuclear power - particular advantages accrue when a ''Nordic group'' can present co-ordinated viewpoints on the international scene. (author)

  8. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. An Operational Short-Term Forecasting System for Regional Hydropower Management

    Science.gov (United States)

    Gronewold, A.; Labuhn, K. A.; Calappi, T. J.; MacNeil, A.

    2017-12-01

    The Niagara River is the natural outlet of Lake Erie and drains four of the five Great lakes. The river is used to move commerce and is home to both sport fishing and tourism industries. It also provides nearly 5 million kilowatts of hydropower for approximately 3.9 million homes. Due to a complex international treaty and the necessity of balancing water needs for an extensive tourism industry, the power entities operating on the river require detailed and accurate short-term river flow forecasts to maximize power output. A new forecast system is being evaluated that takes advantage of several previously independent components including the NOAA Lake Erie operational Forecast System (LEOFS), a previously developed HEC-RAS model, input from the New York Power Authority(NYPA) and Ontario Power Generation (OPG) and lateral flow forecasts for some of the tributaries provided by the NOAA Northeast River Forecast Center (NERFC). The Corps of Engineers updated the HEC-RAS model of the upper Niagara River to use the output forcing from LEOFS and a planned Grass Island Pool elevation provided by the power entities. The entire system has been integrated at the NERFC; it will be run multiple times per day with results provided to the Niagara River Control Center operators. The new model helps improve discharge forecasts by better accounting for dynamic conditions on Lake Erie. LEOFS captures seiche events on the lake that are often several meters of displacement from still water level. These seiche events translate into flow spikes that HEC-RAS routes downstream. Knowledge of the peak arrival time helps improve operational decisions at the Grass Island Pool. This poster will compare and contrast results from the existing operational flow forecast and the new integrated LEOFS/HEC-RAS forecast. This additional model will supply the Niagara River Control Center operators with multiple forecasts of flow to help improve forecasting under a wider variety of conditions.

  10. The Emissions Impacts of Varied Energy Storage Operational Objectives Across Regions

    Energy Technology Data Exchange (ETDEWEB)

    Barrett, Emily L.; Thayer, Brandon L.; Studarus, Karen E.; Pal, Seemita

    2017-11-15

    The emissions consequences of smart grid technologies can be significant but are not always intuitive. This is particularly true in the implementation of energy storage (ES) systems that are being increasingly adopted to integrate more intermittent renewable generation, to reduce peak demand, and to participate in energy markets. Both the location of the ES system within the grid and the way it is operated will dictate its resulting impacts. The Grid Project Impact Quantification tool can provide insight into some of the emissions implications of hypothetical ES systems for a variety of operational objectives in diverse locations within the United States.

  11. Study on profits and the financial position of regional grid operators 2006-2009

    International Nuclear Information System (INIS)

    2010-11-01

    Grid operators have a distribution duty and a legal task to take care of a reliable energy network. To carry out the legal tasks it is important that grid operators have sufficient financial means. On the other hand, it is also important that users of energy networks do not pay too much. Chapter 1 addresses the research approach. The results of the first research question on regulated profits are discussed in chapter 2. The findings on the impact of the economic profit on the financial position are described in chapter 3. And finally, the findings on the financial position are described in chapter 4. [nl

  12. Integration Strategies and Barriers to Co-Operation in Cross-Border Regions

    DEFF Research Database (Denmark)

    Hansen, Povl Adler; Serin, Göran Folke

    2007-01-01

    the Swedish and Danish sides of the Sound. The strengths and weaknesses of the Øresund Region’s ‘traditional’ and new institutions as instruments for change are examined. The article identifies and discusses the structures, institutions, and players which are the driving forces in the field between markets...... and business on the global level. In this respect, the article points out the importance of market forces and their influence on institutional change. Recent economic crises have put growth center stage at both the national and regional level, and have called for regional development programs on both...

  13. Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts

    International Nuclear Information System (INIS)

    Pitkaeranta, P.; Haapiainen, R.; Kivisaari, L.; Schroeder, T.

    1991-01-01

    Hemorrhage is an uncommon but serious complication of pancreatic pseudocysts. When gastrointestinal bleeding or intra-abdominal hemorrhage is associated with a pancreatic pseudocysts and the usual sources of bleeding are not detected by endoscopy, the rupture of a pseudoaneurysm inside the pseudocyst should be suspected. The article present 13 cases, 11 associated with chronic and 2 with late complications after acute necrotizing pancreatitis. On the basis of sonographic findings, bleeding site was suspected in 8 of 11 patients. Computed tomography (CT) was performed on 10, and bleeding was suspected in 8. The pseudoaneurysm itself was detected by CT in one and by ultrasonography in none. Visceral angiography was performed on five patients, and the pseudoaneurysm was evident in all. External drainage with arterial ligation was done as a primary operation in five patients; four of them later underwent pancreatic resection because of rebleeding. In eight cases pancreatic resection was the initial operation; none of these patients continued to bleed or needed reoperation because of the same pseudoaneurysm. There were no intraoperative deaths, but one patient died postoperatively. Aggressive diagnostic evaluation and surgical approach are associated with a reduction in mortality and morbidity in this serious complication of pancreatic pseudocysts. 28 refs., 2 figs., 1 tab

  14. EVALUATING THE OVERALL TECHNICAL EFFICIENCY OF ISLAMIC BANKS OPERATING IN THE MENA REGION DURING THE FINANCIAL CRISIS.

    Directory of Open Access Journals (Sweden)

    Ali Said

    2013-04-01

    Full Text Available The present paper measured overall technical efficiency of Islamic banks operating in the MENA region during the financial crisis of 2007-2009 to address the question what are the levels of overall, pure technical and scale efficiency of Islamic banks operating in the MENA region and how they evolved during the financial crisis. This paper addresses this question technical, pure technical, and scale efficiency measures are analyzed by employing on-parametric technique, Data Envelopment Analysis (DEA. The study results suggested that Islamic banks in other MENA countries and North Africa on an average are relatively technically inefficient. This might be due to the underdeveloped banking system in those countries. In addition, the decomposition of technical efficiency into pure technical and scale efficiency shows that on average, the Islamic banks in North Africa counties and other MENA counties are having problems in the allocation of resources between their inputs and outputs mix compare to Islamic banks in GCC.

  15. Bleeding points in cerebral hemorrhage caused by Moyamoya disease in adults

    International Nuclear Information System (INIS)

    Sasaki, Tatsuya; Sakurai, Yoshiharu; Shimizu, Yukihiko; Ogawa, Akira; Komatsu, Shinro.

    1983-01-01

    Even before the introduction of CT we reported that the intracranial hemorrhage in Moyamoya disease was not subarachnoid hemorrhage but intraventricular hemorrhage and that the bleeding point was the paraventricular subependymal region of lateral ventricles; these findings were based on our experience with three Moyamoya cases in which ventricular hemorrhage occurred and pseudoaneurysms were revealed in the territory of the posterior choroidal artery. Twelve cases with intracranial hemorrhage caused by Moyamoya disease have now been studied by CT in order to determine (1) whether the hemorrhage is subarachnoid or intraventricular, and (2) where the bleeding point is. In the results for the eight cases for which the CT scan was performed within one day after the onset, intraventricular hemorrhage was shown in all cases. The bleeding point was examined in twelve cases; in four cases it was recognized by initial CT only, but if five cases in which ventricular hemorrhage only appeared in the initial CT,follow-up plain and contrast-enhanced CT were necessary. In a total of nine cases, then, bleeding points were recognized. In one case putaminal hemorrhage penetrated into the lateral ventricle, while in eight cases the intracerebral hematoma was located in the paraventricular region of the lateral ventricle, such as at the head of the caudate nucleus or the thalamus. In some cases, small subependymal hematoma projected into the lateral ventricle. In cases with symptoms of intracranial hemorrhage at the onset, the bleeding points were at the paraventricular parenchyma of the lateral ventricle in almost all cases. (author)

  16. A review of operational, regional-scale, chemical weather forecasting models in Europe

    Czech Academy of Sciences Publication Activity Database

    Kukkonen, J.; Olsson, T.; Schultz, D.M.; Baklanov, A.; Klein, T.; Miranda, A.I.; Monteiro, A.; Hirtl, M.; Tarvainen, V.; Boy, M.; Peuch, V.H.; PoupKou, A.; Kioutsioukis, I.; Finardi, S.; Sofiev, M.; Sokhi, R.; Lehtinen, K.E.J.; Karatzas, K.; San José, R.; Astitha, M.; Kallos, G.; Schaap, M.; Reimer, E.; Jakobs, H.; Eben, Kryštof

    2012-01-01

    Roč. 12, - (2012), s. 1-87 ISSN 1680-7316 Institutional research plan: CEZ:AV0Z10300504 Keywords : chemical weather * numerical models * operational forecasting * air Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 5.510, year: 2012

  17. The relevance of operational skills towards business sustainability: A focus on SMME manufacturers in the Vaal triangle region

    Directory of Open Access Journals (Sweden)

    R. Naidoo

    2010-12-01

    Full Text Available Purpose: Activities in the manufacturing sector are often considered the bedrock of an economy and a key driver of growth and development. Within the South African manufacturing sector, operations skills are reported to be deficient and are often cited as a main cause of failure in small, medium and micro enterprises (SMMEs. This study explores and tests this fragile relationship between operations skills and SMME sustainability. Empirical investigations are conducted in a high-density SMME manufacturing environment - the Vaal Triangle Region. Design/Methodology/Approach: Building on previously established literature on SMME sustainability and operations skills, various measures are developed and tested for reliability and validity. Factor analysis is used to identify relevant factors in terms of operations skills. Co-relational analysis is then employed to test the hypothesised relationship. The study is cross-sectional in design and relies on trained fieldworkers administering surveys for data collection. Findings: Five clear factors for operations skills are identified through factor analysis with an overall high reliability value. Based on descriptive and co-relational analysis results reveal that operations skills are positively associated with sustainability. Implications: SMME owners, educators and service providers may benefit from the study's findings in terms of the nature and associations that operational skills have on developing sustainable SMME's. Originality/Value: The study focused on a neglected area of SMMEs - the importance of operations towards business sustainability, and made an important contribution towards theory development through empirical explorations. In South Africa, this is the first time an instrument measuring operations skills has been validated and associated with SMMEs in a manufacturing context.

  18. Operational and regulatory impacts of regional management on transportation of commercial low-level radioactive waste

    International Nuclear Information System (INIS)

    Shirley, C.G.; Wilmot, E.L.; Shepherd, E.W.

    1981-09-01

    The 96th Congress of the United States, as part of the Low-level Radioactive Waste Policy Act of 1980 (Public Law 96-573), instructed the Secretary of the Department of Energy (DOE) to prepare a report on the current US low-level waste management situation and the conditions and requirements for management on a regional basis. The Transportation Technology Center has compared the transportation requirement and regional management scenarios for commercial low-level radioactive waste in support of the DOE response to this instruction. Using 1979 low-level waste volumes shipped to commercial burial grounds and six management regions postulated by DOE, transportation requirements were estimated and compared for the two management scenarios in terms of cumulative shipping distance and transportation cost. Effects of these results on the demand for transportation services and equipment and on population risks were considered. Finally, current regulatory issues and the potential effects of regional management on regulation of low-level waste transportation were reviewed

  19. Impacts of Regional Integration in Mercosur on the co-operative sector

    International Development Research Centre (IDRC) Digital Library (Canada)

    Historically, the cooperative sector in Latin America has contributed to job creation, and been a relevant provider of housing, consumer goods, marketing services, financial services, and other goods and services. Despite its significance, however, the sector has not been actively involved in the process of regional economic ...

  20. Emergency readmission following acute upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Strömdahl, Martin; Helgeson, Johan; Kalaitzakis, Evangelos

    2017-01-01

    OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution...

  1. Continued bleeding following acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Brouwers, H.B.

    2014-01-01

    In this Ph.D. thesis, ‘Continued bleeding following acute intracerebral hemorrhage’, we have discussed the background literature, risk factors, and underlying biology of hematoma expansion, as well as the clinical applicability of the CT angiography (CTA) 'spot sign' as an imaging marker of this

  2. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    barium enema studies have indicated increasing world prevalence ... Other diagnostic modalities include barium enema, computerised ... This is in contrast to the findings in our patient when colonoscopy was carried out, in which the diverticula were more at the descending colon-left sided, and were found to be bleeding.

  3. Acute radiologic intervention in gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment. (orig.) [de

  4. Acute radiologic intervention in gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.

  5. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

    Conclusion: Perianal conditions contributed to the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared to Western populations. Understanding the common pathologies and outcomes guides the management of our patients.

  6. Medical treatment for heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Jen Chen

    2015-10-01

    Full Text Available Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL. During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.

  7. Systemic causes of heavy menstrual bleeding

    NARCIS (Netherlands)

    Verschueren, Sophie

    2017-01-01

    Heavy menstrual bleeding (HMB) is a common problem in fertile women. In addition to local factors, such as a polyp or a uterine fibroid, systemic causes may lead to HMB. These systemic causes are discussed in this thesis. For years, women with HMB were tested underlying thyroid disorder, but our

  8. Endometrial biopsy findings in postmenopausal bleeding

    International Nuclear Information System (INIS)

    Sarfraz, T.; Tariq, H.

    2007-01-01

    To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)

  9. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  10. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    Both presented with a history of fever and passage of bloody stools. There was a positive history of NSAID ingestion in both patients that was prescribed in the referring hospitals. ..... Bostwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children following ingestion of low-dose. Ibuprofen.

  11. Dysfunctional uterine bleedings of a climacteric period

    International Nuclear Information System (INIS)

    Prilepskaya, V.N.

    1993-01-01

    Climacteric period of some women is complicated by dysfunctional uterine bleedings (DUB). Bearing in mind the fact that DUBS are caused by disorder of estrin rhysmic secretion, the paper presents the methods of differential diagnostics for investigations into functional disorders in the hypothalamus -hypophysis - ovaries - uterus system. The preference is given to roentgenologic and radioimmunologic diagnostic methods

  12. Evaluation the Metoprolol Effects in Controlled Hypotension and Reduction of Bleeding During Head and Neck Surgery

    Directory of Open Access Journals (Sweden)

    P Rahimzadeh

    2012-05-01

    Full Text Available

    Background and objectives

    Intraoperative bleeding, which reduces visibility in the operative field, is one of the major problems of head and neck surgeries. Improvement of intraoperative visibility and reduction of bleeding is an important task for an anesthetist during head and neck surgery. It has been shown that preoperative beta-blockade decreases bleeding during the operation.

     

    Methods

    In a 18 month period,88 patients , who were candidate for nasal procedures in hazrat Rasul medical complex, were selected in a randomized open clinical trial study. They were divided to 4 groupes:

    50 mg metoprolol at night before surgery

    50 mg metoprolol in the morning of the surgery

    50 mg metoprolol at night before surgery and in the morning of the surgery

    placebo

    Heart rate, Systolic and diastolic blood pressure was measured in a non-invasive way just both upon arrival on the operation bed and after induction of anesthesia during operation. For evaluation of the visibility of the operative field during operation the quality scale proposed by Fromm and Boezzart was used.

     

    Results

    SPSS13 was used for assessment. There was significant relationship between metoprolol administration and bleeding during the operation. All patients who received two doses of metoprolol one in the last night and another in the morning of the operation day had only mild bleeding. There was statistically significant relation between agitation and time of administration of metoprolol.

     

    Conclution

    Nowadays, there are growing evidences that not only decrease in systolic blood pressure but also a low heart rate (< 60 beats per minute can minimize surgical bleeding. Both of the above mentioned effects could be induced by beta blockers.

    In this study, two

  13. Operational Efficiency of Information Technology and Organizational Performance of State Universities and Colleges in Region VI, Philippines

    Directory of Open Access Journals (Sweden)

    Samson M. Lausa

    2016-11-01

    Full Text Available Over the past years educational institutions have been investing increasingly substantial amount of money in integrating Information Technology (IT in the course of educational services delivery with the objective of improving operational efficiency and competitive advantage. The important role IT plays in educational institutions is unquestionable. It is regarded as a critical factor of innovation for growth and survival. The evaluation of the impact of this innovation in the educational system drives the researcher to undertake a study on Operational Efficiency of Information Technology and Organizational Performance of State Universities and Colleges (SUCs of Region VI, Philippines. Descriptive method was used utilizing a validated survey questionnaire which also involved the desk and field research conducted by a panel of two field researchers including the researcher himself covering selected SUCs of Region VI. Deans or department heads and faculty of the different colleges or departments, administrative and academic officials constitute the respondents of the study. Stratified proportional random sampling and purposive sampling were used in the study. Results of the study were viewed and analyzed using the Mean and the Pearson r Correlation Coefficient. Findings revealed that the operational efficiency of the SUCs of Region VI is moderately efficient while the majority of colleges/universities are performing moderately efficient. The study also revealed that the organizational performance of SUCs and the majority of colleges/universities are performing very satisfactory. Likewise, the findings also showed a significant relationship between the operational efficiency of information technology and organizational performance of SUCs. However, a significant relationship between operational efficiency and organizational performance of SUCs in instruction does not exist while a significant relationship exists in research, extension and

  14. Results of the regional intercomparison exercise for the determination of operational quantity Hp(10) in Latin America

    International Nuclear Information System (INIS)

    Saravi, M.; Zaretzky, A.; Lindner, C.; Diaz, J.; Walwyn, G.; Amorim, R.; De Souza, D.; Gregori, B.; Papadopulos, S.; Meghzifene, A.; Ferruz, P.; Suarez, R. C.

    2007-01-01

    Several intercomparison exercises were organised by the International Atomic Energy Agency (IAEA) on the determination of operational quantities at the regional or inter-regional basis. In the Latin American region an intercomparison for the determination of the operational quantity H p (10) was completed mid-2004, as a follow-up to previous exercises carried out during the 1990's. Eighteen individual external monitoring services from nineteen Member States participated in the first phase. The second phase grouped 15 services that had participated in the first phase. Dosemeter irradiations in photon beams were done by four Secondary Standard Dosimetry Laboratories (SSDLs) of the region. The preparation of this exercises involved an audit by the IAEA SSDL, where reference irradiations were provided to all participants for verification of their systems. During the first phase (2002-2003) only 9 out of 18 services met the performance requirements for such monitoring services. Necessary corrective actions and procedure verification were implemented. During the second phase (2004) 11 out of 15 services fulfilled the performance criteria. This intercomparison shows that there has been improvement in the second phase and most participants demonstrated a satisfactory performance of the quantity tested. (authors)

  15. THE IMPACT OF STRUCTURAL FUNDS IMPLEMENTATION IN BIHOR COUNTY. CASE STUDY ON THE REGIONAL OPERATIONAL PROGRAMME 2007-2013

    Directory of Open Access Journals (Sweden)

    Chirila Lavinia Florentina

    2010-12-01

    Full Text Available As The County's Development Plan 2007-2013 shows, Bihor county, which through its geographic position and existing local resources, plays a strategic role, of the West gate of Romania, distinguishes through a low unemployment rate, of 2,7% in 2007, on the third place in Romania after Bucharest and Timis county and on the first place in the North-West region that he is part of, through a high living standard, with a GDP of 55% of the European average, ranks among the most developed counties in Romania ( range 8 in the country according to the GDP value per capita, range 2, after Cluj county in the North-West region.The present paper analises the absorbtion rate of structural funds allocated through the Regional Operational Programme of Bihor county and sets itself to formulate some conclusions regarding the way in which Bihor county has valued until present the development opportunities offered by the Regional Operational Programme, respective regarding future action directions, established by the Bihor County Development Plan, 2007-2013.

  16. Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    D'Othee, Bertrand Janne; Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

    2006-01-01

    Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age ± 95% confidence interval = 70 ± 6 years) requiring blood transfusion (10 ± 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 ± 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding

  17. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  18. Impact of connection density on regional cost differences for network operators in the Netherlands

    International Nuclear Information System (INIS)

    2009-04-01

    The Dutch Office of Energy Regulation ('Energiekamer') has an obligation to investigate the extent to which the electricity and gas distribution businesses (DNOs) in the Netherlands face different structural environments that result in regional cost differences which, in turn, could justify tariff differences. On the basis of previous studies, Energiekamer has identified 'water crossings' and 'local taxes' as allowable regional differences. To account for them, Energiekamer has introduced an adjustment to the regulated revenues formula in order to guarantee a level-playing field to the Dutch DNOs. In addition to these factors, it has been claimed that connection density may have an impact on distribution costs and that, therefore, regulated revenues should be adjusted to compensate for regional differences in connection density between DNOs. However, so far, the research in this field has been unable to identify a sufficiently robust relationship between cost and connection density to support this claim. In order to address this issue, Energiekamer has asked Frontier Economics and Consentec to further investigate the relationship between connection density and distribution costs in the Netherlands. Therefore, our analysis has aimed at determining whether, and to what extent, connection density in the Netherlands is a significant driver of the costs of electricity and gas distribution networks. The following three questions are answered: (1) Is connection density a significant cost driver in electricity and gas networks in the Netherlands?; (2) If so, which functional form (e.g. U-shaped) does this relationship have in the Netherlands?; (3) Finally, based on the evidence collected, is the influence of connection density sufficiently well-determined to be considered a regional difference in the Dutch regulatory framework?

  19. Current Sharing inside a High Power IGBT Module at the Negative Temperature Coefficient Operating Region

    CERN Document Server

    AUTHOR|(CDS)2084596; Papastergiou, Konstantinos; Bongiorno, M; Thiringer, T

    2016-01-01

    This work investigates the current sharing effect of a high power Soft Punch Through IGBT module in the Negative Temperature Coefficient region. The unbalanced current sharing between two of the substrates is demonstrated for different current and temperature levels and its impact on the thermal stressing of the device is evaluated. The results indicate that the current asymmetry does not lead to a significant thermal stressing unbalance between the substrates.

  20. Multibeam Mapping and Remotely Operated Vehicle Exploration of the Puerto Rico and Virgin Islands Region

    Science.gov (United States)

    Coleman, D. F.; Ten Brink, U. S.; Armstrong, R.; Chaytor, J. D.; Demopoulos, A. W.

    2013-12-01

    During October 2013, an ocean exploration project took place off the coast of Puerto Rico and the Virgin Islands. This project, a collaborative effort between the Ocean Exploration Trust, the US Geological Survey, the University of Puerto Rico at Mayaguez, the University of Rhode Island, and NOAA, was aimed at exploring regions of the US exclusive economic zone (EEZ) south of the Puerto Rico Trench axis, and north of Mona Island, Puerto Rico, and the US and British Virgin Islands, and portions of the Anegada Passage. The research vessel E/V Nautilus and the Hercules/Argus ROV system were used to expand the multibeam sonar bathymetric data coverage of the region, collect high definition video footage of seafloor features, and to collect biological and geological samples along selected transects. Particular areas of interest for targeted ROV dives included: the region where a large M7.2 1918 earthquake produced a tsunami that struck northwestern corner of Puerto Rico; a transect up the vertical wall of the Mona Rift (4000 to 1500 m depth); transects along the Septentrional fault system; dives in areas of suspected fluid flow through faults, fissures, and offshore Karst systems associated with the tilted carbonate platform north of Puerto Rico; dives in the Anegada Passage at the entry points for surface Atlantic waters that circulate into the Caribbean; and in regions to investigate and date sedimentary features offset by fault motion and potential tsunamigenic landslides. Biological sampling of many deep-sea benthic organisms (including deep water corals) have never been attempted before in this area. These samples are being used to understand more about the diversity, population dynamics, genetics, and habitat connectivity of these communities, and to provide an age constraint for disturbed sedimentary features. Until this cruise, the location and distribution of deep coral habitats in the US Caribbean was largely unknown. The available information on benthic

  1. Bleeding in cancer patients and its treatment: a review.

    Science.gov (United States)

    Johnstone, Candice; Rich, Shayna E

    2017-12-18

    Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

  2. Prediction of massive bleeding. Shock index and modified shock index.

    Science.gov (United States)

    Terceros-Almanza, L J; García-Fuentes, C; Bermejo-Aznárez, S; Prieto-Del Portillo, I J; Mudarra-Reche, C; Sáez-de la Fuente, I; Chico-Fernández, M

    2017-12-01

    To determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma. Retrospective cohort. Severe trauma patient's initial attention at the intensive care unit of a tertiary hospital. Patients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015. We studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV-), positive and negative likelihood ratio (LR+ and LR-), ROC curves (Receiver Operating Characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage. 287 patients were included, 76.31% (219) were male, mean age was 43,36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21-34). The overall frequency of massive bleeding was 8.71% (25). For Shock Index: AUROC was 0.89 (95% confidence intervals [CI] 0.84 to 0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2 to 97.58) and Sp was 79.69% (95% CI: 74.34 to 84.16). For the Modified Shock Index: AUROC was 0.90 (95% CI: 0.86 to 0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01 to 99.23) and Sp was 75.78% (95% CI: 70.18 to 80.62). Shock Index and Modified Shock Index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. To Bleed or Not to Bleed: That is the Question. The Side Effects of Apixaban.

    Science.gov (United States)

    Ciccone, Marco Matteo; Zito, Annapaola; Devito, Fiorella; Maiello, Maria; Palmiero, Pasquale

    2018-01-01

    Apixaban is a new oral anticoagulant (NOACs: Novel Oral Anticoagulant), like dabigatran, rivaroxaban, and edoxaban. All of them are prescribed to patients with non valvular atrial fibrillation or venous thromboembolism, to replace warfarin, because of the lower probability of bleeding, however they can cause bleeding by themselves. Bleeding is an adverse event in patients taking anticoagulants. It is associated with a significant increase of morbidity and risk of death. However, these drugs should be used only for the time when anticoagulation is strictly required, especially when used for preventing deep vein thrombosis. Prolonged use increases the risk of bleeding. In the ARISTOTLE Trial Apixaban, compared with warfarin, was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage. Many physicians still have limited experience with new oral anticoagulants and about bleeding risk managment. We reviewed the available literature on extracranial and intracranial bleeding concerning apixaban. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. Investigation of Tractor Base Bleeding for Heavy Vehicle Aerodynamic Drag Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, J; Salari, K; Storms, B

    2007-10-25

    One of the main contributors to the aerodynamic drag of a heavy vehicle is tractor-trailer gap drag, which arises when the vehicle operates within a crosswind. Under this operating condition, freestream flow is entrained into the tractor-trailer gap, imparting a momentum exchange to the vehicle and subsequently increasing the aerodynamic drag. While a number of add-on devices, including side extenders, splitter plates, vortex stabilizers, and gap sealers, have been previously tested to alleviate this source of drag, side extenders remain the primary add-on device of choice for reducing tractor-trailer gap drag. However, side extenders are not without maintenance and operational issues. When a heavy vehicle pivots sharply with respect to the trailer, as can occur during loading or unloading operations, the side extenders can become crushed against the trailer. Consequently, fleet operators are forced to incur additional costs to cover the repair or replacement of the damaged side extenders. This issue can be overcome by either shortening the side extenders or by devising an alternative drag reduction concept that can perform just as effectively as side extenders. To explore such a concept, we investigate tractor base bleeding as a means of reducing gap drag. Wind tunnel measurements are made on a 1:20 scale heavy vehicle model at a vehicle width-based Reynolds number of 420,000. The tractor bleeding flow, which is delivered through a porous material embedded within the tractor base, is introduced into the tractor-trailer gap at bleeding coefficients ranging from 0.0-0.018. To determine the performance of tractor base bleeding under more realistic operating conditions, computational fluid dynamics simulations are performed on a full-scale heavy vehicle within a crosswind for bleeding coefficients ranging from 0.0-0.13.

  5. Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades.

    Science.gov (United States)

    Naor, Michael; Heyman, Samuel N; Bader, Tarif; Merin, Ofer

    2017-01-01

    The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide. Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions. A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers. The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.

  6. A Swedish co-operation programme for radiological emergency planning activities in the Baltic Sea region

    International Nuclear Information System (INIS)

    Petersson, B.

    1998-01-01

    Short overview of the Swedish cooperation projects with Baltic countries in the field of radiological emergency preparedness is presented. Cooperation programme is going since 1993 and is divided into following sections: sub-projects on planning, training and exercises, sub-projects on measurement strategies, including early warning systems, sub-project on information to the public and the media, sub-projects on review of the Ignalina NPP on-site emergency preparedness and planning of on-site rescue operations. Total budget amount allocated for these projects is 9 million Swedish crowns

  7. Dynamic modeling and dynamical analysis of pump-turbines in S-shaped regions during runaway operation

    International Nuclear Information System (INIS)

    Zhang, Hao; Chen, Diyi; Wu, Changzhi; Wang, Xiangyu; Lee, Jae-Myung; Jung, Kwang-Hyo

    2017-01-01

    Highlights: • Novel dynamic model of a pump-turbine in S-shaped regions is proposed. • A stability criterion of runaway point is given. • Global dynamic characteristics of the pump-turbine are investigated. • Effects of the slopes of the characteristic curve on the stability are studied. - Abstract: There is a region of pump-turbine operation, often called the S-shaped region, in which one unit rotational speed corresponds to three unit flows or torques. In this paper, the dynamic model of the pump-turbine in S-shaped regions is established by introducing the nonlinear piecewise function of relative parameters. Then, the global bifurcation diagrams of the pump-turbine are presented to analyze its dynamic characteristics in the S-shaped regions. Meanwhile, a stability criterion of runaway point is given based on the established theoretical model. The numerical experiments are conducted on the model and the results are in good agreement with the theoretical analysis. Furthermore, the effects of the characteristic curve slopes on the stability of the pump-turbine are studied by an innovative use of the three-dimensional bifurcation diagrams. Finally, the factors influencing the runaway stability of pump-turbines are also discussed, based on the dynamic analysis.

  8. No increased systemic fibrinolysis in women with heavy menstrual bleeding

    NARCIS (Netherlands)

    Wiewel-Verschueren, S.; Knol, H. M.; Lisman, T.; Bogchelman, D. H.; Kluin-Nelemans, J. C.; van der Zee, A.G.J.; Mulder, A.B.; Meijer, K.

    BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of

  9. Scintigraphic detection and localization of gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  10. Regional climate model simulations indicate limited climatic impacts by operational and planned European wind farms.

    Science.gov (United States)

    Vautard, Robert; Thais, Françoise; Tobin, Isabelle; Bréon, François-Marie; Devezeaux de Lavergne, Jean-Guy; Colette, Augustin; Yiou, Pascal; Ruti, Paolo Michele

    2014-01-01

    The rapid development of wind energy has raised concerns about environmental impacts. Temperature changes are found in the vicinity of wind farms and previous simulations have suggested that large-scale wind farms could alter regional climate. However, assessments of the effects of realistic wind power development scenarios at the scale of a continent are missing. Here we simulate the impacts of current and near-future wind energy production according to European Union energy and climate policies. We use a regional climate model describing the interactions between turbines and the atmosphere, and find limited impacts. A statistically significant signal is only found in winter, with changes within ±0.3 °C and within 0-5% for precipitation. It results from the combination of local wind farm effects and changes due to a weak, but robust, anticyclonic-induced circulation over Europe. However, the impacts remain much weaker than the natural climate interannual variability and changes expected from greenhouse gas emissions.

  11. Summary Report, Southwest Regional Geothermal Operations Research Program: First project year, June 1977-August 1978

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Richard T.; Davidson, Ray

    1978-12-01

    The overall objectives of the first year project were as follows: (1) to develop realistic but aggressive scenarios with certainty factors for the development of each identified geothermal resource area in Arizona, Colorado, Nevada, New Mexico, and Utah; (2) to delineate the public actions, together with their schedules, required for the scenarios to materialize; and (3) to develop a computer-based data storage and retrieval system (i.e. a Regional Program Progress Monitor) of the level of a preliminary working model, which is capable of displaying program approach but is not loaded with all available data. In addition, each sponsor had supplementary objectives aligned to its own programmatic goals. DOE sought to develop expertise and programs within the appropriate state agencies upon which future DOE development and commercialization activities could be structured. FCRC sought to promote the utilization of geothermal energy throughout the five-state region for purposes of expanded economic development, increased employment, and higher citizen incomes. The goals of the five states varied from state to state, but generally included the following: development of alternative energy sources to replace dwindling supplies of oil and natural gas; economic and industrial development in rural areas; encouragement of industry and utility development of geothermal energy for electrical power generation; demonstration of the practical applications of energy research and development; and close interaction with business and industry for the commercialization of both electric and direct thermal applications.

  12. Development and Pre-Operational Validation of NEMO Based Eddy Ressolving Regional Configuration for Gulf of Finland

    Science.gov (United States)

    Sofina, Ekaterina; Vankevich, Roman; Tatiana, Eremina

    2014-05-01

    At the present day RSHU the Operational Oceanographic System for the Gulf of Finland (GULFOOS) is in a trial operation. For the future development of the operational system, the quality of which also strongly depends on the hydrothermodynamic model spatial resolution. The new model configuration has been implemented, based on the international project NEMO (Nucleus for European Modelling of the Ocean). Based on NEMO toolbox a new eddy permitting z-coordinated configuration realized with horizontal resolution 30x15'' (~500 m) and 1 m vertical step. Chosen horizontal resolution enough to resolve typical submesoscale eddies in this basin where the internal Rossby radius is usually 2-4 km [1]. Verification performed with use all available measurements including vessel, ferry boxes, autonomous profilers, satellite SST. It was shown that submesoscale eddies and filaments generated by baroclinic instability of fronts in upper layers of the Gulf can change vertical stratification and deepening of the mixed layer. Increase in the model resolution leads to a clear improvement of the representation of the key hydro-physical fields: filaments propagation, local eddies. Obtained results confirm that model adequately reproduce general circulation and seasonal evolution of vertical water structure. It is shown that NEMO model initially designed for a global ocean can be used in regional operational application in case of highly stratified shallow basin with complex bathymetry. Computation efficiency of the system including 3DVar assimilation was enough for 24x7 operational task on 12 nodes of Intel based cluster. Proposed regional modeling system has potential to give information on non-observed physical quantities and to provide links between observations by identifying small-scale patterns and processes. References 1. Alenius P., Nekrasov A., Myrberg, K. The baroclinic Rossby-radius in the Gulf of Finland. Continental Shelf Research, 2003, 23, 563-573.

  13. Spatial distribution patterns of illegal artisanal small scale gold mining (Galamsey) operations in Ghana: A focus on the Western Region.

    Science.gov (United States)

    Owusu-Nimo, F; Mantey, J; Nyarko, K B; Appiah-Effah, Eugene; Aubynn, A

    2018-02-01

    Recently, there have been efforts by stakeholders to monitor illegal mining ( galamsey) activities, foster their formalization and reclaim the many abandoned wastelands in Ghana. However, limited information exists on the locations, abundance, scope and scale of galamsey types, which hinders the development of effective policy response. This study attempts to map and analyze the distribution patterns, abundance, activity statuses and the extents of nine (9) galamsey types within eleven (11) Municipal and District Assemblies (MDAs) of Ghana's Western Region. It explores the utility of field-based survey, using the Open Data Kit (ODK) system, ArcGIS and Google Earth Imagery to map and visualize different galamsey types under a hostile working environment. A total of 911 galamsey sightings, of which 547 were found in clusters (corresponding to approximately 7106 individual operational units) and 364 in stand-alone mode. Overall, a total of 7470 individual galamsey operations were encountered in 312 different communities (towns and villages). Operationally, the Alluvial Washing Board, Mill-House and Chamfi were found to be the three most popular and practiced galamsey types. The three main galamsey hotspot districts (out of the 11) are the Tarkwa Nsuaem (294 sightings and 3648 individual galamsey sites), Amenfi East (223 sightings and 1397 individual galamsey sites) and Prestea Huni-Valley Districts (156 sightings and 1130 individual galamsey sites). In terms of their activity statuses, 199 abandoned operations (entailing 1855 individual operations), 664 active (entailing 5055 individuals operations) and 48 semi-active (comprising 560 individuals within clusters) galamsey operations were sighted at the time of the study. While galamsey is generally acknowledged to be widespread in Ghana, the results suggest a scale that probably surpasses any previous estimate or expectation. The findings will adequately inform the prioritization of reclamation efforts.

  14. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    BACKGROUNDThere is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores.METHODSThis study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European...... guidelines ("European risk score") versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation.RESULTSThe European score had modest...... predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

  15. When math operations have visuospatial meanings versus purely symbolic definitions: Which solving stages and brain regions are affected?

    Science.gov (United States)

    Pyke, Aryn A; Fincham, Jon M; Anderson, John R

    2017-06-01

    How does processing differ during purely symbolic problem solving versus when mathematical operations can be mentally associated with meaningful (here, visuospatial) referents? Learners were trained on novel math operations (↓, ↑), that were defined strictly symbolically or in terms of a visuospatial interpretation (operands mapped to dimensions of shaded areas, answer = total area). During testing (scanner session), no visuospatial representations were displayed. However, we expected visuospatially-trained learners to form mental visuospatial representations for problems, and exhibit distinct activations. Since some solution intervals were long (~10s) and visuospatial representations might only be instantiated in some stages during solving, group differences were difficult to detect when treating the solving interval as a whole. However, an HSMM-MVPA process (Anderson and Fincham, 2014a) to parse fMRI data identified four distinct problem-solving stages in each group, dubbed: 1) encode; 2) plan; 3) compute; and 4) respond. We assessed stage-specific differences across groups. During encoding, several regions implicated in general semantic processing and/or mental imagery were more active in visuospatially-trained learners, including: bilateral supramarginal, precuneus, cuneus, parahippocampus, and left middle temporal regions. Four of these regions again emerged in the computation stage: precuneus, right supramarginal/angular, left supramarginal/inferior parietal, and left parahippocampal gyrus. Thus, mental visuospatial representations may not just inform initial problem interpretation (followed by symbolic computation), but may scaffold on-going computation. In the second stage, higher activations were found among symbolically-trained solvers in frontal regions (R. medial and inferior and L. superior) and the right angular and middle temporal gyrus. Activations in contrasting regions may shed light on solvers' degree of use of symbolic versus mental

  16. The Text of the Agreement of 8 July Extending the Asian Regional Co-Operative Project on Food Irradiation. Extension Agreement

    International Nuclear Information System (INIS)

    1983-12-01

    The text of the Agreement to Extend the Agreement of 23 May 1980 Establishing the Asian Regional Co-operative Project on Food Irradiation within the framework of the Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology of 1972, as extended in 1977 and in 1982, is reproduced herein for the information of all Members

  17. The Role of Demand Resources In Regional Transmission Expansion Planning and Reliable Operations

    Energy Technology Data Exchange (ETDEWEB)

    Kirby, Brendan J [ORNL

    2006-07-01

    Investigating the role of demand resources in regional transmission planning has provided mixed results. On one hand there are only a few projects where demand response has been used as an explicit alternative to transmission enhancement. On the other hand there is a fair amount of demand response in the form of energy efficiency, peak reduction, emergency load shedding, and (recently) demand providing ancillary services. All of this demand response reduces the need for transmission enhancements. Demand response capability is typically (but not always) factored into transmission planning as a reduction in the load which must be served. In that sense demand response is utilized as an alternative to transmission expansion. Much more demand response is used (involuntarily) as load shedding under extreme conditions to prevent cascading blackouts. The amount of additional transmission and generation that would be required to provide the current level of reliability if load shedding were not available is difficult to imagine and would be impractical to build. In a very real sense demand response solutions are equitably treated in every region - when proposed, demand response projects are evaluated against existing reliability and economic criteria. The regional councils, RTOs, and ISOs identify needs. Others propose transmission, generation, or responsive load based solutions. Few demand response projects get included in transmission enhancement plans because few are proposed. But this is only part of the story. Several factors are responsible for the current very low use of demand response as a transmission enhancement alternative. First, while the generation, transmission, and load business sectors each deal with essentially the same amount of electric power, generation and transmission companies are explicitly in the electric power business but electricity is not the primary business focus of most loads. This changes the institutional focus of each sector. Second

  18. Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database.

    Science.gov (United States)

    Mani, K; Venermo, M; Beiles, B; Menyhei, G; Altreuther, M; Loftus, I; Björck, M

    2015-06-01

    National differences exist in the outcome of elective abdominal aortic aneurysm (AAA) repair. The role of case mix variation was assessed based on an international vascular registry collaboration. All elective AAA repairs with aneurysm size data in the Vascunet database in the period 2005-09 were included. AAA size and peri-operative outcome (crude and age adjusted mortality) were analysed overall and in risk cohorts, as well as per country. Glasgow Aneurysm Score (GAS) was calculated as risk score, and patients were stratified in three equal sized risk cohorts based on GAS. Predictors of peri-operative mortality were analysed with multiple regression. Missing data were handled with multiple imputation. Patients from Australia, Finland, Hungary, Norway, Sweden and the UK (n = 5,895) were analysed; mean age was 72.7 years and 54% had endovascular repair (EVAR). There were significant variations in GAS (lowest = Finland [75.7], highest = UK [79.4], p for comparison of all regions 82. Of those with a GAS >82, 8.4% of men and 20.8% of women had an AAA case selection for elective AAA repair, including variations in AAA size and patient risk profile. These differences partly explain the variations in peri-operative mortality. Further audit is warranted to assess the underlying reasons for the regional variation in case-mix. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  19. The decommissioning of WWER type nuclear power plants. Final report on an IAEA regional technical co-operation project

    International Nuclear Information System (INIS)

    2000-01-01

    Numerous WWER-440 nuclear power plants are in operation in central and eastern Europe and a small number have already been shut down. In addition to reactors already shut down, many other reactors will reach the end of their design lifetime in a few years and become candidates for decommissioning. It is unfortunate that little consideration was devoted to decommissioning of WWER-440 reactors at the plant design and construction stage, and little emphasis was placed on planning for decommissioning. It is within this context that the IAEA launched a regional technical co-operation project in 1994 with the aim of providing guidance on planning and management of decommissioning for WWERs. The project, which had a duration of four years (1995-1998), included the organization of workshops and scientific visits to countries having WWERs and other countries where active decommissioning projects were under way. Eventually, participants suggested the consolidation of expert guidance and collective opinions into a TECDOC, which was drafted by both designated participants from project recipient countries and invited experts. The TECDOC has the aim of serving as a stimulus for all concerned parties in central and eastern European countries to initiate concrete decommissioning planning, including assessment of existing and required resources for the eventual implementation of decommissioning plans. In addition, the regional technical co-operation project has managed to bring together in this TECDOC a number of good practices that could be useful in WWER-440 decommissioning

  20. Tennessee Valley region study: potential year 2000 radiological dose to population resulting from nuclear facility operations. [Includes glossary

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-06-01

    A companion report, DOE/ET-0064/1, presents a geographic, cultural, and demographic profile of the Tennessee Valley Region study area. This report describes the calculations of radionuclide release and transport and of the resultant dose to the regional population, assuming a projected installed capacity of 220,000 MW in the year 2000, of which 144,000 MW would be nuclear. All elements of the fuel cycle were assumed to be in operation. The radiological dose was calculated as a one-year dose based on ingestion of 35 different food types as well as for nine non-food pathways, and was reported as dose to the total body and for six specific organs for each of four age groups (infant, child, teen, and adult). Results indicate that the average individual would receive an incremental dose of 7 x 10/sup -4/ millirems in the year 2000 from the operation of nuclear facilities within and adjacent to the region, five orders of magnitude smaller than the dose from naturally occurring radiation in the area. The major contributor to dose was found to be tritium, and the most significant pathways were immersion in air, inhalation of air, transpiration of tritium (absorption through the skin), and exposure radionuclide-containing soil. 60 references.

  1. Emergency transcatheter arterial embolization for critical massive bleeding due to duodenal bulb ulcer

    International Nuclear Information System (INIS)

    Li Qiang; Li Yiyun; Zhao Chunmei

    2011-01-01

    Objective: To evaluate the efficacy and feasibility of emergency transcatheter arterial embolization (ETAE) in treating critical massive bleeding due to duodenal bulb ulcer. Methods: ETAE was carried out in seven patients with acute massive bleeding due to endoscopically-proved duodenal bulb ulcer, who failed to respond conservative measures and were critically ill clinically. Super-selective catheterization of gastroduodenal artery or right gastroepiploic artery was performed, which was followed by arterial angiography to identify the bleeding site. According to the angiographic findings, ETAE with Gelfoam particles and coils was carried out. After the operation medical management was given and endoscopy re-examination was conducted. All the patients were follow up for 3∼6 months. Results: Angiographically, gastroduodenal artery bleeding was detected in all seven patients. ETAE was successfully accomplished in all cases. Complete clinical effectiveness was obtained in six patients while partial effectiveness in one case. No procedure-related complications occurred. Conclusion: For critical massive bleeding due to duodenal bulb ulcer ETAE is a highly effective and safe treatment, which can be regarded as an alternative to surgery. It is worth popularizing this technique in clinical practice. (authors)

  2. Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding

    Directory of Open Access Journals (Sweden)

    Ali M. El Saman

    2015-01-01

    Full Text Available Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women’s Health Center of Assiut University. The outcomes measured were; patient’s acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

  3. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Directory of Open Access Journals (Sweden)

    Miettinen Simo

    2012-09-01

    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  4. Severe hyponatraemia after terlipressin treatment in the patient with surgically untreatable bleeding into gastrointestinal system

    International Nuclear Information System (INIS)

    Vojtko, M.; Smolar, M.; Laca, L.; Danova, I.; Strelka, L.; Hulo, E.; Mikolajcik, A.; Kicina, R.; Laca, L.; Zelenak, K.

    2014-01-01

    The authors present the case report of a 46 year old woman. In personal history, she was operated for congenital duodenal stenosis at the age 2 days, later reoperated due to restenosis. The patient had congenital vascular malformations of gastrointestinal tract (GIT) and was recurrently hospitalized for recidivous bleeding into GIT with concurrent development of portal hypertension. In 2012 she was admitted to our department because of relapsing bleeding into GIT which was impossible surgically treated so the patient was treated conservatively. In the course of terlipressin use, sharp decline of natremia developed with subsequent altered consciousness with CT verified brain edema. Further management included discontinuation of terlipressin, slow correction of hyponatraemia, embolization of arterial lienalis, hemosubstitution and recombinant factor VIIa. This treatment led to stop bleeding and improvement of state of consciousness however mild form of organic psycho syndrome persists. (author)

  5. Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

    Science.gov (United States)

    Alaqzam, Tasneem S; Stanley, Angela C; Simpson, Pippa M; Flood, Veronica H; Menon, Seema

    2018-03-07

    This study sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder. DESIGN, SETTING, PARTICIPANT, INTERVENTION, AND MAIN OUTCOME MEASURES: Retrospective chart review of adolescent <21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information included demographics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into two categories based on the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared. 73 subjects tested for a bleeding disorder. Of the subjects completing testing, 34 (46%) were diagnosed with a bleeding disorders. 39 (54%) subjects had heavy menstrual bleeding due to other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without bleeding disorder. When comparing hormone therapy success, the levonorgestrel IUD (LNG-IUD) (89%) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10mg/day (83%), and the transdermal patch (80%). All subjects using both tranexamic acid and hormonal therapy had 100% achievement of menstrual suppression. A high frequency of bleeding disorder was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron

  6. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  7. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    DEFF Research Database (Denmark)

    Olesen, J B; Lip, G Y H; Hansen, P R

    2011-01-01

    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme...

  8. DEA (Data Envelopment Analysis) assessment of operational and environmental efficiencies on Japanese regional industries

    International Nuclear Information System (INIS)

    Goto, Mika; Otsuka, Akihiro; Sueyoshi, Toshiyuki

    2014-01-01

    A balance between industrial pollution and economic growth becomes a major policy issue to attain a sustainable society in the world. To discuss the problem from economics and business perspectives, this study proposes a new use of DEA (Data Envelopment Analysis) as a methodology for unified (operational and environmental) assessment. A unique feature of the proposed approach is that it separates outputs into desirable and undesirable categories. Such separation is important because energy industries usually produce both desirable and undesirable outputs. This study discusses how to unify the two types of outputs under natural and managerial disposability. The proposed DEA approach evaluates various organizations by the three efficiency measures such as OE (Operational Efficiency), UEN (Unified Efficiency under Natural disposability) and UENM (Unified Efficiency under Natural and Managerial disposability). An important feature of UENM is that it separates inputs into two categories and unifies them under the two disposability concepts in addition to the proposed output separation and unification. This study incorporates an amount of capital assets for technology innovation, as one of the two input group, into the measurement of UENM. Then, it compares UENM with the other two efficiency measures. This study is the first research effort in which DEA has an analytical capability to quantify the importance of investment on capital assets for technology innovation. To confirm the practicality of the proposed approach, this study applies the three efficiency measures to a data set regarding manufacturing and non-manufacturing industries of 47 prefectures in Japan. This study empirically confirms the validity of Porter hypothesis in Japanese manufacturing industries, so implying that environmental regulation has been effective for betterment on the performance of Japanese manufacturing industries. Another important finding is that the emission of greenhouse gases is a

  9. Operation Strategy for a Power Grid Supplied by 100% Renewable Energy at a Cold Region in Japan

    Directory of Open Access Journals (Sweden)

    Jorge Morel

    2014-09-01

    Full Text Available This paper presents an operation strategy for a power system supplied from 100% renewable energy generation in Kitami City, a cold region in Japan. The main goal of this work is the complete elimination of the CO2 emissions of the city while keeping the power frequency within prescribed limits. Currently, the main energy related issue in Japan is the reduction of CO2 emissions without depending on nuclear generation. Also, there is a need for the adoption of distributed generation architecture in order to permit local autonomous operation of the system by the local generation of power. As a solution, this paper proposes a strategy to eliminate CO2 emissions that considers digital simulations using past hourly meteorological data and demand for one year. Results shows that Kitami City can be supplied entirely by renewable generation, reducing its CO2 emission to zero while keeping the quality of its power grid frequency within permitted limits.

  10. Methods, systems and apparatus for controlling third harmonic voltage when operating a multi-space machine in an overmodulation region

    Science.gov (United States)

    Perisic, Milun; Kinoshita, Michael H; Ranson, Ray M; Gallegos-Lopez, Gabriel

    2014-06-03

    Methods, system and apparatus are provided for controlling third harmonic voltages when operating a multi-phase machine in an overmodulation region. The multi-phase machine can be, for example, a five-phase machine in a vector controlled motor drive system that includes a five-phase PWM controlled inverter module that drives the five-phase machine. Techniques for overmodulating a reference voltage vector are provided. For example, when the reference voltage vector is determined to be within the overmodulation region, an angle of the reference voltage vector can be modified to generate a reference voltage overmodulation control angle, and a magnitude of the reference voltage vector can be modified, based on the reference voltage overmodulation control angle, to generate a modified magnitude of the reference voltage vector. By modifying the reference voltage vector, voltage command signals that control a five-phase inverter module can be optimized to increase output voltages generated by the five-phase inverter module.

  11. Strategic innovation: An empirical study on hotel firms operating in Antalya region

    Directory of Open Access Journals (Sweden)

    Fatma Nur Iplik

    2014-06-01

    Full Text Available Strategic innovation is an issue that is frequently debated by the recent studies. The contemporary organizations almost in all industries seek to increase their strategic innovation capabilities in order to possess a sustainable competitive advantage. Similarly, in the hospitality industry strategic innovation is an essential instrument of gaining competitive advantage in the marketplaces. In modern days of hospitality and tourism, satisfying consurmers with providing only accommodation and catering services is not sustainable since demand is becoming diversified and rivals are offering new services. Thus, strategic innovation may assist hotel firms in meeting new demand and expanding the range of services they offer. Therefore, the purposes of this paper are to measure the level of strategic innovation of hotel firms, and to reveal the obstacles to strategic innovation activities. The paper will also examine the importance of strategic innovation for hotel firms. To this end, a questionnaire was developed and employed to middle and top level executives of hotel firms operating in Antalya province. Results show that hotel firms primarily innovate to improve service quality and to satisfy guests. It was also found that the most important obstacle to innovation is cost of innovation activities.

  12. Quantitative Assessment of Resilience in the operatives unitsof National Iranian Drilling Company (regional study: Khuzestan

    Directory of Open Access Journals (Sweden)

    M. Arassi

    2015-01-01

    Full Text Available Introduction: Resilience engineering is a new approach in safety science. Its goal is to maintain organizational capacity in an acceptable level to help system in managing the crisis. Indeed, resilience engineering rely on systems abilities instead of weaknesses, and try to find indicators that help the system durability. .Material and Method: In this study,first, 6 resilience engineering factors were chosen and sent toexperts in the form of paired comparison sheets. On the other hand, a valid standard questionnaire distributed among drilling rigs operational workers for measuring the NIDC resilience level. Finally,the priority of corrective actionswas determinedaccording to the score of the two analyzedquestionnaires. .Results: The results of resilience engineering factors weighting showed that the management commitment has the highest value andthe second place belonged to the correct culture. The indicators’scores,based on the distributed questionnaires among workers, showed that all of the six factors had similar scoreswhich can be evaluated as fairly good. Finally, the results of prioritization of indicators ofresilience engineering, basedon the combination ofthe questionnaire and experts opinions showed that management commitment is the most effective resilience factor in the organization. ..Conclusion: Management commitment and the current culture are the most importantcontributing factorsin company resilience level. Experienced workforce was the best strengthof the company and the effect of financial issues on resilience and safety was the biggest problem ahead.

  13. Characteristic time series and operation region of the system of two tank reactors (CSTR) with variable division of recirculation stream

    International Nuclear Information System (INIS)

    Merta, Henryk

    2006-01-01

    The paper deals with a system of a cascade of two tank reactors, being characterized by the variable stream of recirculating fluid at each stage. The assumed mathematical model enables one to determine the system's dynamics for the case when there is no time delay and for the opposite case. The time series of the conversion degree and of the dimensionless fluid temperature, characteristic for the system considered as well as the operation regions-the latter-basing on Feingenbaum diagrams with respect to the division ratio of the recirculating stream are presented

  14. Text of an African regional co-operative agreement for research, development and training related to nuclear science and technology

    International Nuclear Information System (INIS)

    1994-01-01

    As of 1 September 1994, notifications of acceptance of the African Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology (see INFCIRC/377), in accordance with Article XIII thereof, had been received by the Director General from the Governments of: Tunisia, Egypt, Algeria, Nigeria, Madagascar, Libya, Morocco, Kenya, Sudan, Ghana, Tanzania, Mauritius, Cameroon, South Africa, Zaire, Ethiopia, Zambia, Niger. The Agreement entered into force on 4 April 1990, the date of receipt of the third notification of acceptance

  15. Treatment and prognosis in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, Stig Borbjerg

    2014-01-01

    Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after

  16. The localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    International Nuclear Information System (INIS)

    Stevens, J.M.; Northover, J.M.A.; Raphael, M.J.; Slack, W.W.

    1981-01-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated. (author)

  17. Localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, J M; Northover, J M.A.; Raphael, M J; Slack, W W [Middlesex Hospital, London (UK)

    1981-10-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated.

  18. The HAT Score-A Simple Risk Stratification Score for Coagulopathic Bleeding During Adult Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Lonergan, Terence; Herr, Daniel; Kon, Zachary; Menaker, Jay; Rector, Raymond; Tanaka, Kenichi; Mazzeffi, Michael

    2017-06-01

    The study objective was to create an adult extracorporeal membrane oxygenation (ECMO) coagulopathic bleeding risk score. Secondary analysis was performed on an existing retrospective cohort. Pre-ECMO variables were tested for association with coagulopathic bleeding, and those with the strongest association were included in a multivariable model. Using this model, a risk stratification score was created. The score's utility was validated by comparing bleeding and transfusion rates between score levels. Bleeding also was examined after stratifying by nadir platelet count and overanticoagulation. Predictive power of the score was compared against the risk score for major bleeding during anti-coagulation for atrial fibrillation (HAS-BLED). Tertiary care academic medical center. The study comprised patients who received venoarterial or venovenous ECMO over a 3-year period, excluding those with an identified source of surgical bleeding during exploration. None. Fifty-three (47.3%) of 112 patients experienced coagulopathic bleeding. A 3-variable score-hypertension, age greater than 65, and ECMO type (HAT)-had fair predictive value (area under the receiver operating characteristic curve [AUC] = 0.66) and was superior to HAS-BLED (AUC = 0.64). As the HAT score increased from 0 to 3, bleeding rates also increased as follows: 30.8%, 48.7%, 63.0%, and 71.4%, respectively. Platelet and fresh frozen plasma transfusion tended to increase with the HAT score, but red blood cell transfusion did not. Nadir platelet count less than 50×10 3 /µL and overanticoagulation during ECMO increased the AUC for the model to 0.73, suggesting additive risk. The HAT score may allow for bleeding risk stratification in adult ECMO patients. Future studies in larger cohorts are necessary to confirm these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Environmental and economic assessment of discharges from Gulf of Mexico region oil and gas operations

    International Nuclear Information System (INIS)

    Gettleson, D.A.

    1993-01-01

    Continental Shelf Associates, Inc. (CSA) was contracted to conduct a three-year study of the environmental and health related impacts of produced water and sand discharges from oil and gas operations. Data on naturally occurring radioactive materials (NORM), heavy metals, and hydrocarbons in water, sediment, and biota will be collected and evaluated. Health related impacts will be studied through field collections and analyses of commercially- and recreationally-important fish and shellfish tissues. Additionally, information on seafood catch, consumption, and use patterns for the Gulf of Mexico will be gathered and analyzed. The facilities to be studied will include both offshore and coastal facilities in the Gulf of Mexico. Coastal sites will be additionally studied to determine ecological recovery of impacted wetland and open bay areas. The economic impact of existing and proposed effluent federal and state regulations will also be evaluated. The primary objectives of the project are to increase the base of scientific knowledge concerning (1) the fate and environmental effects of organics, trace metals, and NORM in water, sediment, and biota near several offshore oil and gas facilities; (2) the characteristics of produced water and produced sand discharges as they pertain to organics, trace metals, and NORM variably found in association with the discharges; (3) the recovery of four terminated produced water discharge sites located in wetland and high-energy open bay sites of coastal Louisiana and Texas; (4) the economic and energy supply impacts of existing and anticipated federal and state offshore and coastal discharge regulations; and (5) the catch, consumption and human use patterns of seafood species collected from coastal and offshore waters. Accomplishments for this period are described

  20. Combining operational models and data into a dynamic vessel risk assessment tool for coastal regions

    Science.gov (United States)

    Fernandes, R.; Braunschweig, F.; Lourenço, F.; Neves, R.

    2016-02-01

    The technological evolution in terms of computational capacity, data acquisition systems, numerical modelling and operational oceanography is supplying opportunities for designing and building holistic approaches and complex tools for newer and more efficient management (planning, prevention and response) of coastal water pollution risk events. A combined methodology to dynamically estimate time and space variable individual vessel accident risk levels and shoreline contamination risk from ships has been developed, integrating numerical metocean forecasts and oil spill simulations with vessel tracking automatic identification systems (AIS). The risk rating combines the likelihood of an oil spill occurring from a vessel navigating in a study area - the Portuguese continental shelf - with the assessed consequences to the shoreline. The spill likelihood is based on dynamic marine weather conditions and statistical information from previous accidents. The shoreline consequences reflect the virtual spilled oil amount reaching shoreline and its environmental and socio-economic vulnerabilities. The oil reaching shoreline is quantified with an oil spill fate and behaviour model running multiple virtual spills from vessels along time, or as an alternative, a correction factor based on vessel distance from coast. Shoreline risks can be computed in real time or from previously obtained data. Results show the ability of the proposed methodology to estimate the risk properly sensitive to dynamic metocean conditions and to oil transport behaviour. The integration of meteo-oceanic + oil spill models with coastal vulnerability and AIS data in the quantification of risk enhances the maritime situational awareness and the decision support model, providing a more realistic approach in the assessment of shoreline impacts. The risk assessment from historical data can help finding typical risk patterns ("hot spots") or developing sensitivity analysis to specific conditions, whereas real

  1. Increasing the regional availability of the Standardized Precipitation Index: an operational approach

    Directory of Open Access Journals (Sweden)

    Monica Cristina Meschiatti

    Full Text Available ABSTRACT The need to use a length of rainfall records of at least 30 years to calculate the Standardized Precipitation Index (SPI limits its application in several Drought Early Warning Systems of developing countries. Therefore, in order to increase the number of weather stations in which the SPI may be applied, this study quantified the difference among SPI values derived from calibration periods (CP smaller than 30 years in respect to those computed from the 30-year period of 1985 – 2014 in the State of São Paulo, Brazil (time scales ranging from 1 to 12 months were considered. The correlation, agreement and consistency of SPI values derived from CP ranging from the last 30 to 21 years have been evaluated. The Kolmogorov-Smirnov/Lilliefors test indicated, for all CP, that the 2-parameter gamma distribution may be used to calculate the SPI in the State of São Paulo. The normality test indicated that, even for the period of 1985 – 2014, the normally assumption of the SPI series is not always met. However, it was observed no remarkable difference in the rejection rates of the normality assumption obtained from the different CP. Finally, both absolute mean error and the modified index of agreement indicated a high consistence among SPI values derived from the calibration period of 1991 – 2014 (24 years in respect to those derived from the 30-year period. Accordingly, it is possible to use weather stations with rainfall records starting in 1991 (or earlier to calculate, in operational mode, the SPI in the State of São Paulo.

  2. The usefulness of MDCT in acute intestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

    2006-01-01

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted

  3. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding

    DEFF Research Database (Denmark)

    Dueholm, M; Forman, A; Jensen, ML

    2001-01-01

    OBJECTIVES: To evaluate whether saline contrast sonohysterography (SCSH) adds additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS: This was a two......-center prospective study at a university clinic and a central hospital in Denmark. The uterine cavity was evaluated with TVS and SCSH in 470 premenopausal patients with abnormal uterine bleeding. One hundred and eighty-nine of the patients had operative hysteroscopy or hysterectomy within 4 months which provided...... uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in four equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding....

  4. The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection.

    Science.gov (United States)

    Dadgarnia, Mohammad Hossein; Aghaei, Mohammad Ali; Atighechi, Saeid; Behniafard, Nasim; Vahidi, Mohammad Reza; Meybodian, Mojtaba; Zand, Vahid; Vajihinejad, Maryam; Ansari, Abdollah

    2016-10-01

    Although tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. This double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. In both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001). patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups. Moreover, Compared pain scores in all times across two groups, no significant difference was found. In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. Our study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Effects of regional groundwater flow on the performance of an aquifer thermal energy storage system under continuous operation

    Science.gov (United States)

    Lee, Kun Sang

    2014-01-01

    Numerical investigations and a thermohydraulic evaluation are presented for two-well models of an aquifer thermal energy storage (ATES) system operating under a continuous flow regime. A three-dimensional numerical model for groundwater flow and heat transport is used to analyze the thermal energy storage in the aquifer. This study emphasizes the influence of regional groundwater flow on the heat transfer and storage of the system under various operation scenarios. For different parameters of the system, performances were compared in terms of the temperature of recovered water and the temperature field in the aquifer. The calculated temperature at the producing well varies within a certain range throughout the year, reflecting the seasonal (quarterly) temperature variation of the injected water. The pressure gradient across the system, which determines the direction and velocity of regional groundwater flow, has a substantial influence on the convective heat transport and performance of aquifer thermal storage. Injection/production rate and geometrical size of the aquifer used in the model also impact the predicted temperature distribution at each stage and the recovery water temperature. The hydrogeological-thermal simulation is shown to play an integral part in the prediction of performance of processes as complicated as those in ATES systems.

  6. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Energy Technology Data Exchange (ETDEWEB)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  7. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    International Nuclear Information System (INIS)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

    1989-01-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of 99m Tc-DTPA, 99m Tc-RBCs and 99m Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both 99m Tc-DTPA and 99m Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only 99m Tc-DTPA was successful in detecting the bleeding site. The results indicate that 99m Tc-DTPA is the most useful 99m Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.) [de

  8. Establishing an operational waterhole monitoring system using satellite data and hydrologic modelling: Application in the pastoral regions of East Africa

    Science.gov (United States)

    Senay, Gabriel B.; Velpuri, Naga Manohar; Alemu, Henok; Pervez, Shahriar Md; Asante, Kwabena O; Karuki, Gatarwa; Taa, Asefa; Angerer, Jay

    2013-01-01

    Timely information on the availability of water and forage is important for the sustainable development of pastoral regions. The lack of such information increases the dependence of pastoral communities on perennial sources, which often leads to competition and conflicts. The provision of timely information is a challenging task, especially due to the scarcity or non-existence of conventional station-based hydrometeorological networks in the remote pastoral regions. A multi-source water balance modelling approach driven by satellite data was used to operationally monitor daily water level fluctuations across the pastoral regions of northern Kenya and southern Ethiopia. Advanced Spaceborne Thermal Emission and Reflection Radiometer data were used for mapping and estimating the surface area of the waterholes. Satellite-based rainfall, modelled run-off and evapotranspiration data were used to model daily water level fluctuations. Mapping of waterholes was achieved with 97% accuracy. Validation of modelled water levels with field-installed gauge data demonstrated the ability of the model to capture the seasonal patterns and variations. Validation results indicate that the model explained 60% of the observed variability in water levels, with an average root-mean-squared error of 22%. Up-to-date information on rainfall, evaporation, scaled water depth and condition of the waterholes is made available daily in near-real time via the Internet (http://watermon.tamu.edu). Such information can be used by non-governmental organizations, governmental organizations and other stakeholders for early warning and decision making. This study demonstrated an integrated approach for establishing an operational waterhole monitoring system using multi-source satellite data and hydrologic modelling.

  9. The effect of Tranexamic acid on cardiac surgery bleeding

    Directory of Open Access Journals (Sweden)

    Mohammad Esmaeelzadeh

    2014-02-01

    Full Text Available Serious bleeding in cardiac surgery leads to re-exploration, blood transfusion and increases the risks of mortality and morbidity. Using the lysine analogous of antifibrionlytic agents are the preferred strategy to suppress the need for transfusion procedures and blood products. Although tranexamic acid has been very influential in reducing the transfusion requirement after operation, tranexamic acid induced seizures is one of the common side effects of this drug. Due to inhibiting the fibrinolysis, thrombotic events are other possible side effects of using tranexamic acid. There are no certain results regarding decreasing the mortality rate by using the drug but it is identified that tranexamic acid does not increase the mortality. In this article, we aimed to review the literature on using tranexamic acid in cardiac surgeries.

  10. LOAD FORECASTING FOR POWER SYSTEM PLANNING AND OPERATION USING ARTIFICIAL NEURAL NETWORK AT AL BATINAH REGION OMAN

    Directory of Open Access Journals (Sweden)

    HUSSEIN A. ABDULQADER

    2012-08-01

    Full Text Available Load forecasting is essential part for the power system planning and operation. In this paper the modeling and design of artificial neural network for load forecasting is carried out in a particular region of Oman. Neural network approach helps to reduce the problem associated with conventional method and has the advantage of learning directly from the historical data. The neural network here uses data such as past load; weather information like humidity and temperatures. Once the neural network is trained for the past set of data it can give a prediction of future load. This reduces the capital investment reducing the equipments to be installed. The actual data are taken from the Mazoon Electrical Company, Oman. The data of load for the year 2007, 2008 and 2009 are collected for a particular region called Al Batinah in Oman and trained using neural networks to forecast the future. The main objective is to forecast the amount of electricity needed for better load distribution in the areas of this region in Oman. The load forecasting is done for the year 2010 and is validated for the accuracy.

  11. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    International Nuclear Information System (INIS)

    Stoupis, Christoforos; Ludwig, Karin; Triller, Juergen; Inderbitzin, Daniel; Do, Dai-Do

    2007-01-01

    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  12. Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding.

    Science.gov (United States)

    Paulasir, Sylvester; Khorfan, Rhami; Harsant, Christina; Anderson, Harry Linne

    2017-04-26

    A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

    Science.gov (United States)

    Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

    2013-09-01

    Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

  14. Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma.

    Science.gov (United States)

    Pang, Chang Hwan; Lee, Soo Eon; Kim, Chang Hyeun; Kim, Jeong Eun; Kang, Hyun-Seung; Park, Chul-Kee; Paek, Sun Ha; Kim, Chi Heon; Jahng, Tae-Ahn; Kim, Jin Wook; Kim, Yong Hwy; Kim, Dong Gyu; Chung, Chun Kee; Jung, Hee-Won; Yoo, Heon

    2015-07-01

    There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients. A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed. A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10-104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding. Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.

  15. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  16. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  17. Management of bleeding in vascular surgery.

    Science.gov (United States)

    Chee, Y E; Liu, S E; Irwin, M G

    2016-09-01

    Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Bleeding aneurysms of the celiac trunk

    International Nuclear Information System (INIS)

    Ziviello, M.; D'Isa, L.; Siani, A.; Maglione, F.; Cataldo, B.; Ziviello, R.; Capalbogiliberti, R.

    1988-01-01

    The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US,CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biospy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), anobulated solid-like lesion, and complex lesion (2 cases). Continuity of the lesion with adjancent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases)

  19. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  20. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

  1. Taeniasis: A possible cause of ileal bleeding.

    Science.gov (United States)

    Settesoldi, Alessia; Tozzi, Alessandro; Tarantino, Ottaviano

    2017-12-16

    Taenia spp. are flatworms of the class Cestoda, whose definitive hosts are humans and primates. Human infestation (taeniasis) results from the ingestion of raw meat contaminated with encysted larval tapeworms and is considered relatively harmless and mostly asymptomatic. Anemia is not recognized as a possible sign of taeniasis and taeniasis-induced hemorrhage is not described in medical books. Its therapy is based on anthelmintics such praziquantel, niclosamide or albendazole. Here we describe a case of acute ileal bleeding in an Italian man affected with both Taenia spp. infestation resistant to albendazole and Helicobacter pylori -associated duodenal ulcers.

  2. Effect of tranexamic acid administration on bleeding in primary total hip arthroplasty.

    Science.gov (United States)

    Fernández-Cortiñas, A B; Quintáns-Vázquez, J M; Gómez-Suárez, F; Murillo, O Simón; Sánchez-López, B R; Pena-Gracía, J M

    To study the efficacy of tranexamic acid to decrease perioperative bleeding in patients who have undergone a total hip arthroplasty operation and to evaluate drug safety. Observational, prospective, controlled and randomized study on the efficacy of tranexamic acid as a method to reduce bleeding in primary hip replacement surgery. We included 134 patients operated during 2014 in our centre, who were divided into 2 groups according to whether or not they had received tranexamic acid. The main study variables were haemoglobin and haematocrit levels, the amount of blood collected from the post-operative drain in the first 12, 24 and 48hours and transfusion requirements. Post-operative haemoglobin and haematocrit levels were statistically higher (Ptranexamic acid. Statistically significant differences (P=.001) were found as to the need for transfusion according to group, more transfusions were performed in the cohort that had not received tranexamic acid: 25.37% compared to 4.48% for the group with tranexamic acid. No adverse events related to administration of tranexamic acid were recorded. Administration of tranexamic acid has proved to be an effective and safe method to reduce peri-operative bleeding in patients who underwent total hip arthroplasty and avoids allogenic blood transfusion. Therefore, tranexamic acid treatment could entail a financial saving for the healthcare system and expose the patient to less risk. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. In vivo imaging of twist drill drainage for subdural hematoma: a clinical feasibility study on electrical impedance tomography for measuring intracranial bleeding in humans.

    Science.gov (United States)

    Dai, Meng; Li, Bing; Hu, Shijie; Xu, Canhua; Yang, Bin; Li, Jianbo; Fu, Feng; Fei, Zhou; Dong, Xiuzhen

    2013-01-01

    Intracranial bleeding is one of the most severe medical emergencies in neurosurgery. Early detection or diagnosis would largely reduce the rate of disability and mortality, and improve the prognosis of the patients. Electrical Impedance Tomography (EIT) can non-invasively image the internal resistivity distribution within a human body using a ring of external electrodes, and is thus a promising technique to promptly detect the occurrence of intracranial bleedings because blood differs from other brain tissues in resistivity. However, so far there is no experimental study that has determined whether the intracranial resistivity changes in humans could be repeatedly detected and imaged by EIT. Hence, we for the first time attempt to clinically validate this by in vivo imaging the influx and efflux of irrigating fluid (5% dextrose in water, D5W) during the twist-drill drainage operation for the patients with subdural hematoma (SDH). In this study, six patients (four male, two female) with subacute or chronic SDH received the surgical operation in order to evacuate the hematoma around subdural region, and EIT measurements were performed simultaneously on each patient's head. The results showed that the resistivity significantly increased on the corresponding position of EIT images during the influx of D5W and gradually decreased back to baseline during the efflux. In the quantitative analysis, the average resistivity values demonstrated the similar results and had highly linear correlation (R(2) = 0.93 ± 0.06) with the injected D5W volumes, as well as the area of the resistivity gain(R(2) = 0.94 ± 0.05). In conclusion, it was clinically validated that intracranial resistivity changes in humans were detectable and quantifiable by the EIT method. After further technical improvements, EIT has the great potential of being a routine neuroimaging tool for early detection of intracranial bleedings.

  4. In vivo imaging of twist drill drainage for subdural hematoma: a clinical feasibility study on electrical impedance tomography for measuring intracranial bleeding in humans.

    Directory of Open Access Journals (Sweden)

    Meng Dai

    Full Text Available Intracranial bleeding is one of the most severe medical emergencies in neurosurgery. Early detection or diagnosis would largely reduce the rate of disability and mortality, and improve the prognosis of the patients. Electrical Impedance Tomography (EIT can non-invasively image the internal resistivity distribution within a human body using a ring of external electrodes, and is thus a promising technique to promptly detect the occurrence of intracranial bleedings because blood differs from other brain tissues in resistivity. However, so far there is no experimental study that has determined whether the intracranial resistivity changes in humans could be repeatedly detected and imaged by EIT. Hence, we for the first time attempt to clinically validate this by in vivo imaging the influx and efflux of irrigating fluid (5% dextrose in water, D5W during the twist-drill drainage operation for the patients with subdural hematoma (SDH. In this study, six patients (four male, two female with subacute or chronic SDH received the surgical operation in order to evacuate the hematoma around subdural region, and EIT measurements were performed simultaneously on each patient's head. The results showed that the resistivity significantly increased on the corresponding position of EIT images during the influx of D5W and gradually decreased back to baseline during the efflux. In the quantitative analysis, the average resistivity values demonstrated the similar results and had highly linear correlation (R(2 = 0.93 ± 0.06 with the injected D5W volumes, as well as the area of the resistivity gain(R(2 = 0.94 ± 0.05. In conclusion, it was clinically validated that intracranial resistivity changes in humans were detectable and quantifiable by the EIT method. After further technical improvements, EIT has the great potential of being a routine neuroimaging tool for early detection of intracranial bleedings.

  5. The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

    International Nuclear Information System (INIS)

    Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

    1986-01-01

    Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

  6. Developing skills and competence of employees of the Kujawsko-Pomorskie regional operational programme managing body – research findings

    Directory of Open Access Journals (Sweden)

    Małgorzata Michalcewicz-Kaniowska

    2011-01-01

    Full Text Available In the contemporary world it is the employees or the human capital of any company who are responsible for effective management and caring for the future of their business. Organisations change all the time which means that continual staff training should be provided. The purpose of the research was to evaluate the training policy of the managing body of the Kujawsko-Pomorskie Regional Operational Programme (IZ RPO WK-P and its employees’ development potential. The research participants preferred mentoring (47%, coaching (27% and briefing (26% techniques. They also benefited from a range of educational techniques such as training courses, post-graduate studies etc. and a wide choice of subjects. Thus, it is necessary to conduct periodic research on training requirements, focusing on subjects and training techniques.

  7. Magnetic structure in the entrance region of spheromaks sustained by a magnetized coaxial plasma gun under long pulse operation

    International Nuclear Information System (INIS)

    Amemiya, Naoyuki; Takaichi, Kazuaki; Katsurai, Makoto

    1989-01-01

    The magnetic structure in coaxial-gun-sustained spheromaks has been investigated. The plasma gun has been operated with a small axial/radial bias magnetic flux as compared to the azimuthal magnetic flux produced by the discharge current. Stronger magnetic field is observed in the entrance region (ER) than in the flux conserver (FC). In both ER and FC, the magnetic structure is nearly axisymmetric. The axial magnetic field in ER is amplified up to about sixteen times as large as the bias magnetic field. This amplification is limited by the drastic change in the magnetic structure, which occurs when the discharge current becomes very large. The magnetic structure before the drastic change is interpreted with the Bessel function model. The μ estimation shows that the magnetic structure is mainly determined by the boundary geometry, not by the external magnetic flux and current. (author)

  8. The text of an African regional co-operative agreement for research, development and training related to nuclear science and technology

    International Nuclear Information System (INIS)

    1990-04-01

    The document reproduces the text of an African Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology among African Member States that was endorsed by the Board of Governors on 21 February 1990

  9. Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

    Science.gov (United States)

    Pingleton, S K; Hadzima, S K

    1983-01-01

    The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

  10. Timing of onset of gastrointestinal bleeding in the ICU

    DEFF Research Database (Denmark)

    Granholm, A; Lange, T; Anthon, C T

    2018-01-01

    BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

  11. Use of heparin in the investigation of obscure gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

    2001-01-01

    To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)

  12. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  13. Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke.

    Science.gov (United States)

    Stone, David H; Nolan, Brian W; Schanzer, Andres; Goodney, Philip P; Cambria, Robert A; Likosky, Donald S; Walsh, Daniel B; Cronenwett, Jack L

    2010-03-01

    Controversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate registry. We reviewed a prospective regional registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis. Of the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P < .001). Independent of protamine use, consequences of reoperation for bleeding were significant, with a four-fold increase in MI, a seven-fold increase in stroke, and a 30-fold increase in death. Protamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke

  14. Radiotherapy Can Cause Haemostasis in Bleeding Skin Malignancies

    Directory of Open Access Journals (Sweden)

    Helena Sung-In Jang

    2012-01-01

    Full Text Available Radiotherapy (RT can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.

  15. The role of endoscopy in pediatric gastrointestinal bleeding

    OpenAIRE

    Franke, Markus; Gei?, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-J?rgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20?% of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediat...

  16. Assessing Bleeding Risk in Patients Taking Anticoagulants

    Science.gov (United States)

    Shoeb, Marwa; Fang, Margaret C.

    2013-01-01

    Anticoagulant medications are commonly used for the prevention and treatment of thromboembolism. Although highly effective, they are also associated with significant bleeding risks. Numerous individual clinical factors have been linked to an increased risk of hemorrhage, including older age, anemia, and renal disease. To help quantify hemorrhage risk for individual patients, a number of clinical risk prediction tools have been developed. These risk prediction tools differ in how they were derived and how they identify and weight individual risk factors. At present, their ability to effective predict anticoagulant-associated hemorrhage remains modest. Use of risk prediction tools to estimate bleeding in clinical practice is most influential when applied to patients at the lower spectrum of thromboembolic risk, when the risk of hemorrhage will more strongly affect clinical decisions about anticoagulation. Using risk tools may also help counsel and inform patients about their potential risk for hemorrhage while on anticoagulants, and can identify patients who might benefit from more careful management of anticoagulation. PMID:23479259

  17. Vascular parenchymal sources of upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

  18. Vascular parenchymal sources of upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    1989-01-01

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment. (orig.)

  19. Risk of gastrointestinal bleeding during anticoagulant treatment.

    Science.gov (United States)

    Lanas-Gimeno, Aitor; Lanas, Angel

    2017-06-01

    Gastrointestinal bleeding (GIB) is a major problem in patients on oral anticoagulation therapy. This issue has become even more pressing since the introduction of direct oral anticoagulants (DOACs) in 2009. Areas covered: Here we review current evidence related to GIB associated with oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and post-marketing observational studies. Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily increase the risk of GIB compared to warfarin. The risk increase with edoxaban is dose-dependent, while apixaban shows apparently, no increased risk. We summarize what is known about GIB risk factors for individual anticoagulants, the location of GIB in patients taking these compounds, and prevention strategies that lower the risk of GIB. Expert opinion: Recently there has been an important shift in the clinical presentation of GIB. Specifically, upper GIB has decreased with the decreased incidence of peptic ulcers due to the broad use of proton pump inhibitors and the decreased prevalence of H. pylori infections. In contrast, the incidence of lower GIB has increased, due in part to colonic diverticular bleeding and angiodysplasia in the elderly. In this population, the addition of oral anticoagulation therapy, especially DOACs, seems to increase the risk of lower GIB.

  20. Land application of waste waters in the Alligator Rivers region, Northern Territory - environmental constraints on design and operation

    International Nuclear Information System (INIS)

    Kearns, A.

    1986-01-01

    The existing uranium mines in the Alligator River Region presently operate under a no release water management regime for water stored within the designated restricted release zones (RRZ). This water is of variable quality ranging from rainwater influenced by runoff from the mill sites and ore stockpiles to mill process water stored within the trailings repositories. There is a pressing need to reduce the volume of stored RRZ water at Nabarlek as a prerequisite to decommissioning. There is also a requirement at Ranger to rapidly reduce the volume of stored water in the mine pit at the end of the season to allow the mining of ore. Land application of RRZ water by spray irrigation has been investigated at both sites because it offers the benefits of applying chemical constituents in the wastewater within a clearly defined irrigation area. the environmental planning for the design of a land application system involves calculations of the chemical load in the wastewater and evaluation of the assimilative capacity of the soil-plant system. The monsoon climate, lateritic soil and fluctuating water table creates a unique set of environmental constraints and conditions in which to design and operate a successful land application system for the treatment of stored water at minesites within ecologically sensitive areas

  1. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    International Nuclear Information System (INIS)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

    2012-01-01

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  2. Evaluation of rectal bleeding factors associated with prostate brachytherapy

    International Nuclear Information System (INIS)

    Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

    2009-01-01

    The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

  3. A rare case of bleeding disorder: Glanzmann's thrombasthenia.

    Science.gov (United States)

    Swathi, Jami; Gowrishankar, A; Jayakumar, S A; Jain, Karun

    2017-01-01

    Glanzmann's thrombasthenia (GT) is a rare bleeding disorder, which is characterized by a lack of platelet aggregation. It is characterized by qualitative or quantitative abnormalities of the platelet membrane glycoprotein IIb/IIIa. Physiologically, this platelet receptor normally binds several adhesive plasma proteins, and this facilitates attachment and aggregation of platelets to ensure thrombus formation at sites of vascular injury. The lack of resultant platelet aggregation in GT leads to mucocutaneous bleeding whose manifestation may be clinically variable, ranging from easy bruising to severe and potentially life-threatening hemorrhages. To highlight this rare but potentially life-threating disorder, GT. We report a case of GT that was first detected because of the multiple episodes of gum bleeding. The patient was an 18-year-old girl who presented with a history of repeated episodes of gum bleeding since childhood. Till the first visit to our hospital, she had not been diagnosed with GT despite a history of bleeding tendency, notably purpura in areas of easy bruising, gum bleeding, and prolonged bleeding time after abrasions and insect stings. GT was diagnosed on the basis of prolonged bleeding time, lack of platelet aggregation with adenosine di phosphate, epinephrine and collagen. GT should always be considered as differential diagnosis while evaluating any case of bleeding disorder.

  4. Photocoagulation in the treatment of bleeding peptic ulcer

    Science.gov (United States)

    Otto, Wlodzimierz; Paczkowski, Pawel M.

    1996-03-01

    The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

  5. Appendiceal hemorrhage – An uncommon cause of lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ching-Chung Chiang

    2011-06-01

    Full Text Available Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn’s disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding.

  6. Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

    Directory of Open Access Journals (Sweden)

    Sebastião Freitas De Medeiros

    2013-01-01

    Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

  7. Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

  8. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  9. Recent developments in the applications of the Regional Atmospheric Modeling System (RAMS) for emergency response planning and operational forecasting at the Kennedy Space Center

    International Nuclear Information System (INIS)

    Lyons, W.A.; Tremback, C.J.

    1996-01-01

    The authors will summarize ten years of developing and applying the Regional Atmospheric Modeling System (RAMS) to emergency response and operational dispersion forecasting at the Kennedy Space Center (KSC). RAMS forms the core of two workstation-based operational systems, ERDAS (the Emergency Response Dose Assessment System) and PROWESS (Parallelized RAMS Operational Weather Simulation System) which are undergoing extensive operational testing prior to potential deployment as part of the range forecasting system at KSC. RAMS has been interfaced with HYPACT (the Hybrid Particle and Concentration Transport Model) to produce detailed 3-D dispersion forecasts from a variety of sources including cold spills, routine launch operations, and explosive conflagrations of launch vehicles

  10. Results of the regional intercomparison exercise for the determination of operational quantity Hp(d) in Latin America

    International Nuclear Information System (INIS)

    Saravi, M.; Zaretzky, A.; Lindner, C.; Diaz, J.; Walwyn, G.; Souza, D.; Amorin, R.; Gregory, B.; Papadopulos, S.; Meghzifene, A.; Ferruz Cruz, P.; Cruz Suarez, R.

    2005-01-01

    Full text: Several intercomparison exercises were organized by the International Atomic Energy Agency (IAEA) on the determination of operational quantities at the regional or interregional basis. These exercises revealed significant differences in the approach, methods and assumptions, and consequently in the measurement results obtained by participating laboratories. In the Latin America region, an intercomparison for determination of operational quantity Hp(10), organized within the frame of a technical cooperation regional project, was completed mid-2004, as a follow-up to previous exercises carried out during the 1990s. Eighteen laboratories from 19 member states participated in the first phase; the second phase grouped 15 laboratories from 16 member states. Dosimeter irradiations (5 different radiation qualities for photon simulating workplace fields) were done by 4 Secondary Standards Dosimetry Laboratories (SSDL). The preparations for the exercise involved an audit by the IAEA SSDL, where reference irradiations were provided to all participants for verification of their system. During the first phase (2002/03), only 9 out of 18 laboratories met the performance requirements for such monitoring services. Necessary corrective actions and procedure verification were implemented, and staff involved in these evaluations were subsequently trained. During the second phase (2004), 11 out of 15 laboratories fulfilled the performance criteria. The 4 laboratories still having difficulties in assessing occupational exposure participated in a results meeting, during which problem areas were identified. An ongoing technical cooperation mission is expected to assist these laboratories accordingly. There has been a definite improvement in the second phase and most laboratories demonstrated a good performance in the quantity tested. The technical results clearly show that the laboratories' capability in assessing occupational exposure from external sources of radiation is

  11. Tribal Grant Program Area Polygons with Project Officer and Tribal Contact Information, US EPA Region 9, 2015, Regional Tribal Operations Committee

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset contains information pertaining to EPA Region 9 project officers and their areas of oversight, EPA Region 9 grant program recipients and grant types,...

  12. Effects of opium addiction on bleeding after coronary artery bypass graft surgery: report from Iran.

    Science.gov (United States)

    Nemati, Mohammad Hassan; Astaneh, Behrooz; Ardekani, Gholamreza Safaee

    2010-09-01

    Opium abuse is a major type of drug abuse in Iran. This study was designed to find the possible relation between opium addiction and excessive bleeding after coronary artery bypass graft (CABG) surgery. In a historical cohort study during a 1.5-year period, consecutive patients scheduled for elective CABG surgery were assigned to two group on the basis of having or not having the criteria for inhalational opium addiction. Before and after operations, the complete blood count, bleeding time, prothrombin time, partial thromboplastin time, and platelet count were checked for all patients. The volumes of infused red blood cells during and after the operation were recorded. After operations, the volumes of bleeding through the patients' chest tubes were recorded. The recorded data were analyzed using SPSS software version 11.5. Independent t, chi-square and repeated measure tests were used; and P Opium-addicted patients received more packed red blood cells during and after the operations. Inhalational opium addiction might lead to more hemorrhage after CABG surgery. It is recommended that cardiac surgeons consider these patients at high risk for major complications after surgery.

  13. Packing of renal fossa: Useful technique for intractable bleeding after open pyelolithotomy surgery

    Directory of Open Access Journals (Sweden)

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU is also described in trauma but not in controlling bleeding after open pyelolithotomy .This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications.

  14. Los Alamos PWR feed-and-bleed studies summary results and conclusions

    International Nuclear Information System (INIS)

    Boyack, B.E.; Henninger, R.J.; Lime, J.F.

    1985-01-01

    The adequacy of shutdown decay heat removal in pressurized water reactors (PWRs) is currently under investigation by the Nuclear Regulatory Commission. One part of this effort is review of feed-and-bleed procedures that could be used if the normal cooling mode through the steam generators was unavailable. Feed-and-bleed cooling is effected by manually activating the high-pressure injection (HPI) system and opening the power-operated relief valves (PORVs) to release the core decay energy. The feasibility of the feed-and-bleed concept as a diverse mode of heat removal has been evaluated at the Los Alamos National Laboratory. The TRAC-PF1 code has been used to predict the expected performances of the Oconee-1 and Calvert Cliffs-1 reactors of Babcock and Wilcox and Combustion Engineering, respectively, and the Zion-1 and H.B. Robinson-2 plants of Westinghouse. Feed and bleed was successfully applied in each of the four plants studied, provided it was initiated no later than the time of loss-of-secondary heat sink

  15. Risk of bleeding with dabigatran in atrial fibrillation.

    Science.gov (United States)

    Hernandez, Inmaculada; Baik, Seo Hyon; Piñera, Antonio; Zhang, Yuting

    2015-01-01

    It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Dabigatran users (n = 1302) and warfarin users (n = 8102). We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of

  16. ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Daniela Benedeto-Stojanov

    2015-06-01

    Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

  17. Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

    Science.gov (United States)

    Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

    2016-08-01

    We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  18. RECOMBINANT FACTOR VIIa – NEW TREATMENT OPTION FOR CONTROL OF INTRACTABLE BLEEDING IN SURGICAL AND TRAUMA PATIENTS AND IN OTHER HAEMOSTASIS DISORDERS

    Directory of Open Access Journals (Sweden)

    Samo Zver

    2004-12-01

    Full Text Available Background. Recombinant factor VIIa (rFVIIa, which is currently registered only for the treatment of haemophilia A and B patients with inhibitors, is seen increasingly as a possible universal haemostatic agent in untractable bleedings. One possible mechanism for the efficacy rFVIIa may be a consequence of it’s from the tissue factor (TF and from the level of disfunction in haemostatic system independant activity, which generates »thrombin burst« formation. It seems that rFVIIa remains active only at the site of tissue injury/bleeding.Conclusions. There are two components of bleeding in surgery and trauma patients. One is bleeding from large calibre arteries and veins which requires surgical intervention. The other, which goes along with the first one, is coagulopathic bleeding. The latter is a consequence of consumptional and dilutional coagulopathy, hypothermia, multitransfusion syndrom and metabolic disbalances in patients. rFVIIa effects coagulopathic component of the bleeding. For effective treatment with rFVIIa in such patients, replacement therapy with erythrocytes, platelets and fresh frozen plasma is mandatory and requires a haematologist assistance in the treatment strategy.Most reported cases of effective rFVIIa usage are from the field of traumatology. Until now, there have been no universal recommendations when to start treatment with rFVIIa in a bleeding trauma patient. Most experience with rFVIIa are from Israel and their recommendations are perhaps the most valuable ones. rFVIIa was used several times during intra-operative and post-operative bleeding episodes. There are reports of clinical studies and usage in patients with/ after prostate surgery, cardiovascular operations and liver transplants.There are data about effective rFVIIa usage in neurology and neurosurgery patients (intracranial haemorrhages, obstetrics and gynecology field. Possible future indications are thrombocytopenias, thrombocytopathias (Glanzmann

  19. Tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Bennett, Cathy; Klingenberg, Sarah Louise; Langholz, Ebbe

    2014-01-01

    Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus......-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse...... sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised...

  20. Recurrent life-threatening haemoptysis from a bleeding vertebral artery pseudoaneurysm: A diagnostic dilemma.

    Science.gov (United States)

    Chandran, Arun; Biswas, Shubhabrata; Hartley, James Leon; Nahser, Hans Christean; Lancaster, Jeffrey; Puthuran, Mani

    2016-10-01

    A bleeding vertebral artery pseudoaneurysm is a rare cause of haemoptysis. Pseudoaneurysm can arise due to radionecrosis from previous radiotherapy in the base of skull and neck region and may present with haemoptysis many years later. It is important to be aware of this entity in the work-up of haemoptysis, particularly in patients with previous base of skull and neck radiotherapy. Our patient was successfully treated with endovascular occlusion. © The Author(s) 2016.

  1. Modelling the Dynamic Impacts of High Speed Rail Operation on Regional Public Transport—From the Perspective of Energy Economy

    Directory of Open Access Journals (Sweden)

    Ching-Chih Chou

    2018-05-01

    Full Text Available While the introduction of a high speed rail (HSR provides passengers with another more environmentally friendly, convenient, and time-saving transport option, it also disrupts the existing passenger transport market. This study adopts time series analysis to model the dynamic competition in a regional passenger transport market when an HSR is introduced. The analyses include examining the long-run equilibrium and causal relationships, and the short-run causality and dynamic relationships between transport modes. In addition, based on the model we conduct impulse response tests and variance decomposition tests to further interpret the interactions between two transport modes. An empirical study is carried out, and the findings indicate that the HSR has a negative impact on conventional rail and air transport in the long-run. In the short-run dynamics, the air passenger transport volume could be regarded as a good predictor of HSR passenger volume. In turn, the HSR passenger volume could be used to predict conventional rail transport volume. The operations of HSR and conventional rail are complementary in the short term. From the short-run market viewpoint, the HSR and conventional rail meet different kinds of passenger demand. Therefore, a previous increased passenger volume for the HSR implies an overall increasing demand for regional transport. Consequently, the past increased HSR passenger volume could be used to predict the growth of conventional rail transport. Through the impulse response test, we can further track the responses of the three transport modes to the shocks from themselves and each other.

  2. An improvement of the base bleed unit on base drag reduction and heat energy addition as well as mass addition

    International Nuclear Information System (INIS)

    Xue, Xiaochun; Yu, Yonggang

    2016-01-01

    Highlights: • A 2D axisymmetric Navier-Stokes equation for a multi-component reactive system is solved. • The coupling of the internal and wake flow field with secondary combustion is calculated. • Detailed data with combined effects of boattailing and post-combustion are obtained. • The mechanism of heat energy addition and thermodynamics performances is investigated. - Abstract: Numerical simulations are carried out to investigate the base drag and energy characteristics of a base-bleed projectile with and without containing the effect of a post-combustion process for a boattailed afterbody in a supersonic flow, and then to analyze the key factor of drag reduction and pressure decreasing of base bleed projectile. Detailed chemistry models for H_2−CO combustion have been incorporated into a Navier-Stokes computer code and applied to flow field simulation in the base region of a base-bleed projectile. Detailed numerical results for the flow patterns and heat energy addition as well as mass addition for different conditions are presented and compared with existing experimental data. The results shows that, the post-combustion contributes to energy addition and base drag reduction up to 78% on account of that the heat energy released from the post-combustion using fuel-rich reaction products as the fuel in the wake region is much higher than for the corresponding cold bleed and hot bleed cases. In addition, the temperature distribution regularities are changed under post-combustion effect, presenting that the peak appears in a couple of recirculation regions. The fuel-rich bleed gas flows into the shear layer along the crack between these two recirculation regions and then those can readily burn when mixing with the freestream, thus causing component changes of H_2 and CO in the base flowfield.

  3. Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

    African Journals Online (AJOL)

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

  4. The role of nuclear medicine in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Robinson, P.

    1993-01-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. 99 Tc m -sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. 99 Tc m -labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author)

  5. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    Science.gov (United States)

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  6. Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Kjeldsen, J

    2000-01-01

    Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

  7. First-trimester vaginal bleeding and complications later in pregnancy

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Dideriksen, Katrine Lehrmann; Lidegaard, Øjvind

    2010-01-01

    To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy.......To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy....

  8. Recombinant activated factor VII for uncontrolled bleeding postcardiac surgery

    Directory of Open Access Journals (Sweden)

    Aly Makram Habib

    2016-10-01

    Conclusion: In this analysis, rFVIIa succefully reduced the chest tube bleeding and blood products transfused during severe post cardiac surgical bleeding. However, safety of rFVIIa remains unclear. Prospective controlled trials are still needed to confirm the role of rFVIIa.

  9. Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism

    DEFF Research Database (Denmark)

    Brown, Joshua D; Goodin, Amie J; Lip, Gregory Y H

    2018-01-01

    BACKGROUND: The Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile International Normalized Ratio (INR), Elderly, Drugs or alcohol use (HAS-BLED) score has strong predictive validity for major bleeding complications, but limited validation has been conducted in venous thromboem...

  10. Clinical approach to a patient with abnormal uterine bleeding

    African Journals Online (AJOL)

    bleeding, type, appearance, duration, cyclicity and associated ... Clinical approach. In all cases where the main complaint is that of excessive menstrual bleeding, an immediate differentiation must be made between acute severe blood loss and chronic excessive ... management rules can be implemented. In such patients ...

  11. Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

    Science.gov (United States)

    Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

    2017-12-01

    The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

  12. Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

    Directory of Open Access Journals (Sweden)

    Wessel Jens

    2009-07-01

    Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.

  13. Bleeding complications during anticoagulant treatment in patients with cancer

    NARCIS (Netherlands)

    Kamphuisen, Pieter W.; Beyer-Westendorf, Jan

    Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or

  14. 21 CFR 864.6100 - Bleeding time device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bleeding time device. 864.6100 Section 864.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6100 Bleeding time device...

  15. A sensitive venous bleeding model in haemophilia A mice

    DEFF Research Database (Denmark)

    Pastoft, Anne Engedahl; Lykkesfeldt, Jens; Ezban, M.

    2012-01-01

    Haemostatic effect of compounds for treating haemophilia can be evaluated in various bleeding models in haemophilic mice. However, the doses of factor VIII (FVIII) for normalizing bleeding used in some of these models are reported to be relatively high. The aim of this study was to establish a se...

  16. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  17. EPIDEMIOLOGICAL CORRELATES OF POSTMENOPAUSAL BLEEDING IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sonia Arora

    2012-06-01

    Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management

  18. Bleeding gastrointestinal stromal tumour of the stomach complicated ...

    African Journals Online (AJOL)

    Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate ...

  19. Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

    Science.gov (United States)

    Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

    2015-03-01

    Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and

  20. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

    Science.gov (United States)

    Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

    2016-08-01

    Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.

  1. A Simple Technique for Creating Regional Composites of Sea Surface Temperature from MODIS for Use in Operational Mesoscale NWP

    Science.gov (United States)

    Knievel, Jason C.; Rife, Daran L.; Grim, Joseph A.; Hahmann, Andrea N.; Hacker, Joshua P.; Ge, Ming; Fisher, Henry H.

    2010-01-01

    This paper describes a simple technique for creating regional, high-resolution, daytime and nighttime composites of sea surface temperature (SST) for use in operational numerical weather prediction (NWP). The composites are based on observations from NASA s Moderate Resolution Imaging Spectroradiometer (MODIS) aboard Aqua and Terra. The data used typically are available nearly in real time, are applicable anywhere on the globe, and are capable of roughly representing the diurnal cycle in SST. The composites resolution is much higher than that of many other standard SST products used for operational NWP, including the low- and high-resolution Real-Time Global (RTG) analyses. The difference in resolution is key because several studies have shown that highly resolved SSTs are important for driving the air sea interactions that shape patterns of static stability, vertical and horizontal wind shear, and divergence in the planetary boundary layer. The MODIS-based composites are compared to in situ observations from buoys and other platforms operated by the National Data Buoy Center (NDBC) off the coasts of New England, the mid-Atlantic, and Florida. Mean differences, mean absolute differences, and root-mean-square differences between the composites and the NDBC observations are all within tenths of a degree of those calculated between RTG analyses and the NDBC observations. This is true whether or not one accounts for the mean offset between the skin temperatures of the MODIS dataset and the bulk temperatures of the NDBC observations and RTG analyses. Near the coast, the MODIS-based composites tend to agree more with NDBC observations than do the RTG analyses. The opposite is true away from the coast. All of these differences in point-wise comparisons among the SST datasets are small compared to the 61.08C accuracy of the NDBC SST sensors. Because skin-temperature variations from land to water so strongly affect the development and life cycle of the sea breeze, this

  2. Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects.

    Science.gov (United States)

    Alexander, D. A.; Naji, A. A.; Pinion, S. B.; Mollison, J.; Kitchener, H. C.; Parkin, D. E.; Abramovich, D. R.; Russell, I. T.

    1996-01-01

    OBJECTIVE: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN: Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital. SUBJECTS: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women). MAIN OUTCOME MEASURES: Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. RESULTS: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. CONCLUSIONS: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. PMID:8611783

  3. Technical Note: An operational landslide early warning system at regional scale based on space-time variable rainfall thresholds

    Science.gov (United States)

    Segoni, S.; Battistini, A.; Rossi, G.; Rosi, A.; Lagomarsino, D.; Catani, F.; Moretti, S.; Casagli, N.

    2014-10-01

    We set up an early warning system for rainfall-induced landslides in Tuscany (23 000 km2). The system is based on a set of state-of-the-art intensity-duration rainfall thresholds (Segoni et al., 2014b), makes use of LAMI rainfall forecasts and real-time rainfall data provided by an automated network of more than 300 rain-gauges. The system was implemented in a WebGIS to ease the operational use in civil protection procedures: it is simple and intuitive to consult and it provides different outputs. Switching among different views, the system is able to focus both on monitoring of real time data and on forecasting at different lead times up to 48 h. Moreover, the system can switch between a very straightforward view where a synoptic scenario of the hazard can be shown all over the region and a more in-depth view were the rainfall path of rain-gauges can be displayed and constantly compared with rainfall thresholds. To better account for the high spatial variability of the physical features, which affects the relationship between rainfall and landslides, the region is subdivided into 25 alert zones, each provided with a specific threshold. The warning system reflects this subdivision: using a network of 332 rain gauges, it allows monitoring each alert zone separately and warnings can be issued independently from an alert zone to another. An important feature of the warning system is the use of thresholds that may vary in time adapting at the conditions of the rainfall path recorded by the rain-gauges. Depending on when the starting time of the rainfall event is set, the comparison with the threshold may produce different outcomes. Therefore, a recursive algorithm was developed to check and compare with the thresholds all possible starting times, highlighting the worst scenario and showing in the WebGIS interface at what time and how much the rainfall path has exceeded or will exceed the most critical threshold. Besides forecasting and monitoring the hazard scenario

  4. Technical Note: An operational landslide early warning system at regional scale based on space-time-variable rainfall thresholds

    Science.gov (United States)

    Segoni, S.; Battistini, A.; Rossi, G.; Rosi, A.; Lagomarsino, D.; Catani, F.; Moretti, S.; Casagli, N.

    2015-04-01

    We set up an early warning system for rainfall-induced landslides in Tuscany (23 000 km2). The system is based on a set of state-of-the-art intensity-duration rainfall thresholds (Segoni et al., 2014b) and makes use of LAMI (Limited Area Model Italy) rainfall forecasts and real-time rainfall data provided by an automated network of more than 300 rain gauges. The system was implemented in a WebGIS to ease the operational use in civil protection procedures: it is simple and intuitive to consult, and it provides different outputs. When switching among different views, the system is able to focus both on monitoring of real-time data and on forecasting at different lead times up to 48 h. Moreover, the system can switch between a basic data view where a synoptic scenario of the hazard can be shown all over the region and a more in-depth view were the rainfall path of rain gauges can be displayed and constantly compared with rainfall thresholds. To better account for the variability of the geomorphological and meteorological settings encountered in Tuscany, the region is subdivided into 25 alert zones, each provided with a specific threshold. The warning system reflects this subdivision: using a network of more than 300 rain gauges, it allows for the monitoring of each alert zone separately so that warnings can be issued independently. An important feature of the warning system is that the visualization of the thresholds in the WebGIS interface may vary in time depending on when the starting time of the rainfall event is set. The starting time of the rainfall event is considered as a variable by the early warning system: whenever new rainfall data are available, a recursive algorithm identifies the starting time for which the rainfall path is closest to or overcomes the threshold. This is considered the most hazardous condition, and it is displayed by the WebGIS interface. The early warning system is used to forecast and monitor the landslide hazard in the whole region

  5. BLEEDING AND STARVING: fasting and delayed refeeding after upper gastrointestinal bleeding

    OpenAIRE

    FONSECA,Jorge; MEIRA,Tânia; NUNES,Ana; SANTOS,Carla Adriana

    2014-01-01

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. See more: http://creativecommons.org/licenses/by-nc/3.0//deed.en "Context - Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. Objective - The aim of this study was obtain...

  6. Endometrial ablation in the management of abnormal uterine bleeding.

    Science.gov (United States)

    Laberge, Philippe; Leyland, Nicholas; Murji, Ally; Fortin, Claude; Martyn, Paul; Vilos, George; Leyland, Nicholas; Wolfman, Wendy; Allaire, Catherine; Awadalla, Alaa; Dunn, Sheila; Heywood, Mark; Lemyre, Madeleine; Marcoux, Violaine; Potestio, Frank; Rittenberg, David; Singh, Sukhbir; Yeung, Grace

    2015-04-01

    , preoperative and postoperative care, operative set-up, anaesthesia, and practical considerations for practice. Implementation of the guideline recommendations will improve the provision of EA as an effective treatment of AUB. Following these recommendations would allow the surgical procedure to be performed safely and maximize success for patients. EA is a safe and effective minimally invasive option for the treatment of AUB of benign etiology. Summary Statements 1. Endometrial ablation is a safe and effective minimally invasive surgical procedure that has become a well-established alternative to medical treatment or hysterectomy to treat abnormal uterine bleeding in select cases. (I) 2. Endometrial preparation can be used to facilitate resectoscopic endometrial ablation (EA) and can be considered for some non-resectoscopic techniques. For resectoscopic EA, preoperative endometrial thinning results in higher short-term amenorrhea rates, decreased irrigant fluid absorption, and shorter operative time than no treatment. (I) 3. Non-resectoscopic techniques are technically easier to perform than resectoscopic techniques, have shorter operative times, and allow the use of local rather than general anaesthesia. However, both techniques have comparable patient satisfaction and reduction of heavy menstrual bleeding. (I) 4. Both resectoscopic and non-resectoscopic endometrial ablation (EA) have low complication rates. Uterine perforation, fluid overload, hematometra, and cervical lacerations are more common with resectoscopic EA; perioperative nausea/vomiting, uterine cramping, and pain are more common with non-resectoscopic EA. (I) 5. All non-resectoscopic endometrial ablation devices available in Canada have demonstrated effectiveness in decreasing menstrual flow and result in high patient satisfaction. The choice of which device to use depends primarily on surgical judgement and the availability of resources. (I) 6. The use of local anaesthetic and blocks, oral analgesia, and

  7. Resin bleed improvement on surface mount semiconductor device

    Science.gov (United States)

    Rajoo, Indra Kumar; Tahir, Suraya Mohd; Aziz, Faieza Abdul; Shamsul Anuar, Mohd

    2018-04-01

    Resin bleed is a transparent layer of epoxy compound which occurs during molding process but is difficult to be detected after the molding process. Resin bleed on the lead on the unit from the focused package, SOD123, can cause solderability failure at end customer. This failed unit from the customer will be considered as a customer complaint. Generally, the semiconductor company has to perform visual inspection after the plating process to detect resin bleed. Mold chase with excess hole, split cavity & stepped design ejector pin hole have been found to be the major root cause of resin bleed in this company. The modifications of the mold chase, changing of split cavity to solid cavity and re-design of the ejector pin proposed were derived after a detailed study & analysis conducted to arrive at these solutions. The solutions proposed have yield good results during the pilot run with zero (0) occurrence of resin bleed for 3 consecutive months.

  8. Diagnosis and management of upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.

  9. Scintigraphy in gastrointestinal bleeding in the pediatric population

    International Nuclear Information System (INIS)

    Hall, T.R.; Miller, J.H.; Sty, J.R.

    1986-01-01

    Gastrointestinal (GI) tract bleeding in the pediatric population is not uncommon, especially in chronically ill patients. A total of 29 patients with GI tract bleeding were studied scintigraphically using Tc-99m-labeled red blood cells (RBCs) or sulfur colloid (SC). The patients ranged in age from 3 weeks to 20 years, with an equal sex distribution. Of 19 patients studied with Tc-99m-labeled RBCs using an in vitro labeling technique, evidence of GI tract bleeding was documented scintigraphically in 15. Tc-99m-labeled SC scans in the remaining ten patients demonstrated GI tract bleeding in six. The Tc-99m RBC method was slightly more sensitive than the Tc-99m SC method. Advantages of using labeled RBCs include increased sensitivity in detecting upper abdominal bleeding, ability to delay imaging for up to 18-24 hours, and the use of provocative testing

  10. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    Science.gov (United States)

    Kim, Young-Il

    2015-01-01

    Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

  11. A prospective cohort study of light transmission platelet aggregometry for bleeding disorders: is testing native platelet-rich plasma non-inferior to testing platelet count adjusted samples?

    Science.gov (United States)

    Castilloux, Jean Francois; Moffat, Karen A; Liu, Yang; Seecharan, Jodi; Pai, Menaka; Hayward, Catherine P M

    2011-10-01

    Light transmission platelet aggregometry (LTA) is important to diagnose bleeding disorders. Experts recommend testing LTA with native (N) rather than platelet count adjusted (A) platelet-rich plasma (PRP), although it is unclear if this provides non-inferior, or superior, detection of bleeding disorders. Our goal was to determine if LTA with NPRP is non-inferior to LTA with APRP for bleeding disorder assessments. A prospective cohort of patients, referred for bleeding disorder testing, and healthy controls, were evaluated by LTA using common agonists, NPRP and APRP (adjusted to 250 x 10⁹ platelets/l). Recruitment continued until 40 controls and 40 patients with definite bleeding disorders were tested. Maximal aggregation (MA) data were assessed for the detection of abnormalities from bleeding disorders (all causes combined to limit bias), using sample-type specific reference intervals. Areas under receiver-operator curves (AUROC) were evaluated using pre-defined criteria (area differences: 0 for superiority). Forty-four controls and 209 patients were evaluated. Chart reviews for 169 patients indicated 67 had bleeding disorders, 28 from inherited platelet secretion defects. Mean MA differences between NPRP and APRP were small for most agonists (ranges, controls: -3.3 to 5.8; patients: -3.0 to 13.7). With both samples, reduced MA with two or more agonists was associated with a bleeding disorder. AUROC differences between NPRP and APRP were small and indicated that NPRP were non-inferior to APRP for detecting bleeding disorders by LTA, whereas APRP met superiority criteria. Our study validates using either NPRP or APRP for LTA assessments of bleeding disorders.

  12. SAVING BEHAVIOUR AND DETERMINANTS OF SAVING MOBILIZATION BY RURAL FINANCIAL CO-OPERATORS IN TIGRAI REGION, ETHIOPIA

    Directory of Open Access Journals (Sweden)

    Sebhatu Kifle Tesfamariam

    2012-01-01

    Full Text Available This paper identified and examined saving behaviour and determinants of saving mobiliza-tion by the rural co-operators in Southern Tigrai Ethiopia. The input for the study was ob-tained from randomly selected 120 rural household savers from six purposively selected ru-ral savings and credit cooperatives. The result of the study using least squares method showed that savings mobilized is determined by household annual income, amount of loan borrowed and year of member stay in the cooperative. These factors therefore have to be considered in designing strategies aimed at improving the saving mobilization of coopera-tive members in the study area. Besides, economically feasible cooperative societies in the region should be encouraged among the rural households by supporting them with revolv-ing funds as they are more effective and efficient in mobilizing rural savings and provide collateral plus guarantor-based loans with low default rate. This will enable them to boost up their production output and increase their savings thereby stimulating the rural economy.

  13. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Thanapirom, Kessarin; Ridtitid, Wiriyaporn; Rerknimitr, Rungsun; Thungsuk, Rattikorn; Noophun, Phadet; Wongjitrat, Chatchawan; Luangjaru, Somchai; Vedkijkul, Padet; Lertkupinit, Comson; Poonsab, Swangphong; Ratanachu-ek, Thawee; Hansomburana, Piyathida; Pornthisarn, Bubpha; Thongbai, Thirada; Mahachai, Varocha; Treeprasertsuk, Sombat

    2016-04-01

    Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  14. [AIMS65 score validation for upper gastrointestinal bleeding in the National Hospital Cayetano Heredia].

    Science.gov (United States)

    Aguilar Sánchez, Víctor; Bravo Paredes, Eduar Alban; Pinto Valdivia, José Luis; Valenzuela Granados, Vanessa; Espinoza-Rios, Jorge Luis

    2015-01-01

    To validate the score AIMS65 in patients with upper gastrointestinal bleeding, in terms of mortality and rebleeding a 30-day event. Patients included were those with higher age to 18 years attending the Hospital Nacional Cayetano Heredia during the period May 2013 to December 2014, by upper gastrointestinal bleeding. Data were analyzed using ROC curve (Receiver Operating Characteristic) and the area was obtained under the curve (AUC) to properly qualify the score AIMS65. 209 patients were included, 66.03% were male, with an average age of 58.02 years. The mortality rate was 7.65%, the multiorgan failure the most common cause of death. Plus 3.82% of the patients had recurrent bleeding and 11% required a transfusion of more than 2 units of blood. When analyzing the ROC curve with AIMS65 and mortality score a value of 0.9122 is reported; identifying it as cutoff greater than or equal to 3 value in the score AIMS65 to discriminate patients at high risk of death, likewise the ROC curve was analyzed for recurrence of bleeding with a value of 0.6266 and the need to Transfusion of packed red blood cells over two a value of 0.7421. And it was determined the average hospital stay with a value of 4.8 days, however, no correlation was found with the score AIMS65. AIMS65 score is a good predictor of mortality, and is useful for predicting the need for transfusion of more than 2 globular packages. However it is not a good predictor for recurrence of bleeding, or hospital stay.

  15. Bleeding detection in wireless capsule endoscopy using adaptive colour histogram model and support vector classification

    Science.gov (United States)

    Mackiewicz, Michal W.; Fisher, Mark; Jamieson, Crawford

    2008-03-01

    Wireless Capsule Endoscopy (WCE) is a colour imaging technology that enables detailed examination of the interior of the gastrointestinal tract. A typical WCE examination takes ~ 8 hours and captures ~ 40,000 useful images. After the examination, the images are viewed as a video sequence, which generally takes a clinician over an hour to analyse. The manufacturers of the WCE provide certain automatic image analysis functions e.g. Given Imaging offers in their Rapid Reader software: The Suspected Blood Indicator (SBI), which is designed to report the location in the video of areas of active bleeding. However, this tool has been reported to have insufficient specificity and sensitivity. Therefore it does not free the specialist from reviewing the entire footage and was suggested only to be used as a fast screening tool. In this paper we propose a method of bleeding detection that uses in its first stage Hue-Saturation-Intensity colour histograms to track a moving background and bleeding colour distributions over time. Such an approach addresses the problem caused by drastic changes in blood colour distribution that occur when it is altered by gastrointestinal fluids and allow detection of other red lesions, which although are usually "less red" than fresh bleeding, they can still be detected when the difference between their colour distributions and the background is large enough. In the second stage of our method, we analyse all candidate blood frames, by extracting colour (HSI) and texture (LBP) features from the suspicious image regions (obtained in the first stage) and their neighbourhoods and classifying them using Support Vector Classifier into Bleeding, Lesion and Normal classes. We show that our algorithm compares favourably with the SBI on the test set of 84 full length videos.

  16. Constituents and Antioxidant Activity of Bleeding Sap from Various Xinjiang Grapes.

    Science.gov (United States)

    Le, Lv; Umar, Anwar; Iburaim, Arkin; Moore, Nicholas

    2017-10-01

    Wine grape sap or bleeding sap of grapes (GBS) is commonly used in Xinjiang (China) for therapeutic aims. Do variations in composition related to region and variety affect its properties? GBS samples originating in various parts of Xinjiang (Turpan, Hotan, Kashgar, and Atush) were tested for phenols and polyphenols, polysaccharides, saponin, proteins, individual amino acids, and minerals. Their antioxidant activity was measured using ascorbic acid as reference. Polyphenol content varied from 2.6 to 6.6 mg/L, polysaccharides 18.3-816 mg/L, saponin 6.25-106 mg/L, and protein 3.0-22.4 mg/L. Mineral elements and amino acids ranged from 6.20 to 201.2 mg/L and 0.06-118.7 mg/L, respectively. ·OH scavenging ability varied from 70% to over 90%, higher than Vitamin C. Grapes from Turpan had lower antioxidant activity than other grapes even though the polyphenol content was generally higher. Bleeding sap of Xinjiang grape is rich in amino acids, polysaccharides, polyphenols, and protein. The contents are different according to the origin, related possibly to species, climate, and environment. Antioxidant effects were not correlated with polyphenol content. Antioxidant activity of plants or plant extracts is often associated with polyphenolsBleeding sap of grapes has strong antioxidant propertiesBleeding sap from different grape varieties from different parts of Xinjiang (China) had different polyphenol concentrationsThere was no correlation of polyphenol concentrations with antioxidant activity. Abbreviations used: GBS: Bleeding sap of grapes; PITC: phenyl isothiocyanate.

  17. Immunosuppressive agents are associated with peptic ulcer bleeding.

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Hasegawa, Rumiko; Shirai, Yoshinori; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2017-05-01

    Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at

  18. Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding

    NARCIS (Netherlands)

    Sanders, Yvonne V.; Fijnvandraat, Karin; Boender, Johan; Mauser-Bunschoten, Evelien P.; van der Bom, Johanna G.; de Meris, Joke; Smiers, Frans J.; Granzen, Bernd; Brons, Paul; Tamminga, Rienk Y. J.; Cnossen, Marjon H.; Leebeek, Frank W. G.

    2015-01-01

    The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large

  19. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

    NARCIS (Netherlands)

    Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

    OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were

  20. The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

    International Nuclear Information System (INIS)

    Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

    2011-01-01

    Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

  1. Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

    NARCIS (Netherlands)

    Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

    2017-01-01

    Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric

  2. Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder

    NARCIS (Netherlands)

    Stokhuijzen, Eva; Segbefia, Catherine I.; Biss, Tina T.; Clark, Dewi S.; James, Paula D.; Riddel, Jim; Blanchette, Victor S.; Rand, Margaret L.

    2018-01-01

    Objective To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children. Study design The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with

  3. [Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery].

    Science.gov (United States)

    Wang, Gang-cheng; Han, Guang-sen; Ren, Ying-kun; Xu, Yong-chao; Zhang, Jian; Lu, Chao-min; Zhao, Yu-zhou; Li, Jian; Gu, Yan-hui

    2013-10-01

    To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery. We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed. In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml. Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.

  4. The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm.

    Science.gov (United States)

    Filipce, Venko; Caparoski, Aleksandar

    2015-01-01

    Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

  5. Predictive Value of Whole Blood and Plasma Coagulation Tests for Intra- and Postoperative Bleeding Risk: A Systematic Review

    DEFF Research Database (Denmark)

    Larsen, Julie Brogaard; Hvas, Anne-Mette

    2017-01-01

    review of the existing literature assessing the ability of whole blood coagulation (thromboelastography [TEG]/thromboelastometry [ROTEM]/Sonoclot), platelet function tests, and standard plasma-based coagulation tests to predict bleeding in the perioperative setting. We searched PubMed and Embase...... value of testing in patients receiving antithrombotic medication. In general, studies reported low positive predictive values for perioperative testing, whereas negative predictive values were high. The studies yielded moderate areas under receiver operator characteristics (ROC) curve (for the majority...... recommend that both whole blood and plasma-based coagulation tests are primarily used in case of bleeding and not for screening in unselected patients prior to surgery....

  6. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

    Science.gov (United States)

    Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

    2013-09-21

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.

  7. Acquired Inhibitors: A Special Case of Bleeding in Older Adults

    Directory of Open Access Journals (Sweden)

    Richard G. Stefanacci

    2012-01-01

    Full Text Available This literature review is intended to familiarize physicians and healthcare providers of older adults with the potential causes of acute bleeding in older adults and to review diagnostic approaches that can produce prompt identification of acute bleeding and facilitate timely treatment. Adverse events from anticoagulant treatment and nonsteroidal anti-inflammatory drug (NSAID and aspirin use and abuse are among the most common causes of bleeding in older adults. Diagnoses infrequently considered—mild congenital hemophilia, acquired hemophilia, von Willebrand disease, and platelet dysfunction—can contribute to acute bleeding in older adults. The approach to management of bleeding varies. Management of acute bleeding in older adults can be challenging because these patients often have chronic comorbidity and have been prescribed long-term concomitant medications that can complicate diagnosis and treatment. Prompt recognition of acquired hemophilia, referral to an expert hematologist, and timely initiation of treatment could improve outcome in older patients who experience bleeding episodes resulting from this condition.

  8. [Management of intractable epistaxis and bleeding points localization].

    Science.gov (United States)

    Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

    2005-05-01

    To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

  9. Relationships between ethical climate, political behavior, ethical leadership, and job satisfaction of operational officers in a wholesale company, Bangkok Metropolitan region

    OpenAIRE

    Patthiya Naiyananont; Thipthinna Smuthranond

    2017-01-01

    This research investigated whether the ethical climate, political behavior, ethical leadership, and job satisfaction in one organization have an impact on each other. The research was conducted using a selected group of 177 operational officers in a wholesale business company in the Bangkok Metropolitan region. The operational officers were recruited from four divisions (commercial, finance, marketing, and administration) using a stratified random sampling approach. The majority was female an...

  10. Tamoxifen treatment of bleeding irregularities associated with Norplant use.

    Science.gov (United States)

    Abdel-Aleem, Hany; Shaaban, Omar M; Amin, Ahmed F; Abdel-Aleem, Aly M

    2005-12-01

    To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use. Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception. There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group. Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.

  11. Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

    Directory of Open Access Journals (Sweden)

    Dr. Yaminee Rana

    2017-12-01

    Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

  12. Surgical excision of Infantile Haemangiomas: a technical refinement to prevent bleeding complications

    Directory of Open Access Journals (Sweden)

    F. Leone

    2014-06-01

    Full Text Available Purpose: The aim of the study is to improve operative speed and precision of haemangiomas excision. Methods: Case-report: haemangioma is a common affection of the 8% of the population during the neonatal period. In complicated cases and involution sequelae surgical treatment is the first choice. The Authors propose a surgical refinement to prevent intraoperative bleeding. Methods: several suture stitches were placed around the hemangioma. The edges of the lesion became more defined, thus allowing accurate excision. Results and Conclusions: Haemangiomas are characterized by rich blood supply. Surgery is often hindered by massive bleeding and Temporary placement of full-thickness sutures, surrounding the hemangioma, allowed a noticeable improvement in hemostasis precision and greater definition of the margins of the hemangioma.

  13. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.

    Science.gov (United States)

    Cooper, Natalie A M; Robinson, Lynne L L; Clark, T Justin

    2015-10-01

    Hysteroscopy is now an ambulatory procedure, having moved from a conventional day-case operating theatre environment to the outpatient clinic setting. Outpatient hysteroscopy can be used as a diagnostic test and as a therapeutic modality for women presenting with abnormal uterine bleeding. In many cases women can be diagnosed and treated efficiently during a single hospital appointment. This article reviews the development of ambulatory hysteroscopy and how it should optimally be performed and implemented. The contemporary role of this technology for investigating and treating women with abnormal uterine bleeding is then discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. [Comparative results of surgical treatment for perforating and bleeding pyloroduodenal ulcers].

    Science.gov (United States)

    Gorbunov, V N; Sytnik, A P; Korenev, N N; Gordeev, S A; Stoliarchuk, E V; Urzhumtseva, G A

    1998-01-01

    Results of treatment of 1309 patients with perforated and bleeding pyloroduodenal ulcers for 20-years period have been analysed. Resection of the stomach performed in 85 cases resulted in high postoperative lethality which made up in bleeding ulcers 14.8%. Drainage operations of the stomach with excision or suturing of ulcer combined with bilateral truncal vagotomy was performed in 60 patients, postoperative lethality rate being 8.4%. 128 patients underwent selective proximal vagotomy together with pyloro- and duodenoplasty, lethality rate being 1.6%. Combined vagotomy (posterior truncal and anterior sero-muscular) with excision of ulcer, transversal pyloroplasty and duodenoplasty was carried out in 1036 patients (postoperative lethality--2.4%). Excellent and good functional results were achieved in 79.6% of the patients.

  15. Gastric cirsoid aneurysm: Uncommon cause of death from upper GI bleed

    Directory of Open Access Journals (Sweden)

    Tatiana Bihun, BA

    2017-11-01

    Full Text Available Gastric cirsoid aneurysm is an arterial malformation found in the submucosa of the stomach. It is a rare, but potentially life-threatening cause of gastrointestinal bleed. We present a case of a 48 year old male who presented to the ER unconscious, unresponsive, pale, and tachycardic. Patient expired and an autopsy was performed. Upon examination blood was found in the GI tract. During examination an arterial malformation was found in the body of the stomach. Histological samples were taken and the findings were consistent with gastric cirsoid aneurysm. Diagnosis can be made through endoscopy, angiography, or red cell scanning. Current treatment is hemostasis achieved by either thermal, regional injection or mechanical therapies. Multiple therapies are found to be more successful than monotherapy. Gastric cirsoid aneurysms are thought to make up <5% of upper GI bleeds, however clinicians should be mindful when working up a differential diagnosis.

  16. Interventional embolization with coils for the treatment of surgical stoma bleeding caused by portal hypertension: a therapeutic analysis

    International Nuclear Information System (INIS)

    Chen Feng; Chen Shiwei; Qiao Delin; Tang Zhen

    2010-01-01

    Objective: To assess the feasibility and safety of interventional embolization with coils in treating surgical stoma bleeding caused by portal hypertension. Methods: From February 2008 to May 2010, the authors treated eight patients with surgical stoma bleeding associated with portal hypertension. The patients included 5 females and 3 males, with a mean age of 57 years. The diagnosis was confirmed preoperatively by enhanced CT scanning and vascular reconstruction, and was further verified by angiography after operation. All patients were treated with coil embolization. The percutaneous transhepatic catheterization was performed, after that the catheter was manipulated to pass portal vein into the tortuous dilated mesenteric vein. The bleeding veins were occluded with gelatin sponge, and the spleen was embolized at the same time. The patients were followed up for two months to two years. Based on CT angiographic manifestations, color-Doppler ultrasound findings and clinical conditions the therapeutic results were evaluated. Results: Technical success with single procedure was achieved in all eight patients, the hemostasis rate was 100%. No serious complications occurred. During the follow-up period no recurrent bleeding of the surgical stoma was seen. Conclusion: For the treatment of surgical stoma bleeding caused by portal hypertension interventional embolization with coils is a safe and effective technique. It is worth popularizing this method in clinical practice. (authors)

  17. Controlling Bleeding from Proximal and Coronary Ostial Anastomoses by Using Blood Cardioplegia Delivering Antegradely while Performing Bentall Procedure

    Directory of Open Access Journals (Sweden)

    Erol Şener

    2011-04-01

    Full Text Available Bentall procedure is one of the valved conduit techniques which is used in the treatment of aortic valve diseases accompanied by ascending aortic aneurysm and dissection and it is used commonly around the world. In Bentall procedure, which is a complicated and long surgery, the rate of mortality and morbidity are not only related to the operation itself but also to the complications like major neurological events, myocardial damage and bleeding which take place during the intraoperative and postoperative period. Although the quantity and frequency of bleeding is declined with teflon strips and biological tissue glues, modifications of Bentall procedure are still an important problem. This study was conducted retrospectively with 48 patients in terms of early results of complication of bleeding caused specifically by proximal suture line and coronary ostium anastomosis lines controlled by the method of blood cardioplegia while performing Bentall procedure and supracoronary aort replacement in our clinic.

  18. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Ramon Banos Madrid; Fernando Alberca de las Parras; Angel Vargas Acosta and others

    2006-01-01

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  19. Risk of bleeding related to antithrombotic treatment in cardiovascular disease

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette

    2012-01-01

    Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary...... syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without...

  20. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...