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Sample records for bleed operating regions

  1. Bleeding

    Science.gov (United States)

    ... with problems in the joints, or gastrointestinal or urogenital tracts. Symptoms You may have symptoms such as: Blood ... may be internal bleeding or shock. Signs of infection develop, including increased pain, redness, swelling, yellow or ...

  2. 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, ...

  3. [The development of an electrosurgery appliance used in non-bleeding inferior conha cutting operation].

    Science.gov (United States)

    Wang, S; Wu, G; Miao, A

    1997-11-01

    It can be only a simple mechanic cutting by means of the traditional inferior concha scissor. Since the nose capacity is deep, narrow and rich in blood vessels, it is easy to bleed. We instruct a new type of non-bleeding nose operation appliance--is under the high frequency electric control, with light source and negative pressure abstracting installment. It has cutting, lighting, abstracting function. It dissolve the problems of pre and post operation bleeding with good effects.

  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. An operational research approach to identify cardiac surgery patients at risk of severe post-operative bleeding.

    Science.gov (United States)

    Reddy, Brian; Pagel, Christina; Vuylsteke, Alain; Gerrard, Caroline; Nashef, Sam; Utley, Martin

    2011-09-01

    Severe post-operative bleeding can lead to adverse outcomes for cardiac surgery patients and is a relatively common complication of cardiac surgery. One of the most effective drugs to prevent such bleeding, aprotinin, has been withdrawn from the market due to concerns over its safety. Alternative prophylactic drugs which can be given to patients to prevent bleeding can result in significant side effects and are expensive. For this reason it is difficult to make a clinical or economic case for administering these drugs to all cardiac surgery patients, and the prevailing view is that their use should be targeted at patients considered to be at relatively high risk of post-operative bleeding. However, there is currently no objective method for identifying such patients. Over the past 7 years, a team of clinicians and researchers at Papworth Hospital has collected data concerning post-operative blood loss for each cardiac surgery patient, totalling 11,592 consecutive records. They approached a team of operational researchers (MU, ACP, BR) with extensive experience of developing clinical risk models with the aim of devising a risk stratification scheme that could potentially be used to identify a cohort of higher risk patients. Such patients could be treated with the available prophylactic drugs or recruited to studies to evaluate new interventions. This paper is intended to describe the Operational Research process adopted in the development of this scheme. A concise description of the scheme and its clinical interpretation is published elsewhere.

  9. Acute upper gastrointestinal bleeding in operated stomach: Outcome of 105 cases

    Science.gov (United States)

    Nikolopoulou, Vassiliki N; Thomopoulos, Konstantinos C; Theocharis, George I; Arvaniti, Vassiliki A; Vagianos, Constantine E

    2005-01-01

    AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past. METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery. RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P = 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding, compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P = 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025]. Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d, P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)]. CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients. PMID:16052690

  10. Bleeding Frame and Region Detection in the Wireless Capsule Endoscopy Video.

    Science.gov (United States)

    Yuan, Yixuan; Li, Baopu; Meng, Max Q-H

    2016-03-01

    Wireless capsule endoscopy (WCE) enables noninvasive and painless direct visual inspection of a patient's whole digestive tract, but at the price of long time reviewing large amount of images by clinicians. Thus, an automatic computer-aided technique to reduce the burden of physicians is highly demanded. In this paper, we propose a novel color feature extraction method to discriminate the bleeding frames from the normal ones, with further localization of the bleeding regions. Our proposal is based on a twofold system. First, we make full use of the color information of WCE images and utilize K-means clustering method on the pixel represented images to obtain the cluster centers, with which we characterize WCE images as words-based color histograms. Then, we judge the status of a WCE frame by applying the support vector machine (SVM) and K-nearest neighbor methods. Comprehensive experimental results reveal that the best classification performance is obtained with YCbCr color space, cluster number 80 and the SVM. The achieved classification performance reaches 95.75% in accuracy, 0.9771 for AUC, validating that the proposed scheme provides an exciting performance for bleeding classification. Second, we propose a two-stage saliency map extraction method to highlight bleeding regions, where the first-stage saliency map is created by means of different color channels mixer and the second-stage saliency map is obtained from the visual contrast. Followed by an appropriate fusion strategy and threshold, we localize the bleeding areas. Quantitative as well as qualitative results show that our methods could differentiate the bleeding areas from neighborhoods correctly.

  11. [Principal characteristics of the endoscopic programmed hemostasis in ulcerative gastroduodenal bleedings in patients with high operational-anesthesiological risk].

    Science.gov (United States)

    Timen, L Ia; Trubitsyna, I E; Chikunova, B Z

    2013-01-01

    Application of the endoscopic programmed hemostasis for patients with ulcer gastroduodenal bleedings and with high operational-anesthetic risk provided metabolic rehabilitation (5% solutions of glucose and ascorbic acid) for the purpose of prevention of recurrence of the bleedings which have arisen after a hemostasis at 5.5% of patients.

  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. 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.

  14. An Automatic Bleeding Frame and Region Detection Scheme for Wireless Capsule Endoscopy Videos Based on Interplane Intensity Variation Profile in Normalized RGB Color Space

    Directory of Open Access Journals (Sweden)

    Amit Kumar Kundu

    2018-01-01

    Full Text Available Wireless capsule endoscopy (WCE is an effective video technology to diagnose gastrointestinal (GI disease, such as bleeding. In order to avoid conventional tedious and risky manual review process of long duration WCE videos, automatic bleeding detection schemes are getting importance. In this paper, to investigate bleeding, the analysis of WCE images is carried out in normalized RGB color space as human perception of bleeding is associated with different shades of red. In the proposed method, at first, from the WCE image frame, an efficient region of interest (ROI is extracted based on interplane intensity variation profile in normalized RGB space. Next, from the extracted ROI, the variation in the normalized green plane is presented with the help of histogram. Features are extracted from the proposed normalized green plane histograms. For classification purpose, the K-nearest neighbors classifier is employed. Moreover, bleeding zones in a bleeding image are extracted utilizing some morphological operations. For performance evaluation, 2300 WCE images obtained from 30 publicly available WCE videos are used in a tenfold cross-validation scheme and the proposed method outperforms the reported four existing methods having an accuracy of 97.86%, a sensitivity of 95.20%, and a specificity of 98.32%.

  15. 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

  16. 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.

  17. 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).

  18. 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.)

  19. 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

  20. 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.

  1. Vaginal Bleeding

    Science.gov (United States)

    ... Gynecology. ACOG Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstetrics and Gynecology. 2012;120:197. Kaunitz AM. Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. http://www.uptodate. ...

  2. 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 ...

  3. 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

  4. 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

  5. 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

  6. [Gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2015-09-01

    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  7. Rectal Bleeding

    Science.gov (United States)

    ... rectal bleeding and any signs of shock: Rapid, shallow breathing Dizziness or lightheadedness after standing up Blurred ... shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. © 1998-2018 Mayo ...

  8. 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

  9. Bleeding Disorders

    Science.gov (United States)

    ... study of intranasal desmopressin and oral tranexamic acid . British Journal of Haematology; 145(2): 212-220. Bleeding ... Ayisyen Français Polski Português Italiano Deutsch 日本語 فارسی English A federal government website managed by the Office ...

  10. 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. ACOG. ...

  11. 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,...

  12. EELA Operations: A standalone regional dashboard implementation

    OpenAIRE

    L'Orphelin, Cyril; Cordier, Hélène; Reynaud, Sylvain; Lins, Marcos; Loikkanen, Sinika; Lequeux, Olivier; Veyre, Pierre

    2013-01-01

    International audience; Grid operators in EGEE use a dedicated dashboard as their central operational tool, stable and scalable for the last 5 years despite continuous upgrade from specifications by users, monitoring tools or data providers. In EGEE-III, regionalisation of operations led the tool developers to conceive a standalone instance of this tool. Hereby, we will present the concept and the EELA-II implementation. Indeed, there-engineering of this tool led to an easily deployable packa...

  13. Representative operation of Paris region: Montgeron

    Energy Technology Data Exchange (ETDEWEB)

    Normand, J.

    1984-06-01

    Montgeron geothermal plant was realized between 1980 and 1983. It belongs to the Seimaroise, a low-cost housing agency and provides floor-panels heating to three building units totalizing 3042 dwelling-equivalents. This plant is one of the most representative of Paris region and may also be a model from the point of view of its realization by a private society and its economic aspect.

  14. Post-operative re-bleeding in patients with hypertensive ICH is closely associated with the CT blend sign.

    Science.gov (United States)

    Wu, Guofeng; Shen, Zhengkui; Wang, Likun; Sun, Shujie; Luo, Jinbiao; Mao, Yuanhong

    2017-07-06

    Intracranial post-operative re-haemorrhage is an important complication in patients with hypertensive intracerebral haemorrhage (ICH). The purpose of the present study was to determine the value of the computed tomography (CT) blend sign in predicting post-operative re-haemorrhage in patients with ICH. A total of 126 patients with ICH were included in the present study. All the patients underwent standard stereotactic minimally invasive surgery(MIS) to remove the ICH within 24 h following admission. There were 41 patients with a blend sign on initial CT and 85 patients without a blend sign on the initial CT. Multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on the non-enhanced admission CT scan and post-operative re-haemorrhage. Post-operative re-haemorrhage occurred in 24 of the 41 patients with the blend sign, and in 9 of the 85 patients without the blend sign. The incidence of re-haemorrhage was significantly different between the groups. The multivariate logistic regression analysis demonstrated that the initial Glasgow coma scale score (p = 0.002) and blend sign (P sign for predicting post-operative re-haemorrhage were 72.7, 81.7, 58.5 and 89.4%, respectively. The presence of the blend sign on the initial CT scan is closely associated with post-operative re-haemorrhage in patients with ICH who undergo stereotactic MIS.

  15. 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

  16. 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)

  17. The efficacy, safety and cost-effectiveness of intra-operative cell salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial.

    Science.gov (United States)

    Xie, Yihong; Shen, Sheliang; Zhang, Jun; Wang, Wenyuan; Zheng, Jiayin

    2015-01-01

    Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB. One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related. Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, operative CS in high-bleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.

  18. 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.

  19. 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

  20. Application of whole-exome sequencing to direct the specific functional testing and diagnosis of rare inherited bleeding disorders in patients from the Öresund Region, Scandinavia

    DEFF Research Database (Denmark)

    Leinøe, Eva; Zetterberg, Eva; Kinalis, Savvas

    2017-01-01

    Rare inherited bleeding disorders (IBD) are a common cause of bleeding tendency. To ensure a correct diagnosis, specialized laboratory analyses are necessary. This study reports the results of an upfront diagnostic strategy using targeted whole exome sequencing. In total, 156 patients with a sign......Rare inherited bleeding disorders (IBD) are a common cause of bleeding tendency. To ensure a correct diagnosis, specialized laboratory analyses are necessary. This study reports the results of an upfront diagnostic strategy using targeted whole exome sequencing. In total, 156 patients....... The genetic investigations detailed here extricated our patients from a diagnostic conundrum, thus demonstrating that continuous optimization of the diagnostic work-up of IBD is of great benefit....

  1. 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

  2. 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

  3. 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.

  4. Advances in gastrointestinal bleeding.

    Science.gov (United States)

    Lanas, Ángel

    2016-09-01

    The main innovations of the latest meeting of the Gastroenterological Association (2016) concerning upper gastrointestinal bleeding from the clinician's perspective can be summarised as follows: a) The Glasgow-Blatchford scale has the best accuracy in predicting the need for surgical intervention and hospital mortality; b) Prognostic scales for non-variceal upper gastrointestinal bleeding are also useful for lower gastrointestinal bleeding; c) Preliminary data suggest that treatment with hemospray does not seem to be superior to current standard treatment in controlling active peptic ulcer bleeding; d) Either famotidine or a proton pump inhibitor may be effective in preventing haemorrhagic recurrence in patients taking aspirin, but this finding needs to be confirmed in further studies; e) There was confirmation of the need to re-introduce antiplatelet therapy as early as possible in patients with antiplatelet-associated gastrointestinal bleeding in order to prevent cardiovascular mortality; f) Routine clinical practice suggests that gastrointestinal or cardiovascular complications with celecoxib or traditional NSAIDs are very low; g) Dabigatran is associated with an increased incidence of gastrointestinal bleeding compared with apixaban or warfarin. At least half of the episodes are located in the lower gastrointestinal tract; h) Implant devices for external ventricular circulatory support are associated with early gastrointestinal bleeding in up to one third of patients; the bleeding is often secondary to arteriovenous malformations. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. Bleeding esophageal varices

    Science.gov (United States)

    ... amount of bleeding, the only symptom may be dark or black streaks in the stools. If larger amounts of bleeding occur, symptoms ... exam which may show: Bloody or black stool (in a rectal exam) Low ... the use of a camera on a flexible tube to examine the esophagus ...

  6. Modern Perspectives for Tactical Level Operations in the Arctic Region

    Science.gov (United States)

    2013-06-13

    the Arctic region. The benefits of an analysis of current Russian capabilities will be important for future military leaders of the U.S. in confronting ...capabilities will be important for future military leaders in confronting problems in conducting combat operations in the Arctic environment. By...during Soviet times. These principles are: “high importance of the ideological component and pedagogical training of petty officers, the personnel

  7. Assessment of Postmenopausal Bleeding

    Directory of Open Access Journals (Sweden)

    Chin-Yuan Hsu

    2008-06-01

    Full Text Available Postmenopausal bleeding is bleeding that occurs 12 or more months after the last menstrual period and accounts for 5% of all gynecologic office visits. While it is not always a symptom of cancer, the exclusion of endometrial hyperplasia and carcinoma is the key issue in the evaluation of patients with postmenopausal bleeding. The primary evaluation of postmenopausal women who present with abnormal uterine bleeding includes a medical history and a pelvic examination. Investigative studies, such as a uterine biopsy, ultrasound, hysteroscopy or dilation and curettage, may be required. Treatment will depend on the cause determined. The most important point is that irregular perimenopausal or postmenopausal bleeding should not be ignored or assumed to be a normal phenomenon.

  8. 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

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... uterine cancer isn’t the cause. Women after menopause Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These ...

  14. 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

  15. 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)

  16. 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

  17. HYSTEROSCOPY IN POSTMENOPAUSAL BLEEDING.

    Science.gov (United States)

    Vardhan, S; Mohan, S; Ranjan, P

    2001-04-01

    The purpose of the present study was to evaluate the utility of hysteroscopy as a diagnostic tool in cases of postmenopausal bleeding. The study includes 42 cases presenting with postmenopausal bleeding on which hysterscopy was performed using rigid hysteroscope (CIRCON) with glycine 1.5% as the distension medium. In 17 of the 42 cases positive hysteroscopic findings were noted which included 2 cases of endometrial carcinoma, 2 cases of postmenopausal endometritis, 4 cases of endometrial polyp, 5 cases of endometrial hyperplasia, 1 case of submucous myoma and 3 cases of endocervical polyp whereas normal postmenopausal endometrium was noticed in rest of the 25 cases. Endometrial biopsy was done in all these cases so that the hysteroscopic findings could be corroborated with tissue diagnosis. Hysteroscopy along with directed endometrial biopsy proved to be a useful diagnostic aid in cases of postmenopausal bleeding.

  18. 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.

  19. Optimum bleeding rate of open loop ground source heat pump systems determined by hydrogeological modeling in Korea

    Science.gov (United States)

    Jeon, W. H.; Kim, N.; Lee, J. Y.

    2014-12-01

    This study aims to evaluate the influence of open loop ground source heat pump systems operation on hydrological conditions of aquifer. Test bed is located in Chuncheon, Korea. The step drawdown test was conducted in five stages for 300 minutes. The variation of groundwater levels by open loop ground source heat pump systems operation was estimated using Visual MODFLOW. Transmissivity ranged from 2.02×10-4 to 9.36×10-4, and storage coefficient ranged from 0.00067 to 0.021. The amount of optimum bleeding was calculated to be 240 m3/day. When bleeding will be 50, 90, 240 and 450 m3/day for 5 years, groundwater levels may decrease 1.84, 3.31, 8.89 and 17.0 m, respectively. If the amount of bleeding is 50 m3/day, the influence of bleeding will not reach the boundary regions of the Soyang River after 5 years. Regarding the open loop ground source heat pump system installed at the test bed, the amount of optimum bleeding in accordance with the stand are proposed by the government is 90 m3/day, which is 20% of the 450 m3/day circulation quantity of the system. However, if continuous bleeding of more than 90 m3/day occurs, then the radius of influence is expected to reach the boundary regions of the Soyang River after 5 years. These results indicate that amount of optimum bleeding differ in each open loop ground soured heat pump system. Therefore, the debate for the amount of optimum bleeding in open loop ground source heat pump systems is demanded. This work is supported by the Energy Efficiency and Resources of the Korea Institute of Energy Technology Evaluation and Planning (KETEP) grant funded by the Korea government Ministry of Knowledge Economy (No.20123040110010).

  20. The role of smart traffic centers in regional system operations : a Hampton Roads case study.

    Science.gov (United States)

    2005-01-01

    The objectives of this study were to define the role of smart traffic centers (STCs) in regional systems operations and to help identify performance measures for monitoring the performance of STCs in the scope of regional systems operations. Without ...

  1. Heavy Menstrual Bleeding

    Science.gov (United States)

    ... option. It also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get ... to stop or reduce menstrual bleeding. Endometrial Cancer: Cancer of the lining of the uterus. Endometrial Biopsy: A procedure in which a small ...

  2. Bleeding Disorders Treatment Options

    Science.gov (United States)

    ... rare bleeding disorders are usually made from human plasma and are treated to eliminate viruses like HIV and hepatitis B and C. ... concentrate (PCC) This concentrate is made from human plasma and ... (VKCFD). It is treated to eliminate viruses like HIV and hepatitis B and C. ...

  3. PBO Southwest Region: Baja Earthquake Response and Network Operations

    Science.gov (United States)

    Walls, C. P.; Basset, A.; Mann, D.; Lawrence, S.; Jarvis, C.; Feaux, K.; Jackson, M. E.

    2011-12-01

    The SW region of the Plate Boundary Observatory consists of 455 continuously operating GPS stations located principally along the transform system of the San Andreas fault and Eastern California Shear Zone. In the past year network uptime exceeded an average of 97% with greater than 99% data acquisition. Communications range from CDMA modem (307), radio (92), Vsat (30), DSL/T1/other (25) to manual downloads (1). Sixty-three stations stream 1 Hz data over the VRS3Net typically with theft) to moderate vandalism (solar panel stolen) with one total loss of receiver and communications gear. Security was enhanced at these sites through fencing and more secure station configurations. In the past 12 months, 4 new stations were installed to replace removed stations or to augment the network at strategic locations. Following the M7.2 El Mayor-Cucapah earthquake CGPS station P796, a deep-drilled braced monument, was constructed in San Luis, AZ along the border within 5 weeks of the event. In addition, UNAVCO participated in a successful University of Arizona-led RAPID proposal for the installation of six continuous GPS stations for post-seismic observations. Six stations are installed and telemetered through a UNAM relay at the Sierra San Pedro Martir. Four of these stations have Vaisala WXT520 meteorological sensors. An additional site in the Sierra Cucapah (PTAX) that was built by CICESE, an Associate UNAVCO Member institution in Mexico, and Caltech has been integrated into PBO dataflow. The stations will be maintained as part of the PBO network in coordination with CICESE. UNAVCO is working with NOAA to upgrade PBO stations with WXT520 meteorological sensors and communications systems capable of streaming real-time GPS and met data. The real-time GPS and meteorological sensor data streaming support watershed and flood analyses for regional early-warning systems related to NOAA's work with California Department of Water Resources. Currently 19 stations are online and

  4. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... of regular ovulation (anovulation). Doctors call the problem abnormal uterine bleeding (AUB) . AUB is more common in teenagers and ...

  5. Thromboembolic and Bleeding Complications among Patients with ...

    African Journals Online (AJOL)

    Objective: This study was conducted to determine the incidence of thromboembolic and bleeding complications among patients with mechanical heart valves operated from 1990 to 2003 attending the Muhimbili National Hospital. Study design: This was a retrospective cohort study conducted at the cardiac, anticoagulation ...

  6. 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.

  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...... by the Danish Society of Gastroenterology and Hepatology September 4, 2011. Recommendations: Recommendations emphasize the importance of early and efficient resuscitation. Endoscopy should generally be performed within 24 hours, reducing operation rate, rebleeding rate and duration of in-patient stay. When...... in achieving endoscopic hemostasis. Use of endoscopic monotherapy with epinephrine injection is not recommended. Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended as it decreases both rebleeding rate and mortality in patients with high...

  8. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

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

    2013-01-01

    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......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...... 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...

  9. 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.

  10. 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.

  11. Regional Peace and Security Co-Operation Under the ...

    African Journals Online (AJOL)

    This article is an attempt to contribute to the debate related to the effectiveness of regional organizations as forums of security cooperation. Realists argue that there is no substantive role for regional organizations in conflict prevention in a world characterised by anarchy and relentless competitions for power and security ...

  12. Low hemoglobin levels are associated with upper gastrointestinal bleeding.

    Science.gov (United States)

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

    2016-09-01

    Upper gastrointestinal (GI) bleeding can be fatal. Blood test variables were reviewed in search of threshold values to detect the presence of occult upper GI bleeding. The records of 1,023 patients who underwent endoscopy at the National Hospital Organization Shimoshizu Hospital from October 2014, to September 2015, were retrospectively reviewed. Of those, 95 had upper GI bleeding. One-way analysis of variance was applied to blood test variables comparing patients with and without upper GI bleeding. Logistic regression analysis was applied to detect the association of blood test parameters with upper GI bleeding, and receiver-operator characteristics were applied to establish threshold values. White blood cell count (WBC), platelet (Plt) count, and blood urea nitrogen (BUN) levels were higher, and hemoglobin (Hb) and albumin (Alb) levels were lower in patients with upper GI bleeding. Logistic regression analysis showed that low Hb was significantly associated with upper GI bleeding and a Hb value of 10.8 g/dl was established as the threshold for the diagnosis. In patients with upper GI bleeding, WBC, Plt count, and BUN levels were higher and Hb and Alb levels were reduced. Hb at 10.8 g/dl was established as a threshold value to detect upper GI bleeding.

  13. Mild bleeding disorders

    OpenAIRE

    PERROUD, V.

    2011-01-01

    Contrairement aux troubles hémorragiques sévères, les maladies hémorragiques modérées (Mild Bleeding Disorders = MBD) sont difficiles à diagnostiquer chez les enfants, car la limite entre le physiologique et le pathologique est mal définie et l'approche diagnostique est peu systématisée. Qu'entend-on par MBD ? On peut les définir comme des diathèses hémorragiques sans répercussion sévère sur la vie quotidienne et, en principe, sans risque vital : épistaxis, gingivorragies, rect...

  14. 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)

  15. 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....

  16. 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

  17. Regional Analgesia for Post-Operative Pain Management – Initial ...

    African Journals Online (AJOL)

    The drugs used for top-ups included 0.125% plain bupivacaine (15 patients), 0.125% plain bupivacaine + 2.5mcgs/ml Fentanyl (10 patients) in 10ml aliquots. The outcome was good in most patients with 19 patients (82.4%) experiencing only mild pain (numeric pain score 0-3). Onset of post-operative pain was 13-18 hours ...

  18. 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

  19. [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.

  20. 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.

  1. 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.

  2. Bleeding in children with cancer

    African Journals Online (AJOL)

    Siluan early warning signs of childhood cancer, compiled by the South. African Children's Cancer Study Group (SACCSG). An increased risk of bleeding during the cancer treatment period is almost always present, due to the bone marrow suppressive effect of chemotherapy. Fortunately, death due to bleeding is rare these ...

  3. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...

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

    DEFF Research Database (Denmark)

    Ngu, Jing H.; 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....

  5. THERMOELECTRIC SEMICONDUCTOR DEVICE FOR CAUTERY OF BLEEDING

    Directory of Open Access Journals (Sweden)

    Denis V. Yevdulov

    2017-01-01

    Full Text Available Abstract. Objectives The aim of the work is to study the possibilities for using a semiconductor device to cauterise bleeding by means of cooling (cryocautery. Method The study is based on methods for approximate modeling of heat exchange processes. Results The construction of a device for cauterisation of bleeding, the actuating element of which consists of a thermoelectric battery operating in cooling mode at the time of blood flow cautery and in heating mode when removing the device from the damaged area, is considered. A model of a device, realised on the basis of the solution of the problem of solidification of a viscous liquid by the method of L.S. Leibenson, is proposed, taking into account the electro- and thermo-physical characteristics of the thermoelectric battery cold source. As a result of the numerical experiment, the dependence of the duration of the ice crust formation on tissues 1 mm thick (which corresponds to the cauterisation of bleeding is obtained on the value of the supply current of the thermoelectric battery. With increasing current, the duration of the ice crust formation is reduced; this can be of the order of 160 s at 5 A. It was demonstrated that the selection of thermoelectric battery parameters and current should be guided by medical norms and standards in order to avoid frostbite in the tissues adjacent to the bleeding zone. Conclusion The special design of thermoelectric device provides an effective technical means for cauterising bleeding by freezing (cryocautery, providing high intensity of cooling, shortenened thrombus formation duration, and eliminating painful sensations when removing the device from a damaged area. 

  6. Saliency-Based Bleeding Localization for Wireless Capsule Endoscopy Diagnosis

    Directory of Open Access Journals (Sweden)

    Hongda Chen

    2017-01-01

    Full Text Available Stomach bleeding is a kind of gastrointestinal disease which can be diagnosed noninvasively by wireless capsule endoscopy (WCE. However, it requires much time for physicians to scan large amount of WCE images. Alternatively, computer-assisted bleeding localization systems are developed where color, edge, and intensity features are defined to distinguish lesions from normal tissues. This paper proposes a saliency-based localization system where three saliency maps are computed: phase congruency-based edge saliency map derived from Log-Gabor filter bands, intensity histogram-guided intensity saliency map, and red proportion-based saliency map. Fusing the three maps together, the proposed system can detect bleeding regions by thresholding the fused saliency map. Results demonstrate the accuracy of 98.97% for our system to mark bleeding regions.

  7. 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…

  8. Spatial Dependencies in the Absorption of Funds from Regional Operational Programmes on NUTS 3 Regional Level in Poland

    Directory of Open Access Journals (Sweden)

    Emilia Modranka

    2015-01-01

    Full Text Available Financial support is the main instrument of regional development policy in the European Union. Concentration, programming and partnership, are presented as "core principles" for improving the effectiveness of structural expenditure based on compensating the structural disadvantage of the assisted regions. The purpose of this paper is to analyze the spatial dependencies in level of absorption of funds in comparison to allocation criteria of intervention funded from Regional Operational Programmes. The research was based on data about the state of implementation of European funds in the subregions (NUTS 3 in 2007-2012., generated from the National Information System SIMIK 07-13.

  9. 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 ...

  10. 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.

  11. 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

  12. Electric operation in the Nuremburg/Fuerth region; Elektrischer Betrieb in der Region Nuernberg/Fuerth

    Energy Technology Data Exchange (ETDEWEB)

    Zueckner, Heinz [DB ProjektBau GmbH, Nuernberg (Germany). Regionalbereich Sued, Projektmanagement

    2010-06-15

    The fi rst German railway went from Nuremburg to Fuerth in 1835. One hundred years later electric railway operation was started on the Treuchtlingen-Nuremberg line. Electrification was completed for the time being by the inauguration of the Nuremberg-Ingolstadt line. Current and future projects are geared to fully electrify the railway network and extend it to communicate with Saxony and the Czech Republic. (orig.)

  13. 76 FR 23470 - Version One Regional Reliability Standard for Transmission Operations

    Science.gov (United States)

    2011-04-27

    ... Power Act, the Federal Energy Regulatory Commission approves regional Reliability Standard TOP-007-WECC-1 (System Operating Limits) developed by the Western Electric Coordinating Council (WECC) and... flows on major WECC transfer paths do not exceed system operating limits for more than 30 minutes. The...

  14. 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

  15. 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...

  16. [Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)].

    Science.gov (United States)

    Guţu, E; Ghidirim, Gh; Mişin, I; Iakovleva, Iraida; Vozian, M

    2010-01-01

    Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology.

  17. Visualization of Load Security Region Bounded by Operational Constraints of Power Systems

    OpenAIRE

    Sotdhipong Phichaisawat; Sataporn Limpatthamapanee

    2011-01-01

    This paper presents the method to visualize a set of feasible loading points, called “feasible region”, in the two-dimensional power flow solution space. The visualization can be done by tracing the boundary of feasible region. The boundary points are determined by optimizing the reduced cost function with operational constraints. The method can also determine several kinds of feasible regions by assigning the appropriate free variables and its criteria. These feasible regions show the robust...

  18. 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

  19. Operational Arctic: The Potential for Crisis or Conflict in the Arctic Region and Application of Operational Art

    Science.gov (United States)

    2014-05-22

    truly know who is your friend and who is your enemy.1 Inuit proverb The littoral nations of the Arctic region face potential challenges and...the interests of a globalizing world. This growing world interest, and the lack of political and legal regulation, may lead to an increase in...Arctic Operating Concept,” Canadian Military 26 legal scholar, and expert on international law, Michael Byers, seeks approaches for Canada to

  20. Visualization of Load Security Region Bounded by Operational Constraints of Power Systems

    Directory of Open Access Journals (Sweden)

    Sotdhipong Phichaisawat

    2011-07-01

    Full Text Available This paper presents the method to visualize a set of feasible loading points, called “feasible region”, in the two-dimensional power flow solution space. The visualization can be done by tracing the boundary of feasible region. The boundary points are determined by optimizing the reduced cost function with operational constraints. The method can also determine several kinds of feasible regions by assigning the appropriate free variables and its criteria. These feasible regions show the robustness of operating points and the limit of control actions. The six-bus test system illustrates the boundary tracing and impacts of system parameters on the shape of feasible region, i.e. the capacitor bank operation, load shedding, generator voltage controls, and load level.

  1. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants

    NARCIS (Netherlands)

    Broekema, Ferdinand I.; van Minnen, Baucke; Jansma, Johan; Bos, Rudolf R. M.

    To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103

  2. Operational concepts for maglev railways in regional traffic; Betriebskonzepte fuer Magnetschwebebahnen im Regionalverkehr

    Energy Technology Data Exchange (ETDEWEB)

    Anders, J.; Fritz, E. [Institut fuer Bahntechnik GmbH, Berlin (Germany); Witt, M. [Dornier Consulting GmbH, Friedrichshafen (Germany)

    2002-07-01

    By order of the Federal Ministry of Transport, Construction and Housing, various model lines have been technically and operationally designed for operation of Maglev railways in regional transport systems. For this purpose, different operational concepts have been compared with regard to their effects on vehicle configurations, propulsion, operations control and power supply systems. (orig.) [German] Im Auftrag des Bundesministeriums fuer Verkehr, Bau und Wohnungswesen wurden verschiedene Modellstrecken fuer den Betrieb von Magnetschwebebahnsystemen im Regionalverkehr technisch und betrieblich ausgelegt. Anlass war der Vergleich unterschiedlicher Betriebskonzepte, mit ihren Auswirkungen auf Fahrzeugkonfigurationen, Antrieb, Betriebsleittechnik und Energieversorgung. (orig.)

  3. 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.

  4. 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.)

  5. Coagulation management in massive bleeding.

    Science.gov (United States)

    Griffee, Matthew J; Deloughery, Thomas G; Thorborg, Per A

    2010-04-01

    To update readers on recent literature regarding treatment of coagulopathy for patients with life-threatening bleeding, highlighting emerging therapeutic options, controversial topics, and ongoing clinical trials. Massive transfusion protocols featuring immediate availability of blood products and multidisciplinary communication reduce mortality and conserve resources. There is a growing consensus that immediate administration of plasma and platelet units in a 1: 1: 1 ratio with red cell units reduces early mortality. Lyophilized and recombinant blood product components may have advantages over traditional blood products in certain clinical circumstances. Massive transfusion protocols standardize treatment of the coagulopathy of massive bleeding, leading to rapid restoration of hemostasis and decrease in early mortality.

  6. Managing oral bleeding in children with hereditary bleeding disorders

    African Journals Online (AJOL)

    All the patients presented with bleeding gingivae secondary to either physiologic processes of eruption, infective or traumatic dental conditions. The management of the patients was comprehensive with a multidisciplinary approach. The prevention of traumatic and infective dental conditions is an important part of oral health ...

  7. 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

  8. 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

  9. The Peri-operative Bariatric Surgery Care in the Middle East Region.

    Science.gov (United States)

    Nimeri, Abdelrahman; Al Hadad, Mohammed; Khoursheed, Mousa; Maasher, Ahmed; Al Qahtani, Aayed; Al Shaban, Talat; Fawal, Hayssam; Safadi, Bassem; Alderazi, Amer; Abdalla, Emad; Bashir, Ahmad

    2017-06-01

    Bariatric surgery is common in the Middle East region. However, regional accreditation bodies and guidelines are lacking. We present the current peri-operative practice of bariatric surgery in the Middle East region. Public and private practice in the Middle East region. A questionnaire was designed to study trends of peri-operative care in bariatric surgery. It was sent to members of the Pan Arab Society for Metabolic and Bariatric Surgery (PASMBS). Ninety-three surgeons (88.6%) responded, 63.4% were in private practice, 68.5% have been in practice for more than 5 years, and 61.1% performed more than 125 cases per year. Laparoscopic sleeve gastrectomy (LSG) was the commonest procedure performed, then laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), and laparoscopic adjustable gastric banding (LAGB). Pre-operatively as a routine, 65% referred patients for dietitian and (78.3%) for smoking cessation. In contrast as a routine, 22.6% referred patients to a psychologist, 30% screened for obstructive sleep apnea (OSA), and when they did, they did not use a questionnaire. For patients 50 years of age, 22% performed a screening colonoscopy and 33.7% referred patients to a cardiologist. Intra-operatively as a routine, 25.3% placed a drain and 42.2% placed urinary catheters. In contrast, 77.1% performed a leak test (82.7% as a methylene blue leak test). Post-operatively, 79.5% used chemoprophylaxis for venous thromboembolism and 89% required patients to take vitamins. In contrast, 25% prescribed ursodeoxycholic acid. The wide variation in the peri-operative care of bariatric surgery in the Middle East region highlights the need for regional guidelines based on international guidelines.

  10. 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).

  11. 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)

  12. 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.

  13. 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

  14. Predictors of bleeding during heparin therapy.

    Science.gov (United States)

    Walker, A M; Jick, H

    1980-09-12

    Among 2,656 patients receiving heparin sodium therapy, bleeding was a dose-related phenomenon that occurred most commonly among women, severely ill patients, and patients who received asprin during heparin therapy. Except for dose, factors that predisposed patients to bleeding were more strongly associated with major bleeding than with minor bleeding. Heavy alcohol drinkers were at particularly high risk for major bleeding episodes during heparinization. The seven-day cumulative risk for any bleeding was 9.1%. Risk was greatest on the third day of heparin administration.

  15. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

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

    2012-01-01

    -risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  16. 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

  17. 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

  18. 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

  19. Spontaneous Bleeding Associated with Ginkgo biloba

    Science.gov (United States)

    Bent, Stephen; Goldberg, Harley; Padula, Amy; Avins, Andrew L

    2005-01-01

    BACKGROUND Ginkgo biloba (ginkgo) is a herbal remedy used by over 2% of the adult population in the United States. Several review articles have suggested that ginkgo may increase the risk of bleeding. OBJECTIVE To report a case of bleeding associated with using ginkgo, to systematically review the literature for similar case reports, and to evaluate whether using ginkgo is causally related to bleeding. DATA SOURCES We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions. REVIEW METHODS Published case reports of bleeding events in persons using ginkgo were selected. Two reviewers independently abstracted a standard set of information to assess whether ginkgo caused the bleeding event. RESULTS Fifteen published case reports described a temporal association between using ginkgo and a bleeding event. Most cases involved serious medical conditions, including 8 episodes of intracranial bleeding. However, 13 of the case reports identified other risk factors for bleeding. Only 6 reports clearly described that ginkgo was stopped and that bleeding did not recur. Bleeding times, measured in 3 reports, were elevated when patients were taking ginkgo. CONCLUSION A structured assessment of published case reports suggests a possible causal association between using ginkgo and bleeding events. Given the widespread use of this herb and the serious nature of the reported events, further studies are needed. Patients using ginkgo, particularly those with known bleeding risks, should be counseled about a possible increase in bleeding risk. PMID:16050865

  20. Non-Invasive Monitoring of Intra-Abdominal Bleeding Rate Using Electrical Impedance Tomography

    Science.gov (United States)

    2009-09-01

    for intra-abdominal bleeding are either impractical for field use (MRI/CT), non-specific (pulse, blood pressure) operator dependent (ultrasound/ DPL ...or invasive ( DPL ) Thus, EIT is a potentially highly sensitive and useful technique for detecting and monitoring intra- abdominal bleeding. The aim of

  1. 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 develops shortly ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often have a ...

  2. Statistical analysis of regional capital and operating costs for electric power generation

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, L.R.; Myers, M.G.; Herrman, J.A.; Provanizano, A.J.

    1977-10-01

    This report presents the results of a three and one-half-month study conducted for Brookhaven National Lab. to develop capital and operating cost relationships for seven electric power generating technologies: oil-, coal-, gas-, and nuclear-fired steam-electric plants, hydroelectric plants, and gas-turbine plants. The methodology is based primarily on statistical analysis of Federal Power Commission data for plant construction and annual operating costs. The development of cost-output relationships for electric power generation is emphasized, considering the effects of scale, technology, and location on each of the generating processes investigated. The regional effects on cost are measured at the Census Region level to be consistent with the Brookhaven Multi-Regional Energy and Interindustry Regional Model of the United States. Preliminary cost relationships for system-wide costs - transmission, distribution, and general expenses - were also derived. These preliminary results cover the demand for transmission and distribution capacity and operating and maintenance costs in terms of system-service characteristics. 15 references, 6 figures, 23 tables.

  3. 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.

  4. 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

  5. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

    Lethaby, A; Farquhar, C; Cooke, I

    2000-01-01

    Heavy menstrual bleeding (HMB) is an important cause of ill health in women. Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. A wide variety of medications are available to reduce heavy menstrual bleeding but there is considerable variation in practice and uncertainty about the most appropriate therapy. Plasminogen activators are a group of enzymes that cause fibrinolysis (the dissolution of clots). An increase in the levels of plasminogen activators has been found in the endometrium of women with heavy menstrual bleeding compared to those with normal menstrual loss. Plasminogen activator inhibitors (antifibrinolytic agents) have therefore been promoted as a treatment for heavy menstrual bleeding. There has been a reluctance to prescribe tranexamic acid due to possible side effects of the drugs such as an increased risk of thrombogenic disease (deep venous thrombosis). Long term studies in Sweden, however, have shown that the rate of incidence of thrombosis in women treated with tranexamic acid is comparable with the spontaneous frequency of thrombosis in women. To determine the effectiveness of antifibrinolytics in achieving a reduction in heavy menstrual bleeding. All studies which might describe randomised controlled trials of antifibrinolytic therapy for the treatment of heavy menstrual bleeding were obtained by electronic searches of MEDLINE 1966-1997, EMBASE 1980-1997 and the Cochrane Library. Companies producing antifibrinolytics and experts within the field were contacted for reference lists and information on unpublished trials. Randomised controlled trials in women of reproductive age treated with antifibrinolytic agents versus placebo, no treatment or any other medical (non-surgical) therapy for regular heavy menstrual bleeding within either the primary, family planning or specialist clinic settings. Women with post menopausal bleeding, intermenstrual bleeding, iatrogenic or pathological causes of

  6. 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)

  7. 2011 Operations and Maintenance Activities in the East Region of UNAVCO's Plate Boundary Observatory

    Science.gov (United States)

    Dittmann, T.; Feaux, K.; Kasmer, D.; Jenkins, F.; Mencin, D.

    2011-12-01

    2011 marked Year 3 of Operations and Maintenance of the Plate Boundary Observatory (PBO). In the East Region of PBO, it was a year characterized by several major projects as well as scheduled ongoing maintenance activities. The most significant major project was a USGS/ARRA funded communications upgrade in Yellowstone National Park. This upgrade consisted of bringing 8 existing PBO stations within the Yellowstone volcanic region to near real-time communications. This work will be completed on time and in collaboration with the National Park Service. The upgrade promises to provide much faster latency for invaluable data being recorded for one of the most geodetically critical regions of the current PBO network. Another significant ongoing project in the East Region has been supporting the community that continues to use PBO data. In particular, support of Kristine Larson (Univ of CO) both in installing webcams at PBO sites for monitoring snow depth as well as supporting vegetative surveys at current PBO sites. Similarly, the East Region responded promptly to the community with requests for data quality issues that are station hardware related, including replacing GPS antennae and receivers. With regards to ongoing operations and maintenance projects, reasons for site visits in 2011 were dominated by two significant situations: battery replacement and CDMA modem swaps. 83 site visits were required as part of the Operations and Maintenance strategic battery plan of 5 year battery replacements. This proved to be a considerable challenge due to the scale and geography of the scheduled replacements- the sites were spread throughout the entire network, east to west and north to south. 20 station visits were required due to a Verizon upgrade of the older Alltel network purchased by Verizon. These stations are predominantly in the Rocky Mountain region, but often times had limited access to due weather. Overall, despite record snowfalls throughout the west, state of health

  8. Otorrhagia bleeding due to leech bite

    Directory of Open Access Journals (Sweden)

    Narges Askari

    2012-01-01

    Full Text Available Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin, which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; that stopped with leech removal. A 24-year-old man was presented to Al-Zahra hospital with left otorrhagia and otalgia from 2 days ago. After suction of ear a small soft foreign body was seen in the external ear near the tympanic membrane, then the ear filled with glycerine phenice, the patient explained decreased movement of foreign body. Four hours later the bloody discharge stopped and otalgia decreased. After suction of clots, a leech was extruded from external auditory canal by alligator. Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.

  9. 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.

  10. 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)

  11. 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.

  12. 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

  13. Data analysis on marine engine operating regions in relation to ship navigation

    OpenAIRE

    Perera, Lokukaluge Prasad; Mo, Brage

    2016-01-01

    Data analysis techniques to understand marine engine operating regions as a part of the ship energy efficiency management plan (SEEMP) are proposed in this study. The SEEMP enforces to improve ship energy efficiency under various emission control measures by collecting and analyzing vessel performance and navigation data. The required data analysis techniques to analyze such data sets are presented under the engine-propeller combinator diagram (i.e. one propeller shaft with a direct drive mai...

  14. RADON CONCENTRATION IN THE AIR OF NEWLY BUILT AND OPERATING BUILDINGS IN THE ROSTOV REGION

    Directory of Open Access Journals (Sweden)

    M. Yu Soloviev

    2010-01-01

    Full Text Available The article presents issues of radon accumulation in the air of dwellings and public buildings in the Rostov region. It is shown that radon concentration in the air of commissioned buildings does not depend on the season when the investigation was carried out, while equivalent equilibrium volumetric activity of radon in the operating buildings is approximately twice higher during the cold period, then during the hot period of a year.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. A transportation model for an effective disaster relief operation in the SADC region

    Directory of Open Access Journals (Sweden)

    Baraka, Jean-Claude Munyaka

    2017-08-01

    Full Text Available This paper reviews some challenges faced by humanitarian logistics and supply chain organisations in the transportation of resources, evacuees, and emergency supplies for disaster relief operations in the SADC region. To identify the appropriate transportation to assist in the region, three models were reviewed and proposed: A typical transportation problem, a genetic algorithm based on a spanning tree, and a linear optimisation using Excel Solver. Reviewing the literature revealed that both man-made and natural disasters have caused over ninety thousand fatalities and affected millions just over the past three decades. A further review shows that most disaster deaths are the result of poor infrastructure, especially in populated areas. This presents a challenge to relief organisations in their efforts to provide on-time relief to victims in pre- and post-disaster periods. Although each proposed transportation problem has particular complexities, each of them could assist the region to decrease the relief operation response time and cost. This paper provides the reader with a greater understanding of the challenges faced by the humanitarian supply chain in the SADC region. This paper proposes a conceptual model based on an actual empirical case.

  1. Lower Gastrointestinal Bleeding in Children.

    Science.gov (United States)

    Sahn, Benjamin; Bitton, Samuel

    2016-01-01

    This article provides an overview of the evaluation and management of lower gastrointestinal bleeding (LGIB) in children. The common etiologies at different ages are reviewed. Conditions with endoscopic importance for diagnosis or therapy include solitary rectal ulcer syndrome, polyps, vascular lesions, and colonic inflammation and ulceration. Diagnostic modalities for identifying causes of LGIB in children include endoscopy and colonoscopy, cross-sectional and nuclear medicine imaging, video capsule endoscopy, and enteroscopy. Pre-endoscopic preparation and decision-making unique to pediatrics is highlighted. The authors conclude with a summary of current and emerging therapeutic hemostatic techniques that can be used in pediatric patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

    Science.gov (United States)

    Nikolić, M; Hanževački, M; Jurčić, P; Budimir, I; Ljubičić, N

    2015-11-01

    In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases, we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the state-of-the-art on gastrointestinal bleeding, new classification of gastrointestinal bleeding from the upper, mid and lower gut, controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding from the upper tract, restrictive transfusion strategy, useful clinical stratification of the severity of bleeding, indications for hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed

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

    Directory of Open Access Journals (Sweden)

    P. Rahimzadeh

    2008-01-01

    Full Text Available Background and objectivesIntraoperative 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.MethodsIn 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 surgery50 mg metoprolol in the morning of the surgery50 mg metoprolol at night before surgery and in the morning of the surgeryplaceboHeart 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 doses of metoprolol could decrease the amount of bleeding and improve the operation field significantly and also could decrease the agitation in recovery room.Keywords: Metoprolol; Bleeding; Controlled Hypotension; Agitation

  4. 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.

  5. 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

  6. 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/.

  7. 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.

  8. 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.

  9. Emergency management of lower gastrointestinal bleed in children.

    Science.gov (United States)

    Balachandran, Binesh; Singhi, Sunit

    2013-03-01

    Lower gastro intestinal bleed (LGIB) is defined as any bleeding that occurs distal to the ligament of Treitz (situated at the duodeno jejunal junction). It constitutes the chief complaint of about 0.3 % of children presenting to the pediatric emergency department(ED). Among Indian children the most common causes are colitis and polyps. In most of the cases of LGIB the bleeding is small and self limiting, but conditions like Meckel's diverticulum often presents with life threatening bleeds. The approach in ED should include in order of priority-assessment and maintenance of hemodynamic stability, confirmation of LGIB and then to attempt for specific diagnoses and their management. This is achieved with help of rapid cardiopulmonary assessment, focused history and examination. The management of all serious hemodynamically significant bleeds includes, rapid IV access, volume replacement with normal saline 20 ml/kg, blood sampling (for cross matching, hematocrit, platelet, coagulogram and liver function tests), Inj. Vit K 5-10 mg IV, acid suppression with H2 antagonists/PPI and nasogastric lavage to rule out upper gastrointestinal bleed. Continuous ongoing monitoring of vital signs is important after stabilization. In ill looking infant, infectious colitis, Necrotizing enterocolitis (NEC), Hirschsprung enterocolitis and volvulus and in older infants and children, intussusceptions, typhoid fever, volvulus should be looked for. Proctosigmoidoscopy remains the first investigation to be done and reveals majority of etiology. Multidetector CT scan, Tc 99 m RBC scan, angiography and Push enteroscopy are the further investigation choices according to the clinical condition of the child. Intra operative enteroscopy is reserved for refractory cases with an obscure etiology.

  10. 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

  11. 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

  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

    Gas bearings are popular for their high speed capabilities, low friction and clean operation, but require low clearances and suffer from poor damping properties. The poor damping properties cause high disturbance amplification near the natural frequencies. These become critical when the rotation...... speed coincides with a natural frequency. In these regions, even low mass unbalances can cause rub and damage the machine. To prevent rubbing, the variation of the rotation speed of machines supported by gas bearings has to be carefully conducted during run-ups and run-downs, by acceleration...... 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...

  13. 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.)

  14. 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

  15. 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

  16. 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.

  17. [Gastrointestinal bleeding, NSAIDs, aspirin and anticoagulants].

    Science.gov (United States)

    Lanas, Ángel

    2014-09-01

    The studies presented at the recent American Congress of Gastroenterology in the field of non-variceal upper gastrointestinal bleeding (associated or not to NSAIDs or ASA use) have not been numerous but interesting. The key findings are: a) rabeprazole, the only PPI that had few studies in this field, is effective in the prevention of gastric ulcers; b) famotidine could also be effective in the prevention of complications by AAS; c) the new competitive inhibitors of the acid potassium pump are effective (as much as PPIs) on the recurrence of peptic ulcers by ASA; d) early endoscop (<8 h) in non-variceal upper gastrointestinal bleeding seems to offer no better results than those made in the first 24 h; e) endoscopic therapy in Forrest 1a ulcers does not obliterate the bleeding artery in 30% of cases and is the cause of bleeding recurrence; f) alternative therapies with glue or clotting products are being increasingly used in endoscopic therapy of gastrointestinal bleeding; g) liberal administration of blood in the GI bleeding is associated with poor prognosis; h) lesions of the small intestine are frequent cause of gastrointestinal bleeding when upper endoscopy shows no positive stigmata; and i) capsule endoscopy studies have high performance in gastrointestinal bleeding of obscure origin, if performed early in the first two days after the beginning of the bleeding episode. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  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. Serendipity in scintigraphic gastrointestinal bleeding studies

    Energy Technology Data Exchange (ETDEWEB)

    Goergen, T.G.

    1983-09-01

    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.

  20. Gelatin-thrombin hemostatic matrix injection to salvage refractory post-renal graft biopsy bleed

    Directory of Open Access Journals (Sweden)

    V Jain

    2013-01-01

    Full Text Available Post-renal biopsy bleeding refractory to angioembolization usually requires graft nephrectomy as a life-saving measure. Gelatin-thrombin hemostatic matrix injection in the needle tract is a novel attempt to control bleeding in such cases and to salvage the allograft. We hereby describe two cases of post-graft biopsy bleed. Both these patients continued to bleed even after angioembolization. They were shifted to the operating room upon developing hypotension, having received multiple blood transfusions with the intention of performing graft nephrectomy to save their lives. However, bleeding was successfully controlled by using Gelatin-thrombin hemostatic matrix injection in the biopsy needle tract. Patients improved hemodynamically after the procedure. Graft function returned to normal in both the cases. At an average follow-up of 10.4 months, both the patients have shown stable graft functions.

  1. 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

  2. Experience is more important than technology in paediatric post-tonsillectomy bleeding.

    Science.gov (United States)

    Hinton-Bayre, A D; Noonan, K; Ling, S; Vijayasekaran, S

    2017-07-01

    Paediatric tonsillectomy is a common procedure and one of the first skills acquired by surgical trainees. Post-tonsillectomy bleeding is one of the most significant complications. This study examined post-tonsillectomy bleed rates associated with technology and level of surgical experience. Data were collected on all tonsillectomies performed by surgical consultants (n = 6) and trainees (n = 10) at affiliated hospitals over a nine-month period. Hospital records were audited for post-tonsillectomy bleeding re-admissions and returns to the operating theatre. A total of 1396 tonsillectomies were performed (279 by trainees, 1117 by consultant surgeons). Primary post-tonsillectomy bleed rates were equivalent between trainees and consultants. Secondary bleed rates were significantly greater for trainees (10.0 per cent) compared to consultants (3.3 per cent), as were return to operating theatre rates (2.5 per cent vs 0.7 per cent). Amongst consultants, technology used was not associated with differences in secondary post-tonsillectomy bleeding and returns to the operating theatre. Our data suggest that experience of the surgeon may have greater bearing on post-tonsillectomy bleed rates than the technology used.

  3. 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.

  4. 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

  5. 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).

  6. Use of serotonergic antidepressants and bleeding risk in patients undergoing surgery.

    Science.gov (United States)

    Jeong, Bo-Ok; Kim, Sung-Wan; Kim, Seon-Young; Kim, Jae-Min; Shin, Il-Seon; Yoon, Jin-Sang

    2014-01-01

    Serotonergic antidepressants (SADs) are associated with increased bleeding risk. To develop optimal guidelines for the usage of antidepressants in the perioperative period, this review of the bleeding risk associated with SADs was conducted. A total of 10 original articles describing the relationship between SAD use and perioperative bleeding published in English before June 2013 were selected and reviewed. A total of 6 studies showed positive associations between SAD use and perioperative bleeding. In particular, SAD use before orthopedic or breast surgery was associated with a tendency toward increased intraoperative or postoperative bleeding (i.e., increased need for transfusion during surgery, greater amount of intraoperative blood loss, bleeding events requiring intervention, or reoperation owing to postoperative bleeding). However, 3 studies among SAD users undergoing coronary artery bypass grafting and 1 study in SAD users undergoing facial surgery did not report an increased risk for postoperative bleeding. The risks and benefits of SAD use should be weighed in all patients undergoing surgical operations. Physicians may consider planned discontinuation of SADs 2 weeks before the operation in patients with a high risk of bleeding but in the stable phase of depression. SAD discontinuation syndrome should be managed appropriately. If, despite the expected exacerbation of depression after discontinuation of antidepressants, discontinuation of SADs is nonetheless required because of the patient's clinical risk of bleeding, changing to an antidepressant that does not, or less potently, inhibits serotonin reuptake (e.g., bupropion or mirtazapine) can be considered. © 2013 Published by The Academy of Psychosomatic Medicine on behalf of The Academy of Psychosomatic Medicine.

  7. Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

    Science.gov (United States)

    Guo, Shi-Bin; Gong, Ai-Xia; Leng, Jing; Ma, Jing; Ge, Lin-Mei

    2009-01-01

    AIM: To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping. METHODS: Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS: The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy’s lesion (11 cases), Mallory-Weiss syndrome (six cases), post-operative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy’s lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy’s lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy’s lesion 10 mo later, but in a different location. CONCLUSION: Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes. PMID:19750577

  8. Cluster based statistical feature extraction method for automatic bleeding detection in wireless capsule endoscopy video.

    Science.gov (United States)

    Ghosh, Tonmoy; Fattah, Shaikh Anowarul; Wahid, Khan A; Zhu, Wei-Ping; Ahmad, M Omair

    2018-03-01

    Wireless capsule endoscopy (WCE) is capable of demonstrating the entire gastrointestinal tract at an expense of exhaustive reviewing process for detecting bleeding disorders. The main objective is to develop an automatic method for identifying the bleeding frames and zones from WCE video. Different statistical features are extracted from the overlapping spatial blocks of the preprocessed WCE image in a transformed color plane containing green to red pixel ratio. The unique idea of the proposed method is to first perform unsupervised clustering of different blocks for obtaining two clusters and then extract cluster based features (CBFs). Finally, a global feature consisting of the CBFs and differential CBF is used to detect bleeding frame via supervised classification. In order to handle continuous WCE video, a post-processing scheme is introduced utilizing the feature trends in neighboring frames. The CBF along with some morphological operations is employed to identify bleeding zones. Based on extensive experimentation on several WCE videos, it is found that the proposed method offers significantly better performance in comparison to some existing methods in terms of bleeding detection accuracy, sensitivity, specificity and precision in bleeding zone detection. It is found that the bleeding detection performance obtained by using the proposed CBF based global feature is better than the feature extracted from the non-clustered image. The proposed method can reduce the burden of physicians in investigating WCE video to detect bleeding frame and zone with a high level of accuracy. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. 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

  10. Colonoscopy in the diagnosis of acute lower gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Igor Borba de Souza e Benevides

    2016-10-01

    Full Text Available Lower gastrointestinal bleeding is defined as a bleeding originated from a source distal to the Treitz ligament and the colonoscopy is well established as the diagnostic procedure of choice. Objective: To evaluate the results of colonoscopies performed to diagnose the cause of acute lower gastrointestinal bleeding in a general hospital at Mato Grosso do Sul. Material and methods: Colonoscopy procedures performed in the Endoscopy service of the Hospital Regional de Mato Grosso do Sul in those patients admitted due to an acute lower gastrointestinal bleeding from January 2014 to December 2015 were analyzed retrospectively. The studied variables were age, gender, diagnosis and localization of the lesion. Results: The mean age was 66 years, and there was a little predominance of the male gender. Diverticular disease was the main cause of lower gastrointestinal bleeding in this study, followed by cancer, inflammatory gastrointestinal disease, polyps, and angiodysplasia. Conclusion: The colonoscopy showed to be an effective diagnostic method in the case of acute lower gastrointestinal bleeding and a good therapeutic tool in the case of diverticular disease and angiodysplasia. Resumo: Hemorragia digestiva baixa é definida como sangramento originado de uma fonte distal ao ligamento de Treitz e a colonoscopia esta bem estabelecida como o seu procedimento diagnóstico de escolha. Objetivo: Avaliar os resultados das colonoscopias realizadas para elucidação diagnóstica dos casos de Hemorragia digestiva baixa aguda em um Hospital Geral de Mato Grosso do Sul. Materiais e métodos: Foram analisadas, de forma retrospectiva, as colonoscopias realizadas nos pacientes internados devido à hemorragia digestiva baixa aguda, no período de janeiro de 2014 a dezembro de 2015, no serviço de endoscopia digestiva do Hospital Regional de Mato Grosso do Sul. As variáveis estudadas foram a idade, sexo, diagnóstico e localização da lesão. Resultados: A média de

  11. 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)

  12. 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

  13. Verification of operational solar flare forecast: Case of Regional Warning Center Japan

    Directory of Open Access Journals (Sweden)

    Kubo Yûki

    2017-01-01

    Full Text Available In this article, we discuss a verification study of an operational solar flare forecast in the Regional Warning Center (RWC Japan. The RWC Japan has been issuing four-categorical deterministic solar flare forecasts for a long time. In this forecast verification study, we used solar flare forecast data accumulated over 16 years (from 2000 to 2015. We compiled the forecast data together with solar flare data obtained with the Geostationary Operational Environmental Satellites (GOES. Using the compiled data sets, we estimated some conventional scalar verification measures with 95% confidence intervals. We also estimated a multi-categorical scalar verification measure. These scalar verification measures were compared with those obtained by the persistence method and recurrence method. As solar activity varied during the 16 years, we also applied verification analyses to four subsets of forecast-observation pair data with different solar activity levels. We cannot conclude definitely that there are significant performance differences between the forecasts of RWC Japan and the persistence method, although a slightly significant difference is found for some event definitions. We propose to use a scalar verification measure to assess the judgment skill of the operational solar flare forecast. Finally, we propose a verification strategy for deterministic operational solar flare forecasting. For dichotomous forecast, a set of proposed verification measures is a frequency bias for bias, proportion correct and critical success index for accuracy, probability of detection for discrimination, false alarm ratio for reliability, Peirce skill score for forecast skill, and symmetric extremal dependence index for association. For multi-categorical forecast, we propose a set of verification measures as marginal distributions of forecast and observation for bias, proportion correct for accuracy, correlation coefficient and joint probability distribution for

  14. Verification of operational solar flare forecast: Case of Regional Warning Center Japan

    Science.gov (United States)

    Kubo, Yûki; Den, Mitsue; Ishii, Mamoru

    2017-08-01

    In this article, we discuss a verification study of an operational solar flare forecast in the Regional Warning Center (RWC) Japan. The RWC Japan has been issuing four-categorical deterministic solar flare forecasts for a long time. In this forecast verification study, we used solar flare forecast data accumulated over 16 years (from 2000 to 2015). We compiled the forecast data together with solar flare data obtained with the Geostationary Operational Environmental Satellites (GOES). Using the compiled data sets, we estimated some conventional scalar verification measures with 95% confidence intervals. We also estimated a multi-categorical scalar verification measure. These scalar verification measures were compared with those obtained by the persistence method and recurrence method. As solar activity varied during the 16 years, we also applied verification analyses to four subsets of forecast-observation pair data with different solar activity levels. We cannot conclude definitely that there are significant performance differences between the forecasts of RWC Japan and the persistence method, although a slightly significant difference is found for some event definitions. We propose to use a scalar verification measure to assess the judgment skill of the operational solar flare forecast. Finally, we propose a verification strategy for deterministic operational solar flare forecasting. For dichotomous forecast, a set of proposed verification measures is a frequency bias for bias, proportion correct and critical success index for accuracy, probability of detection for discrimination, false alarm ratio for reliability, Peirce skill score for forecast skill, and symmetric extremal dependence index for association. For multi-categorical forecast, we propose a set of verification measures as marginal distributions of forecast and observation for bias, proportion correct for accuracy, correlation coefficient and joint probability distribution for association, the

  15. 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.

  16. Massive rectal bleeding from colonic diverticulosis | Olokoba ...

    African Journals Online (AJOL)

    Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man. Case report: We highlight a case of a 79 year old man who presented with massive rectal bleeding due to colonic diverticulosis from our centre. Colonoscopy identified multiple diverticula in the ...

  17. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    presented with GI bleeding following ingestion of NSAID. Two female children ... users of NSAIDs [2]. The risk and the magnitude of. NSAID-induced GI injury in children are uncertain. Here, we report two cases of GI bleeding in children following NSAID use. .... Nonsteroidal anti-inflammatory drug induced gastrointestinal ...

  18. 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

  19. 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 ...

  20. 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.

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

    Science.gov (United States)

    ... Feelings Expert Answers Q&A Movies & More for Teens Teens site Sitio para adolescentes Body Mind Sexual Health ... English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) What's in this article? ...

  2. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man. ... also oozing blood. He was worked up, and had surgery for hemicolectomy due to massive blood loss following failure of initial conservative management. .... bleeding patterns observed in fifty cases.

  3. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  4. Design of a reliable and operational landslide early warning system at regional scale

    Science.gov (United States)

    Calvello, Michele; Piciullo, Luca; Gariano, Stefano Luigi; Melillo, Massimo; Brunetti, Maria Teresa; Peruccacci, Silvia; Guzzetti, Fausto

    2017-04-01

    Landslide early warning systems at regional scale are used to warn authorities, civil protection personnel and the population about the occurrence of rainfall-induced landslides over wide areas, typically through the prediction and measurement of meteorological variables. A warning model for these systems must include a regional correlation law and a decision algorithm. A regional correlation law can be defined as a functional relationship between rainfall and landslides; it is typically based on thresholds of rainfall indicators (e.g., cumulated rainfall, rainfall duration) related to different exceedance probabilities of landslide occurrence. A decision algorithm can be defined as a set of assumptions and procedures linking rainfall thresholds to warning levels. The design and the employment of an operational and reliable early warning system for rainfall-induced landslides at regional scale depend on the identification of a reliable correlation law as well as on the definition of a suitable decision algorithm. Herein, a five-step process chain addressing both issues and based on rainfall thresholds is proposed; the procedure is tested in a landslide-prone area of the Campania region in southern Italy. To this purpose, a database of 96 shallow landslides triggered by rainfall in the period 2003-2010 and rainfall data gathered from 58 rain gauges are used. First, a set of rainfall thresholds are defined applying a frequentist method to reconstructed rainfall conditions triggering landslides in the test area. In the second step, several thresholds at different exceedance probabilities are evaluated, and different percentile combinations are selected for the activation of three warning levels. Subsequently, within steps three and four, the issuing of warning levels is based on the comparison, over time and for each combination, between the measured rainfall and the pre-defined warning level thresholds. Finally, the optimal percentile combination to be employed in

  5. 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

  6. Primary evaluation of 99mTc-RBC imaging for the diagnosis of lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Zhang Songhai

    1995-01-01

    99m Tc-RBC gastrointestinal (GI) scintigraphy was performed in 10 patients with lower GI bleeding which was confirmed by operation later. The results suggested that 99m Tc-RBC imaging was an effective method for the diagnosis of intestinal hemorrhage, especially the small intestine. However, there was some difficulty in accurately localizing the bleeding site due to the movement of the blood containing labelled RBC from original bleeding site to lower portion during intestinal peristalsis and also displacement of the moving colon. Therefore it is necessary to completely explore the intestine carefully and awareness of the possibility of biliary hemorrhage

  7. Emergency double balloon enteroscopy: a feasible and promising diagnostic as well as possible therapeutic option in recurrent midgut bleeding

    Science.gov (United States)

    Büschel, Philip; Mönkemüller, Klaus; von Falkenhausen, Uwe; Fry, Lucia C; Malfertheiner, Peter; Lippert, Hans; Meyer, Frank

    2011-01-01

    Gastrointestinal (GI) tract bleeding, in particular originating within the long segment of the small intestine, remains a diagnostic and therapeutic challenge. The authors describe the potential utility of emergency double balloon enteroscopy (DBE) for small bowel bleeding. An elderly woman was admitted because of a hypertensive crisis to the medical department of a regional hospital. Her medical history was significant for non-steroidal anti-inflammatory drug (NSAID) abuse. While in hospital she had massive obscure GI bleeding. Upper GI endoscopy and colonoscopy for recurrent bleeding showed only thrombotic residuals in two sigmoid diverticuli, which led to segmental resection of the sigmoid colon. However, postoperatively, bleeding recurred leading to transfer to our university hospital. Immediate angiography only revealed a vascular malformation at the upper jejunum but no ongoing bleeding. Subsequent emergency DBE detected an oozing jejunal ulcer, which was coagulated using a argon beamer. Because of recurrent falls in haemoglobin with the need for repeated transfusion, the patient underwent surgical reintervention including segmental resection of the ulcerated upper jejunum with subsequent end-to-end anastomosis. Histopathology revealed NSAID-induced ulcerous jejunopathy. Postoperatively, there was no further bleeding and the patient was discharged home in a stable condition. In conclusion, this is one of the first reports of successful emergency use of DBE in a case of recurrent and occult bleeding within the small bowel which successfully located the source of bleeding and facilitated successful superficial ulcer coagulation with an argon beamer to prevent further bleeding. PMID:22700075

  8. 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

  9. 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.

  10. 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.

  11. 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...

  12. [Application study on regional infusion chemotherapy by celiac trunk during operation in advanced gastric cancer patients].

    Science.gov (United States)

    You, Xiaolan; Qian, Haixin; Qin, Lei; Wang, Yuanjie; Li, Wenqi; Lian, Yanjun; Zhao, Xiaojun; Xu, Ning; Huang, Chuanjiang; Chen, Zhiyi; Liu, Guiyuan

    2016-09-25

    To explore the feasibility, safety and efficacy of intraoperative regional infusion chemotherapy by celiac trunk in advanced gastric cancer patients. One hundred and twenty-six patients with advanced gastric cancer(stageII(-III() were screened from database of Gastrointestinal Surgery Department of Taizhou People's Hospital between January 2008 and December 2010 who underwent R0 resection and D2 lymphadenectomy, received postoperative chemotherapy(XELOX or FOLFOX), and had complete follow-up data. They were divided into infusion chemotherapy group (65 cases) and control group (61 cases) according to regional infusion chemotherapy or not (fluorine 1 000 mg and cisplatin 60 mg). The side effects of chemotherapy, parameters related to the operation, long-term survival and relapse rate were compared between the two groups. The baseline data between the two groups were comparable(all P>0.05). Postoperative III( and IIII( adverse reaction of chemotherapy was not significantly different between the two groups (P>0.05). The time of postoperative intestinal function recovery [(67.9±14.8) hours vs. (68.9±15.0) hours, t=-0.380, P=0.705), volume of postoperative 1-week drainage [(66.1±17.1) ml vs.(61.9±18.2) ml, t=1.478, P=0.142], recent morbidity of complications[55.4%(36/65) vs. 49.2%(30/61), χ 2 =0.256, P=0.613], and the long-term morbidity of complications [16.9% (11/65) vs. 14.8% (9/61), χ 2 =0.111, P=0.739] were all not significantly different between the two groups. The 3-year survival rate and 3-year relapse-free survival rate in infusion chemotherapy group were significantly higher than those in control group(58.4% vs. 37.7%, χ 2 =5.382, P=0.020; 58.4% vs. 34.4%, χ 2 =6.636, P=0.010). Regional infusion chemotherapy by celiac trunk during operation for advanced gastric cancer patients is safe and feasible, and can reduce the risk of local recurrence and improve survival rate.

  13. 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)

  14. 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

  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. 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.

  17. 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

  18. Compressor bleed cooling fluid feed system

    Science.gov (United States)

    Donahoo, Eric E; Ross, Christopher W

    2014-11-25

    A compressor bleed cooling fluid feed system for a turbine engine for directing cooling fluids from a compressor to a turbine airfoil cooling system to supply cooling fluids to one or more airfoils of a rotor assembly is disclosed. The compressor bleed cooling fluid feed system may enable cooling fluids to be exhausted from a compressor exhaust plenum through a downstream compressor bleed collection chamber and into the turbine airfoil cooling system. As such, the suction created in the compressor exhaust plenum mitigates boundary layer growth along the inner surface while providing flow of cooling fluids to the turbine airfoils.

  19. Detection of small colon bleeding in wireless capsule endoscopy videos.

    Science.gov (United States)

    Usman, Muhammad Arslan; Satrya, G B; Usman, Muhammad Rehan; Shin, Soo Young

    2016-12-01

    In the recent years, wireless capsule endoscopy (WCE) technology has played a very important role in diagnosing diseases within the gastro intestinal (GI) tract of human beings. The WCE device captures images of the GI tract of patient with a certain frame rate. Physicians examine these images in order to find abnormalities in the GI tract. This examination process is very time consuming and hectic for the physician as a WCE device captures around 60,000 images on the average. At present, there are no standards defined for the WCE image classification. Computer aided methods help reducing the burden on the physicians by automatically detecting the abnormalities in the GI tract such as small colon bleeding. In this paper, a pixel based approach to detect bleeding regions in the WCE videos by using a support vector classifier is proposed. Threshold analysis in HSV color space is performed to compute the features for training an optimal support vector machine. The HSV features of the WCE images are fed to the trained support vector classifier for classification. Also, our method includes image enhancement and edge removal in WCE images, which is done prior to classification, for robust results. The method offers high sensitivity, specificity and accuracy in terms of correctly classifying images that contain bleeding regions as compared to another contemporary method. A detailed experimental analysis is also provided for the purpose of method evaluation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty

    Directory of Open Access Journals (Sweden)

    Navid Nooraei

    2013-01-01

    Full Text Available Background: In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. Objective: In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. Methods: In this study, 30 ASA I (American Society of Anesthesiology physical condition classification patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Results: Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ΁ 13.20 ml than head-up position (83.33 ΁ 21.18 ml, although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Conclusions: Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry.

  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. 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

  3. 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

  4. 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

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

    International Nuclear Information System (INIS)

    1988-10-01

    The document contains the proceedings and the 15 papers presented during the Regional Co-operative Agreement (RCA) Workshop on the WASP Computer Program held in Jakarta, Indonesia, 7-11 December 1987. A separate abstract was prepared for each paper. Refs, figs and tabs

  6. 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.

  7. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... peptic ulcers , tears or inflammation in the esophagus, diverticulosis and diverticulitis , ulcerative colitis and Crohn's disease , colonic ... PubMed (National Library of Medicine) Article: Small intestinal diverticulum with bleeding: Case report and literature review. Article: ...

  8. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    included a control group. Three out of 11 found a reduction in transfusion requirements while mortality was reduced in two and bleeding in one. In the available RCTs, which all have substantial shortcomings, we found a significant reduction in bleeding and transfusions requirements. However, data......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...... 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...

  9. CLSM bleed water reduction test results

    International Nuclear Information System (INIS)

    Langton, C.A.; Rajendran, N.

    1997-01-01

    Previous testing by BSRI/SRTC/Raytheon indicated that the CLSM specified for the Tank 20 closure generates about 6 gallons (23 liters) of bleed water per cubic yard of material (0.76 m3).1 This amount to about 10 percent of the total mixing water. HLWE requested that the CLSM mix be optimized to reduce bleed water while maintaining flow. Elimination of bleed water from the CLSM mix specified for High-Level Waste Tank Closure will result in waste minimization, time savings and cost savings. Over thirty mixes were formulated and evaluated at the on-site Raytheon Test Laboratory. Improved low bleed water CLSM mixes were identified. Results are documented in this report

  10. 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

  11. 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.

  12. Engine bleed air reduction in DC-10

    Science.gov (United States)

    Newman, W. H.; Viele, M. R.

    1980-01-01

    An 0.8 percent fuel savings was achieved by a reduction in engine bleed air through the use of cabin air recirculation. The recirculation system was evaluated in revenue service on a DC-10. The cabin remained comfortable with reductions in cabin fresh air (engine bleed air) as much as 50 percent. Flight test verified the predicted fuel saving of 0.8 percent.

  13. 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...

  14. Assessment of a water hydraulic joint for remote handling operations in the divertor region

    Energy Technology Data Exchange (ETDEWEB)

    Dubus, G. [CEA LIST, Interactive Robotics Unit, 18 route du Panorama, BP6, Fontenay-aux-Roses F-92265 (France)], E-mail: gregory.dubus@cea.fr; David, O.; Nozais, F.; Measson, Y.; Friconneau, J.-P. [CEA LIST, Interactive Robotics Unit, 18 route du Panorama, BP6, Fontenay-aux-Roses F-92265 (France); Palmer, J. [EFDA-CSU Garching, Boltzmannstr. 2, Garching D-85748 (Germany)

    2008-12-15

    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. Due to their high power/weight ratio, hydraulic actuators are interesting in space constrained areas. Pure water is the only fluid medium able to ensure the cleanliness requirements of ITER during maintenance operations. 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. Starting from the standard oil hydraulic Maestro arm, a six-degrees-of-freedom hydraulic manipulator manufactured by Cybernetix and used in decommissioning activities, CEA LIST redesigned for water applications the elbow vane actuator of the arm. Servovalves are essential components of the joint's control loop. To improve performance, stability and safety of the force control loop, CEA LIST launched the development of a pressure control servovalve fitting the space constraints of the Maestro. Both performances of the modified vane actuator and of this new servovalve are presented in this paper.

  15. 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

  16. 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

  17. [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.

  18. 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 gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  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. 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.

  1. Prediction of bleeding and thrombosis by standard biochemical coagulation variables in haematological intensive care patients.

    Science.gov (United States)

    Russell, L; Madsen, M B; Dahl, M; Kampmann, P; Perner, A

    2018-02-01

    We assessed the value of standard biochemical coagulation parameters in predicting bleeding, thrombosis and mortality in adult Intensive Care Unit (ICU) patients with haematological malignancies. We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008-2012. Data were obtained from the clinical chemistry laboratory database and patient files. We graded bleeding according to the World Health Organisation (WHO)-system within 24-h, within 5-days and during the whole ICU stay. We analysed the predictive values of laboratory parameters using multiple logistic regression and receiver operator characteristics (ROC) curves. As we previously have established that platelet count at admission was associated with bleeding, we focused on International Normalised Ratio (INR), activated pro-thrombin time (APTT), anti-thrombin, D-dimer and fibrinogen, and markers of infection (C-reactive protein, pro-calcitonin), kidney function (creatinine) and tissue damage (lactate dehydrogenase (LDH)). We included 116 patients; 66 (57%) had at least one bleeding episode and 11 (9%) patients had at least one thrombotic event. The differences in coagulation values when bleeding compared to baseline values were minor. INR was the only variable we found associated with subsequent bleeding within 24 h from admission to ICU (odds ratio 2.91, 95% CI: 1.01-8.43, P = 0.048). ROC analyses did not show predictive value of any of the other variables with regards to bleeding and none of the variables were associated with thrombosis in adjusted analyses. Increased levels of LDH at admission were associated with increased 7-day and 30-day mortality. Increased INR at admission was associated with a higher rate of bleeding in ICU patients with haematological malignancies. No other biochemical coagulation or other parameter had any association with bleeding, thrombosis or mortality except increased LDH, which at ICU admission was associated

  2. 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.

  3. Reasons of bleeding complications and prevention methods in endovascular stenting for intracranial artery stenosis

    International Nuclear Information System (INIS)

    Xu Bin; Shi Huaizhang; Xu Shancai; Ji Zhiyong; Wu Pei; Chu Ming

    2012-01-01

    Objective: To summarize the reasons of bleeding complications and the prevention methods in stenting for intracranial arterial stenosis. Methods: The clinical data of 366 patients underwent stent-assistant angioplasty of intracranial artery stenosis from July 2006 to December 2011 were analyzed retrospectively. Among them, 14 patients with bleeding complications were found. The initial 100 patients were categorized as early stage group and the rest as mature stage group. The reasons of bleeding and the methods for preventing this complication were summarized. Results: The overall incidence of bleeding complication was 3.8% (14/366). In the early stage group and mature stage group,the rates was 10%(10/100) and 1.5% (4/266). Six cases were related to the operational manipulation and 8 cases secondary to hyperperfusion injury. Death was found in 6 patients,severe disability in 3, mild paralysis in 2, and no neurological deficits in 3. Conclusions: The bleeding complications in stent-assisted angioplasty of intracranial artery stenosis have a high disability and mortality. The improvement of operative techniques and the more strict indications decrease the bleeding complications rate effectively. (authors)

  4. The effect of factor XIII on bleeding in coronary surgery.

    Science.gov (United States)

    Gödje, O; Haushofer, M; Lamm, P; Reichart, B

    1998-10-01

    One cause of diffuse bleeding after cardiac operations may be a low plasma concentration of Factor XIII, which is essential for coagulation, but is not covered by standard coagulation monitoring. In a prospective pilot study, Factor XIII levels before and after extracorporeal circulation were investigated, and drain volumes and blood transfusions of a control group of 11 patients were compared with a group of 11 patients who received 2500 units Factor XIII postoperatively. Factor XIII fell significantly from preoperative values of 96.1% and 88.7% (control) to 55.7% and 51.8% (control) postoperatively. By administration of Factor XIII, plasma level rose significantly from 55.7% to 103.1%; in the control group the value remained low. Drain volumes on the first and second postoperative day were significantly lower in the Factor XIII group. In the control group 1.9 units of red blood cells and 1.6 units fresh frozen plasma were administered, in the Factor XIII group 0.9 and 0.6 units were necessary. Factor XIII influences bleeding after coronary surgery and can reduce the need for blood transfusions. In patients with prolonged diffuse bleeding, we therefore recommend substitution of Factor XIII.

  5. 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.

  6. 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).

  7. 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

  8. 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

  9. Surgical treatment of massive upper gastrointestinal bleeding in ...

    African Journals Online (AJOL)

    Acute upper gastrointestinal bleeding is a potentially life-threatening abdominal emergency condition. More immediately life-threatening is massive upper gastrointestinal bleeding resulting in cardiovascular compromise causing dizziness, syncope and shock. The causes of upper gastrointestinal bleeding include bleeding ...

  10. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED.

    Science.gov (United States)

    Hilkens, Nina A; Algra, Ale; Diener, Hans-Christoph; Reitsma, Johannes B; Bath, Philip M; Csiba, Laszlo; Hacke, Werner; Kappelle, L Jaap; Koudstaal, Peter J; Leys, Didier; Mas, Jean-Louis; Sacco, Ralph L; Amarenco, Pierre; Sissani, Leila; Greving, Jacoba P

    2017-08-29

    To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy after TIA or ischemic stroke. Cox regression analyses stratified by trial were performed to study the association between predictors and major bleeding. A risk prediction model was derived and validated in the PERFORM trial. Performance was assessed with the c statistic and calibration plots. Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed 3-year risk of major bleeding was 4.6% (95% confidence interval [CI] 4.4%-4.9%). Predictors were male sex, smoking, type of antiplatelet agents (aspirin-clopidogrel), outcome on modified Rankin Scale ≥3, prior stroke, high blood pressure, lower body mass index, elderly, Asian ethnicity, and diabetes (S 2 TOP-BLEED). The S 2 TOP-BLEED score had a c statistic of 0.63 (95% CI 0.60-0.64) and showed good calibration in the development data. Major bleeding risk ranged from 2% in patients aged 45-54 years without additional risk factors to more than 10% in patients aged 75-84 years with multiple risk factors. In external validation, the model had a c statistic of 0.61 (95% CI 0.59-0.63) and slightly underestimated major bleeding risk. The S 2 TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding. © 2017 American Academy of Neurology.

  11. Regional lung function impairment following post-operative radiotherapy for breast cancer using direct of tangential field techniques

    International Nuclear Information System (INIS)

    Groth, Steffen; Zaric, Aleksandra; Soerensen, P.B.; Larsen, Jytte; Soerensen, P.G.; Rossing, Niels

    1986-01-01

    The effect of tangential and direct irradiation on regional lung function in 22 consecutive patients with breast cancer, treated by post-operative irradiation 3 months prior to examination. The tangential technique (total dose 32-36 Gy, 99 Tcsup(m)-DTPA. Results were inconclusive, due to variable smoking habits. It is concluded that regional lung function was not significantly affected by the tangential technique, contrasting with a pronounced and harmful effect of the direct technique. (U.K.)

  12. Regional energy markets and the cost of natural flow dam operation

    Energy Technology Data Exchange (ETDEWEB)

    Sparrow, F.T.; Preckel, P.V.; Gotham, D.J. [Purdue University, Energy Center at Discovery Park, West Lafayette, IN (United States); Bowen, B.H. [American University in Kosovo, Pristina (RS); Yu, Z. [EmberClear, Inc., Houston, TX (United States)

    2011-11-15

    With the proliferation of electricity markets for the purchase and sale of firm and non-firm power and capacity, the possibility exists for using trade in these commodities to minimize the cost impact of operating dams to restore downstream flows to pre-dam patterns - so called Run of River (ROR) dam operation. We examine the impact of such markets on the incremental costs of ROR operation relative to least cost operation via a stochastic, dynamic optimization model. We identify features of the dam structure and of the economic environment that are critical to achieving ROR operation at modest incremental cost. (orig.)

  13. 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.

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

    Science.gov (United States)

    Sadeghi, Mostafa; Atefyekta, Reza; Azimaraghi, Omid; Marashi, Seyed Mojtaba; Aghajani, Yasaman; Ghadimi, Fatemeh; Spahn, Donat R; Movafegh, Ali

    2014-01-01

    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. A total of 60 patients undergoing coronary artery bypass surgery were randomly divided into two groups. Patients in the fibrinogen group received 1g 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. 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. Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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

    Science.gov (United States)

    Sadeghi, Mostafa; Atefyekta, Reza; Azimaraghi, Omid; Marashi, Seyed Mojtaba; Aghajani, Yasaman; Ghadimi, Fatemeh; Spahn, Donat R; Movafegh, Ali

    2014-01-01

    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. A total of 60 patients undergoing coronary artery bypass surgery were randomly divided into two groups. Patients in the fibrinogen group received 1g of fibrinogen concentrate 30min 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. 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 72h after surgery. Prophylactic fibrinogen reduces post-operative bleeding in patients undergoing coronary artery bypass graft. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. Interventions for treating post-extraction bleeding.

    Science.gov (United States)

    Kumbargere Nagraj, Sumanth; Prashanti, Eachempati; Aggarwal, Himanshi; Lingappa, Ashok; Muthu, Murugan S; Kiran Kumar Krishanappa, Salian; Hassan, Haszelini

    2018-03-04

    Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016. To assess the effects of interventions for treating different types of post-extraction bleeding. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews. We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted

  17. Secondary electric power generation with minimum engine bleed

    Science.gov (United States)

    Tagge, G. E.

    1983-01-01

    Secondary electric power generation with minimum engine bleed is discussed. Present and future jet engine systems are compared. The role of auxiliary power units is evaluated. Details of secondary electric power generation systems with and without auxiliary power units are given. Advanced bleed systems are compared with minimum bleed systems. A cost model of ownership is given. The difference in the cost of ownership between a minimum bleed system and an advanced bleed system is given.

  18. [Update on non-variceal gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2013-10-01

    This article summarizes the main studies in the field of non-variceal gastrointestinal bleeding reported in the last American Congress of Gastroenterology (Digestive Disease Week) in 2013. Some of these studies have provided new knowledge and expertise in areas of uncertainty. In this context and among other findings, it has been reported that the administration of a proton pump inhibitor (PPI) prior to endoscopy or the early performance of endoscopy-within 6 hours of admission in patients with upper gastrointestinal bleeding (UGIB) (or colonoscopy within 24 hours in patients with lower gastrointestinal bleeding)-does not improve the prognosis of the event. It has also been reported that oral administration of a PPI after endoscopic hemostasis may produce a similar outcome to that of intravenously administered PPI in patients with upper gastrointestinal bleeding (UGIB). In the field of endoscopic therapy, the use of radiofrequency ablation for antral vascular ectasia is of interest. Regarding UGIB and nonsteroidal antiinflammatory drugs (NSAIDs), new data confirm the risk of cardiovascular events by stopping treatment with acetylsalicylic acid (ASA) after an episode of UGIB, the increased risk of UGIB when associating gastrotoxic drugs, and the need to identify both the gastrointestinal and cardiovascular risks of each NSAID and coxib when prescribing these agents. Finally, there is evidence that both environmental and genetic factors are involved in individual susceptibility to gastrointestinal bleeding. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. [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.

  20. 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

  1. Radiotherapy in benign uterine bleeding disorders

    International Nuclear Information System (INIS)

    Ryberg, M.; Pettersson, F.; Lundell, M.

    1989-01-01

    Radiotherapy was earlier a method of choice for treatment of benign bleeding disorders (metropathia), especially in woman of high surgical risk. During the period 1912 to 1977 933 women with benign bleeding disorders were treated at Radiumhemmet with intracavitary brachytherapy or external irradiation or a combination of both. The result with regard to cure of the uterine bleedings was good (48%). Hormonal withdrawal symptoms after treatment were noted in 45% of the patients. In the long term follow up an increased risk of cardiovascular death was found in women treated before menopause. Malignant tumours occurred in 107 cases versus 90.2 expected. The estimated ovarian dose of ionizing radiation varied from 3.5 Gy to 6.0 Gy for the three standard techniques. Two women gave birth to a healthy child 4 and 5 years after intracavitary radium treatment. The estimated absorbed dose to the ovaries in these two women were 1 Gy and 4 Gy, respectively

  2. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    BACKGROUND: Somatostatin and its derivatives are sometimes used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. OBJECTIVES: To study whether somatostatin or its analogues improve survival or reduce the need for blood transfusions in patients...... with bleeding oesophageal varices. SEARCH STRATEGY: PubMed and The Cochrane Library were searched (November 2007). Reference lists of publications, contacts with authors. SELECTION CRITERIA: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute...... 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...

  3. 75 FR 81157 - Version One Regional Reliability Standard for Transmission Operations

    Science.gov (United States)

    2010-12-27

    ..., Division of Policy Analysis and Rulemaking, Federal Energy Regulatory Commission, 888 First Street, NE... based on previously conducted contingency studies. The ``WECC Philosophy of SOL and IROL Conditions'' states that WECC's operating philosophy is to only operate in conditions that have been studied.\\35\\ In...

  4. 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.

  5. [Clinical application of hepatic venous pressure gradient to predict early bleeding after esophageal variceal ligation].

    Science.gov (United States)

    Liu, Bingju; Wu, Lichun; Wang, Guangchuan; Feng, Hua; Hu, Jinhua; Cui, Yi; Zhang, Chunqing

    2015-01-01

    To investigate the predictive value of hepatic venous pressure gradient (HVPG) for early bleeding after esophageal variceal ligation (EVL) by analyzing the differences in HVPG in patients with and without post-EVL bleeding. The medical records of patients who had been diagnosed with cirrhosis and esophageal varices and who had pre-EVL HVPG measurement data were surveyed. The study population included 105 patients from October 2010 to March 2014. Data of HVPG value, previous treatment history, endoscopic manifestation, and whether bleeding and serious complications occurred within 2 weeks after the ligation procedure were investigated as independent risk factors. included the chi-square test and Wilcoxon test, logistic regression modeling and receiver operating characteristic (ROC) analysis using the SPSS software version 16. Only HVPG value was identified as an independent risk factor of early bleeding after EVL.According to the ROC analysis, the area under the curve (AUC) of HVPG for early bleeding after EVL was 0.866; when HVPG was more than or equal to 16 mmHg, AUC was 0.838. The sensitivity was 90.9% and the specificity was 76.4%. HVPG is an independent factor of early bleeding after EVL and when HVPG cut-off value of more than or equal to 16 mmHg is used the predictive ability has certain accuracy and high sensitivity and specificity.

  6. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding.

    Science.gov (United States)

    Huang, Shih-Pei; Wang, Hsiu-Po; Lee, Yi-Chia; Lin, Chun-Che; Yang, Chang-Shiu; Wu, Ming-Shiang; Lin, Jaw-Town

    2002-06-01

    Mallory-Weiss syndrome with active bleeding requires effective hemostasis. This is an investigation of the respective efficacy and safety of endoscopic hemoclip placement and endoscopic epinephrine injection in Mallory-Weiss syndrome. Thirty-five patients with Mallory-Weiss syndrome with spurting vessels or oozing in a university hospital were enrolled prospectively and randomly assigned to endoscopic hemoclip placement (18 patients) or endoscopic epinephrine injection (17 patients) performed by 4 endoscopists with similar clinical experiences. Demographic characteristics, endoscopic variables, and outcome parameters as well as rates of hemostasis and recurrent bleeding were analyzed. The mean (SD) number of hemoclips applied was 2.5 (1.2) and the mean volume of injection was 7.9 (4.3) mL. Primary hemostasis was achieved in all 35 patients. In each group there was 1 case of recurrent bleeding. Secondary hemostasis was achieved by repeating the same procedures as at randomization in both cases. There were no significant differences in age, gender, prior ingestion of alcohol, presenting symptoms, hemoglobin level, shock, comorbid diseases, bleeding stigmata, tear location, blood transfusion, or hospitalization between the groups. There were no procedure-related complications in either group; surgery was not required in any patient. For both groups, there were no second episodes of recurrent bleeding, procedure-related complication, or need of operation. Endoscopic hemoclip placement and endoscopic epinephrine injection are equally effective and safe for the management of active bleeding in Mallory-Weiss syndrome, even in patients with shock or comorbid diseases.

  7. 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.

  8. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    . 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...

  9. 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...... 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...

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

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

    Institution. Asociación Pro-Fundación para las Ciencias Sociales. Institution Country. Uruguay. Outputs. Reports. Impactos de la integración regional del MERCOSUR sobre el sector cooperativo. Download PDF. Reports. Impacto de la integración regional y la globalización sobre las cooperativas de ahorro y crédito en el ...

  11. 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…

  12. New Mexico Southwest Regional Geothermal Development Operations Research Project. Appendix 9 of regional operations research program for development of geothermal energy in the Southwest United States. Final technical report, June 1977--August 1978

    Energy Technology Data Exchange (ETDEWEB)

    Ortiz, Thomas A.; Fedor, Dennis

    1979-01-01

    This final report describes the findings and conclusions of the New Mexico Team during the first project year of the Southwest Regional Geothermal Development Operations Research Project. The purpose of this project is to help realize a goal of the USDOE , Division of Geothermal Energy (DOE/DGE), to accelerate the actual commercial utilization of geothermal energy. This was done by: (1) identifying the potential for development of geothermal energy in the five-state regions of Arizona, Colorado, New Mexico, Nevada and Utah; and (2) identifying the actions needed to accomplish that development.

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

    DEFF Research Database (Denmark)

    Hansen, Povl Adler; Serin, Göran Folke

    2007-01-01

    Abstract: The purpose of the article is to analyze strategies for cross-border integration in the Øresund Region. The point of departure is that the development of strategies for cross-border integration is dependent on the development on both the general level in the EU and deregulation of economy...... 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...

  14. Safety analysis on CANDU-6 nuclear power plant: changes in thermal hydraulic operational conditions concerning regional over power trip setpoints

    International Nuclear Information System (INIS)

    Lee, Jae Yong; Kim, Yong Bae; Kim, Jong Hyun; Son, Hyung Min

    2009-01-01

    A CANDU-6 nuclear power plant has the variable of regional overpower trip (ROPT) to prevent regional overpower within the reactor core. ROPT setpoints are calculated on the basis of channel power where dryout starts to take place in each nuclear fuel channel (i.e. critical channel power; CCP), which is determined based on various core-physical configurations and thermal hydraulic boundary conditions that may be generated throughout the entire life of a nuclear reactor. Variables included in the thermal hydraulic boundary condition (i.e. temperature of the inlet header, pressure on the outlet header, and differential pressure between inlet and outlet headers) change gradually as the number of operational years increases. As for these three operational variables, their operational constraints in consideration of reactor safety are suggested in the operational technical specifications for nuclear power plants. This paper first uses NUCIRC, a code for analyzing thermal hydraulic power at the core of heavy water nuclear reactor, to examine the impacts of changes in these thermal hydraulic boundary condition variables on CCP. To analyze the impacts of changes in the variables for thermal hydraulic boundary conditions on the safety of nuclear reactors, safety analysis is then performed on three representative types of design basis accidents in heavy water reactors-small break loss of coolant accident (SBLOCA), loss of regulations (LOR), and loss of forced circulation-using CATHENA, a thermal hydraulic safety analysis code. By performing two types of thermal hydraulic analysis, the following additional operational margins are ensured against the current operating limits: +2.1 .deg. C for the temperature of the reactor inlet header; -60kPa for differential pressure between inlet and outlet headers; and -40kPa for pressure on the reactor outlet header. By revising the operating limits on this basis, it will be possible to prevent possible reactor power cutbacks caused by

  15. 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.

  16. 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.

  17. [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.

  18. The Multifactorial Nature of Thromboembolic and Bleeding ...

    African Journals Online (AJOL)

    Background: Thromboembolic and bleeding complications are the main causes of morbidity and mortality in patients with mechanical heart valves1. The risk factors for these complications in Tanzania have not been established. Methods: A retrospective cohort study was conducted among patients with mechanical heart ...

  19. 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

  20. 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

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

    African Journals Online (AJOL)

    RESEARCH. 884 November 2012, Vol. 102, No. 11 SAMJ. Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous ... Progress has been made in developing newer endoscopic techniques ... a sclerosant, usually 0.5 - 0.75 ml per injection, at multiple (up to.

  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. An unusual cause of lower gastrointestinal bleeding: ' '

    African Journals Online (AJOL)

    Summary. This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. ' He was also found to be cirrhosis and to have an ectopic left kidney in the ... attribuable a la formation angiomateuse. On a decouvert qu' ... challenging experience to the treating team.

  4. 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.

  5. 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)

  6. 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

  7. 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...

  8. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... nurse: 1. What problems should I call you about? 2. How long should I wait for the bleeding to stop before I call you or go to the emergency room? 3. Is it okay to drink beer, wine, or other drinks with alcohol? Yes No, don’ ...

  9. 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.

  10. 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 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.

  11. 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

  12. 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.

  13. 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

  14. 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

  15. Emergency Operations for Bleeding Duodenal Ulcer:A simple option ...

    African Journals Online (AJOL)

    Emergency surgery was performed. Over sewing (OS) of the ulcer was done and the stenosed first part of duodenum was closed transversely (pyloroplasty). No acid-reducing procedure (ARP) was done. The patient received anti- helicobacter therapy via the intravenous route preoperatively and continued postoperatively.

  16. 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.

  17. 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)

  18. 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

  19. THE STATE FINANCIAL CONTROL IN CONTEXT OF THE STRENGTHENING OF OPERABILITY OF BUDGETARY POLICY OF STIMULATION OF REGIONAL DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    M. Dyachenko

    2014-01-01

    Full Text Available In this article the essence of state financial control as an important factor of strengthening of operability of budgetary policy of stimulation of the socio-economic development of regions is disclosed. The main institutions of control and their authority are defined; the instruments of control and levers of influence are indicated. It is marked the importance of the auditing of efficiency. The estimating index of the level of execution of the budgetary stimulative programs is offered.

  20. 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

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

    Science.gov (United States)

    2017-03-31

    immigration, criminal activity, and corruption. At the same time many countries in the region are making conscious efforts to better facilitate trade...focuses on keeping product prices low by constant and effective supply chain management, minimizing the number of necessary nodes. The Columbian cocaine

  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. Asian regional co-operative project on food irradiation: Research and development

    International Nuclear Information System (INIS)

    1990-03-01

    The importance of food irradiation to reduce post-harvest food losses, improve the hygienic quality of foods and facilitate trade promotion has been recognized by the region of Asia and the Pacific. Several of the regional countries have initiated national programmes on food irradiation in the 50s and 60s. The first coordination programme sponsored by the Agency under RCA in 1974-1979 was the Coordinated Research Programme (CRP) on Radiation Preservation of Fish and Fishery Products. The Asian Regional Cooperative Project on Food Irradiation (RPFI) was implemented by the Agency in 1980 under the sponsorship of the Government of Japan. Bangladesh, People's Republic of China, India, Indonesia, Republic of Korea, Japan, Pakistan, the Philippines, Sri Lanka, Thailand and Vietnam participated in this Programme. Under the scope of this regional project R and D work was carried out on: (i) insect disinfestation and improving hygienic quality of dried and cured fishery products, (ii) insect disinfestation and shelf-life extension of mangoes; (iii) control of sprouting of onions, and (iv) improving hygienic quality of spices. In addition some work related to economic feasibility of food irradiation was also carried out. This publication contains the results of R and D conducted under the RPFI. Under the RPFI, it was demonstrated that the food irradiation technology could play an important role in reducing food losses and facilitating wider distribution of certain food products. The RPFI provided a strong impetus for Asian countries to coordinate their research programmes effectively towards the practical application of the technology to combat food losses and to make more food available to the population in the region. Refs, figs and tabs

  4. Systematic review: tranexamic acid for upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Klingenberg, S.L.; Langholz, S.E.; Gluud, Lise Lotte

    2008-01-01

    BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and...

  5. 14 CFR 23.1109 - Turbocharger bleed air system.

    Science.gov (United States)

    2010-01-01

    ... Induction System § 23.1109 Turbocharger bleed air system. The following applies to turbocharged bleed air... vapors following any probable failure or malfunction of the engine exhaust, hydraulic, fuel, or oil...

  6. 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.

  7. 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 d...

  8. Operational improvement of AlGaN/GaN HEMT on SiC substrate with the amended depletion region

    Science.gov (United States)

    Ghaffari, Majid; Orouji, Ali A.

    2015-11-01

    In this paper, a high performance AlGaN/GaN High Electron Mobility Transistor (HEMT) on SiC substrates is presented to improve the electrical operation with the amended depletion region using a multiple recessed gate (MRG-HEMT). The basic idea is to change the gate depletion region and a better distribution of the electric field in the channel and improve the device breakdown voltage. The proposed gate consists of lower and upper gate to control the channel thickness. Also, the charge of the depletion region will change due to the optimized gate. In addition, a metal between the gate and drain including the horizontal and vertical parts is used to better control the thickness of the channel. The breakdown voltage, maximum output power density, cut-off frequency, maximum oscillation frequency, minimum noise figure, maximum available gain (MAG), and maximum stable gain (MSG) are some parameters for designers which are considered and are improved in this paper.

  9. Surfacing safety hazards using standardized operating room briefings and debriefings at a large regional medical center.

    Science.gov (United States)

    Bandari, Jathin; Schumacher, Kathy; Simon, Michelle; Cameron, Danielle; Goeschel, Christine A; Holzmueller, Christine G; Makary, Martin A; Welsh, Robert J; Berenholtz, Sean M

    2012-04-01

    Briefings and debriefings, previously shown to be a practical and feasible strategy to improve interdisciplinary communication and teamwork in the operating room (OR), was then assessed as a strategy to prospectively surface clinical and operational defects in surgical care--and thereby prevent patient harm. A one-page, double-sided briefing and debriefing tool was used by surgical teams during cases at the William Beaumont Hospital Royal Oak (Royal Oak, Michigan) campus to surface clinical and operational defects during the study period (October 2006-May 2010). Defects were coded into six categories (with each category stratified by briefing or debriefing period) during the first six months, and refinement of coding resulted in expansion to 16 defect categories and no further stratification. A provider survey was used in January 2008 to interview a sample of 40 caregivers regarding the perceived effectiveness of the tool in surfacing defects. The teams identified a total of 6,202 defects--an average of 141 defects per month--during the entire study period. Of 2,760 defects identified during the six-defect coding period, 1,265 (46%) surfaced during briefings, and the remaining 1,495 (54%) during debriefings. Equipment (48%) and communication (31%) issues were most prominent. Of 3,442 defects identified during the 16-defect coding period, the most common were Central Processing Department (CPD) instrumentation (22%) and Communication/Safety (15%). Overall, 70 (87%) of the 80 responses were in agreement that briefings were effective for surfacing defects, as were 59 (76%) of the 78 responses for debriefings. Briefings and debriefings were a practical and effective strategy to surface potential surgical defects in the operating rooms of a large medical center.

  10. Risk of thromboembolism and bleeding after general surgery in patients with atrial fibrillation

    NARCIS (Netherlands)

    Vink, R; Rienstra, Michel; van Dongen, CJJ; Levi, M; Buller, HR; Crijns, HJ; van Gelder, IC

    2005-01-01

    We provide insight into the risk of perioperative thromboembolism and bleeding in patients who have atrial fibrillation, use anticoagulants, and undergo a surgical procedure. Ninety-four patients underwent 121 noncardiac operations during a mean follow-up of 29 months. There was a 3.6-fold increased

  11. 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.

  12. Timing of heparin prophylaxis and bleeding complications in hysterectomy a nationwide prospective cohort study of 9,949 Danish women

    DEFF Research Database (Denmark)

    Hansen, Charlotte T; Kehlet, Henrik; Møller, Charlotte

    2008-01-01

    OBJECTIVE: To examine bleeding complications and thromboembolic events in relation to timing of heparin prophylaxis after hysterectomy. DESIGN: Nationwide prospective cohort study with 30 days post-operative follow-up within the Danish Hysterectomy Database (DHD). SETTING: All gynecological......'s experience, route and type of hysterectomy and additional surgery, and stratification on assistant's experience, peri-operative pain prophylaxis with NSAID and daily use of Acetyl Salicylic Acid (ASA)/NSAID. RESULTS: 9,051 women (92%) received thromboprophylaxis with heparin, initiated pre-operatively in 48......-operative administration of heparin prophylaxis may reduce the risk of bleeding complications after hysterectomy without apparent risk of increased thromboembolic events Udgivelsesdato: 2008...

  13. 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.

  14. A YAP(Ce) imager operated in high energy X-ray region

    CERN Document Server

    Suzuki, M; Mizumaki, M; Ohashi, Y; Yagi, N; Kamitsubo, H; Kuroda, K; Gorin, A; Manuilov, I V; Riazantsuev, A; Nomachi, M; Yosoi, M; Ishikawa, T; Morimoto, K; Tokanai, F

    2001-01-01

    A prototype of YAP(Ce) imager has been characterized with a high energy SR beam at the SPring-8 Facility, which has a [8x8] YAP(Ce) crystal matrix with optical separators. It has attained a 2D spatial resolution of 1 mmx1 mm with a detection efficiency higher than 50% in the energy region from 72 keV up to 84 keV.

  15. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding.

    Science.gov (United States)

    Ernst, A A; Haynes, M L; Nick, T G; Weiss, S J

    1999-01-01

    This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. A total of 63 (51%) presented with blood in stool and 53 (43%) with bloody emesis; 8 (6%) had blood in both emesis and stool. A total of 31 (25%) patients had a lower GI bleed, 88 (70%) had an upper, and 5 (4%) had both upper and lower bleeding sources. The mean BUN level was 24 mg/dL, the mean Cr level 1.03 mg/dL, and the mean BUN/Cr ratio was 24. The mean hemoglobin (Hb) level was 11.3 g/dL, the mean Hct was 32 g/dL, and 51% required transfusion. Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).

  16. 14 CFR 23.1111 - Turbine engine bleed air system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Turbine engine bleed air system. 23.1111... Induction System § 23.1111 Turbine engine bleed air system. For turbine engine bleed air systems, the following apply: (a) No hazard may result if duct rupture or failure occurs anywhere between the engine port...

  17. Colonoscopic examination of rectal bleeding in children: A report of ...

    African Journals Online (AJOL)

    Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children. Key words: Children, colonoscopy, juvenile polyps, rectal bleeding ...

  18. Leech as a cause of abnormal vaginal bleeding: Presentation of ...

    African Journals Online (AJOL)

    Leech bites are a recognized cause of bleeding from any human orifice upon exposure to water which is infested with leeches. A high level of suspicion is necessary to make the diagnosis and institute cost-effective definitive treatment for leech bite induced bleeding including vaginal bleeding as has been revealed by the ...

  19. 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

  20. Small intestinal diverticulum with bleeding: Case report and literature review.

    Science.gov (United States)

    Zhao, Lifang; Lu, Wei; Sun, Yinping; Liang, Junrong; Feng, Shanshan; Shi, Yongquan; Wu, Qiong; Wang, Jianhong; Wu, Kaichun

    2018-03-01

    Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability. This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding. This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods. Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.

  1. 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...... low (3% pass rate for basic delivery and management of postpartum hemorrhage). CONCLUSIONS: The HMS BAB simulation-based training has potential to contribute to education of health care providers. We recommend a full day of training and validation of the facilitators to improve the training....

  2. 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.

  3. Requirements assessment and operational demands for a resource mapping rover mission to the lunar polar regions

    Energy Technology Data Exchange (ETDEWEB)

    KLARER,PAUL R.; BINDER,ALAN B.; LENARD,ROGER X.

    2000-01-26

    A preliminary set of requirements for a robotic rover mission to the lunar polar region are described and assessed. Tasks to be performed by the rover include core drill sample acquisition, mineral and volatile soil content assay, and significant wide area traversals. Assessment of the postulated requirements is performed using first order estimates of energy, power, and communications throughput issues. Two potential rover system configurations are considered, a smaller rover envisioned as part of a group of multiple rovers, and a larger single rover envisioned along more traditional planetary surface rover concept lines.

  4. Cost-effectiveness of office hysteroscopy for abnormal uterine bleeding.

    Science.gov (United States)

    Moawad, Nash S; Santamaria, Estefania; Johnson, Megan; Shuster, Jonathan

    2014-01-01

    Office diagnostic hysteroscopy allows physicians to directly view the endometrial cavity, tubal ostia, and endocervical canal without taking the patient to the operating room (OR). We sought to determine whether office hysteroscopy performed to evaluate abnormal uterine bleeding decreases the need for hysteroscopy performed in the OR and the associated financial and risk implications. One hundred thirty patients who underwent office diagnostic hysteroscopy between January 2009 and March 2012 at 2 outpatient clinics in an academic university setting were identified. Records were reviewed from paper charts and electronic medical records. Hospital charts for patients who required hysteroscopy in the OR were reviewed as well. Charge estimates were obtained from our billing department. These results were analyzed for review of the data. Seventy-five of the 130 women who underwent diagnostic office hysteroscopy for abnormal bleeding did not need to undergo hysteroscopy in the OR. This represents estimated savings of $1498 per patient (95% confidence interval, $1051-$1923) in procedure charges. Among the 55 women who underwent OR hysteroscopy, there was 71% agreement between findings on hysteroscopy in the office and in the OR. Office hysteroscopy is a useful diagnostic tool that can help decrease the rate of diagnostic hysteroscopy in the OR under anesthesia when used in a select patient population.

  5. Mini-loop ligation of a bleeding duodenal Dieulafoy's lesion.

    Science.gov (United States)

    Gomerčić Palčić, Marija; Ljubičić, Neven

    2013-06-14

    Two percent of gastrointestinal hemorrhages are caused by Dieulafoy's lesions, which are located in duodenum in only 15% of cases. There are no recommendations regarding the prime endoscopic treatment technique for this condition. A 61-year-old woman presented with melena without signs of hemodynamic instability. During an urgent upper endoscopy, blood oozing from the normal mucosa of the duodenum was seen and this was classified as a Dieulafoy's lesion. A mini-loop was opened at the rim of a transparent ligation chamber, at the end of the endoscope, and after aspiration of the lesion, closed and detached. Complete hemostasis was achieved without early or postponed complications. In every day clinical practice, mini-loop ligation is rarely used because of possible complications, such as site ulceration, organ perforation, re-bleeding and possible inexperience of the operator. To the best of our knowledge this is the first case of successful treatment of bleeding duodenal Dieulafoy's lesion by mini-loop ligation.

  6. 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.

  7. 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

  8. 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

  9. Prediction of bleeding and thrombosis by standard biochemical coagulation variables in haematological intensive care patients

    DEFF Research Database (Denmark)

    Russell, L.; Madsen, M. B.; Dahl, M.

    2018-01-01

    Purpose: We assessed the value of standard biochemical coagulation parameters in predicting bleeding, thrombosis and mortality in adult Intensive Care Unit (ICU) patients with haematological malignancies. Methods: We screened all patients with acute leukaemia and myelodysplastic syndrome admitted...... to a university hospital ICU during 2008-2012. Data were obtained from the clinical chemistry laboratory database and patient files. We graded bleeding according to the World Health Organisation (WHO)-system within 24-h, within 5-days and during the whole ICU stay. We analysed the predictive values of laboratory...... parameters using multiple logistic regression and receiver operator characteristics (ROC) curves. As we previously have established that platelet count at admission was associated with bleeding, we focused on International Normalised Ratio (INR), activated pro-thrombin time (APTT), anti-thrombin, D...

  10. 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.

  11. 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

  12. 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

  13. Enhancing Tools and Geospatial Data to Support Operational Forest Management and Regional Forest Planning in the Face of Climate Change

    Science.gov (United States)

    Falkowski, M. J.; Fekety, P.; Hudak, A. T.; Kayastha, N.; Nagel, L. M.

    2014-12-01

    A detailed understanding of how forest composition, structure, and function will be impacted by projected climate change and related adaptive forest management activities are particularly lacking at local scales, where on-the-ground management activities are implemented. Climate sensitive forest dynamics models may prove to be effective tools for developing a comprehensive understanding. However, to be applicable to both regional forest planning and operational forest management, modeling approaches must be capable of simulating forest dynamics across large spatial extents (required for regional planning) while maintaining a high-level of spatial detail (required for operational management). LiDAR remote sensing has shown great utility for operational forest inventory and management, including forest dynamics modeling, albeit across relatively small spatial extents. We present a remote sensing driven approach to spatially initialize a climate-sensitive forest dynamics model (LANDIS-II) in the Pacific Northwest of the US via an integration of airborne LiDAR data with satellite remote sensing data. The system provides detailed forest inventory information - at the landscape level - that is subsequently employed to demonstrate how such models can be used to 1) investigate the potential impacts of climate change on future forest composition and structure, and 2) assess how various forest management practices may either enhance or degrade forest resilience to changing climate and disturbance regimes.

  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

    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. 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...

  16. 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.

  17. THE FAULT-BLOCK STRUCTURE OF THE BAIKAL-YENISEI FAULT IN THE REGION OF OPERATING NUCLEAR ENERGY FACILITIES

    Directory of Open Access Journals (Sweden)

    R. M. Lobatskaya

    2014-01-01

    Full Text Available The article reviews specific features of its fault-block structure of the Baikal-Yenisei fault in view of safe operations of nuclear energy facilities in the Krasnoyarsk region, Russia. The fault is located at the junction of the Siberian platform and the West Siberian plate. Velocities of neotectonic movements in the fault zone and adjacent territories are estimated from data on the current positions of fluvial terraces of the Yenisei river valley, peneplanation planes varying in ages and erosional incision depths. It is revealed that maximum gradients of recent movement velocities vary not higher than 10–8 to 10–9. Average velocities of relative displacements amount to 0.1–0.2 mm per year for intra-fault blocks bounded by regional faults and do not exceed 0.02–0.03 mm per year for intra-fault blocks bordered by local faults. There are grounds to conclude that recent geodynamic activity in the zone of the Baikal-Yenisei fault zone is weak and thus does not affect the safety of nuclear energy facilities operating in the region, including FGUP GKhK (Mining and Chemical Combine.

  18. 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

  19. Jejunal Diverticula Causing Unusual Massive Lower Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Chiong-Hee Wong

    2008-09-01

    Full Text Available Jejunal diverticula are rare and difficult to diagnose. They are often asymptomatic, but they may infrequently cause serious acute complications, such as diverticulitis with or without perforation, volvulus, intussusception, or hemorrhage. Hemorrhage of jejunal diverticula usually presents as lower gastrointestinal bleeding. Diverticula with bleeding may be associated with some anticoagulants, antiplatelets or nonsteroidal antiinflammatory agents in the elderly. In our case, upper gastroscopy and colonoscopy could not easily disclose the bleeding. Selective mesenteric angiography is the gold standard for diagnosis of active and fatal bleeding. The management of a bleeding jejunal diverticulum is surgical resection of the involved segment of jejunum.

  20. [ENDOSCOPIC INJECTION TREATMENT OF BLEEDING PEPTIC ULCER

    Science.gov (United States)

    Díaz, Freddy; Contardo, Carlos; Román, Rossana; Eduardo, Vesco; Dávalos, Milagros; Velásquez, Hermes; Soriano, César; Espejo, Hernán

    1997-01-01

    BACKGROUND: Objectives were two. (1) to determine theefficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. METHODS: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996.RESULTS: Initial success was achieved in 119 patients who underwent EIT (99,1%). Bleeding persisted in one patient (0,9%), and in another one, EIT was not sucessful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77,5%) and there was recurrence in 28 cases (23,5%). Twenty-six patients underwent surgical therapy (21,5%). The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p = 0,002), hematemesis (p = 0,2), age over 60 (p = 0,009), number of blood units transfused (p = 0,00000) and ulcer diameter larger than 2 cm (p = 0,018). The global mortality in our patients was of 10%, and surgical mortality was of 34,6%. Factors significantly related to mortality were hemorrhage recurrence (p = 0,000003), presence of concomitant disease (p = 0,05), and presence of gastric ulcer (p = 0,021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p = 0,05).CONCLUSION: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77,5%. The presence of shock, hematemesis, age over 60, transfusion requirements of more than 3 blood units, and ulcer diameter of more than 2 cm are factors that increase the probability of hemorrhage

  1. Nonlinear effects in Paul traps operated in the second stability region: analytical analysis and numerical verification.

    Science.gov (United States)

    Xiong, Caiqiao; Zhou, Xiaoyu; Zhang, Ning; Zhan, Lingpeng; Chen, Suming; Nie, Zongxiu

    2014-11-01

    Paul trap working in the second stability region has long been recognized as a possible approach for achieving high-resolution mass spectrometry (MS), which however is still far away from the experimental implementations because of the narrow working area and inefficient ion trapping. Full understanding of the ion motional behavior is helpful for solving the problem. In this article, the ion motion in a superimposed octopole field, which was characterized by the nonlinear Mathieu equation, was solved analytically using Poincare-Lighthill-Kuo (PLK) method. This method equivalently described the nonlinear disturbance by an effective quadrupole field with perturbed Mathieu parameters, a(u) and q(u), which would bring huge convenience in the studies of nonlinear ion dynamics and was, therefore, used for rapid evaluation of the nonlinear effects of ion motion. Fourth-order Runge-Kutta method (4th R-K) indicated the error of PLK for characterizing the frequency shift of ion motion was within 15%.

  2. Performances and failure of field-aged PV modules operating in Saharan region of Algeria

    Science.gov (United States)

    Sadok, M.; Benyoucef, B.; Othmani, M.; Mehdaoui, A.

    2016-07-01

    This article deals with behaviour of PV modules, of different technologies and manufacturers, exposed for long periods in Saharan region of Algeria. These modules are exposed in Adrar in the south-western part of Algeria. The study uses experimental I-V curves of PV modules for determining their performances. The datasheet information of modules will be useful in determination of degradation rates of the modules. Three types of modules have been tested: Photowatt (PWX 500), UDTS-50 and Isofoton (I-75 and I-100 serials). Results showed that Isofoton I-100 modules present the highest degradation rate while the lowest degradation rate was reached with I-75 serial. However, these rates tallies with other studies. The visual inspection of the modules has revealed various kinds of failures and defects responsible of performances drop (EVA browning, delamination, burn marks,…).

  3. 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.

  4. 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

  5. Mid-infrared pulsed fiber lasers operating at 3μm region

    Science.gov (United States)

    Liu, Yong; Li, Jianfeng; Yu, Luohong; Zhang, Zhiyao; Li, Heping; Zhou, Xiaojun

    2014-11-01

    Mid-infrared pulsed fiber laser with centered wavelength from 2 to 5 μm have attracted substantial attention owing to their potential applications in defence, laser microsurgery, material processing, nonlinear frequency conversion, etc. We demonstrated our recent achievements at 3 μm pulsed fiber lasers by utilizing Q-switching method. Firstly, a cascaded dual wavelength actively Q-switched Ho3+-doped ZBLAN fiber was reported by inserting an external electrically driven acoustic-optical modulator (AOM) into the cavity. The 3.0 μm and 2.07 μm pulse trains were achieved with a μs level time delay corresponding to the pulse energy of 29 μJ and 7 μJ, pulse duration of 380 ns and 260 ns, respectively. The narrower pulse width in this case compared to that in passively Q-switched fiber lasers can be attributed to the much higher modulation depth of AOM. Using a reversely designed semiconductor saturable mirror (SESAM) as the saturable absorber (SA), we presented a passively Q-switched Ho3+-doped ZBLAN fiber laser operating at ~2971 nm, the obtained maximum pulse energy of 6.65 μJ only limited by the maximum pump power was also the highest level from passively Q-switched fiber lasers at this wavelength range, and corresponding pulse repetition rate and duration were 47.6 kHz and 1.68 μs, respectively. Then using a Fe2+: ZnSe crystal with an initial transmission of 69 % as the SA, a passively Q-switched Ho3+-doped ZBLAN fiber laser operating at 2970.3 nm was also achieved. The obtained pulse duration and repetition rate were 1.92 μs and 62.74 kHz, respectively with an output power of 266 mW and a pulse energy of 4.24 μJ. The further performance improvements were possible because they were just limited by the maximum pump power. To sum up, the above achievements would be beneficial for further development of mid-infrared pulsed fiber lasers.

  6. 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.

  7. A New Operative One-Wing Technique to Correct Fronto-Orbital Region in Unilateral Nonsyndromic Plagiocephaly.

    Science.gov (United States)

    Messi, Marco; Luzi, Michele; Consorti, Giuseppe

    2018-01-01

    Anterior plagiocephaly is a premature closing of unilateral coronal suture. This premature suture fusion causes a series of cranial asymmetry and alteration of the fronto-orbital region.The authors described a new surgical technique to correct the facial asymmetry that reduces the operative time and the possible complications.In a period between 2013and 2016, 12 children affected by nonsyndromic anterior plagiocephaly were treated with this new procedure.Clinical, cranial development, and absence of postoperative complication demonstrated that one-wing surgical bone correction is a useful and innovative technique.

  8. Operation and research at the Ithaca MAP3S regional precipitation chemistry site

    Energy Technology Data Exchange (ETDEWEB)

    Butler, T.J.; Likens, G.E.

    1991-07-01

    Annual precipitation chemistry data from network start-up through 1988 is presented for the nine MAP3S sites. Time trends show significant negative linear regressions (P < 0.10) for SO{sub 4}{sup 2-} at 2 sites, H{sup +} at 4 sites, Ca{sup ++} at 1 site, and Na{sup +} at 1 site. Significant positive regressions over time include: NH{sub 4}{sup +} at 2 sites, Ca{sup ++} at 1 site, K{sup +} at 4 sites, and Cl{sup {minus}} at 2 sites. The Ithaca site shows the highest number of significant trends, with positive trends for Cl{sup {minus}}, NH{sub 4}{sup +}, Ca{sup ++}, and K{sup +}, and a negative trend for H{sup +}. Linear regressions of annual SO{sub 4}{sup 2-} concentrations on SO2 emissions show a significant positive relationship for Whiteface, Illinois, and Ohio at p < 0.10, 0.02, and 0.05 respectively. Overall for all MAP3S sites, plus Hubbard Brook a 25% decline in SO2 emissions over the region has been accompanied by a 16.5% decline in annual precipitation concentrations of SO{sub 4}{sup 2-}. For the region as a whole, a 20% decline in combined emissions has been accompanied to a 20% decline in H{sup +} concentrations. Thus a linear relationship exists between combined emissions and precipitation H{sup +} concentrations. No strong relationship exists for NOx emissions and precipitation NO{sub 3}{sup {minus}} concentration at the annual, seasonal or monthly level. Removing the NOx transportation sector, removing high and low precipitation values, or high pH values also does little to improve the NOx -- NO{sub 3}{sup {minus}} concentration relationships. Dry deposition components such a PAN, NO2, gaseous HNO{sub 3}, or aerosol NO{sub 3}{sup {minus}} should be included in the future with precipitation NO{sub 3}{sup {minus}} to relate emissions of NOx to nitrogen deposition. 11 refs., 27 figs.,1 tab.

  9. 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.

  10. 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.

  11. Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

    Directory of Open Access Journals (Sweden)

    Hee Joon Kim

    2016-01-01

    Full Text Available Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

  12. Nanofabrication of free-standing spectroscopic photon sieves operating in soft x-ray region

    Science.gov (United States)

    Zhu, Xiaoli; Wei, Lai; Li, Hailiang; Cao, Leifeng; Xie, Changqing

    2017-08-01

    A novel design of X-ray spectroscopic photon sieves (SPS) was realized to eliminate the higher diffraction orders. SPS gratings consist of randomly distributed circular holes, forming an approximately sinusoidal transmission function. Due to the intensive absorption of soft X-rays in any known material, these gold nanoholes are free-standing without supporting membrane. For applications in soft X-ray region, a hybrid lithographic method was used to manufacture spectroscopic photon sieves (SPS) of 1000 lines/mm in high throughput. In the fabrication process, an electron beam was focused to write patterns on the membrane substrate to achieve a master mask. Using this mask XRL and gold electroplating were performed to efficiently replicate SPS structures. After that, UVL was used to define the supporting coarse frame. In the replication process of XRL, the deviation of circle patterns caused by overheating problem in exposure has been resolved by inserting appropriate filters in X-ray beam path. The spectrum of X-ray source for exposure can be restricted in the 1.0- 2.0 keV energy band. Therefore, less heat are produced in exposure due to less absorption of higher energy X-rays in resist. After the SPS has been finished, the diffraction pattern was achieved at the soft X-ray beam line on Beijing Synchrotron Radiation Facility. The calibration results show that higher-order diffraction orders were efficiently suppressed along the axis of symmetry.

  13. COAL MINING OPERATIONS AND ITS IMPACT ON SECTORAL AND REGIONAL AREA: EVIDENCE OF EAST KALIMANTAN, INDONESIA

    Directory of Open Access Journals (Sweden)

    Rian Hilmawan

    2016-12-01

    Full Text Available Mining sector plays important roles for Indonesian economic performance, especially in East Kalimantan. This study investigates: (a whether economic linkages of the mining sector related with other economic sectors in East Kalimantan, (b who gets benefit from such mining activities; (c how is the impact of mining sector for rural and urban households; and (d what happens if coal mining, oil and gas productions are completely depleted. The quantitative analysis framework using Input-Output and Social Accounting Matrix Tables in period 2009-2010 has been implemented as main data set. The result shows that mining sector was underdeveloped sector in East Kalimantan, including Kutai Kartanegara district. Activities from mining sector tended to give benefit for the owners of capital, which is larger than that benefit for workers employed. Structural Path Analysis (SPA shows that urban households gain the greatest advantages from the activities of this sector. The result also shows that the total output decreased by 65.12% when the mining, oil and gas dissapeared. A drastic reducing income after mining and oil and gas era will have an impact on the decline in the purchasing power in the region. However, the interesting finding of this research shows that the loss of mining and oil or gas sectors actually increases the strength of employment multiplier by 19%.

  14. Risk factors for severity and recurrence of colonic diverticular bleeding

    Directory of Open Access Journals (Sweden)

    Joaquim Natércia

    Full Text Available Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%. Thirty-six patients (48.6% met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8, older age (≥ 75 years; OR 4.7, bilateral diverticular location (OR 14.2 and chronic kidney disease (OR 5.6. The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.

  15. National variation in transfusion strategies in patients with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Svenningsen, Peter; Fabricius, Rasmus

    2016-01-01

    INTRODUCTION: An optimal transfusion strategy for patients with upper gastrointestinal bleeding (UGIB) has yet to be established. The national guidelines contain recommendations for patients with life-threating bleeding in general, but no specific recommendations for patients with UGIB. We...... hypothesised that there are variations in transfusion strategies for patients with UGIB across the Danish regions. METHODS: We performed a retrospective, register-based, analysis on transfusions given to all patients with non-variceal UGIB in Denmark in 2011-2013. We compared the results from the five regions...... in Denmark in order to discover regional differences. RESULTS: A total of 5,292 admissions with treatment for non-variceal UGIB were identified, and analysis was made for the total group and a massive transfusions group (330 admissions). In the Capital Region, transfusion of platelets was more likely than...

  16. National variation in transfusion strategies in patients with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Svenningsen, Peter Olsen; Fabricius, Rasmus

    2016-01-01

    hypothesised that there are variations in transfusion strategies for patients with UGIB across the Danish regions. METHODS: We performed a retrospective, register-based, analysis on transfusions given to all patients with non-variceal UGIB in Denmark in 2011-2013. We compared the results from the five regions......INTRODUCTION: An optimal transfusion strategy for patients with upper gastrointestinal bleeding (UGIB) has yet to be established. The national guidelines contain recommendations for patients with life-threating bleeding in general, but no specific recommendations for patients with UGIB. We...... in Denmark in order to discover regional differences. RESULTS: A total of 5,292 admissions with treatment for non-variceal UGIB were identified, and analysis was made for the total group and a massive transfusions group (330 admissions). In the Capital Region, transfusion of platelets was more likely than...

  17. 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

  18. 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

  19. 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....

  20. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers.

    Science.gov (United States)

    Schroder, Vanessa T; Pappas, Theodore N; Vaslef, Steven N; De La Fuente, Sebastian G; Scarborough, John E

    2014-06-01

    To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers. Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice. A retrospective analysis of data for patients from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database who underwent emergency operation for bleeding or perforated peptic ulcer disease was performed to determine the association between surgical approach (local procedure alone, vagotomy/drainage, or vagotomy/gastric resection) and 30-day postoperative outcomes. Multivariable regression analysis was used to adjust for a number of patient-related factors. A total of 3611 patients undergoing emergency ulcer surgery (775 for bleeding, 2374 for perforation) were included for data analysis. Compared with patients undergoing local procedures alone, vagotomy/gastric resection was associated with significantly greater postoperative morbidity when performed for either ulcer perforation or bleeding. For patients with perforated ulcers, vagotomy/drainage produced similar outcomes as local procedures but required a significantly greater length of postoperative hospitalization. Conversely, vagotomy/drainage was associated with a significantly lower postoperative mortality rate than local ulcer oversew when performed for bleeding ulcers. Simple repair is the procedure of choice for patients requiring emergency surgery for perforated peptic ulcer disease. For patients requiring emergency operation for intractable ulcer bleeding, vagotomy/drainage is associated with lower postoperative mortality than with simple ulcer oversew.

  1. 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.

  2. An unusual case of gastrointestinal bleeding.

    Science.gov (United States)

    Fiorino, Kristin N; Lestini, Brian; Nichols, Kim E; Anupindi, Sudha A; Maqbool, Asim

    2011-01-01

    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. (123)Iodine metaiodobenzylguanidine ((123)MIBG) 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 (123)MIBG in evaluation and treatment.

  3. An Unusual Case of Gastrointestinal Bleeding

    Science.gov (United States)

    Fiorino, Kristin N.; Lestini, Brian; Nichols, Kim E.; Anupindi, Sudha A.; Maqbool, Asim

    2011-01-01

    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. PMID:22606522

  4. Optimized reservoir operation model of regional wind and hydro power integration case study: Zambezi basin and South Africa

    International Nuclear Information System (INIS)

    Gebretsadik, Yohannes; Fant, Charles; Strzepek, Kenneth; Arndt, Channing

    2016-01-01

    Highlights: • The study introduced reliability assessment method of integrated wind–hydropower operation. • The method identifies optimum target power operations that maximizes the firm generation. • We test the proposed method on interconnected system of reservoirs in Southern Africa region. • Results indicate that higher penetration of wind power can be achieved through the proposed frame work of operation. - Abstract: The present study develops a reliability assessment method of wind resource using optimum reservoir target power operations that maximizes the firm generation of integrated wind and hydropower. A combination of water resources model for a system of reservoirs that implements a demand–priority based linear programing algorithm and a single node power grid system model is implemented on hourly time step. This model was accompanied by a global genetic algorithm solver to determine optimum operation targets for each storage reservoir aiming at maximizing the 90th percentile power generation produced by the integration of wind and hydro over the entire simulation period. This model was applied on the reservoir storages and hydropower system in the Zambezi river basin to test if the storage reservoirs could be efficiently be used to offset wind power intermittence in South Africa subjected to the different physical and policy constraints. Based on the optimized target operation and hourly annual real data for the year 2010, the water resources system and power interconnection system were simulated together to assess the maximum firm generation of power as a result of the new wind and hydro combination target for storage hydropower plants. The result obtained indicates that high regulation of wind and hydro can be achieved as a result of combined operation and showed 45% increase in the level of wind penetration in South Africa’s power system over the reference scenario. The result also indicated a reduced level of coal power utilization and

  5. 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.)

  6. Endoscopic hemostasis state of the art - Nonvariceal bleeding.

    Science.gov (United States)

    Goelder, Stefan Karl; Brueckner, Juliane; Messmann, Helmut

    2016-02-25

    New endoscopic techniques for hemostasis in nonvariceal bleeding were introduced and known methods further improved. Hemospray and Endoclot are two new compounds for topical treatment of bleeding. Initial studies in this area have shown a good hemostatic effect, especially in active large scale oozing bleeding, e.g., tumor bleedings. For further evaluation larger prospective studies comparing the substanced with other methods of endoscopic hemostasis are needed. For localized active arterial bleeding primary injection therapy in the area of ​​bleeding as well as in the four adjacent quadrants offers a good method to reduce bleeding activity. The injection is technically easy to learn and practicable. After bleeding activity is reduced the bleeding source can be localized more clearly for clip application. Today many different through-the-scope (TTS) clips are available. The ability to close and reopen a clip can aid towards good positioning at the bleeding site. Even more important is the rotatability of a clip before application. Often multiple TTS clips are required for secure closure of a bleeding vessel. One model has the ability to use three clips in series without changing the applicator. Severe arterial bleeding from vessels larger than 2 mm is often unmanageable with these conventional methods. Here is the over-the-scope-clip system another newly available method. It is similar to the ligation of esophageal varices and involves aspiration of tissue into a transparent cap before closure of the clip. Thus a greater vascular occlusion pressure can be achieved and larger vessels can be treated endoscopically. Patients with severe arterial bleeding from the upper gastrointestinal tract have a very high rate of recurrence after initial endoscopic treatment. These patients should always be managed in an interdisciplinary team of interventional radiologist and surgeons.

  7. 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.

  8. 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

  9. 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.

  10. Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED

    NARCIS (Netherlands)

    Hilkens, Nina A.; Algra, Ale; Diener, Hans-Christoph; Reitsma, Johannes B.; Bath, Philip M.; Csiba, Laszlo; Hacke, Werner; Kappelle, L. Jaap; Koudstaal, Peter J.; Leys, Didier; Mas, Jean-Louis; Sacco, Ralph L.; Amarenco, Pierre; Sissani, Leila; Greving, Jacoba P.; Gent, M.; Beaumont, D.; Blanchard, J.; Bousser, M. G.; Coffman, J.; Easton, J. D.; Hampton, J. R.; Harker, L. A.; Janzon, L.; Kusmierek, Jje; Panak, E.; Roberts, R. S.; Shannon, S.; Sicurella, J.; Tognoni, G.; Topol, E. J.; Verstraete, M.; Warlow, C.; Blard, J. M.; Capildeo, R.; Diener, H. C.; Ersmark, B.; Escartin, A.; Ferro, J.; Galvin, R.; Hogenhuis, Lah; Laterre, C.; Provincial, L.; Rinne, U. K.; Bovim, G.; Lowenthal, A.; Bogousslavsky, J.; Brass, L.; Cimminiello, C.; Csiba, L.; Kaste, M.; Leys, D.; Matias-Guiu, J.; Rupprecht, H. J.; Berger, P. B.; Bhatt, D. L.; Black, H. R.; Boden, W. E.; Cacoub, P.; Cohen, E. A.; Creager, M. A.; Flather, M. D.; Fox, Kaa; Hacke, W.; Haffner, S. M.; Hamm, C. W.; Hankey, G. J.; Johnston, S. C.; Mak, K. H.; Mas, J. L.; Montalescot, G.; Pearson, T. A.; Steg, P. G.; Steinhubl, S. R.; Weber, M. A.; Aichner, F.; Algra, A.; Chamorro, A.; Chen, Cplh; de Schryver, Ellm; Ferro, J. M.; van Gijn, J.; Hertzberger, L. I.; Koudstaal, P. J.; Ricci, S.; Ringelstein, E. B.; Vanhooren, G.; Venables, G. S.; Albers, G.; Bath, P.; Bornstein, N.; Chan, B.; Chen, S.-T.; Cunha, L.; Dahlöf, B.; DeKeyser, J.; Donnan, G.; Estol, C.; Gorelick, P.; Lu, C.; Pais, P.; Roberts, R.; Sacco, R.; Skvortsova, V.; Teal, P.; Toni, D.; Weber, M.; Yoon, B. W.; Yusuf, S.; Amarenco, P.; Bousser, M.-G.; Fisher, M.; Ford, I.; Fox, K. M.; Hennerici, M. G.; Mattle, H. P.; Rothwell, P.; Sissani, L.; Labreuche, J.; Steg, G.; Vicaut, E.

    2017-01-01

    To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy

  11. 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.

  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. 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)

  14. New Trends in Acute Management of Colonic Diverticular Bleeding

    OpenAIRE

    Cirocchi, Roberto; Grassi, Veronica; Cavaliere, Davide; Renzi, Claudio; Tabola, Renata; Poli, Giulia; Avenia, Stefano; Farinella, Eleonora; Arezzo, Alberto; Vettoretto, Nereo; D?Andrea, Vito; Binda, Gian Andrea; Fingerhut, Abe

    2015-01-01

    Abstract Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding. The aim of this systematic review is to define the best treatment for colonic diverticular bleeding. A systematic bibliographic research was performed on the online databases for studies ...

  15. New Trends in Acute Management of Colonic Diverticular Bleeding

    Science.gov (United States)

    Cirocchi, Roberto; Grassi, Veronica; Cavaliere, Davide; Renzi, Claudio; Tabola, Renata; Poli, Giulia; Avenia, Stefano; Farinella, Eleonora; Arezzo, Alberto; Vettoretto, Nereo; D’Andrea, Vito; Binda, Gian Andrea; Fingerhut, Abe

    2015-01-01

    Abstract Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding. The aim of this systematic review is to define the best treatment for colonic diverticular bleeding. A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology. The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding. Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments. Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former. PMID:26554768

  16. Predictive factors of recurrent bleeding in Mallory-Weiss syndrome.

    Science.gov (United States)

    Kim, Jae Woo; Kim, Hyun Soo; Byun, Jong Won; Won, Chan Sik; Jee, Myeong Gwan; Park, Yong Soon; Baik, Soon Koo; Kwon, Sang Ok; Lee, Dong Ki

    2005-12-01

    Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients. The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated. A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis. Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients.

  17. 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.

  18. 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

  19. 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.

  20. CERVICAL ECTOPIC PREGNANCY WITH MASSIVE BLEEDING: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Slavcho Tomov

    2015-05-01

    Full Text Available A 29-year-old patient with cervical ectopic pregnancy (CEP presented as "suspected" cervical mass, and irregular vaginal bleeding was directed to a gynecologic oncologist for consultation. During the examination a massive bleeding occurred. After an unsuccessful attempt to stop the bleeding with a balloon catheter and vaginal tamponade, a total abdominal hysterectomy was performed. The predisposing factors, the differential diagnostic possibilities and the clinical approaches in CEP are discussed. Total abdominal hysterectomy is the procedure of choice for treatment of cervical pregnancy under conditions of urgency and life-threatening bleeding.

  1. 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.

  2. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  3. 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.

  4. [Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding'].

    Science.gov (United States)

    de Vries, Corlien J H; Meijer, Loes J; Janssen, C A H Ineke; Burgers, Jako S; Opstelten, Wim

    2015-01-01

    The revised Dutch College of General Practitioners' practice guideline on 'Vaginal bleeding' provides recommendations for abnormal bleeding in women in the reproduction phase of life and for post-menopausal bleeding. This guideline is closely attuned to the guideline on 'Heavy menstrual bleeding' of the Dutch Society of Obstetrics and Gynaecology. Transvaginal sonography is not reliable for excluding endometrial carcinoma in women with abnormal vaginal bleeding treated with tamoxifen. The choice of medical treatment is determined in consultation with the patient. The following factors are assessed: severity and bother, long-term need for contraception, preference for cycle control, desire to have a child, pain during menstruation, comorbidity and use of medication. Treatment options are nonhormonal (NSAIDs, or tranexamic acid) or hormonal (a levonorgestrel-releasing intrauterine system, or combined oral contraceptive). In women of reproductive age, referral is indicated if medical treatment is not effective. Other indications are intracavitary abnormalities diagnosed by transvaginal sonography, tamoxifen use, persistent contact bleeding, and suspicion of coagulation disorders. Indications for referral for post-menopausal bleeding include: sonographic endometrial thickness > 4 mm, abnormal cervical cytology, tamoxifen use, irregular bleeding during use of hormone therapy for vasomotor symptoms and persistent or recurrent bleeding, regardless of endometrial thickness.

  5. 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.

  6. 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 (P<.001) in the group with treatment. During the first 48hours bleeding values from the group that did not receive TAX were higher compared to patients treated with tranexamic 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.

  7. Comparison of Two Major Perioperative Bleeding Scores for Cardiac Surgery Trials: Universal Definition of Perioperative Bleeding in Cardiac Surgery and European Coronary Artery Bypass Grafting Bleeding Severity Grade.

    Science.gov (United States)

    Bartoszko, Justyna; Wijeysundera, Duminda N; Karkouti, Keyvan; Callum, Jeannie; Rao, Vivek; Crowther, Mark; Grocott, Hilary P; Pinto, Ruxandra; Scales, Damon C; Achen, Blaine; Brar, Sukhpal; Morrison, Doug; Wong, David; Bussières, Jean S; de Waal, Tonya; Harle, Christopher; de Médicis, Étienne; McAdams, Charles; Syed, Summer; Tran, Diem; Waters, Terry

    2018-03-15

    Research into major bleeding during cardiac surgery is challenging due to variability in how it is scored. Two consensus-based clinical scores for major bleeding: the Universal definition of perioperative bleeding and the European Coronary Artery Bypass Graft (E-CABG) bleeding severity grade, were compared in this substudy of the Transfusion Avoidance in Cardiac Surgery (TACS) trial. As part of TACS, 7,402 patients underwent cardiac surgery at 12 hospitals from 2014 to 2015. We examined content validity by comparing scored items, construct validity by examining associations with redo and complex procedures, and criterion validity by examining 28-day in-hospital mortality risk across bleeding severity categories. Hierarchical logistic regression models were constructed that incorporated important predictors and categories of bleeding. E-CABG and Universal scores were correlated (Spearman ρ = 0.78, P model discrimination based on predictors of perioperative mortality increased with additional inclusion of the Universal score (c-statistic increase from 0.83 to 0.91) or E-CABG (c-statistic increase from 0.83 to 0.92). When other major postoperative complications were added to these models, the association between Universal or E-CABG bleeding with mortality remained. Although each offers different advantages, both the Universal score and E-CABG performed well in the validity assessments, supporting their use as outcome measures in clinical trials.

  8. 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.

  9. 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

  10. 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

  11. Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa: A retrospective cohort study.

    Science.gov (United States)

    Lee, Ji Yeon; Ahn, Eun Hee; Kang, Sukho; Moon, Myung Jin; Jung, Sang Hee; Chang, Sung Woon; Cho, Hee Young

    2018-01-01

    We aimed to identify factors associated with massive post-partum bleeding in pregnancies with placenta previa and to establish a scoring model to predict post-partum severe bleeding. A retrospective cohort study was performed in 506 healthy singleton pregnancies with placenta previa from 2006 to 2016. Cases with intraoperative blood loss (≥2000 mL), packed red blood cells transfusion (≥4), uterine artery embolization, or hysterectomy were defined as massive bleeding. After performing multivariable analysis, using the adjusted odds ratios (aOR), we formulated a scoring model. Seventy-three women experienced massive post-partum bleeding (14.4%). After multivariable analysis, seven variables were associated with massive bleeding: maternal old age (≥35 years; aOR 1.79, 95% confidence interval [CI] 1.00-3.20, P = 0.049), antepartum bleeding (aOR 4.76, 95%CI 2.01-11.02, P placenta previa (aOR 1.93, 95%CI 1.05-3.54, P = 0.034), anterior placenta (aOR 2.74, 95%CI 1.54-4.89, P = 0.001), multiple lacunae (≥4; aOR 2.77, 95%CI 1.54-4.99, P = 0.001), and uteroplacental hypervascularity (aOR 4.51, 95%CI 2.30-8.83, P placenta previa type (incomplete: 0, complete: 1), placenta location (posterior: 0, anterior: 1), uteroplacental hypervascularity (no: 0, yes: 2), and multiple lacunae (no: 0, yes: 1) to predict post-partum massive bleeding. According to our scoring model, a score of 5/10 had a sensitivity of 81% and a specificity of 77% for predicting massive post-partum bleeding. The area under the receiver-operator curve was 0.856 (P placenta previa. © 2017 Japan Society of Obstetrics and Gynecology.

  12. Bleeding Time, Volume of Shed Blood Collected at the Bleeding Time Site, and the Peripheral Venous Hematocrit.

    Science.gov (United States)

    1995-01-10

    Journal of Obstetrics and Gynaecology 1991;98:327-328. 20. Bain B, Forster T. A sex difference in the bleeding time. 21. Smith PS, Baglini R, Meissner GF...Description of a method for determining the bleeding time and coagulation time and report of three cases of hemorrhagic disease relieved by...OFFICE OF NAVAL RESEARCH CONTRACT N00014-88-C-0118 CONTRACT N00014-94-C-0149 TECHNICAL REPORT 95-01 BLEEDING TIME, VOLUME OF SHED BLOOD

  13. 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

  14. 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...... antithrombotic drugs. METHODS: A population-based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB from a hospital during the period 1995 to 2006. Age- and gender-matched controls (10 for each case) (n = 36 502...... significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)]. CONCLUSION: Statins do not prevent UGB, except possibly in users of low-dose aspirin....

  15. Bleeding complications after oral surgery in outpatients with compromised haemostasis: incidence and management.

    Science.gov (United States)

    Reich, Waldemar; Kriwalsky, Marcus S; Wolf, Hans H; Schubert, Johannes

    2009-06-01

    PURPOSE AND RESULTS: The aim of this prospective study was to determine the incidence of postoperative bleeding after oral surgery under local anaesthesia performed in outpatients with haemostatic disorders within a 5-year period (2003-2007). One hundred twenty one (70 males, 51 females) out of 2,056 outpatients with different haemostatic disorders (acquired or hereditary) were included in this study. The following data were recorded: medical history and general condition; medications; indication for the surgical procedure; specification of local anaesthesia; applied surgical techniques, considering the kind of haemostatic disorder; and peri- or postoperative bleeding complications. Postoperative bleeding was observed in 12 patients (9.9%). In three cases, inpatient treatment became necessary. The management of two patients with a haemostatic disorder (von Willebrand s disease and haemophilia A) is presented in short case reports. In a heterogeneous group of 121 outpatients with known haemostatic disorders, a combination of a few haemostatic agents with appropriate operative technique enables an effective wound management. In cases of failed local interventions after postoperative bleeding, further diagnostic investigations are required.

  16. 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.

  17. 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.

  18. Acute and massive bleeding from placenta previa and infants' brain damage.

    Science.gov (United States)

    Furuta, Ken; Tokunaga, Shuichi; Furukawa, Seishi; Sameshima, Hiroshi

    2014-09-01

    Among the causes of third trimester bleeding, the impact of placenta previa on cerebral palsy is not well known. To clarify the effect of maternal bleeding from placenta previa on cerebral palsy, and in particular when and how it occurs. A descriptive study. Sixty infants born to mothers with placenta previa in our regional population-based study of 160,000 deliveries from 1998 to 2012. Premature deliveries occurring atplacenta accreta were excluded. Prevalence of cystic periventricular leukomalacia (PVL) and cerebral palsy (CP). Five infants had PVL and 4 of these infants developed CP (1/40,000 deliveries). Acute and massive bleeding (>500g within 8h) occurred at around 30-31 weeks of gestation, and was severe enough to deliver the fetus. None of the 5 infants with PVL underwent antenatal corticosteroid treatment, and 1 infant had mild neonatal hypocapnia with a PaCO2 placenta previa at around 30 weeks of gestation may be a risk factor for CP, and requires careful neonatal follow-up. The underlying process connecting massive placental bleeding and PVL requires further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. 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,...

  20. Use of an intraoperative checklist to decrease the incidence of re-exploration for postoperative bleeding after cardiac surgery.

    Science.gov (United States)

    van Boxtel, Astrid G M; van Veghel, Dennis; Soliman Hamad, Mohamed A; Schulz, Daniela N; Stepaniak, Pieter S; van Straten, Albert H M

    2017-10-01

    We have implemented an intraoperative checklist aiming to reduce the incidence of re-exploration for bleeding after cardiac surgery. The present report addresses the results of adopting such a checklist regarding the incidence of postoperative bleeding. The checklist was implemented by presenting it in several staff meetings of the Catharina Heart Center. Copies of the checklist were presented in every operating room. Data were collected by the Catharina Heart Center, aligned with the 'Meetbaar Beter' data manual and validated by 'Meetbaar Beter' through their data quality system. The incidence of re-exploration for bleeding was analysed in a variable life-adjusted display curve. The patient population operated after the implementation of the checklist was compared with a recent historical population before its implementation. From January 2013 through April 2016, 4817 cardiac surgical procedures were performed in our institution. Before May 2015, 3210 procedures were performed (Group 1), complicated by 112 re-exploration for bleeding (3.5%). The 'reoperation for bleeding checklist' was implemented on 1 May 2015. After this date, the number of re-explorations for bleeding decreased to 29 (1.8%) of the 1607 cardiac surgical procedures (Group 2) (P checklist is feasible to implement, low cost, quick and simple to measure with a significant reduction in the incidence of re-exploration for bleeding. This report shows an example of the positive effects of transparency in publishing outcomes' data in cardiac surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  1. Challenges in the Management of Bleeding Disorders in Nigeria

    African Journals Online (AJOL)

    2018-04-04

    Apr 4, 2018 ... Background: Bleeding disorders (BDs) are characterized by abnormal bleeding for which effective management requires a combination of skill, workforce, diagnostic facilities, and adequate therapeutic options. Objectives: The objectives of this study were to determine the capacity of Nigerian hematologists ...

  2. The efficacy of endoscopic therapy in bleeding peptic ulcer patients ...

    African Journals Online (AJOL)

    Background. Endotherapy is the primary modality for the control of bleeding from peptic ulceration. Objective. To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. Methods. Two hundred and twenty-seven patients with peptic

  3. Coffee grounds emesis: not just an upper GI bleed.

    Science.gov (United States)

    Bou-Abdallah, Jad Z; Murthy, Uma K; Mehta, Nilish; Prasad, Heramba N; Kaul, Vivek

    2012-07-01

    Acute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates. We present a case series to illustrate that patients with coffee grounds emesis (CGE) often have other unsuspected illnesses that may be overlooked due to preoccupation with the GI bleed. A retrospective chart review of a series of 6 patients presenting with CGE and admitted for upper GI bleeding was performed. All 6 patients were hemodynamically stable at admission. NG lavage showed coffee grounds that cleared easily. None of the patients required blood transfusions during their hospital stay. Endoscopy in 3 of 6 patients failed to find any significant UGI lesions or stigmata of recent bleed. Although patients were admitted for UGI bleeding, the more significant associated diagnoses included acute myocardial infarction, urosepsis, small bowel obstruction, bilateral pulmonary emboli, and acute renal failure. Hemodynamically stable patients presenting with coffee grounds NG aspirate and no fall in hemoglobin/hematocrit should be evaluated for other non-GI bleeding-related conditions even as the GI bleed is being managed. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Leech as a cause of abnormal vaginal bleeding: Presentation of ...

    African Journals Online (AJOL)

    days, menstrual cycle of 80ml. Rather than this specific figures, however, abnormal uterine bleeding should be defined in terms of deviation from an individual patient's established menstrual pattern1,2. Leech bite as a cause pf abnormal vaginal bleeding has been reported in ...

  5. 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.

  6. 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....

  7. Increased accuracy in heparin and protamine administration decreases bleeding

    DEFF Research Database (Denmark)

    Runge, Marx; Møller, Christian H; Steinbrüchel, Daniel A

    2009-01-01

    Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. The purpose...

  8. Endoscopic injection sclerotherapy for bleeding varices in children ...

    African Journals Online (AJOL)

    Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: Benefit of injection tract embolisation. ... In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection ...

  9. 14 CFR 33.66 - Bleed air system.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Bleed air system. 33.66 Section 33.66 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: AIRCRAFT ENGINES Design and Construction; Turbine Aircraft Engines § 33.66 Bleed air system. The...

  10. 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.

  11. [Prophylaxis for stress ulcer bleeding in the intensive care unit].

    Science.gov (United States)

    Avendaño-Reyes, J M; Jaramillo-Ramírez, H

    2014-01-01

    The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit". The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  12. Aetiology of Upper Gastrointestinal Bleeding in North-Eastern Nigeria

    African Journals Online (AJOL)

    Oesophageal varices were the most frequent cause of bleeding (45.3%) followed by non-ulcer peptic acid disease (23.7%) and peptic ulcer disease (16.9%). Gastric cancer and Mallory-Weiss syndrome were rare with each accounting for 1.9% of the cases. In 11 (10.4%) patients no source of bleeding could be identified.

  13. 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 ...

  14. Histopathological findings of Post-Menopausal bleeding in ...

    African Journals Online (AJOL)

    Background: Postmenopausal bleeding is an alarming sign that may be associated with uterine malignancy. In recent years about 60% of women with post menopausal bleeding are said to have no organic cause in developed countries. There is no data concerning about this issue in Ethiopia. Objective: To determine ...

  15. Prediction models in women with postmenopausal bleeding: a systematic review

    NARCIS (Netherlands)

    van Hanegem, Nehalennia; Breijer, Maria C.; Opmeer, Brent C.; Mol, Ben W. J.; Timmermans, Anne

    2012-01-01

    Postmenopausal bleeding is associated with an elevated risk of having endometrial cancer. The aim of this review is to give an overview of existing prediction models on endometrial cancer in women with postmenopausal bleeding. In a systematic search of the literature, we identified nine prognostic

  16. 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 ...

  17. 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....

  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. 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

  1. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  2. Bleeding disorders in the tribe: result of consanguineous in breeding

    Directory of Open Access Journals (Sweden)

    Borhany Munira

    2010-09-01

    Full Text Available Abstract Objective To determine the frequency and clinical features of bleeding disorders in the tribe as a result of consanguineous marriages. Design Cross Sectional Study Introduction Countries in which consanguinity is a normal practice, these rare autosomal recessive disorders run in close families and tribes. Here we describe a family, living in village Ali Murad Chandio, District Badin, labeled as haemophilia. Patients & Methods Our team visited the village & developed the pedigree of the whole extended family, up to seven generations. Performa was filled by incorporating patients, family history of bleeding, signs & symptoms, and bleeding from any site. From them 144 individuals were screened with CBC, bleeding time, platelet aggregation studies & RiCoF. While for PT, APTT, VWF assay and Factor VIII assay, samples were kept frozen at -70 degrees C until tested. Results The family tree of the seven generations comprises of 533 individuals, 63 subjects died over a period of 20 years and 470 were alive. Out of all those 144 subjects were selected on the basis of the bleeding history. Among them 98(68.1% were diagnosed to have a bleeding disorder; 44.9% patients were male and 55.1% patients were female. Median age of all the patients was 20.81, range (4 months- 80 yrs. The results of bleeding have shown that majority had gum bleeding, epistaxis and menorrhagia. Most common bleeding disorder was Von Willebrand disease and Platelet functional disorders. Conclusion Consanguineous marriages keep all the beneficial and adversely affecting recessive genes within the family; in homozygous states. These genes express themselves and result in life threatening diseases. Awareness, education & genetic counseling will be needed to prevent the spread of such common occurrence of these bleeding disorders in the community.

  3. Does painless rectal bleeding equate to a colonic polyp?

    Science.gov (United States)

    Campbell, Alison Morag; Sugarman, Ian

    2017-11-01

    It is often stated that if a patient presents with 'painless rectal bleeding' then a rectal polyp is the probable diagnosis. The aim of this study is to review our experience of children undergoing endoscopy to assess if the above statement is correct. The senior author keeps a prospective database of every child undergoing flexible sigmoidoscopy or colonoscopy. As part of this database, the symptoms and signs that the patient presents with, specifically abdominal pain, diarrhoea, mucous per rectum and rectal bleeding, are recorded. These results have been analysed specifically to assess whether the opening statement is correct. Between 2000 and 2014, a total of 401 children have undergone flexible sigmoidoscopy (21) or colonoscopy (380) to investigate rectal bleeding. Of these 401 patients, 42 (10.5%) had at least one polyp. Four polyps (9%) occurred in 159 patients with no rectal bleeding during the study period. The remaining 42 polyps (91%) were identified in patients with rectal bleeding. Of these 42 polyps, painless rectal bleeding was the only symptom in 24 (57%). However, 123 patients were endoscoped with painless rectal bleeding alone, giving a polyp rate of 19.5% for this symptom. The polyp pickup rate was increased to 28% if rectal bleeding and mucous per rectum were present; however, only 25 patients had this clinical history. We confirm that the most common symptom of rectal polyps is painless rectal bleeding. However, only one in five patients with this clinical history has a rectal polyp at endoscopy. The polyp pickup rate at endoscopy is greater (28%) when a history of both rectal bleeding and mucous per rectumispresent. This information can be used to counsel parents preoperatively. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. 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

  5. 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)

  6. [The role of endoscopy in determining the indications for the surgical treatment of the Mallory-Weiss syndrome and of bleeding acute gastroduodenal ulcers].

    Science.gov (United States)

    Skriabin, O N; Korobchenko, A A; Lobach, S M; Musinov, I M

    1997-01-01

    The frequency of acute sources of bleeding has recently increased (47%) in the general picture of gastrointestinal bleedings which makes the improvement of diagnosing "acute" sources of hemorrhage and the development of more perfect methods of nonoperative hemostasis very actual. The authors believe that "Kaprofer" used in most of patients with bleedings from acute ulcers and ruptures of the gastro-esophageal zone mucosa (95%) allows the hemorrhage to be arrested. The treatment can be continued without operative interventions. Search for new hemostatic drugs must be performed in order to obtain reliable and long-term effects of drugs with a minimum aggressive action upon the mucosa.

  7. 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.

  8. 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.

  9. 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.

  10. Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty.

    Science.gov (United States)

    Tuncel, Umut; Turan, Aydin; Bayraktar, M Alper; Erkorkmaz, Unal; Kostakoglu, Naci

    2013-03-01

    The aim of this retrospective study was to evaluate the efficacy of dexamethasone with controlled hypotension on intraoperative bleeding and postoperative morbidity in rhinoplasty. Sixty rhinoplasty patients required hump resection and lateral osteotomy were included in this study. The patients were randomized into four groups. In group I (n=15), a single dose of 10mg/kg dexamethasone was intravenously administered at the beginning of the operation. In group II (n=15), the patients were given 2 doses of 10mg/kg intravenously dexamethasone at the beginning of the operation, and 24 hours after the operation. In group III (n=15), 3 doses of 10mg/kg intravenously dexamethasone were given at the beginning of the operation, before osteotomy and 24 hours after the operation. Group IV (n=15) was assigned as control group and the patients were neither administered dexamethasone nor applied hypotension. All cases in groups I, II and III were operated under controlled hypotension. Systolic arterial pressure was aimed to keep between 65 and 75 mmHg for controlled hypotensive anaesthesia. Controlled hypotension was achieved by a remifentanil infusion of 0.1-0.5 microg/kg/min, following a bolus of 1 microg/kg. Degree of eyelid oedema and periorbital soft-tissue ecchymosis was evaluated separately using a scale of 0-4. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and postoperative days 2, 5, 7, and 10. In groups I, II and III, intraoperative bleeding was more decreased and the operation time was significantly shorter compared with control group (Pcontrolled hypotension considerably reduced postoperative morbidities of rhinoplasty with osteotomy as well as intraoperative bleeding. Thus, in group III receiving 3 doses of steroid, when compared to other groups, more uneventful postoperative period were provided for surgeon and the patients. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier

  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. Giant bleeding renal angiomyolipoma: diagnosis and management

    International Nuclear Information System (INIS)

    Ashebu, S.D.; Elshebiny, Y.H.; Dahniya, M.H.; Varro, J.; Al-khawari, H.

    2002-01-01

    A case of a giant bleeding renal angiomyolipoma is presented. The patient was a 40-year-old Egyptian male with no clinical or radiological evidence of tuberous sclerosis. The radiological features and management, including the role of angiography are briefly discussed and the medical reviews on this subject are briefly considered. There was no fever. He had a history of renal calculi. Physical examination revealed a mass in the right loin. His haemoglobin was 9.9 g/dL, blood pressure 110/70 and pulse 96 b.p.m. Routine biochemical investigations were normal. A plain radiograph of the abdomen suggested a right upper pole renal mass. Intravenous urography (IVU) confirmed a large space-occupying lesion. Ultrasonography (US) discovered mixed echogenicity but predominantly echogenic. A few hours after admission, the patient's blood pressure and haematocrit dropped. Plain and contrast enhanced CT (CECT) performed after resuscitation with three units of blood revealed a huge, heterogeneously enhancing and very vascular right renal tumour, with multiple small pseudoaneurysms. The tumour was predominantly of fat density, with soft tissue components and extended beyond the kidney into the perinephric space. The appearance was typical of an angiomyolipoma (AML). Small AML were demonstrated in the left kidney. Copyright (2002) Blackwell Science Pty Ltd

  13. Wireless capsule endoscopy: perspectives beyond gastrointestinal bleeding.

    Science.gov (United States)

    Redondo-Cerezo, Eduardo; Sánchez-Capilla, Antonio Damián; De La Torre-Rubio, Paloma; De Teresa, Javier

    2014-11-14

    Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.

  14. 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

  15. 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

  16. Management of dysfunctional uterine bleeding based on endometrial thickness

    Directory of Open Access Journals (Sweden)

    Ozgul Muneyyirci-Delale

    2010-09-01

    Full Text Available Ozgul Muneyyirci-Delale1,2, Anuja Gupta1,2, Cynthia Abraham1, Ashadeep Chandrareddy1, Charles H Bowers Jr2, Jed B Cutler2Departments of Obstetrics and Gynecology, 1SUNY Downstate Medical Center, 2Kings County Hospital Center, Brooklyn, New York, USAObjective: To manage patients with dysfunctional uterine bleeding (DUB according to endometrial thickness.Methods: A retrospective chart review of 49 patients who reported 8 or more days of bleeding was performed. They were then divided into three groups based on endometrial thickness (mm: less than 6, 6–11, and greater than 11. These three groups were treated with combined oral contraceptive pills (OCP, conjugated estrogen plus progesterone and megestrol respectively. Patients given megestrol also underwent endometrial biopsy before treatment. Patients recorded the degree of bleeding each day for one month after starting treatment.Results: Mean endometrial thickness in the combined OCPs, conjugated estrogen plus progesterone and megestrol groups were 4, 8 and 14 mm, respectively. Combined OCPs decreased bleeding from 46 to 8 days (P < 0.05, n = 8. Conjugated estrogen plus progesterone decreased the number of days of bleeding from a mean of 41 to 9 (P < 0.01, n = 16. Megestrol decreased bleeding from 54 to 3 days (P < 0.001, n = 25. 52% of patients given megestrol had endometrial hyperplasia.Conclusion: These results support the effectiveness of treating patients with DUB according to endometrial thickness.Keywords: DUB, abnormal uterine bleeding, endometrium, hyperplasia, megestrol acetate

  17. [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.

  18. Bleeding related to etonogestrel subdermal implant in a US population.

    Science.gov (United States)

    Casey, Petra M; Long, Margaret E; Marnach, Mary L; Bury, Jessica E

    2011-05-01

    The etonogestrel subdermal implant received US Food and Drug Administration approval in 2006. Menstrual changes represent a common reason why recipients of this implant request early implant removal. Retrospective review of medical records of 155 patients with placement of this implant at Mayo Clinic in Rochester, Minnesota, and medical literature review. In 151 patients (97.4%), this implant was placed for contraception. Sixty-four patients (41.3%) contacted a health care provider about implant-related issues after insertion, including 39 (25.2%) for abnormal bleeding. Mean body mass index (BMI) was 28.5, higher than prior studies of implant-related bleeding. Implant removal rate was 25.2% (mean interval, 9.8 months), with 14.8% requesting removal for bleeding changes. No insertion or postinsertion complications or contraceptive failures were found. Age, race, BMI, parity, prior contraception method, and postpartum and breastfeeding status did not predict bleeding or removal for bleeding risk. Removal rates were higher for amenorrhea, occasional spotting or bleeding, and regular menses than for prolonged or continuous bleeding. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. 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.

  20. 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.

  1. 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.

  2. National consensus on management of peptic ulcer bleeding in Denmark 2014

    DEFF Research Database (Denmark)

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

    2014-01-01

    DESCRIPTION: The Danish Society of Gastroenterology and Hepatology have compiled a national guideline for the management of peptic ulcer bleeding. Sources of data included published studies up to June 2014. Quality of evidence and strength of recommendations have been graded. The guideline...... stable patients without serious ischaemic disease. Endoscopy should generally be performed within 24 hours, reducing operation rate, rebleeding rate and duration of in-patient stay. When serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result....... Intravenous high-dose proton pump inhibitor (PPI) therapy for 72 hours after successful endoscopic hemostasis is recommended even though the evidence is questionable. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least three days after...

  3. Therapeutic Options for Patients Bleeding with Peptic Ulcers

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1994-01-01

    Full Text Available It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies.

  4. Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

    International Nuclear Information System (INIS)

    Banos Madrid, Ramon; Alberca de las Parras, Fernando; Vargas Acosta, Angel and others

    2006-01-01

    The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. 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 occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

  5. 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

  6. 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...

  7. Gastrointestinal bleeding from supraduodenal artery with aberrant origin

    Directory of Open Access Journals (Sweden)

    Qiong Han, MD, PhD

    2017-09-01

    Full Text Available Angiography and endovascular embolization play an important role in controlling acute arterial upper gastrointestinal hemorrhage, particularly when endoscopic intervention fails to do so. In our case, the patient presented with recurrent life-threatening bleed in spite of multiple prior endoscopic interventions and gastroduodenal artery embolization. Our teaching points focus on the role of angiography in acute upper gastrointestinal bleed and when to conduct empiric embolization, while reviewing the supraduodenal artery as an atypical but important potential culprit for refractory upper gastrointestinal bleed.

  8. Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

    Science.gov (United States)

    Wheeler, Karen C; Goldstein, Steven R

    2017-03-01

    Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. In this article we discuss specific ultrasound findings and technical considerations useful in the diagnosis of abnormal uterine bleeding.

  9. Predicting Major Bleeding in Ischemic Stroke Patients With Atrial Fibrillation.

    Science.gov (United States)

    Hilkens, Nina A; Algra, Ale; Greving, Jacoba P

    2017-11-01

    Performance of risk scores for major bleeding in patients with atrial fibrillation and a previous transient ischemic attack or ischemic stroke is not well established. We aimed to validate risk scores for major bleeding in patients with atrial fibrillation treated with oral anticoagulants after cerebral ischemia and explore the net benefit of oral anticoagulants among bleeding risk categories. We analyzed 3623 patients with a history of transient ischemic attack or stroke included in the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). We assessed performance of HEMORR 2 HAGES (hepatic or renal disease, ethanol abuse, malignancy, older age, reduced platelet count or function, hypertension [uncontrolled], anemia, genetic factors, excessive fall risk, and stroke), Shireman, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and ORBIT scores (older age, reduced haemoglobin/haematocrit/history of anaemia, bleeding history, insufficient kidney function, and treatment with antiplatelet) with C statistics and calibration plots. Net benefit of oral anticoagulants was explored by comparing risk reduction in ischemic stroke with risk increase in major bleedings on warfarin. During 6922 person-years of follow-up, 266 patients experienced a major bleed (3.8 per 100 person-years). C statistics ranged from 0.62 (Shireman) to 0.67 (ATRIA). Calibration was poor for ATRIA and moderate for other models. The reduction in recurrent ischemic strokes on warfarin was larger than the increase in major bleeding risk, irrespective of bleeding risk category. Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot

  10. Clival chordoma manifesting as nasal bleeding. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma [University of Fukui, Department of Neurosurgery, Fukui (Japan); Nakajima, Hirofumi [Tsuruga Municipal Hospital, Department of Neurosurgery, Fukui (Japan)

    2005-05-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  11. Clival chordoma manifesting as nasal bleeding. A case report

    International Nuclear Information System (INIS)

    Kitai, Ryuhei; Yoshida, Kazuhiko; Kubota, Toshihiko; Sato, Kazufumi; Handa, Yuji; Kasahara, Kazuma; Nakajima, Hirofumi

    2005-01-01

    Chordoma is a rare cartilaginous tumor, for which bleeding presentation is unusual. We report a case of rare hemorrhaged clival chordoma, which was diagnosed correctly by magnetic resonance imaging. A 32-year-old man presented with nasal bleeding. The tumor was totally removed via a trans-sphenoidal approach, from which the surgical specimen confirmed chordoma. Epistaxis seemed to be caused by the spreading of the intratumoral hemorrhage into the sphenoid sinus. This case demonstrates the importance of an exact differential diagnostic evaluation, including chordoma, by use of modern imaging techniques for nasal bleeding. (orig.)

  12. [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.

  13. The Text of the Agreement of 20 August 1984 extending the Asian Regional Co-Operative Project on Food Irradiation. Second Extension Agreement

    International Nuclear Information System (INIS)

    1985-04-01

    The text of the Second 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 Cooperative 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. The First Extension Agreement of 8 July 1983 was due to expire on 27 August 1984

  14. 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.

  15. 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.

  16. Embolization of a Bleeding Maxillary Arteriovenous Malformation via the Superficial Temporal Artery after External Carotid Artery Ligation

    International Nuclear Information System (INIS)

    Wang, Chaohua; Yan, Qing; Xie, Xiaodong; Li, Jiangtao; Zhou, Dong

    2008-01-01

    An arteriovenous malformation (AVM) of the jaw is an uncommon lesion found mainly in children. It can present with massive oral bleeding, resulting in death. The external carotid artery (ECA) is often the feeding artery and can be ligated to control the hemorrhage. As a result, transarterial embolization is difficult or even impossible to perform when re-bleeding occurs. We report a new approach of a successful embolization of a bleeding maxillary AVM via the superficial temporal artery (STA) after a previous ECA ligation. This technique has not yet been reported for endovascular management of a bleeding maxillary AVM. This approach of embolization of a maxillary AVM via the STA is minimally invasive, repeatable and has little effect on the physical appearance of the patient. It may be performed on patients with hyper vascular craniofacial lesions whose feeding arteries have been ligated or are too tortuous to navigate a catheter. It can also be performed urgently during active bleeding, pre-operatively and before trans-venous embolization

  17. Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders.

    Science.gov (United States)

    Karanth, Laxminarayan; Barua, Ankur; Kanagasabai, Sachchithanantham; Nair, Sreekumar

    2015-09-09

    Congenital bleeding disorders can cause obstetric haemorrhage during pregnancy, labour and following delivery. Desmopressin acetate is found to be an effective drug which can reduce the risk of haemorrhage and can also stop bleeding in certain congenital bleeding disorders. Its use in pregnancy has been controversial. Hence beneficial and adverse effects of desmopressin acetate in these groups of pregnant women should be evaluated.This is an update of a Cochrane review first published in 2013. To determine the efficacy of desmopressin acetate in preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant and abstract books of conferences proceedings. We also searched for any randomised controlled trials in a registry of ongoing trials and the reference lists of relevant articles and reviews.Date of most recent search: 18 June 2015. Randomised and quasi-randomised controlled trials investigating the efficacy of desmopressin acetate versus tranexamic acid or factor VIII or rFactor VII or fresh frozen plasma in preventing and treating congenital bleeding disorders during pregnancy were eligible. No trials matching the selection criteria were eligible for inclusion. No trials matching the selection criteria were eligible for inclusion. The review did not identify any randomised controlled trials investigating the relative effectiveness of desmopressin acetate for bleeding during pregnancy in women with congenital bleeding disorders. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials) to decide whether or not to treat women with congenital bleeding disorders with desmopressin acetate.Given the ethical considerations, future

  18. Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology.

    Science.gov (United States)

    Tikkinen, Kari A O; Agarwal, Arnav; Craigie, Samantha; Cartwright, Rufus; Gould, Michael K; Haukka, Jari; Naspro, Richard; Novara, Giacomo; Sandset, Per Morten; Siemieniuk, Reed A; Violette, Philippe D; Guyatt, Gordon H

    2014-12-23

    Pharmacological thromboprophylaxis in the peri-operative period involves a trade-off between reduction in venous thromboembolism (VTE) and an increase in bleeding. Baseline risks, in the absence of prophylaxis, for VTE and bleeding are known to vary widely between urological procedures, but their magnitude is highly uncertain. Systematic reviews and meta-analyses addressing baseline risks are uncommon, needed, and require methodological innovation. In this article, we describe the rationale and methods for a series of systematic reviews of the risks of symptomatic VTE and bleeding requiring reoperation in urological surgery. We searched MEDLINE from January 1, 2000 until April 10, 2014 for observational studies reporting on symptomatic VTE or bleeding after urological procedures. Additional studies known to experts and studies cited in relevant review articles were added. Teams of two reviewers, independently assessed articles for eligibility, evaluated risk of bias, and abstracted data. We derived best estimates of risk from the median estimates among studies rated at the lowest risk of bias. The primary endpoints were 30-day post-operative risk estimates of symptomatic VTE and bleeding requiring reoperation, stratified by procedure and patient risk factors. This series of systematic reviews will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding. Our work advances standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at best estimates of risk (including modeling of timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate certainty in estimates of risk. The results will be incorporated in the upcoming European Association Urology Guideline on Thromboprophylaxis. PROSPERO CRD42014010342.

  19. Abnormal Uterine Bleeding including coagulopathies and other menstrual disorders.

    Science.gov (United States)

    Deligeoroglou, Efthimios; Karountzos, Vasileios

    2018-04-01

    Abnormal Uterine Bleeding (AUB) is a frequent cause of visits to the emergency department and a major reason for concern among adolescents and their families. The most common cause of AUB, in otherwise healthy adolescents, is ovulatory dysfunction, although 5-36% of adolescents who present with heavy menstrual bleeding, have an underlying bleeding disorder (BD). The most common form of BDs is von Willebrand Disease, reflecting 13% of adolescents with AUB. Management of AUB depends on the underlying etiology, the bleeding severity, as well as the need for hospitalization. Treatment of adolescents with an underlying coagulopathy depends on the severity of the BD, while therapeutic interventions are summarized in supportive measures, hormonal treatments (e.g. Combined Oral Contraceptives), non-hormonal treatments (e.g. tranexamic acid and desmopressin), surgical options (e.g. dilatation & curettage) and treatment options in specific conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Hormone Replacement Therapy: Can It Cause Vaginal Bleeding?

    Science.gov (United States)

    Hormone replacement therapy: Can it cause vaginal bleeding? I'm taking hormone therapy for menopause symptoms, and my monthly ... mayoclinic.org/diseases-conditions/menopause/expert-answers/hormone-replacement-therapy/FAQ-20058499 . Mayo Clinic Footer Legal Conditions ...

  1. Predictive factors for intraoperative excessive bleeding in Graves’ disease

    Directory of Open Access Journals (Sweden)

    Kosho Yamanouchi

    2015-01-01

    Conclusion: A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves’ disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g.

  2. Management of bleeding and leakage after pancreatic surgery

    NARCIS (Netherlands)

    de Castro, S. M. M.; Busch, O. R. C.; Gouma, D. J.

    2004-01-01

    Pancreatic surgery has advanced considerably during the past decades. Recent studies report reduced morbidity rates and virtually no mortality after resection. However, postoperative complications are still a formidable menace. In this chapter we discuss the management of postoperative bleeding and

  3. Anode reactive bleed and injector shift control strategy

    Science.gov (United States)

    Cai, Jun [Rochester, NY; Chowdhury, Akbar [Pittsford, NY; Lerner, Seth E [Honeoye Falls, NY; Marley, William S [Rush, NY; Savage, David R [Rochester, NY; Leary, James K [Rochester, NY

    2012-01-03

    A system and method for correcting a large fuel cell voltage spread for a split sub-stack fuel cell system. The system includes a hydrogen source that provides hydrogen to each split sub-stack and bleed valves for bleeding the anode side of the sub-stacks. The system also includes a voltage measuring device for measuring the voltage of each cell in the split sub-stacks. The system provides two levels for correcting a large stack voltage spread problem. The first level includes sending fresh hydrogen to the weak sub-stack well before a normal reactive bleed would occur, and the second level includes sending fresh hydrogen to the weak sub-stack and opening the bleed valve of the other sub-stack when the cell voltage spread is close to stack failure.

  4. Risk of bleeding related to antithrombotic treatment in cardiovascular disease

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette

    2012-01-01

    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......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...... a stent dual antiplatelet therapy with a P2Y12 receptor antagonist and acetylsalicylic acid (ASA) is recommended for 12 months, preferable with prasugrel or ticagrelor unless there is an additional indication of warfarin or increased risk of bleeding. In patients with AF, warfarin is recommended...

  5. Pregnancy Complications: Bleeding and Spotting from the Vagina

    Science.gov (United States)

    ... miscarry have bleeding or spotting before the miscarriage. Ectopic pregnancy. This is when a fertilized egg implants itself ... of the uterus and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. ...

  6. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  7. Evaluation and Management of Adolescents with Abnormal Uterine Bleeding.

    Science.gov (United States)

    Mullins, Tanya L Kowalczyk; Miller, Rachel J; Mullins, Eric S

    2015-09-01

    The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB. Copyright 2015, SLACK Incorporated.

  8. Intraoperative bleeding during open flap debridement and regenerative periodontal surgery.

    Science.gov (United States)

    Zigdon, Hadar; Levin, Liran; Filatov, Margarita; Oettinger-Barak, Orit; Machtei, Eli E

    2012-01-01

    The objective of this study was to measure the intraoperative bleeding during periodontal flap surgery. Patients scheduled for periodontal surgery were recruited for this study. Data regarding smoking habits, general health, and medications were collected. The amount of the local anesthetic that was injected was then recorded, as well as the number of teeth in the operative field and the duration of the procedure. During surgery, the liquids from the oral cavity were suctioned and collected into a sterile empty vial. To calculate the net amount of blood volume in the liquids, colorimetric assay using capillary blood fructosamine as a reference molecule was used. Twenty-six patients were included in this study. The amount of blood lost during the procedure ranged from 6.0 to 145.1 mL, with an overall mean of 59.47 ± 38.2 mL. Patients taking aspirin (acetylsalicylic acid) showed mean blood loss of 43.26 ± 31.5 mL, whereas the mean blood loss among patients that did not use this medication was higher (65.4 ± 39.4 mL) but not statistically significant. Local anesthetic amount, surgical field size, and the operation duration did not relate to blood-loss volume. The mean blood loss among current smokers was significantly higher (96.47 ± 44.2 mL) compared to former (12 ± 8.4 mL) or never (54.74 ± 30.5 mL, P = 0.011) smokers. The results of the current study support previous papers and confirm that blood loss during periodontal surgery is minimal.

  9. [New concept minimizes bleeding in radical retropubic prostatectomy].

    Science.gov (United States)

    Schostak, M; Matischak, K; Schäfer, M; Müller, M; Schrader, M; Christoph, F; Miller, K

    2005-11-01

    Radical retropubic prostatectomy is an intervention known to be associated with severe bleeding. Even experienced surgeons report a blood transfusion rate of up to 20%. The perioperative concept for this intervention underwent various modifications in January 2001. This study describes the effect of these modifications on the blood loss in a retrospective analysis comparing approximately 100 operations by a single experienced surgeon before the change (group 1) with 100 operations thereafter (group 2). The new perioperative concept comprised the following points: reducing the intravenously applied volume, employing a peridural catheter (PDC), and maintaining a 25-30 degrees Trendelenburg's position. The difference in pre- and postsurgical hemoglobin (Hb) was analyzed before (group 1) and after the intervention (group 2). If transfusions were performed, this value was corrected according to the following formula: 1 ml of erythrocyte concentrate increases the patient's Hb by 0.003 g/dl. Assessment was possible in 201 of 234 cases, 110 from the first and 91 from the second group. The mean transfusion-corrected Hb difference was 5.3 g/dl in group 1 (20% transfusion rate) and 3.52 g/dl in group 2 (1.09% transfusion rate); p>0.0001. The median intravenous volume applied was 5.960 ml in group 1 and 3.490 ml in group 2 (p>0.0001). The complication rate did not differ between groups. The new perioperative concept minimizes the intraoperative blood loss during radical open retropubic prostatectomy. Transfusions are only necessary in rare cases. The complication rate remains unaltered.

  10. Transarterial embolization for management of severe postcoital bleeding

    Directory of Open Access Journals (Sweden)

    Armen Eskandari

    2016-08-01

    Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

  11. Appendicular bleeding: an excepcional cause of lower hemorrhage

    Directory of Open Access Journals (Sweden)

    Marta Magaz-Martínez

    Full Text Available Chronic complications of acute appendicitis managed in a conservative manner are not frequent. We present a case of acute lower gastrointestinal hemorrhage in a young patient with a previous acute appendicitis without surgical intervention. The colonoscopy detected an appendicular bleeding which was surgically treated. The anatomopathological diagnosis was granulomatous appendicitis. The clinical evolution of the patient was favorable without bleeding recurrence. Appendicular hemorrhage can be an unusual complication -however potentially severe- of acute appendicitis not treated surgically.

  12. Practical Approach to Endoscopic Management for Bleeding Gastric Varices

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Young Suk [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.

  13. Abnormal uterine bleeding in reproductive-aged women.

    Science.gov (United States)

    Matthews, Michelle L

    2015-03-01

    Abnormal uterine bleeding is a common medical condition with several causes. The International Federation of Gynecology and Obstetrics published guidelines in 2011 to develop universally accepted nomenclature and a classification system. In addition, the American College of Obstetrics and Gynecology recently updated recommendations on evaluation of abnormal uterine bleeding and indications for endometrial biopsies. This article reviews both medical and surgical treatments, including meta-analysis reviews of the most effective treatment options. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Fibrinogen concentrates for bleeding trauma patients: what is the evidence?

    DEFF Research Database (Denmark)

    Meyer, Martin; Ostrowski, S R; Windeløv, N A

    2011-01-01

    A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions.......A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions....

  15. Bleeding disorders in dental practice: A diagnostic overview

    Directory of Open Access Journals (Sweden)

    Abhirup Goswami

    2014-01-01

    Full Text Available Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient′s physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.

  16. Transvaginal sonography in abnormal uterine bleeding and correlation to hysteroscopy

    International Nuclear Information System (INIS)

    Saeed, S.; Shah, S.; Ali, H.; Khan, S.; Ehsan, N.; Ahmed, S.Z.

    2017-01-01

    To correlate results of Transvaginal sonography with those of hysteroscopy and biopsy in abnormal uterine bleeding to estimate the accuracy and analytical values of non-invasive transvaginal sonography in abnormal uterine bleeding. Methodology: This cross-sectional Study was carried out at BMCH, Quetta, Balochistan, Pakistan from March 2013 to February 2014 and included 200 patients of abnormal uterine bleeding. Exclusion criteria were pregnancy, virginity, local bleeding of perineal or vaginal origin. Hysteroscopy and biopsy and Transvaginal Ultrasound (TVS) were performed in all. Result: The most common type of bleeding was found to be menorrhagia in 39% while the least common type was postmenopausal bleeding in 9%. Mean endometrial thickness was 11.64 mm and it was noted that at less than 14mm thickness no serious pathology was found. Sensitivity of TVS for endometrial hyperplasia was found to be 66.66% while specificity was 100%. Positive analytical value was 100% while negative value was 100%. Overall sensitivity calculated for TVS was 94.44%, specificity 98.55%, PPV was 81.93% and NPV 98.55%. Conclusion: Sensitivity and specificity of TVS were lower than hysteroscopy and biopsy but the difference was not significant. TVS can be used as first line investigation while hysteroscopy and biopsy may be left for cases of high risk or in those cases where some positive findings could be found on TVS. (author)

  17. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

    Energy Technology Data Exchange (ETDEWEB)

    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  18. Evaluation and management of abnormal uterine bleeding in premenopausal women.

    Science.gov (United States)

    Sweet, Mary Gayle; Schmidt-Dalton, Tarin A; Weiss, Patrice M; Madsen, Keith P

    2012-01-01

    Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.

  19. The Text of the Third Agreement to Extend the Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology of 1972

    International Nuclear Information System (INIS)

    1987-09-01

    The text of the Third Agreement to Extend the Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology of 1972 the RCA Agreement, extended first in 1977 and then in 1982, for a further period of five years with effect from 12 June 1987, is reproduced herein for the information of all Members [fr

  20. The Text of a Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology. Latest Status. Declarations/Reservations

    International Nuclear Information System (INIS)

    1972-01-01

    The text of a Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology between the Agency and Member States is reproduced herein for the information of all Members. Section 9 thereof specifies the Members that may become party to it [fr

  1. The Text of a Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology. Latest Status. Declarations/Reservations

    International Nuclear Information System (INIS)

    1972-01-01

    The text of a Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology between the Agency and Member States is reproduced herein for the information of all Members. Section 9 thereof specifies the Members that may become party to it

  2. The Text of a Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology. Latest Status. Declarations/Reservations

    International Nuclear Information System (INIS)

    1972-01-01

    The text of a Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology between the Agency and Member States is reproduced herein for the information of all Members. Section 9 thereof specifies the Members that may become party to it [es

  3. CASE STUDIES OF CROSS-BORDER CO-OPERATION IN EUROPEAN TOURISM – PERSPECTIVES AND CHALLENGES FOR THE CROSS-BORDER REGION BUCOVINA/OBLAST TSCHERNIWZI

    Directory of Open Access Journals (Sweden)

    HEIKE BÄHRE

    2016-06-01

    Full Text Available The article focuses on success factors and management models in destination management for cross-border co-operation in tourism. The method is based on literature research, case-studies in European cross-border-regions and descriptive.

  4. ARCAL. Regional co-operative arrangements for the promotion of nuclear science and technology in Latin America, Phase I (1985-1990)

    International Nuclear Information System (INIS)

    Gillen, V.A.

    1990-09-01

    The Regional Co-operative Arrangement for the Promotion of Nuclear Science and Technology in Latin America, ARCAL, has completed its first five-year phase (1985-1989). This booklet summarizes the first phase of the ARCAL programme and contains descriptions of projects in the fields of agriculture, medicine, industry and energy

  5. The text of the second agreement to extend the 1987 Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology

    International Nuclear Information System (INIS)

    1998-03-01

    The document reproduces the text of the Second Agreement to Extend the 1987 Regional Co-operative Agreement for Research, development and Training Related to Nuclear Science and Technology for a further period of five years with effect from 12 june 1997, i.e., through 11 June 2002

  6. The text of the third agreement to extend the regional co-operative agreement for research, development and training related to nuclear science and technology of 1972

    International Nuclear Information System (INIS)

    1987-09-01

    The full text of the third agreement to extend the regional co-operative agreement for research, development and training related to nuclear science and technology of 1972 (INFCIRC/167) (extended first in 1977 and then in 1982) for a further period of five years with effect from 12 June 1987, is reproduced

  7. The Experimental Regional Ensemble Forecast System (ExREF): Its Use in NWS Forecast Operations and Preliminary Verification

    Science.gov (United States)

    Reynolds, David; Rasch, William; Kozlowski, Daniel; Burks, Jason; Zavodsky, Bradley; Bernardet, Ligia; Jankov, Isidora; Albers, Steve

    2014-01-01

    The Experimental Regional Ensemble Forecast (ExREF) system is a tool for the development and testing of new Numerical Weather Prediction (NWP) methodologies. ExREF is run in near-realtime by the Global Systems Division (GSD) of the NOAA Earth System Research Laboratory (ESRL) and its products are made available through a website, an ftp site, and via the Unidata Local Data Manager (LDM). The ExREF domain covers most of North America and has 9-km horizontal grid spacing. The ensemble has eight members, all employing WRF-ARW. The ensemble uses a variety of initial conditions from LAPS and the Global Forecasting System (GFS) and multiple boundary conditions from the GFS ensemble. Additionally, a diversity of physical parameterizations is used to increase ensemble spread and to account for the uncertainty in forecasting extreme precipitation events. ExREF has been a component of the Hydrometeorology Testbed (HMT) NWP suite in the 2012-2013 and 2013-2014 winters. A smaller domain covering just the West Coast was created to minimize band-width consumption for the NWS. This smaller domain has and is being distributed to the National Weather Service (NWS) Weather Forecast Office and California Nevada River Forecast Center in Sacramento, California, where it is ingested into the Advanced Weather Interactive Processing System (AWIPS I and II) to provide guidance on the forecasting of extreme precipitation events. This paper will review the cooperative effort employed by NOAA ESRL, NASA SPoRT (Short-term Prediction Research and Transition Center), and the NWS to facilitate the ingest and display of ExREF data utilizing the AWIPS I and II D2D and GFE (Graphical Software Editor) software. Within GFE is a very useful verification software package called BoiVer that allows the NWS to utilize the River Forecast Center's 4 km gridded QPE to compare with all operational NWP models 6-hr QPF along with the ExREF mean 6-hr QPF so the forecasters can build confidence in the use of the

  8. Viscoelastic blood coagulation measurement with Sonoclot predicts postoperative bleeding in cardiac surgery after heparin reversal.

    Science.gov (United States)

    Bischof, Dominique B; Ganter, Michael T; Shore-Lesserson, Linda; Hartnack, Sonja; Klaghofer, Richard; Graves, Kirk; Genoni, Michele; Hofer, Christoph K

    2015-01-01

    The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points. A prospective, observational clinical study. A teaching hospital, single center. Consecutive patients undergoing cardiac surgery (N = 300). Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure. Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding. Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Massive upper GI bleeding: A rare complication of Zenker′s diverticulum

    Directory of Open Access Journals (Sweden)

    Haas I

    2008-01-01

    Full Text Available Bleeding from a Zenker′s diverticulum is rare. A 71-year-old man was urgently admitted with massive hematemesis. It was known that he had a Zenker′s diverticulum, but on emergency endoscopy, the source of bleeding was not detected due to large blood clots in the esophagus, hypo-pharynx and also into the tracheal-bronchial tree. Computerized tomography angiography demonstrated a blush of intravenous contrast arising from the diverticulum. The patient was operated upon urgently; the diverticle had a deep ulceration which was the source of the bleeding. The cause of the ulceration is unknown but it is possible that it was caused by the direct effect of an aspirin pill within the diverticle. A similar case with the same conclusion has been published in the past and since the use of aspirin has become common, especially in the elder population, we present this case report to highlight this possible life-threatening complication of Zenker′s diverticulum in patients receiving aspirin.

  10. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies.

    Science.gov (United States)

    McEvoy, Michael T; Shander, Aryeh

    2013-11-01

    The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.

  11. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Christensen, E

    1994-01-01

    As identification of patients at risk of bleeding or death is essential for prophylaxis, we determined the prognostic influence of various patient characteristics on the risk of bleeding and death. Fifty-five patients with cirrhosis and oesophageal varices without previous bleeding were included...... a significant relation with an increased risk of bleeding or death: high plasma volume (p varices (p

  12. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Gunes Ali

    2002-09-01

    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  13. Fasting for haemostasis in children with gastrointestinal bleeding.

    Science.gov (United States)

    Luo, Shuang-Hong; Guo, Qin; Liu, Guan J; Wan, Chaomin

    2016-05-19

    Gastrointestinal bleeding refers to loss of blood from any site of the digestive tract. In paediatric clinical practice, it is usually a complaint of children attending the emergency department as a symptom of diseases such as ulcers, gastric or oesophageal varices, gastritis, Mallory-Weiss tears, anorectal fissures, allergic colitis, infectious colitis, intussusception, Henoch-Schonlein purpura, and Meckel's diverticulum; it also occurs with high incidence in critically ill children hospitalised in intensive care units and is caused by stress-induced gastropathy. No matter what the cause of gastrointestinal bleeding, fasting is believed to be necessary due to the fear that eating may affect haemostasis or aggravate bleeding. To assess the effects and safety of fasting for haemostasis in gastrointestinal bleeding in children. We searched EBM Reviews - the Cochrane Central Register of Controlled Trials (CENTRAL) (May 2016), Ovid MEDLINE(R) (1946 to 3 May 2016), EMBASE (1980 to 2016 Week 18), Chinese Biomedical Database (CBM) (1978 to 3 May 2016), China National Knowledge Infrastructure (CNKI) (1979 to 3 May 2016), VIP Database (1989 to 4 May 2016) and Wanfang Data (1990 to 4 May 2016). We used no restrictions on language or study setting and limited searches in CNKI and Wanfang Data to the medical field. Randomised controlled trials (RCTs) or quasi-RCTs in children with gastrointestinal bleeding that compared fasting with feeding. Two review authors independently screened the literature search results, and there were no disagreements. We identified no RCTs or quasi-RCTs that compared the effects and safety of fasting with feeding for haemostasis in children with gastrointestinal bleeding. No study fulfilled the criteria for considering studies for our review. There is currently no information available from RCTs or quasi-RCTs to support or refute the use of fasting for haemostasis in children with gastrointestinal bleeding.

  14. A novel semi-quantitative method for measuring tissue bleeding.

    Science.gov (United States)

    Vukcevic, G; Volarevic, V; Raicevic, S; Tanaskovic, I; Milicic, B; Vulovic, T; Arsenijevic, S

    2014-03-01

    In this study, we describe a new semi-quantitative method for measuring the extent of bleeding in pathohistological tissue samples. To test our novel method, we recruited 120 female patients in their first trimester of pregnancy and divided them into three groups of 40. Group I was the control group, in which no dilation was applied. Group II was an experimental group, in which dilation was performed using classical mechanical dilators. Group III was also an experimental group, in which dilation was performed using a hydraulic dilator. Tissue samples were taken from the patients' cervical canals using a Novak's probe via energetic single-step curettage prior to any dilation in Group I and after dilation in Groups II and III. After the tissue samples were prepared, light microscopy was used to obtain microphotographs at 100x magnification. The surfaces affected by bleeding were measured in the microphotographs using the Autodesk AutoCAD 2009 program and its "polylines" function. The lines were used to mark the area around the entire sample (marked A) and to create "polyline" areas around each bleeding area on the sample (marked B). The percentage of the total area affected by bleeding was calculated using the formula: N = Bt x 100 / At where N is the percentage (%) of the tissue sample surface affected by bleeding, At (A total) is the sum of the surfaces of all of the tissue samples and Bt (B total) is the sum of all the surfaces affected by bleeding in all of the tissue samples. This novel semi-quantitative method utilizes the Autodesk AutoCAD 2009 program, which is simple to use and widely available, thereby offering a new, objective and precise approach to estimate the extent of bleeding in tissue samples.

  15. [Protection of working mothers: operational guide document. The Marche Regional Section of the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) ].

    Science.gov (United States)

    Alessandroni, Morena; Balzani, Barbara; Cancellieri, Francesca; Colao, Annamaria; Comai, M; Elezi, Lindita; Mengucci, Rosella; Montesi, Simona; Olivi, Cinzia; Perticaroli, Patrizia; Pettinari, A; Ruschioni, Angela

    2013-01-01

    Protection of working mothers: operational guide document. The aim of this operational guide document is to protect the health of working mothers and their babies during pregnancy, puerperium and breastfeeding. The project was developed by a technical working group which included professionals in the pertinent fields from the Workplace Prevention and Safety Services of the local Vasta-2 Area of the Marche Regional Health Service:physicians, health assistants, and nurses. It is considered to be a useful tool for risk assessment at the workplace aimed at professionals who are involved, with various duties and responsibilities, in the health care of the working mother. This paper consists of two functionally related sections, "Table of risks" and "Technical specifications". In the "Table of Risks" section, the occupational hazards for women during pregnancy or postpartum were analyzed with the highest possible degree of care. To this end the technical group provided, for each occupational hazard, its own operational suggestions, in relation to legislation, current scientific knowledge and Guidelines of other Italian Regions. The Marche Regional Section of the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) participated in the final draft of the entire document. The second section, "Technical Specifications", illustrates the main tasks and any risks involved in the 34 manufacturing sectors most prevalent in this area. This operational guide document is intended to be the beginning of a common strategy in public health to achieve a wider field of action in promotion and information aimed at protecting the reproductive health of working mothers.

  16. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

    NARCIS (Netherlands)

    van Doorn, H. C.; Timmermans, A.; Opmeer, B. C.; Kruitwagen, R. F. M. P.; Dijkhuizen, F. P. H. L. J.; Kooi, G. S.; van de Weijer, P. H. M.; Mol, B. W. J.

    2008-01-01

    Objective. To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness <= 4 mm after a first episode of postmenopausal bleeding. Methods. Consecutive patients not using hormone replacement therapy (HRT) presenting with a first

  17. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

    NARCIS (Netherlands)

    Doorn, H.C. van; Timmermans, A.; Opmeer, B.C.; Kruitwagen, R.F.P.M.; Dijkhuizen, F.P.; Kooi, G.S.; Weijer, P.H.M. van de; Mol, B.W.; Dupomeb, F.

    2008-01-01

    OBJECTIVE: To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness < or =4 mm after a first episode of postmenopausal bleeding. METHODS: Consecutive patients not using hormone replacement therapy (HRT) presenting with a

  18. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Jan Yi-Yin

    2006-01-01

    Full Text Available Abstract Background A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. Methods The medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78% was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7, computed tomographic (4/7, ultrasound (2/5, and surgical (2/2 findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months. Results Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%. Angiography determined correct diagnosis in 7 patients (7/7, 100%. The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4 or elective (n = 3 surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5 and 89% (8/9. Five patients developed pseudocysts before treatment (n = 3 or following intervention (n = 2. Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality

  19. Bleed water testing program for controlled low strength material

    International Nuclear Information System (INIS)

    Langton, C.A.

    1996-01-01

    Bleed water measurements for two Controlled Low Strength Material (CLSM) mixes were conducted to provide engineering data for the Tank 20F closure activities. CLSM Mix 1 contained 150 pounds of cement per cubic yard whereas CLSM Mix 2 contained 50 pounds per cub yard. SRS currently used CLSM Mix 2 for various applications. Bleed water percentages and generation rates were measured along with flow and compressive strength. This information will be used to select a mix design for the Tank 20F closure activities and to establish the engineering requirements, such as, lift height, time required between lifts and quantity of bleed water to be removed from the tank during the placement activities. Mix 1 is recommended for placement within Tank 20F because it has better flow characteristics, less segregation, lower percentage of bleed water and slightly higher strength. Optimization of Mix 1 was beyond the scope of this study. However, further testing of thickening additives, such as clays (bentonite), sodium silicate or fine silicas maybe useful for decreasing or eliminating bleed water

  20. Computed tomography angiography in patients with active gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Reis, Fatima Regina Silva; D'Ippolito, Giuseppe

    2015-01-01

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  1. Computed tomography angiography in patients with active gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Fatima Regina Silva; D' Ippolito, Giuseppe, E-mail: fatima.rsreis@gmail.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Cardia, P.P. [Hospital Vera Cruz, Campinas, SP (Brazil)

    2015-11-15

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. (author)

  2. Portable semiconductor laser system to stop internal bleeding

    Science.gov (United States)

    Rediker, Robert H.; Durville, Frederic M.; Cho, George; Boll, James H.

    1995-03-01

    One significant cause of death during a sever trauma (gun wound or stab wound) is internal bleeding. A semiconductor diode laser system has been used in in vitro studies of cauterizing veins and arteries to stop bleeding. The conditions of laparoscopic surgery, including bleeding conditions (blood flow and pressure), are simulated. Results have been obtained both with and without using a hemostat (e.g., forceps) to temporarily stop the bleeding prior to the cautery. With the hemostat and a fiber-coupled 810-nm laser, blood vessels of up to 5 mm diameter were cauterized with an 8 W output from the fiber. Great cautions must be used in extrapolating from these in vitro results, since the exact conditions of bleeding in a living being are impossible to exactly reproduce in a laboratory in-vitro experiment. In a living being, when blood flow stops the cessation of nourishment to the vessels results in irreversible physiological changes. Also, the blood itself is different from blood in a living being because an anti-clotting agent (heparin) was added in order to inhibit the blood's natural tendency to coagulate.

  3. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

    Science.gov (United States)

    Vaidya, S; Lakhey, M; Vaidya, S; Sharma, P K; Hirachand, S; Lama, S; KC, S

    2013-03-01

    Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

  4. Mortality in high-risk patients with bleeding Mallory-Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study.

    Science.gov (United States)

    Ljubičić, Neven; Budimir, Ivan; Pavić, Tajana; Bišćanin, Alen; Puljiz, Zeljko; Bratanić, Andre; Troskot, Branko; Zekanović, Dražen

    2014-04-01

    The aim of this study was to identify the predictive factors influencing mortality in patients with bleeding Mallory-Weiss syndrome in comparison with peptic ulcer bleeding. Between January 2005 and December 2009, 281 patients with endoscopically confirmed Mallory-Weiss syndrome and 1530 patients with peptic ulcer bleeding were consecutively evaluated. The 30-day mortality and clinical outcome were related to the patients' demographic data, endoscopic, and clinical characteristics. The one-year cumulative incidence for bleeding Mallory-Weiss syndrome was 7.3 cases/100,000 people and for peptic ulcer bleeding 40.4 cases/100,000 people. The age-standardized incidence for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding remained unchanged during the observational five-year period. The majority of patients with bleeding Mallory-Weiss syndrome were male patients with significant overall comorbidities (ASA class 3-4). Overall 30-day mortality rate was 5.3% for patients with bleeding Mallory-Weiss syndrome and 4.6% for patients with peptic ulcer bleeding (p = 0.578). In both patients with bleeding Mallory-Weiss syndrome and peptic ulcer bleeding, mortality was significantly higher in patients over 65 years of age and those with significant overall comorbidities (ASA class 3-4). The incidence of bleeding Mallory-Weiss syndrome and peptic ulcer bleeding has not changed over a five-year observational period. The overall 30-day mortality was almost equal for both bleeding Mallory-Weiss syndrome and peptic ulcer bleeding and was positively correlated to older age and underlying comorbid illnesses.

  5. Old technique revisited with surgical innovation: complicated Mallory-Weiss tear with bleeding gastric ulcer exclusion.

    Science.gov (United States)

    Yoshino, Osamu; Prichard, Peter J; Choi, Julian

    2016-01-11

    Mallory-Weiss tears (MWTs) rarely require surgical intervention. A 60-year-old female presented with massive hematemesis secondary to MWT and gastric ulceration. After failure of endoscopic management, an operative approach was embarked on, with a direct surgical hemostasis of the Mallory-Weiss tear and exclusion of the gastric ulcer. This exclusion strategy may be applicable for other patients with uncontrolled upper gastrointestinal bleeding in whom a simple repair would be difficult. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  6. Analysis and Research on the effect of the Operation of Small Hydropower in the Regional Power Grid

    Science.gov (United States)

    Ang, Fu; Guangde, Dong; Xiaojun, Zhu; Ruimiao, Wang; Shengyi, Zhu

    2018-03-01

    The analysis of reactive power balance and voltage of power network not only affects the system voltage quality, but also affects the economic operation of power grid. In the calculation of reactive power balance and voltage analysis in the past, the problem of low power and low system voltage has been the concern of people. When small hydropower stations in the wet period of low load, the analysis of reactive power surplus and high voltage for the system, if small hydropower unit the capability of running in phase is considered, it can effectively solve the system low operation voltage of the key point on the high side.

  7. An assessment of the failure rate for the beltline region of PWR pressure vessels during normal operation and certain transient conditions. Technical report

    International Nuclear Information System (INIS)

    Gamble, R.M.; Strosnider, J. Jr.

    1981-06-01

    A study was conducted to assess the failure rate for the beltline region of a generic pressurized-water reactor (PWR) pressure vessel. This assessment included the evaluation of several normal operating and transient reactor conditions. Failure rates were calculated from a computer code that used fracture mechanics methods to model the failure process; random number generation techniques were used to simulate random variables and model their interaction in the failure-process. This investigation had three major objectives: (1) to better define the effect of neutron irradiation, material variation, and flaw distribution on the failure rate for the beltline region of PWR pressure vessels, (2) to estimate the relative margins against failure for normal operation and certain transient conditions associated with nuclear pressure vessels, and (3) to evaluate the current limitations for using fracture mechanics models to predict failure rates for nuclear pressure vessels

  8. Context is King: The Importance of Regional Narratives and History to the Special Operator and Strategic Communications

    Science.gov (United States)

    2016-12-07

    communication will not sim - ply try to reframe the mission objectives for the audience, but will listen to what they are already saying and repeat it back to...a success- ful operation in support of a resistance; it is the gold standard. “Complete success,” T.E. Lawrence wrote, “is when [they] forget your

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

    Science.gov (United States)

    2003-06-06

    were placed under operational control of Major General Peter Cosgrove from Australia, the Force Commander INTERFET. He in turn worked directly for the...mentioned that Commander KFOR had the authority to use troops from one multinational brigade in another brigade’s sector, such freedom was denied in

  10. Enabling the Future Force: The Use of Regional Alignment, Mission Command and Cultural Competence to Create an Operationally Adaptive Army

    Science.gov (United States)

    2014-05-22

    Creation of the Operating System Stella Ting-Toomey, a Professor of Human Communication Studies at California State...cultures are added this basic figure, it becomes more complex and communication must then take place across multiple cultures. Stella Ting-Toomey...Intelligence: People Skills for Global Business. San Francisco, CA: Berrett-Koehler, 2004. Ting-Toomey, Stella . Communicating across Cultures. The

  11. Bleeding Jejunal Diverticulosis in a Patient with Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    I. Zuber-Jerger

    2008-01-01

    Full Text Available A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100 cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.

  12. No impact of fish oil supplements on bleeding risk

    DEFF Research Database (Denmark)

    Begtrup, Katrine Munk; Krag, Andreas Engel; Hvas, Anne-Mette

    2017-01-01

    Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... it is necessary to discontinue fish oil supplementation prior to surgery. Methods: Studies were identified through PubMed and Embase searches and by reviewing the reference lists of the included papers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Included...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...

  13. Computed tomography diagnosis of active bleeding into the thyroid gland.

    Science.gov (United States)

    Veverková, Lucia; Bakaj-Zbrožková, Lenka; Hallamová, Lucie; Heřman, Miroslav

    2013-10-01

    Fine-needle biopsy of the thyroid gland is the most common interventional procedure used to diagnose thyroid diseases. Serious complications are rare in this procedure. They comprise an infection with abscess formation and hemorrhage. To date, only a few case reports have described an ultrasound diagnosis of active bleeding into the thyroid gland. We established such a diagnosis using computed tomography (CT). A 74-year-old woman presented to the emergency department of our hospital with complications after fine-needle biopsy of the thyroid gland. Ultrasound revealed a large hematoma surrounding the gland. A subsequent CT scan confirmed the presence of hematoma and, moreover, showed active bleeding. This finding prompted rapid surgical intervention. CT has the capability to show active bleeding into the thyroid gland.

  14. Reduced bleed air extraction for DC-10 cabin air conditioning

    Science.gov (United States)

    Newman, W. H.; Viele, M. R.; Hrach, F. J.

    1980-01-01

    It is noted that a significant fuel savings can be achieved by reducing bleed air used for cabin air conditioning. Air in the cabin can be recirculated to maintain comfortable ventilation rates but the quality of the air tends to decrease due to entrainment of smoke and odors. Attention is given to a development system designed and fabricated under the NASA Engine Component Improvement Program to define the recirculation limit for the DC-10. It is shown that with the system, a wide range of bleed air reductions and recirculation rates is possible. A goal of 0.8% fuel savings has been achieved which results from a 50% reduction in bleed extraction from the engine.

  15. Effects of Aglumin on the rectal bleeding following radiotherapy

    International Nuclear Information System (INIS)

    Yamashita, Michitaka; Tanaka, Motoshi; Yoshimura, Osamu; Matsubayashi, Shigeru

    1978-01-01

    Aglumin was administered to 20 cases which had rectal bleeding following radiotherapy. The results were as follows. Rectal bleeding decreased in 16 of 20 cases (80%): remarkably effective, 15%; effective, 25%; slightly effective, 40%. Bleeding time decreased in 11 cases (55%). Rumpel-Leede test gave remarkable improvement in 10 of 14 cases which had been abnormal (71.4%). Platelet increased in 18 of 20 cases (90%). Liver function test and peripheral blood findings showed no remarkable changes. No side effects such as intestinal disturbance etc were noted. In the series of symptomatic treatment for rectal disturbance resulting from radiotherapy, this drug had considerable effect of hemostasis. It was concluded that this drug is useful in combined use with other antiphlogistics, analgesic, and hematinic etc. (Ueda, J.)

  16. PALM-COEIN Nomenclature for Abnormal Uterine Bleeding.

    Science.gov (United States)

    Deneris, Angela

    2016-05-01

    Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system. © 2016 by the American College of Nurse-Midwives.

  17. Regional operations research program for commercialization of geothermal energy in the Rocky Mountain basin and range. Final technical report, January 1980-March 1981

    Energy Technology Data Exchange (ETDEWEB)

    1981-07-01

    This report describes the work accomplished from January 1980 to March 1981 in the Regional Operations Research efforts for the Rocky Mountain Basin and Range Geothermal Commercialization Program. The work included continued data acquisition and extension of the data base, enhancement and refinement of the economic models for electric and direct use applications, site-specific and aggregated analyses in support of the state teams, special analyses in support of several federal agencies, and marketing assistance to the state commercialization teams.

  18. The text of the agreement to extend the regional co-operative agreement for research, development and training related to nuclear science and technology, 1987

    International Nuclear Information System (INIS)

    1992-09-01

    The document reproduces the text of the Agreement to Extend the Regional Co-operative Agreement for Research, Development and Training Related to Nuclear Science and Technology, 1987, for a further period of five years with effect from 12 June 1992. Australia, Bangladesh, the People's Republic of China, India, Indonesia, Japan, the Republic of Korea, Malaysia, Pakistan, the Philippines, Singapore, Sri Lanka, Thailand and Viet Nam are parties of this Agreement

  19. What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.

    Science.gov (United States)

    Bennett, Alyssa R; Gray, Susan H

    2014-08-01

    This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. The readers will learn a practical approach to the evaluation and treatment of mild-to-severe uterine bleeding. In 2011, a new classification system was proposed to standardize the terminology used to describe AUB. This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. The term dysfunctional uterine bleeding has been replaced by AUB. The negative effect of AUB on adolescents' quality of life is now well established. The levonorgestrel-releasing intrauterine system is considered a first-line treatment for heavy menstrual bleeding and should be considered, especially in those adolescents who may also need contraception. AUB is a common adolescent complaint that can vary from mild to life-threatening if not recognized and treated promptly. This article reviews the appropriate assessment and management of AUB and proposes a practical algorithm that can be used in an office or hospital setting.

  20. The timing of neovascularization in fingertip replantation by external bleeding.

    Science.gov (United States)

    Han, Seung-Kyu; Chung, Heung-Soo; Kim, Woo-Kyung

    2002-09-15

    To overcome venous congestion in fingertip replantation with no venous anastomosis, the authors have used a salvage procedure that consists of continuous external bleeding through a stab incision on the paraungual area and dripping a heparinized saline solution at the incision site to maintain external bleeding. Because this method requires continuous bleeding for a certain period of time, it may be a great burden on the patient; therefore, it is most important to minimize the duration of bleeding. Many authors have studied the timing of the new venous channel formation of the flap. However, to our knowledge, a study on fingertip replantations has not yet been performed. From June of 1985 to November of 1999, the authors performed fingertip replantations on 144 fingers of 137 patients using our salvage procedure at Korea University Guro Hospital. Among the 144 fingers, 101 fingers of 96 patients were successfully transplanted, including those with partial necrosis. The authors reviewed the medical records of these 101 fingers retrospectively; they compared and analyzed the necessary duration of external bleeding according to sex, age, level of injury, cause of amputation, and the type of injury. The average period of the salvage procedure was 7.6 days. Regarding age, the shortest period (5.5 days) was required for patients younger than 10 years. On the basis of the types of injuries, the duration of bleeding was shortest for the guillotine injury group (5.9 days) compared with crush (8.2 days) or avulsion (8.0 days) injuries. Sex and level of injury did not make much difference in the duration of the procedure.